Now, President Trump and the Republicans have the “going second” problem. The public will compare their proposed bill with Obamacare and conclude that the one metric they understand – the number of people covered – does not compare favorably with Obamacare. The contrast is fatal.
June 23, 2017
"Any Obamacare replacement needs to cover more people than Obamacare, or else it is dead on arrival."
"Any skilled persuader would see that," says Scott Adams.
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The ACA is failing, and perhaps it should be left to fail and we can continue to hang it around the left's collective neck.
Sadly, real people are hurt by it, and the answer is easy - freedom to buy insurance without the government.
Megan McArdle has been suggesting the solution for years. Make a federal safety net for all Americans, that if medical bills exceed a certain sizable fraction of your income (say 30%) the government picks up the tab from then on. The point is to stop medical bankruptcies, while still making the people pay themselves up to a point. Effectively catastrophic insurance. _All_ Americans are covered, without having to sign up or pay a premium.
The rest of us get our health care back.
Why, again, is there a replacement, rather than just a straight-up repeal? It's almost as if the evil Republican congress is determined to keep O-care.
Obamacare is not some stable program with a dependable number of insured. The CBO scores of the proposed programs are compared to the hypothetical number number covered by Obamacare. The other day I saw that over 2 million people that had signed up for 2017 coverage had not paid their first monthly payment by March 2017.
So expect to be bamboozled by the experts who believe that figures don't lie, but liars can figure crowd.
Not necessarily. Distinguish between the voluntarily uninsured and the involuntarily uninsured and then compare. Many people did not want to be forced to buy a product they didn't want. If they drop out now they are part of the uninsured group but that's what they want. Don't assume every uninsured person is upset about the change. The media won't distinguish of course, and will promote the lazy comparison.
Call me naive, but it's been a surprise to me that Trump is so stupid on the raw politics of this issue. Why should he care what Ryan and McConnell think? Why does he trust them to navigate the Washington swamp? They are alligators who have never gone hungry in the swamp. They have their eyes on donors. Why not just go for the votes of people who want more care, not less? Kaus, a Democrat who is constantly criticized for not toeing the party line, says lower the eligibility age for Medicare, thereby removing some relatively high-cost patients from the mix, and make it easier for private insurers to cover more people under revised Obamacare. Yes, it's going to be costly.
This is in addition to the fact that there was no reason to make this the #1 priority of Trump's first six months. Ryan thinks you have to cut spending on the big ticket items, health and social security, then you can have fun with infrastructure. This is Republican Beltway thinking.
Obamacare works provided the Federal Borrowed Money (Deficit) is all spent on paying everyone's $10,000.00 + deductible. Now that would provide a Cadillac Care every bit as good as Congressional Slugs get for free.
And nobody really cares if the Military has no weapons or troops and the Dollar is suddenly worth 90% less. It is saving lazy lives that matters. Ask Nancy Pelosi.
Cover everybody. One billion dollar annual deductible. One dollar maximum lifetime benefits.
Done.
"Any Obamacare replacement needs to cover more people than Obamacare, or else it is dead on arrival." Depends on what the meaning of "cover" is. if by "cover" you mean subsidies for families that make $80K or forcing young people to buy insurance they don't need, then the GOP should not accept the Dem default.
The number one metric is NOT how many people are covered.
#1 metric is monthly premium price
#2 is network (is my doctor in it?)
#3 is coverage for existing conditions.
#4 is deductible.
Adams is way off base.
But I do agree in the sense that if one less person is covered, even it was totally free for everybody else, the nightly talking point would be the grandma who got left out...
MikeR said...
Megan McArdle has been suggesting the solution for years.... The point is to stop medical bankruptcies...
I generally like Megan McArdle, but I disagree here. What is bankruptcy for, if not for things like a major medical event.
Make the federal government the insurer of last resort. The price of getting that government insurance is declaring bankruptcy. If you want to protect your assets, buy your own insurance.
Rene Saunce said...
The ACA is failing, and perhaps it should be left to fail and we can continue to hang it around the left's collective neck.
Wasn't that Charles Krauthammer's idea? Do nothing, until/while the ACA's failings exposed themselves. Making the case for reform stronger. (The risk being that the entitlements part would get more entrenched. And just maybe, fixes for the ACA would present themselves pretty clearly.)
But it was too high on Trump's to-do list; all of the promises he needed to keep. Even his ridiculous, impossible promises. Trump had to Repeal Obamacare!
I have contempt for Scott Adams, and he doesn't get much credit for the obvious observation I already alluded to (a terrible political price to be paid by Republicans for taking back any benefits extended under ObamaCare). I don't think he is correct about the details, but I do have to acknowledge that he's made a correct, if obvious, observation.
RyanCare will soon be the law of the land. Adams sees the problem, the Dems see the opportunity. As was noted in another thread the question is why the Red team insisted on tax cuts for the rich over tackling problems that affected working people. The answer, sadly, is obvious.
I have a good health care plan unaffected by Obamacare, so I think I've been shielded from its ramifications. As a result, I'm inclined to agree with Scott Adams. (Or, if not more, the plan must cover as least as many as Obamacare.)
I know a self-employed couple whose rates tripled under Obamacare. I just don't know how common they are.
My gut feeling is the Right lost the health care debate. We had 25 years between the proposed Hillarycare and Obamacare to make a convincing case, and we couldn't do it. And then when we got the chance to repeal Obamacare, it was clear the GOP still didn't know what it was doing.
On a purely political level - which seems to be the only level at which America exists anymore - the voters are judging this issue solely on how many people are covered. The right never convinced them to judge it on any other basis.
Immigration, crime, terrorism, race, families, middle America...on all of these Trump's GOP is on the popular side. But not health care. I think.
Oh dear, Scott Adams won't get overwhelming agreement from Trumpists on this one.
Less people will be covered, premiums and deductibles won't go down, but it won't be Obamacare anymore! So much winning, huh?
Rene Saunce said...
Sadly, real people are hurt by it, and the answer is easy - freedom to buy insurance without the government.
Unfortunately the US Constitution requires the federal government to micro-manage the health insurance industry: "insure domestic tranquility".
Adams may be onto something. The latest slogan is that the GOP is replacing ObamaCare with Trumpdon'tCare.
So, it's not about health care, but rather the financing of a product and service. Sex and abortion in political progress. The Democrats did the same with housing, and one too many Republicans were more than happy to follow, before it exploded in their faces, and the People were forced to absorb the repercussions of "too big to fail". The same thinking was behind Obama's war and immigration reform in clean, green social justice adventures; or welfare profits and spiritual destruction in perpetual smoothing functions.
Less people will be covered, premiums and deductibles won't go down, but it won't be Obamacare anymore! So much winning, huh?
If you think premiums won't go down by removing the ever-increasing mandatory list of what must be covered, you don't know how insurance works.
The issue with Adams' statement is the word "covered". If people could afford to buy healthcare insurance but choose not to do so, are they "covered" or not?
The current narrative presumes insurance at the point of a gun is preferable to free choice. You can't play into that. You have to change the rubric from coverage to affordability. Coverage was not simply about healthcare, it was about the need for more government power in order to provide this outcome.
That will take a master persuader. Adams is just saying that if the topic isn't reframed, the old measuring sticks will still be in use.
Unfortunately the US Constitution requires the federal government to micro-manage the health insurance industry: "insure domestic tranquility".
If that's the standard, then the nation is doomed. Anyone who stirs up a ruckus gets a Constitutionally-mandated and government funded band-aid for their boo boo.
Money and civil liberties will run out way before self-imagined boo boos.
The key to pulling off another Fannie/Freddie is a compliant press, the public education schools/"Churches", control the popular culture through mainstream media outlets (e.g. network, PBS), and progressive population replacement through immigration reform/insourcing and Planned Parenthood/decimation.
lower the eligibility age for Medicare, thereby removing some relatively high-cost patients from the mix, and make it easier for private insurers to cover more people under revised Obamacare. Yes, it's going to be costly.
No, what you do is to make more eligible for Medicaid, not Medicare.
Obamacare is just Medicaid with higher income limits. Leave that alone and block grant it to states.
Make Obamacare optional. If you want that, you can have it. Pre-existing conditions are covered. Let everyone else buy real insurance.
Catastrophic care policies for young people are cheap.
The Democrats never dared to enforce the employer mandate.
The obvious thing is to expand and reform Medicare. The failure to do so is the biggest blot on the Democrats record.
It is all in how you count the numbers.
Obamacare has/had expanded coverage because people are FORCED by law and penalties if you don't get coverage. So there are more just because you MAKE it so.
If the new plan allows people to make a choice and DECIDE not to get coverage and there are less, this is a terrible thing? Because choice and free will should not be allowed?
The passing of Obamacare was the death of private healthcare, except of course for Congress, which will always figure out a way to exempt itself from its stupid laws.
If you don’t have to buy insurance until you get sick what you have is only one inevitable step away from single payer 100% socialized medicine. It’s only a matter of time. The game was over when Obamacare was passed.
Once an entitlement is bestowed it quickly becomes politically impossible to take it away.
Maybe the emphasis should now be to try to make the American version of socialized healthcare better than what we see in the nations already socialized.
Look at Adams' suggestion: to be a good "persuader", Trump must give people what they think they want. That's not persuasion, that's pandering.
"Hold up. Remind me what the House Trumpcare bill would do.
This is not a bill to improve health care; it's a bill to repeal taxes on very wealthy people.
The House-passed version of the American Health Care Act would strip $834 billion from Medicaid, deprive 23 million Americans of health insurance over a decade and spike premiums in the individual insurance market by 20 percent in the first year alone, according to the nonpartisan Congressional Budget Office. The legislation would leave many Americans with pre-existing conditions without access to affordable coverage, the CBO concludes, "if they could purchase it at all." In addition, the House bill would allow insurers to jack up premiums on rural and older-working-age Americans. In rural Alaska, a 60-year-old would be hit with insurance premiums of $28,000 a year.
The only real winners in Trumpcare are Americans in the top 0.1 percent, who would receive a $200,000 tax break."
http://www.rollingstone.com/politics/features/wtf-is-going-on-with-the-secret-senate-version-of-trumpcare-w488612
The first lesson for Republicans is that no matter what they will do, the MSM and Democrats will label it "heartless." So they might as well do what's best for the country. In any remotely "conservative" plan, coverage is a choice by individuals, not an outcome to be somehow enforced.
Dust Bunny Queen said...
Obamacare has/had expanded coverage because people are FORCED by law and penalties
The main reason for the expanded coverage was the expansion of Medicaid. No one was forced to use Medicaid.
Inga said...
This is not a bill to improve health care; it's a bill to repeal taxes on very wealthy people.
The good news, these people tend to live in blue states.
So many Trumpski's are going to suffer with Trumpcare. Over the coming years, individuals, family members and friends will all be talking about Trumpcare. Personal bankruptcy will shoot right back up. Pre-exising conditions? Get on yer bike.
In the meantime, Progressives will be laughing out loud because Trumpski's VOTED for TRUMP who PROMISED repeal and replace of Obamacare with something much better and cheaper.
Guess what Trumpski's? Better and cheaper it ain't going to be. You have been suckered, again.
Choice and free will are for suckers, DBQ. As Gruber, the architect of the ACA stated-- the stupidity of the American voter will glide Obamacare into our hearts.
Nevermind the premium spikes, sky high deductibles, and reduced access to the care we need. Government knows best. Medicare for all. Embrace the suck.
Easy solution: redistributive change. Borrow more from Medicare than Obama did. Also, the Fannie/Freddie solution: [catastrophic anthropogenic] global debt change.
""As currently drafted, this bill draft does not do nearly enough to lower premiums," Cruz said in a statement obtained by CNN. "That should be the central issue for Republicans -- repealing Obamacare and making health care more affordable. Because of this, I cannot support it as currently drafted, and I do not believe it has the votes to pass the Senate."
http://www.cnn.com/2017/06/22/politics/senate-health-care-bill/index.html
Government mandates are freedom, you stupid Trumpskis. Ha! Just look at how great the government does when it does stuff. It's all just great when people in Washington, D.C. make decisions for you. Don't fight the truth.
Everything within Leviathan. Nothing outside of Leviathan.
Never consider the wonderful results Democrats have enjoyed since solving all health related issues in America.
/sarc
Rene Saunce said...
Choice and free will are for suckers, DBQ. As Gruber, the architect of the ACA stated-- the stupidity of the American voter will glide Obamacare into our hearts.
Nevermind the premium spikes, sky high deductibles, and reduced access to the care we need. Government knows best. Medicare for all. Embrace the suck.
I presume that you'd like to see a free, independent, national (geographically, not "nationalized" health care marketplace. Perhaps even something that frees people from being captives to employer-based plans.
TrumpCare seems likely to destroy that market. By forcing insurers to cover everybody, no pre-existing conditions barred, but not requiring people to be insured in the first place. The logical marketplace reaction to this would be to buy insurance only when you get sick or need care. Which will destroy the independent/individual market.
The main reason for the expanded coverage was the expansion of Medicaid. No one was forced to use Medicaid.
Bullshit. If you were eligible for coverage, meaning not covered by a company plan or MediCARE, you HAD to get Obamacare or pay a penalty that escalated for each year you didn't get coverage. If you were under a certain income limit you got subsidies (which didn't always cover everything)but you were still FORCED to get coverage by buying through an exchange....IF one was available in your State.
Surely you remember John Roberts and his magic wand turning a penalty into a tax in order to MAKE the law Constitutional? In effect the Supreme Court writing the laws?
I remember. I was FORCED to comply until I was Medicare age. Had to file forms, pay my insurance, which I didn't want or need.
Employers with enough 'full time' employees were FORCED to have coverage. This make them choose to have less employees and/or have more part time employees.
IN addition, href="http://www.heritage.org/health-care-reform/report/obamacare-impact-states">the States were not ultimately forced to expand Medicaid and many chose not to do so.
Because choice and free will should not be allowed?
If your choice and free will means my insurance goes up because your choice results in more uninsured in the emergency room, then it shouldn't be allowed.
Like public education, health care should be a basic right in an advanced society. You pay for public education, even if you don't have children, because it is a benefit to society. Same with health care (although it is the very rare individual who never needs health care).
Dust Bunny Queen said...
Bullshit.
If you did not already have coverage or were not eligible for the Medicaid expansion, then you were forced to either buy insurance on the exchanges or pay a tax to avoid the free-rider problem. This doesn't change the fact that the main cause of the increase in coverage was the expansion of Medicaid.
Chuck asked: I presume that you'd like to see a free, independent, national (geographically, not "nationalized" health care marketplace. Perhaps even something that frees people from being captives to employer-based plans.
Actually Chuck, this (what you said)is what I have been advocating since before Obamacare. Plus portability of employer plans so that when changing or losing jobs, you can get other coverage without triggering pre existing conditions. I would advocate for a national fund for real, true, pre existing condition patients to get some subsidies on coverage.
CHOICE in the coverage you want and CHOICE to chose to do a high wire act with no coverage.
I haven't seen much about this "new" plan from the Republican Congress, but I imagine it to be the same piece of crap that they always come up with. They are afraid to make the hard decisions, try to appease everyone equally and it becomes a Dog's Breakfast.
What I would like to see from Trump is that if it is the mess that I think it will be, he veto it and send it back to Congress.
I was FORCED to comply until I was Medicare age.
And after you reached medicare age, you were relieved of the burden of having medical insurance.
This doesn't change the fact that the main cause of the increase in coverage was the expansion of Medicaid.
In some States.
You act like Medicaid is some free thing or is funded by going out back and picking money off of the money tree.
CHOICE in the coverage you want and CHOICE to chose to do a high wire act with no coverage.
But your choice means that I am the net under your high wire act.
Health insurance = basic right
Free speech = not a basic right
Self defense = not a basic right
Leftists love control.
(If the number of doctors does not change, health care cannot be a basic human right. That is, unless Leftists are willing to enslave doctors.)
People hate health insurance companies. When you "reform" health care you become a health insurance company.
"Repeal" is a winning political strategy; "Replace", not so much.
But your choice means that I am the net under your high wire act.
It doesn't have to be that way. Or at least the net can be a lot cheaper than it is now. Repeal EMTALA (look it up), and give uninsured something much less attractive.
Agree with Chuck that allowing insurance for pre-existing conditions is a disaster unless it's a separate pool.
Either Trump was involved in crafting this legislation and it is Trump Insurance -OR- this is a creation of Congress.
Fopdoodles must choose.
Dust Bunny Queen said...
You act like Medicaid is some free thing
No. I, like most rational people, recognize that health care costs money and therefore health insurance also costs money. What many people question is why every other western nation has figured out how to provide basic health insurance to every citizen and we continue to flounder on this issue.
Health insurance is not a basic right in the sense that every nation can afford to provide a reasonable level of coverage, but when every western nation other than our own can afford to provide coverage it is reasonable to ask why we cannot. The health care system may be ridiculously inefficient and expensive or we may lack the political will to treat all citizens in a comparable fashion as our peer nations, or both may be true. Whatever the favored explanation there clearly is a problem.
McConnell has mad skilz.
The health plan isn't dead unless he wants it dead.
I wouldn't be surprised if it passed. I wouldn't be surprised if it doesn't pass because he's using the bill for tactical reasons.
If it passes, and he cuts Medicaid, McConnell can pass tax reform with a bare majority.
I wouldn't bet either way. Could go either way. But if I was forced to place money, I'd guess that this plan is going to pass.
And after you reached medicare age, you were relieved of the burden of having medical insurance.
Seriously? Do you not understand how Medicare works?
Unless I opt for just Medicare A there is a cost. If I opt for Medicare A and decide to NOT get better coverage (Medicare B), I am penalized for NOT getting more coverage when eligible. Same thing with Medicare D. Forced or pay a penalty later. SO....I have Medicare B and pay for that monthly. Monthly premium for D, even though I take zero drugs. And because I CAN afford it and chose to, Medicare Supplement plan.
BTW: I have paid into Medicare, and my employers have paid into Medicare for over 50 years. It is called Medicare PREMIUMS. Not a tax. Not a fee. Premiums for something that I am FORCED to pay for.
I USED to have a decent plan for myself BEFORE Obamacare, however since if you like your plan you can keep it turned out to be a big fat lie, my plan was eliminated and I was FORCED to get an Obamacare plan.
What part of any of this do you not understand?
Freder Frederson said...
If your choice and free will means my insurance goes up because your choice results in more uninsured in the emergency room, then it shouldn't be allowed.
Then Obamacare shouldn't be allowed because it raised some peoples' premiums. Or is your only concern your personal costs?
Like public education, health care should be a basic right in an advanced society.
Food is more important than either of those.
Perhaps the gov't should insure/mandate a food supply, or at least impose price controls, to insure that everyone has the same access to scrumpdillyicious nutrition: Think outside the bun.
Dan the Man wrote: Adams is way off base.
Agreed. And I would add two more metrics with higher priority:
#5 Is not compulsory
#6 Is not a tax
CHOICE in the coverage you want and CHOICE to chose to do a high wire act with no coverage.
As long as hospitals are required by law to cover, there is a net under the high wire act that everyone else is obliged to pay for.
I said: CHOICE in the coverage you want and CHOICE to chose to do a high wire act with no coverage.
Freder says: But your choice means that I am the net under your high wire act.
Now you are the net for (paying for) EVERYONE including millions of illegal aliens, everyone on welfare, people who abuse themselves and take drugs etc etc etc. Much better than the occasional person right?
Medicare, like social security, doesn't come out of individual ROTH IRA funds or personal medical savings accounts.
The youngsters pay for it.
They pay for it while paying student loan debt, saving for mortgages and paying for diapers.
It's not surprising for the young to take care of the old, but let's not pretend there's no burden on them.
"Much better than the occasional person right"
"Occasional person"? Not hardly. Emergency rooms were bogged down with people who had no insurance, taking time away from true emergencies.
If the goal is health care, and not medical insurance, then the legitimate criterion is not coverage. Health care begins with education reform. And affordable may cost less than free.
DBQ - Real life people with real life stories to tell about the realities of the ACA do not move or shake the fake-reality created in the minds of devout leftists. They have their Gruber talking points, their scare tactics and their economic BS down pat.
ooo the emergency room exaggeration. That's new. We had to destroy health care for most Americans - because emergency room.
Medicare, like social security, doesn't come out of individual ROTH IRA funds or personal medical savings accounts.
The youngsters pay for it.
They pay for it while paying student loan debt, saving for mortgages and paying for diapers.
Oh boo hoo. I guess I was never young, had debts, children etc. I started work at 16 and am now 67....51 years of paying paying paying. I am STILL paying into Medicare and Social Security. Even at my age. It isn't just the young.
Is it a Ponzi Scheme. Hell yes. That isn't my problem. I was forced to pay into that Ponzi scheme. Congress should and could fix it...if they really wanted to do so. One way to fix it is to STOP using SS and Medicare as social welfare, as handouts for votes and only pay out to those who paid in.
Why don't the two parties agree on something like this?
Health Insurance Freedom of Choice Act.
It will offer each American citizen and business two options:
• Option One is to choose to stay under the rules and regulations of the Affordable Health Care Act [Obamacare].
• Option Two is to choose to be free of the rules and regulations of the Affordable Health Care Act.
o By choosing Option Two, you are free to get your insurance on the open market.
o This market shall not be regulated by Obamacare nor by the federal government in any substantive way.
Each American citizen and business must choose one of the two options by 1/1/2018.
Your choice is a lifetime choice but can be changed only once in every ten years.
[class] diversity is also a problem. The reestablishment of institutional racism, sexism, etc. under Pro-Choice/dignity has progressive consequences. Not the least of which is to promote distrust between people based on "color of skin" criteria. One step forward. Two steps back.
Dust Bunny Queen said...
...
I haven't seen much about this "new" plan from the Republican Congress, but I imagine it to be the same piece of crap that they always come up with. They are afraid to make the hard decisions, try to appease everyone equally and it becomes a Dog's Breakfast.
Remember; one reason that this new Senate plan looks so much like Obamacare structurally, is because it is a "reconciliation" bill. Not real legislation. You can only do so much with reconciliation.
I like making the hard decisions. But it will require some bipartisanship. The kind of bipartisanship that is impossible with Trump's personal toxicity.
"Occasional person"? Not hardly. Emergency rooms were bogged down with people who had no insurance, taking time away from true emergencies.
If it isn't a true emergency send them to the Doctor.
The kind of bipartisanship that is impossible with Trump's personal toxicity.
Bullshit again. You can't blame a lack of bipartisanship on Trump. This idiocy and deadlocking is nothing new. Congress Critters haven't been truly bipartisan in my lifetime.
Inga: ""Occasional person"? Not hardly. Emergency rooms were bogged down with people who had no insurance, taking time away from true emergencies."
"were"
https://www.usatoday.com/story/news/nation/2015/05/04/emergency-room-visits-rise-under-affordable-care-act/26625571/
Poor poor Inga.
If I might paraphrase "TopGun", "That "Ossoff loss"/"Illegal alien murdering Muslim Girl" really messed her up".
“It’s a massive transfer of wealth from middle-class and poor families to the richest people in America.”
Aren't poor people poor because they don't have wealth?
Trump had to Repeal Obamacare!
Wait a minute. How many Republicans have run on repealing Obamacare? Just about every freaking one since since 2010. Why is it not their promises that you highlight? Why we even had a "total repeal" bill that was passed by this congress in 2015! Before you lay all the blame on Trump, please explain why these Republicans didn't just resubmit the full repeal bill that had already passed in an earlier congress.
I'm sure you can explain the "establishment Republican" logic to me!
Heritage Foundation article from 2007
http://www.heritage.org/health-care-reform/report/the-crisis-americas-emergency-rooms-and-what-can-be-done
"Moreover, hospital emergency departments (EDs) are the only part of the health care system that is required by federal law to provide care to all patients, regardless of ability to pay.[1] A sizable number of patients who visit the ED do not require the level of care that an emergency room provides. In Maryland, for example, patients with non-urgent medical problems account for over 40 percent of ED visits.[2]
Jammed with increasing numbers of uninsured Americans and enrollees in public programs, emergency rooms find their overcrowding further aggravated by outdated federal and state policies. Worse, while many emergency rooms are already operating at peak capacity on a day-to-day basis, the emergency medical system is incapable of absorbing the massive surge in demand for emergency medical assistance that would follow a natural disaster or terrorist attack."
Perhaps the gov't should insure/mandate a food supply, or at least impose price controls, to insure that everyone has the same access to scrumpdillyicious nutrition: Think outside the bun.
Are you contending that the government doesn't insure basic nutrition, not only in this country, but also internationally? (The system may be imperfect, and devastating famines still happen, although not in this country, but governments all over the world are involved in providing basic food supplies)
"Sadly, real people are hurt by it, and the answer is easy - freedom to buy insurance without the government."
Ummm...people are free to buy insurance without the government.
Those who can afford it, anyhow.
"The emergency medical system is stretched beyond capacity. From 1994 to 2004, visits to hospital emergency departments increased from 93.4 million to 110.2 million-an 18 percent jump. Meanwhile, the numbers of hospitals, hospital beds, and emergency departments have declined significantly.
In most states, the system could not absorb the surge in demand that would accompany a pandemic, natural disaster, or terrorist attack. Global projections warn that millions could die in the next outbreak of pandemic flu.According to a recent report by the Trust for America's Health,a nonpartisan organization promoting public health,25 states do not have the surge capacity to meet the number of hospital beds necessary within two weeks of the outbreak of a "moderately severe" pandemic flu, and 47 states lack the capacity to deal with a severe outbreak, such as the one caused by the devastating 1918 virus.[3]
Recent increases in ED demand are driven by patients seeking care for non-urgent problems. Not surprisingly, patients with private health plans recorded the lowest usage of emergency room care. Medicaid and State Children's Health Insurance Program (SCHIP) enrollees use EDs at roughly four times the rate of privately insured patients and nearly twicethe rate of uninsured patients or Medicare beneficiaries.
Current conditions degrade the quality of patient care. Patients are "boarded," sometimes for hours or even days, in emergency rooms until a hospital bed becomes available. Ambulances are diverted from overcrowded emergency departments, losing precious time, with nearly one in six urban hospitals reporting that they are on ambulance diversion more than 20 percent of the time. There are also shortages of doctors providing on-call emergency services. Over 65 percent of emergency department directors report physician coverage problems. According to a 2004 survey conducted by the American Association of Neurological Surgeons, 46 percent of neurosurgeons limited their emergency medical practices, with 87 percent citing liability concerns.
Current conditions contribute to the uncompensated care burden on physicians. More than 30 percent of all physicians provide emergency medical services, and 42 percent of self-employed doctors report that a major portion of their bad debt is attributable to delivery of medical services required by federal law, amounting to $4.2 billion annually."
Re: Inga:
"Occasional person"? Not hardly. Emergemcy rooms were bogged down with people who had no insurance, taking time away from true emergencies.
Not sure what the reason for the "were" there is -- ER use has increased in recent years. Even famously biased Politifact had to acknowledge that it's probably increased, and at minimum, hasn't decreased since Obamacare came into effect:
Is Price correct that emergency room usage has gone up -- not down -- since passage of the law? Our research suggests that Price has a strong case.
People weren't using the emergency room because they didn't have insurance -- they use the emergency room because it's hard to schedule visits with doctors.
For the most part, we don't have inexpensive walk-in clinics in the US. Your experience may be different, but I've always had to schedule check-ups at least a month in advance (or try to squeeze it in at odd hours), so I have never, in my adult life, gone to see a doctor here in the US just because I'm feeling poorly. It's check-ups only. If I were feeling really poorly, I . . . well, I'd probably go to the emergency room too, because there's no clinic I know of where I can schedule a visit in the afternoon because I was sick in the morning. I'll just drink a bit of soup and hope I can sleep it off.
If I were in Tokyo, there's three clinics in my office building alone, and a couple hospitals in easy walking distance from my condo. If I were feeling really sick, I'd go to a clinic, in the expectation that if they couldn't handle it, they could at least route me to someone who could. But short of showing up at GWU Hospital and asking for help (which, that basically counts as going to the emergency room, right?), I have no idea where I'd go here in DC.
"The rest of us get our health care back."
How has your health care been taken from you?
"The Affordable Care Act Reduces Emergency Department Use By Young Adults: Evidence From Three States"
Oh boo hoo. I guess I was never young, had debts, children etc. I started work at 16 and am now 67....51 years of paying paying paying. I am STILL paying into Medicare and Social Security. Even at my age. It isn't just the young.
come now --
DEMOGRAPHICS. Baby boomers will pay much less into the system & live a hell of a lot longer then previous generations.
The post world War II generation got a sweet deal.
And college was a hell of a lot cheaper in the 60s and 70s. Sputnik!
1 salary could provide for a middle-class family.
People didn't even have to spend $$ on car seats. Now a days kids need car seats until they are 9.
The size of government is a ratchet that only moves in one direction.
Mike said...
"Trump had to Repeal Obamacare!"
Wait a minute. How many Republicans have run on repealing Obamacare? Just about every freaking one since since 2010. Why is it not their promises that you highlight? Why we even had a "total repeal" bill that was passed by this congress in 2015! Before you lay all the blame on Trump, please explain why these Republicans didn't just resubmit the full repeal bill that had already passed in an earlier congress.
I'm sure you can explain the "establishment Republican" logic to me!
I'll tell you what you already know. House Republicans took and passed votes that never had any chance of becoming law. And being the government is harder and more complicated than being the opposition. Now, the job is how to hold the House and Senate in 2018. Trump had better fucking hope that he doesn't lose them. He'll be impeached if Republicans don't hold.
Inga cannot fathom how millions of poor, uneducated illegal immigrants who flood across our borders and cannot by law be denied care at emergency rooms, even for minor illnesses, might impact hospitals ability to function properly.
Gee, it's a mystery the socialists can never quite figure out.
Ever.
But they do know one thing: its all YOUR fault.
So carry on lefties. Just a few more minor tweaks to the "system" and we'll be able to create our very own Venezuelan paradise above the Rio Grande!
"And nobody really cares if the Military has no weapons or troops...."
Oh, please.
Our military budget is the biggest in the world, bigger than most of the rest of the world's military budgets combined.
We need to cut our military budget by more than half and apply those funds to domestic budget needs.
"lifelong republican" Chuck: "I'll tell you what you already know."
LOL
That about sums that up.
Robert Cook: "We need to cut our military budget by more than half and apply those funds to domestic budget needs."
Sure we do Comrade. Sure we do.
Your experience may be different, but I've always had to schedule check-ups at least a month in advance (or try to squeeze it in at odd hours), so I have never, in my adult life, gone to see a doctor here in the US just because I'm feeling poorly. It's check-ups only.
That sounds like poor organization on the part of the scheduling doctor's office. All of the doctor's I dealt reserved a certain amount of appointments for more urgent matters like ear aches.
I had good insurance when I lived in the States, so I could always get in very quickly. For an ear infection, they got me in same day. Also have gotten in within a few days for a bad cold.
Even shots for traveling overseas wasn't a month wait.
Yeah Inga. All those hospitals in LA County closed because obamacare helped "reduce" the burden.
LOL
Increased numbers of Medicaid patient visits, UNINSURED VISITS down by 31.4% we were speaking of UNINSURED patients using the ER for their primary care.
http://www.policyprescriptions.org/how-the-aca-impacted-emergency-room-visits/
"These findings differ slightly from prior literature showing increased ED visits among those who gain Medicaid. Potential explanations for the observed differences include: (1) increased access to non-ED ambulatory care as a result of legislated by the ACA; (2) unobserved differences among those newly eligible for Medicaid under the ACA compared to populations historically eligible for Medicaid; and (3) other differences in expansion vs. non-expansion states such as urgent care centers and .
The authors did find a 27.1% increase in Medicaid ED visits, a relative 31.4% decrease in uninsured ED visits, as well as a 6.7% decrease in privately insured ED visits in expansion states compared to non-expansion states.
Decreased privately insured ED visits may be due either to the crowd out of privately insured patients who switched to Medicaid in expansion states or, alternatively, enrollment in private health insurance through exchanges in non-expansion states counteracting the effects in states embracing the ACA."
The overall impact of these changes in payer mix on ED revenue is likely mixed: Medicaid payments typically exceed those of uninsured patients but are far lower than those received from private insurance. Whether the gain from Medicaid exceeds the loss from fewer private coverage visits is difficult to determine based on this study but of utmost importance to providers of emergency services.
"If you want to protect your assets, buy your own insurance."
People who do buy their own insurance still end up filing for bankruptcy because the medical expenses not covered by their insurance is greater than they can afford.
Unaffordable medical bills are the single biggest cause of personal bankruptcies.
"And if you think only Americans without health insurance face financial troubles, think again. NerdWallet estimates nearly 10 million adults with year-round health-insurance coverage will still accumulate medical bills that they can't pay off this year."
Does Trump veto this bill, if passed as is?
Cookie - that is one of the biggest falsehoods ever concocted by liberals and it has been debunked thoroughly. I think the crazed nasty senator from Massachusetts was behind it.
I think Scott has it wrong. Most people are covered, and most people aren't really concerned about "coverage". Most 'Uncovered' people are young people who - quite rightly - don't think they need health insurance.
What peeps are REALLY concerned about is cost. Medical costs keep going up and up. Which must be nice if you're in the Health profession or own stock in a drug company. But it sucks for everyone else.
Something needs to be done about drug prices - they're out of control.
In D.C. the solution to a problem always seems to be to figure out what the cause is and increase it. With the ACA as with most other things, it's over-control (regulation) and over-spending which are tied together like mosquitos and malaria.
To be fair, I suppose they never really try to figure out the cause, becuase they already know the solution. It's the same one they use for everything: tax dollars, and rule making. The smallest minority in the government is people who understand the free market and the miracles it can produce. Everything we have comes from it. Even when we keep it handcuffed, it still produces miracles, but not all the ones we need. Healthcare needs a miracle, and those don't come from Washington, D.C. Let Amazon run it. Offer a hundred different kinds of plans and let people buy whatever insurance they want, but if you need care, and are not covered, then you should get a bill. If you can't pay it, you go bankrupt, and only then do the rest of us cover it. Why should paying for your own healthcare be less expected of you than paying your mortgage, or a car payment. You don't buy a house or a car without insurance.
There could still be some subsidies and a safety net at a fraction of what we are paying for the ACA, but unless you pay for that level of coverage, getting a check up or birth control or a few stitches should not be covered any more than car insurance covers an oil change, a flat tire, or gas. Pay for own damned life, you bunch of toddlers.
Can I just remind everyone that Obamacare IS a Republican idea? Modeled after Mitt Romney's plan for Massachusetts. It's a public-private compromise, leaving all the private industry in place but regulating the insurance market, which was really running amok. Premiums were absolutely skyrocketing before the ACA. I saw yearly increases of 15-20%. It still goes up, but at a much slower rate. Today's Repubs seem to have such ideological animus towards regulation of any kind. I work for a community health center in finance, and I can tell you the ACA has made a LOT of difference to low-middle income people in terms of access to care and quality of care. The Repubs are making a HUGE mistake trying to repeal this.
CJinPA said I have a good health care plan unaffected by Obamacare...
This can't be true. All health care plans have been affected by the ACA. Do you know that if your doctor prescribes aspirin that it is now a covered prescription? Aspirin.
The cost of employer-sponsored plans have gone up significantly. Some are better situated with a larger pool, but the chickens are coming home to roost. Part of the goal of this law was to destroy employer-sponsored health care. I don't think it has quite worked out the way the designer's hoped, but stay tuned.
It DID hurt the people who could afford it the least, like my former neighbor, unable to work due to her advanced MS. Obamacare caused her carrier to pull out of the state and what she was left with was at a cost that she couldn't afford and that even if she could afford, would not cover much and none of her doctors would accept.
Disaster. As painful as it will be, I still believe Republicans should let it fail. A painful lesson now may save us from the bigger disaster of fully socialized medicine.
Jives - then why didn't a single Republican support it? It passed on party-line vote.
The Repubs are making a HUGE mistake trying to repeal this.
I agree. Let it fail.
People also don't understand the relationship between illegal and legal immigration and health care.
They love it when "hard-working" Jose and his family come here, and he mows their lawn for 50 cents. But these people use the health care system and they pay very little $$$ into the system.
Also, because of "chain migration" we have large numbers of sick and old immigrants coming here. I personally know many Asian-Americans who've brought over their parents (all over 55). These people will add to the burden.
BTW, I see the same pattern with College costs.
Basically everyone wants to argue about how to pay for it, and who should pay for it, and disregard how much it costs or how we can contain costs.
Rene Saunce:
because the politicians are petty and competitive and the present incarnation of the Republcan party is completely blinded by ideology.
Scott Adams- does have it wrong and right in a way.
The media will harp on the net number of insured as a result of any new law. Unless the CBO says more people will be covered, the Repub bill will be a loser in the eyes of the media. And so Scott Adams is right on that count.
However, the impact of the bill will also be felt in whether people and businesses feel they have more choices. If the bill succeeds on that front, it could be a winner. On this count, Adams is wrong.
For now, it appears to me that the bill WILL NOT OFFER US MORE CHOICES.
Leftists do not want to pay for their own health care. They want to go on vacation, or buy some video games, or a jet ski. If they get sick, they want a safety net that is paid for by someone else. Leftists do not want to buy any insurance, they want it given to them.
Part of the problem, of course, is the CBO forecasts of coverage are worthless. The WSJ recently ran an article that examined the CBO forecast vs, actual enrollment for Obamacare coverage. In 2014 CBO forecast that 26 million people would be covered on the exchanges in 2017. The actual number is 10 million - a forecast error of 160%. Even in 2016 CBO forecast coverage of 15 million in 2017 - a forecast error of 50% for one year. Completely unreliable.
I tend to agree with Adams on the marketing side, but CBO is so unreliable that all the Senate can hope to do is minimize their inaccurate forecast. I don't think the Republicans can afford to do nothing regardless of what CBO says about coverage.
Jives- you just got done telling us the ACA is a republican idea, but not a single republican voted for it.
choices, choices, choices
..."sometimes I don't want more choices, sometimes I just want nicer things!"
-Edina Monsoon
Look it up Rene, it's a Republican idea, Mitt Romney, I kid you not.
Rene Saunce makes the most important point right at the start. Real people are being hurt and will continue to be hurt under Obamacare. Both parties should be willing to address the problems of Obamacare, but the Dems have painted themselves into a corner by committing to do nothing and the Rep's have painted themselves into a corner with their numerous repeals. Health Care/ health insurance issues are too complex and too varied to be managed by a one size fits all Federal program. It really should be managed on a state by state basis with federal funding help. The Republicans come closest to that model.
Healthcare is a right not a privilege. It is life or death.The GOP shows their true colors here. They don't care if people live or die. They enjoy deciding who deserves...
Agreed! Trumpcare needs to provide for catastrophic coverage for individuals who incur more than $50,000 in annual medical costs.
Mitt Romney had nothing to do with the ACA's passage. Look it up.
Sunsong - No - Health insurance is something you buy or not. You want it given to you.
Jives - then why didn't a single Republican support it? It passed on party-line vote.
It wasn't a Republican idea when it passed, but years before it had been developed by Republican think tanks. Later developed into a policy by Mitt Romney's administration in MA.
What's her name from Maine voted to get it out of committee, but mostly people went with Mitch McConnell's plan to not compromise.
McConnell has mad skilz. he got the medicare drug package passed years ago, he did a great job using health care policy to get his people elected under Obama, and now his office is writing the reconciliation bill.
Don't underestimate McConnell. He's more powerful then Trump & what he wants to happen is going to happen in health care.
The Republicans come closest to that model.
I agree, except over time, that party has become so rigidly opposed to regulation of any kind (except abortion and birth control, I guess) that they refuse to do the required regulation of that market.
100% democrat passed ACA fails - it's Mitt Romney's fault.
Does Trump veto this bill, if passed as is?
why would he veto it? This bill would allow tax reform to happen with 51 votes.
They need to cut medicaid to get tax reform allowed with 51 votes. Otherwise they need to compromise with Ds to get tax reform.
I don't know what McConnell is thinking, but if he wants tax reform, he wants this bill to go through. if he wants this bill it'll pass.
Anyways, we'll know next week. McConnell won't want to drag this thing out.
The right of medical care is based on the moral principle of intrinsic value. This principle was rejected with the establishment of the Pro-Choice Church, which rejects the moral principle of intrinsic value as well as individual dignity. The logical conclusion is that the left, whether it is carrying out elective wars, engaged in redistributive change, environmental and labor arbitrage, or perpetual smoothing functions (e.g. welfare industry), is doing it solely for the purpose of exploiting democratic leverage (i.e. marginalizing competing interests) and skimming profits.
That said, health care reform begins with education and moral reform. Medical reform begins with reestablishment of capitalism to control progressive costs and a triage system to increase availability. Obamacare is a financial product that addresses neither availability nor affordability of medical care, and only obliquely addresses health care. It is the Fannie/Freddie debacle on a progressive path.
This is a "real plan" and sorry to say would not, could not ever get approved...
100% democrat passed ACA fails - it's Mitt Romney's fault.
??? Mitt Romney wasn't involved in ACA.
He was involved with the MA plan when he was governor.
Obamacare is Romneycare after a living interpretation by Democrats deformed it beyond recognition.
Premiums were absolutely skyrocketing before the ACA.
Obamacare really fixed that one, did it not?
It appears to be impossible to know the actual number of people who are currently, in violation of the law, uninsured. Is that number greater or smaller than the number a.) before ACA was passed or b.) estimated after the revision is passed or c.) both? 'Does anyone have these numbers?
Obamacare is Romneycare after a living interpretation by Democrats deformed it beyond recognition.
Look - this shit is only interesting if you care about the history & philosophy of health care coverage. It was a philosophical & policy question -- do you go with single-payer or do you go with something that looks like "Romneycare" and keep free market insurance industries in place.
There's a lot of other ways to do health care besides Romneycare and single-payer. Germany for example.
None of this matters. The USA is not having a debate about Romneycare versus Single Payer.
Mitch McConnell is in charge and a Republican is in the White House. Romney is NOT in power, so it doesn't matter.
McConnell is the decider.
Wrong - premiums were not skyrocketing before ObamaCare.
Obamacare caused premiums to skyrocket necessarily. Not a bug - a feature.
.
Healthcare is a right not a privilege. It is life or death.The GOP shows their true colors here. They don't care if people live or die. They enjoy deciding who deserves...
This is why we are here. Whether or not a person may choose to seek "health care" is and always will be a CHOICE. Not a right. Prior to Obama care, any person would have a legal RIGHT to be treated in any ER. They could not be refused. If you could not demonstrate and ability to pay or had insurance, PRIVATE doctors could choose not to take you on as a patient. Doctors have a RIGHT to make money, no?
Now...as to the conflation of health care and insurance...well, now apparently a majority of Americans have been persuaded to believe that insurance is a RIGHT. It has never been.
What is maddening and insane about this is it is our own government which has meddled so far into actual health care that, for instance, the days of doctors being able to take on very poor patients through their PRIVATE practice and write off the expense (there are expenses to this - it is not FREE) are gone. They are not able to do this legally.
Yeah, best to let the government handle this. Well, they've done a bang up job. Hallelujah.
OMG! Democrats and Obama were duped by Romney. He's so powerful.
@Jives yes of course, Obamacare is a Republican idea, because Mitt Romney is a Republican and signed it.
Never mind Romney is a pretty liberal Republican, elected by a state full of Democratic voters, and the Romneycare law itself was written and passed by a heavily Democratic controlled state legislature...
And then never mind that Obamacare was written and passed by Democrats without a single Republican vote, over the protestations of not only Republicans but quite a few moderate Democrats...
yeah the ACA is totally a Republican thing. you got us.
Eliminate the tax deduction for employers providing health insurance so that people start asking about costs and quality of healthcare service, like actual consumers. That way consumers, rather than bureaucrats drive the market and make it more efficient.
Allow the insurance industry to expand the risk pool by selling insurance products across state lines.That will also incentivize them to tailor plans for specific age groups. I don't want to pay for a 30 year old's birth control and I am sure that they do not want to pay for my eventual knee replacement.
Deregulate healthcare by getting rid of bureaucratic crap (e.g., EMR) that actually interferes with the doctor-patient relationship.
Of course, none of these ideas will pass because they represent capitalism and it threaten the livelihood of useless bureaucrats.
Something needs to be done about drug prices - they're out of control.
Drug companies don't have any incentive to research new drugs if you control costs too tightly. It all costs $$$
McConnell understands this.
rcocean said...
Something needs to be done about drug prices - they're out of control.
6/23/17, 10:17 AM
The drug price problem is easily solved. Simply tell your doctor you only want a generic drug. That cuts out a whole swath of new "miracle" drugs but your drugs costs will go way down.
I do believe the system is rigged against America. Other countries have passed drug price controls that drug sellers have to meet if they want to sell in those countries so America subsidizes drug research for the entire planet. The only way to "fix" that is to allow an American to purchase drugs from anywhere in the world. Drug companies would then be forced to decide if they can make it at the controlled prices or if they just need to avoid those controlled countries. Either way, some peoples will suffer.
wwww:
I didn't bring up Romneycare as Obamacare.
history & philosophy of health care coverage
Be careful not to conflate health care and medical care. This is the basis of an emotional appeal that prevents education (e.g. biology) and moral (e.g. individual dignity and intrinsic value) reform, as well as prevents medical reform (e.g. triage, monopoly mitigation, debt reduction practices) that would ensure affordability and availability of medical services and products.
The American people don't need to be covered. What we need is health care, not insurance. We're none of us covered by insurance when it comes to food, sex or education, for which there is, fortunately, good and increasing market competition.
All we need for access to health care is to force medical providers to compete for our business, at least by publishing their prices online, as Walmart does. Until then, government involvement in health care will do no more than serve to choose winners and losers in costs and services.
Healthcare is a right not a privilege. It is life or death.The GOP shows their true colors here. They don't care if people live or die. They enjoy deciding who deserves...
6/23/17, 10:38 AM
You are 100% correct! Also, this is too important to wait for politicians. I need you to immediately start sending me all of your money not spent on food and lodging so that I can start spending that money on insurance for those that do not have any. I need Arm, and Once, and the rest of the liberal posters to do the same! You HAVE to, right? Send me your contact information and I will send you might so you can start getting those checks in the mail.
I eagerly await you putting your wallets where your hearts are.
Todd:
The reason why Denninger's comprehensive reform is intolerable is because of the prevailing establishment of Pro-Choice. This quasi-religious philosophy is the basis for not only selective moral practices (e.g. abortion rites/denying life deemed unworthy, [class] diversity including institutional racism), but also selective legal practices that underlie the progress of monopoly formation and practices.
the point is, that Republicans used to be reasonable and open to compromise, and could imagine government being a moderating influence in an area as essential as healthcare.
And from where I'm sitting --that is, working in an accounting department, and paying my companies monthly 6-figure insurance premium bill-- I can tell you that during the Bush years, the increases were absolutely appalling, there was nothing to stop them, they had a stranglehold. Our company was having to downgrade the plan, increase deductibles, AND pay double digit increases every year. The ACA has brought premium growth much closer in line with ordinary inflation, and has encouraged competition in our state. We just switched carriers and got a better plan.
Mitch McConnell is a cold-eyed calculator, but I think he's overplaying his hand.
Rene, I love your picture.
This conversation would materially change if Democrats rejected the Pro-Choice religious/moral/legal philosophy. The rationale for universal medical care, which bears a correlation with health care, is the moral principle of intrinsic value. As it is, progressive and liberals are only in it for material profit and environmental stability.
Be careful not to conflate health care and medical care.
I meant the ways in which national states organize the health care sections of their economies.
Medicare for people over 65? Medicare for all? Romney care? how Japan, Germany or Singapore do it?
Free market, vs. single-payer vs. mixed vs. heavily regulated by state. Difference in terms of Age? (medicare for elderly? Medicaid for disabled/those in elder care vs. medicare for all?) How are drugs regulated? How are services regulated? How are hospitals organized?
These debates can be fun if you are just having a friendly intellectual policy debate. "Whaddya think about how Germany does it?" That's an entirely different question then what is practical on the ground.
For the political question -- I think Scott Adams is wrong. I don't think this plan is dead on arrival. I think it can pass.
Will it be popular? That's a separate question.
The ACA has brought premium growth much closer in line with ordinary inflation, and has encouraged competition in our state.
You are aptly named.
n.n said...
Todd:
The reason why Denninger's comprehensive reform is intolerable is because of the prevailing establishment of Pro-Choice. This quasi-religious philosophy is the basis for not only selective moral practices (e.g. abortion rites/denying life deemed unworthy, [class] diversity including institutional racism), but also selective legal practices that underlie the progress of monopoly formation and practices.
6/23/17, 11:12 AM
I disagree. I believe it will not even be considered is because it makes individuals responsible for their life choices and in America today, you can't do that. Forcing an individual to actually have to face the consequences of their choices is no longer acceptable and must be "shared" with the entire country.
You are aptly named.
I just described in detail, a good thing that happened as a result of the ACA, do you have any substantive reply?
Inga said...
The emergency medical system is stretched beyond capacity.
Inga, you are an RN? Doesn't this mean we need more doctors and nurses and MRI machines and probably more hospitals and medical schools?
Can you explain to me how Obamacare actually provided any of this? It didn't right? It said You can have this, but didn't actually provide "this"?
I don't like Obamacare, never did. I have always advocated for Medicare for All.
Physicians for a National Health Program
I always think of the polite word "disingenuous" when I see a lefty pretending that free riders should absolutely not be allowed under any circumstances when it comes to health care paid by health insurance. Also the words dishonest, liar and bullshitter. And the phrase "the ends are justified by the means".
Johnny Depp's problem?
It's the Scissors, Edward!
Go on, give me a hand.
The Expanded and Improved Medicare for All Act
Inga said...
"I don't like Obamacare, never did. I have always advocated for Medicare for All."
"If you think health care is expensive now, wait until you see what it costs when it's free."
~P.J. O'Rourke, May 6, 1993; speaking to The Cato Institute.
;-)
Jives, my employer-sponsored coverage cost has doubled, at least, under Obamacare. And while I worked at General Motors briefly and had the supposed benefit of a larger pool, deductibles went way up with cost of premium up sharply. No one but you and other propagandists are claiming that the ACA "brought premium growth closer in line with ordinary inflation". Laughable. And competition? Do you not read the news? Many, many carriers have pulled out of states due to Obamacare losses, in many cases leaving Blue Cross with basically a monopoly. This does not add up to your boast, does it?
Obamacare brought Bush-caused skyrocketing health insurance costs under control? Are you kidding me? On only one possible basis: a decrease of actual benefit and astronomical deductibles. Too high to be anything but what used to be called catastrophic coverage - until Obamacare got rid of that too.
In a nutshell: I don't believe you.
Medicare for all is single payer, Inga.
Government run health care paid for by tax-payers, run by bureaucratic flunkies.
Bad Lieutenant said...
Can you explain to me how Obamacare actually provided any of this? It didn't right? It said You can have this, but didn't actually provide "this"?
6/23/17, 11:21 AM
Mixed in with the fine print, it also says that every adult is legally allowed to have a free unicorn. It just didn't bother to say where you can get one.
fair enough Darcy, thanks for the details. Just adding my experience to the mix. Our premiums really did level off. Maybe it has something to do with how your state administered the ACA transition.
I do believe you, but these are big economic wheels turning, and there seem to be a range of outcomes depending where one is situated. The ACA ain't perfect, but it's waaaay better than what's in the pipeline....
Shall we discuss all the secret Obama to mega-health insurance company tax payer bailouts?
Oh yes he did.
WaPO: Obama administration may use obscure fund to pay billions to ACA insurers
How Obamacare Execs Broke the Law and Cost Taxpayers Billions
NY Times: U.S. (Obama) Paid Insurers Funds Meant for Treasury, Auditors Say
(mealy mouthed headline)
Chuck said...
"If you think health care is expensive now, wait until you see what it costs when it's free."
~P.J. O'Rourke
The problem with this argument is that US health care already costs much more than comparable nations while providing no better outcomes. For most of the other nations some form of universal coverage has been in operation for decades.
Beyond the ACA: A physicians' proposal for Single-Payer Health Care
Funding
"Total expenditures under the NHP would be limited to approximately the same proportion of GDP as the year prior to its establishment. While the needed funds could be garnered in a variety of ways, we favor the use of progressive taxes in order to reduce income inequality – itself an important social determinant of poor health.
During a transition period, all public funds currently spent on health care – including Medicare, Medicaid, and state and local health care programs – would be redirected to the unified NHP budget. Such public spending – together with tax subsidies for employer-paid insurance and government expenditures for public workers’ health benefits – already accounts for 60% of total U.S. health expenditures.28 Additional funds would be raised through taxes, though importantly these would be fully offset by a decrease in out-of-pocket spending and premiums.
During the transition period, these additional public funds could be raised through a variety of measures, e.g. redirecting employers’ health benefit spending to the NHP through payroll taxes. In the longer term, however, direct funding through progressive taxes would be fairer. By unburdening employers, the NHP would facilitate entrepreneurship while increasing the global competitiveness of American business."
Cost Containment
"A single-payer system would trim administration, reduce incentives to over-treat, lower drug prices, minimize wasteful investments in redundant facilities, and eliminate almost all marketing and investor profits. These measures would yield the substantial savings needed to fund universal care and new investments in currently under-funded services and public health activities – without any net increase in national health spending.
Private insurers’ overhead currently averages 12.0%,26 as compared with only 2.1% for fee-for-service Medicare.27 The complexity of reimbursement systems also forces physicians and hospitals to waste substantial resources on documentation, billing and collections. As a result, U.S. health care administration costs are about double those in Canada, where the single-payer system pays hospitals global budgets and physicians via simplified fee schedules. Reducing U.S. administrative costs to Canadian levels would save over $400 billion annually.25"
Medications, Devices, and Supplies
"The NHP would cover all medically necessary prescription medications, devices and supplies. It would directly negotiate prices with manufacturers, producing substantial savings. An expert panel would establish and update a national formulary, which would specify the use of the lowest cost medications among therapeutically equivalent drugs (with exceptions where clinically required).
Full drug coverage is an essential component of an NHP. Copayments reduce adherence to medications and worsen clinical outcomes. The NHP would, like other large purchasers, use its market clout and formularies to negotiate lower drug prices with manufacturers. For instance, the Veterans Administration pays only 56-63% as much as Medicare does for drugs,24 because Medicare is prohibited from negotiating for lower prices."
Darcy is talking about not just herself, but millions of people who share a similar experience.
My health insurance premiums have jumped by thousands. I pay thousands more now. My care and access to doctors in-network? diminished.
Freder Frederson said...
Are you contending that the government doesn't insure basic nutrition, not only in this country, but also internationally?
Yes.
My three favorite government nutrition insurance programs are paying farmers to not grow something, to keep prices high; subsidizing tobacco, to keep prices low; and the Raisin Administrative Committee, just for shits and grins. And to keep prices high.
LOL - Marxists and leftists with economic ideas. Point and laugh.
Coverage
"A single-payer NHP would cover every American for all medically necessary services, including mental health, rehabilitation and dental care, without copayments or deductibles. Covered services would be determined by boards of experts and patient advocates; ineffective services would be excluded from coverage.
Patient cost sharing blocks access to vital care (e.g. by delaying care for patients with myocardial infarction); reduces adherence to medications; and selectively burdens the sick and the poor.5,15-19 Moreover, cost sharing has proven ineffective at containing system-wide costs, in part because collecting and tracking co-payments and deductibles entails substantial administrative effort and cost.
The NHP would, like Medicare, ban private insurance that duplicates the public coverage to forestall the emergence of a two-tiered health care system, in which insurers would compete by lobbying to underfund the public part of the system. Moreover, in the NHP, as in Medicare, inclusion of the affluent would serve as an important guarantor of adequate coverage."
Jives, I have not read this bill. I'm convinced it is as bad as the ACA. I would love for the government to get as far out of private health insurance as they can. Government regulation is one of the causes of the insane rise of the cost of care. I think it insane to believe our government will "fix" it.
I would rather have them put their pencils down. They've failed the test. But our elected officials keep trying. Bless their hearts.
I guess we will have to find out how many of us do not want any part of whatever they come up with, and to what lengths Congress is willing to go to force participation against our wishes.
Rene and Darcy, you're still ignoring that there are also millions of people having the opposite experience. Coverage that they can afford for the first time in their lives. Sounds like your respective employers put all the burden on you when it came into effect.
I live in a rural area, and my costs have leveled off, and I have more choice of providers because the ACA helps medically under-served areas with grants for facilities improvement, and incentives to providers to work in more remote areas. I'm sure that's cold comfort from your point of view, but it's also part of the picture.
All we need for access to health care is to force medical providers to compete for our business, at least by publishing their prices online, as Walmart does.
Pretty good evidence that you don't understand healthcare.
The cash medical market, which Obamacare was developing pretty rapidly as physicians dropped out, does that as a standard.
The cash market eliminates the insurance overhead which is about 50% average for most physicians.
The problem with managed care is that prices are determined by the insurance company and are mostly trade secrets. When I retired, fortunately before Obama, I had 276 contracts with various entities. I was a surgeon so my overhead was about 33% while GPs were much higher. I had to buy the computer billing system because all those contracts had different criteria for such things as referral to other "providers."
I was once fined $500 for sending a patient to the "wrong" lab for a $16 culture of a wound.
The GPs in my area were getting annual bonuses, determined by such things as how well they rationed hospital care, that were equal to half their annual income. That is a pretty powerful incentive to obey the rules when your over head is 75%.
"put their pencils down.." I like that.
"the ACA helps medically under-served areas with grants for facilities improvement, and incentives to providers to work in more remote areas."
I can see why you would prefer that. Using other people's money is attractive until it runs out, like Venezuela.
Covered services would be determined by boards of experts and patient advocates; ineffective services would be excluded from coverage.
Well, that lets me out. Ezekial wants everyone to die at 75.
It is not perfect, but I would much rather my care be determined by the market and my ability to pay than by a "board of experts and patient advocates", where eventually the resource-draining elderly and the chronically ill are thrown under the bus. After all, shouldn't they rather die than live like that? Right? It would be their duty for the good of the collective.
$1200 a month with a $25000 deductible is not "covering".
The most common complaint I hear from voters re ObamaCare is that are forced to purchase insurance they can't use.
what do you mean "other people's money"? Michael K, I pay the taxes and premiums, that's MY money too. And this investment in healthcare, which I have seen first-hand, looks to be a very solid one.
"Somebody making $20,000 a year could easily see deductibles increase dramatically, from $1,000 (the average deductible for lowest-income consumers in 2016, according to Aviva Aron-Dine of the Center on Budget and Policy Priorities) up to that $6,300 average. And for somebody at that income level ― think a home care worker or retail clerk barely covering costs like food and rent ― even modestly higher out-of-pocket medical costs would be crippling.
None of this should be surprising. A core principle of conservative health policy is that people should face higher out-of-pocket expenses ― that they should have “more skin in the game” ― because, in theory, people would shop more aggressively for better prices or simply avoid getting medical care.
For the last few years, Republican politicians acted as if they felt differently, and it’s entirely possible many of them had no idea that, by campaigning to reduce out-of-pocket costs, they were deviating from this bedrock piece of conservative orthodoxy."
Rene Saunce said...
The ACA is failing, and perhaps it should be left to fail and we can continue to hang it around the left's collective neck.
Pure GOP fantasy. Allowing millions of people to suffer in a vain attempt at political retribution will only be suicide for Republicans in 2018. But I expect nothing less from the nihilists on Althouse.
Jives said...
what do you mean "other people's money"? Michael K, I pay the taxes and premiums, that's MY money too. And this investment in healthcare, which I have seen first-hand, looks to be a very solid one.
6/23/17, 12:15 PM
So if someone eats themselves into disease, they should get all the healthcare in the world right? Or alcoholics, drug addicts...
"Why don't the two parties agree on something like this - "
Because the Democrats don't really care about providing insurance to the poor. They want to make voters dependent on The State.
If you like deductibles, then you'll love the Senate Health Care Bill
Edit, the Dems don't really care about providing *health care* to the poor, they just want to make voters more dependent on The State.
Funny how Inga is quoting the same "experts" who promised we could keep our health care and our doctors.
Would you still trust your financial health to the stock broker who lied to you about Enron?
Then why trust information brokers like CNN and Wapo?
Pure GOP fantasy. Allowing millions of people to suffer in a vain attempt at political retribution will only be suicide for Republicans in 2018. But I expect nothing less from the nihilists on Althouse.
So if the ACA is allowed to continue as is, and thus to fail, it will be the fault of those awful Republicans.
And Rolling Stone as a source? Don't they have some rape hoaxes left to promote?
"It is not perfect, but I would much rather my care be determined by the market and my ability to pay than by a "board of experts and patient advocates", where eventually the resource-draining elderly and the chronically ill are thrown under the bus. After all, shouldn't they rather die than live like that? Right? It would be their duty for the good of the collective."
The Senate health Care Bill cuts Medicaid Funding more deeply, affecting children and the disabled.
The Senate health care bill released Thursday closely mirrors what the House narrowly approved in May. Some analysts called it a tempered version of the House bill ― which President Donald Trump called “mean.” But it nevertheless puts vulnerable seniors smack in its crosshairs, according to advocates for elderly people.
“Actually, the Senate bill is even meaner” than the House bill, Howard Bedlin, vice president for public policy and advocacy for the National Council on Aging, said in a phone interview.
Bedlin cited the Medicaid cuts and per-capita caps that would harm elderly people who rely on the program to pay for their long-term care. The Senate didn’t stop the weakening of the Medicare Trust Fund that will result from the repeal of the payroll tax on wealthy Americans, nor did it change the so-called age tax that would dramatically increase out-of-pocket costs for older Americans in the form of higher premiums.
"Funny how Inga is quoting the same "experts" who promised we could keep our health care and our doctors."
Wrong. If you're referring to The PNHP , these doctors were NEVER in favor of the ACA. If you want to make accusations, at least be accurate.
Inga, have you understood my point, that if there are, say, 1 million doctors at 10,000 hospitals, currently being seen by, say, 300 million Americans, and we are jammed up; your increasing it to 320M, with no more doctors or hospitals, is not helping? Or did you respond and I missed it? If so please post verbatim the part that makes more doctors and hospitals.
Shorter Inga:
The GOP hates poor people, children, women.
Bad LT. I understood your question and chose not to answer it at the moment, because I had more important things I wanted to address first. As far as the numbers of doctors we'll need, we can make going to med school less expensive or free in exchange for some community health care service in exchange. Several European countries have free medical school education. There are also plenty of foreign doctors that would love to practice here.
How to fix the Doctor shortage
As far as hospitals go, I don't know about there actually being a shortage. If you have info about hospital shortages , I'd be interested in seeing it.
Hospitals closing, shrinking as outpatient care grows.
The good news is that I, along with my wealthy coastie friends, are going to get a nice tax cut. I love the plan. I don't really care about poor people not getting coverage...sorry.
Yeah, I don't like it, Inga. Nor do I like the failing Obamacare, which brought us to this place.
I don't wish for anyone to die due to lack of coverage. There are no longer any simple answers to a maze of regulation thanks to our government and Obamacare.
Letting it fail will be painful, but perhaps the only way to truly restore the insurance market to what it once was and should be. I was raised in a family of seven children. We always owed the doctor and we always were treated when we had to go in. My mother did not complain about the bill nor did the doctor. But it wasn't something that would bankrupt our family, either. The really large bills were offset by insurance. That is what insurance was for.
My husband's father was a country doctor. He did very well on what his practice generated, but also provided a ton of virtually free care to the community as needed. He didn't turn people away if they couldn't pay. That literally cannot happen anymore thanks to our government.
The introduction of managed care - HMOs and PPOs - sold as "cost saving" alternatives created a belief that a doctor visit shouldn't cost a thing! Or, possibly a small copay. And so on. This contributed to costs skyrocketing. Who would have thunk it?
I could go on all day. The debate we should have had never happened. But those of us who saw all of this coming DID say so and were completely ignored as partisan.
Don't any of you dare tell me that I don't care if people die. I care. I just have zero belief that anything our Congress dreams up is going to fix what they broke.
I truly do not understand the trust in government that would hand over such an important part of our lives to it. But this is something that the rest of the world found too tempting. It is a socialist's dream, and a pipe dream at that.
It never ends well.
Why one third of hospitals will close by 2020
Jives said: The ACA has brought premium growth much closer in line with ordinary inflation, and has encouraged competition in our state.
The real pain is in the individual market. In my state, the average premium has increased over 150% since 2013, a single insurance company is left, and there are rumors of an increase in premiums of another 43% next year. In that scenario, coverage for a single 64-year-old will be over $20,000 a year, and for a single 50-year-old adult with 3 children, over $30,000 a year.
The average premium was less than $3,000 a year just 4 years ago.
Even in the individual market, before the ACA, you could be denied coverage for being sick in the first place. Remember "pre-existing conditions?" I sure don't want to go back to that state of affairs.
Darcy
Exactly! And now we have a system that I would take advantage of if I didn't already have insurance. 1. I would not buy it but would pay the ridiculous "fine" or "tax" or whatever we decided to call it. If I got a bad biopsy then I would sign up for "insurance". Not the right time of year, you say? Bullshit.
The idea that people were dying in the street before ACA was/is utter bullshit.
The left promise that NEXT time they will stop lying to us, and they will get it right. We just need to give the left more power over our lives. You know- because it will be free and wonderful, and we are heartless if we do not allow them.
The huffington post is hollywood. Fake news. Hollywood can F off.
Jives
So you would like a system in which you could buy homeowners insurance after your house burned down? Good plan. You could save many thousands by not paying premiums up to that point and could deploy those funds into new bass boats and cars.
"I pay the taxes and premiums, that's MY money too. "
I have more choice of providers because the ACA helps medically under-served areas with grants for facilities improvement, and incentives to providers to work in more remote areas. I'm sure that's cold comfort from your point of view, but it's also part of the picture.
I'm sorry. I did not realize you paid that much in taxes. You must do very well to pay millions in taxes for your "more remote area."
Jives said: Even in the individual market, before the ACA, you could be denied coverage for being sick in the first place. Remember "pre-existing conditions?"
When I priced coverage in my state's high-risk pool around 2013, it was close to $10,000 year--about half of what I could wind up paying in next year's individual market.
People with chronic health conditions should not handled through insurance, nor should people unable to afford the insurance. Their care should be financed through other means.
So you would like a system in which you could buy homeowners insurance after your house burned down?
Not an apposite example really, if you're life burned down, you'd be dead.
People with chronic health conditions should not handled through insurance, nor should people unable to afford the insurance. Their care should be financed through other means
Amen
seems to me this is what Medicare and Medicaid exist for.
The recent issue of the New England Journal of Medicine has several articles on the subject. Here is a key quote when one looks to the supposed disaster of the AFA: " As 2017 began, the market was poised to leave behind the growing pains of the past few years. Then the President and Congress acted to create needless turmoil.
ACA reforms that greatly expanded the individual market form the backdrop for the current debate. These reforms include a bar on insurers denying coverage or charging higher premiums based on health status; subsidies to make insurance coverage more affordable; and a requirement that people carry health insurance or pay a penalty. These provisions triggered a dramatic increase in individual market enrollment from 11 million in 2013 to roughly 17 million today."
Since 2013 the average premiums have increased 105%. The idea that the ACA has slowed increases is just bullshit.
I have 90 employees. I negotiate, choose the plans, and pay the premiums. I've done so for three decades. They have skyrocketed under the ACA like never before, but even more fucked up is that now the coverage is nearly useless at these crazy prices. The deductibles make the premiums virtually theft. Even after all that, the insurance companies still can't make it work for them. Put that in mind as you remember the billions spent on the incredibly bad websites and roll out, and you have the most dysfunctional, inept, and harmful government policy ever enacted, since the Civil War.
Every problem with health care is rooted in or made worse by some regulation that destroys competition, choice, or transparency. Go ahead, name one that isn't.
The introduction of managed care - HMOs and PPOs - sold as "cost saving" alternatives created a belief that a doctor visit shouldn't cost a thing! Or, possibly a small copay. And so on. This contributed to costs skyrocketing. Who would have thunk it?
I don't really understand what people want. There ain't no such thing as a free lunch. Medical care is much more expensive then it was 30 years ago.
MRIs cost money. More machines cost more money. New drugs cost more money.
There ain't no such thing as a free lunch.
The really ugly thing about ACA is it promises universal coverage without providing the resources, so Americans have gotten used to the idea they can have their cake and eat it when it comes to medical care. It's a poison pill for whoever tries to fix it.
wwww said...
I don't really understand what people want.
The level of medical coverage provided by most other western countries.
It's telling that nobody wants to claim ownership of either the ACA or it's Republican update.
It was all someone else's mistake, it's failing miserably and hurting people, but don't blame me, and we should keep it.
The lack of courage and imagination in this nation now days is stifling.
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