Healthcare Proposals to "replace" ACA in usa

[Lumpenproletariat]

"DEATH PANELS" have to enter this picture at some point.

It's a "disaster" to let people be free to decide what they want to be insured for?

It was a disaster to expect individual people to be able to afford crisis care at unexpected times and regardless of how many times they are hit with health crisis.

It caused people to die of treatable conditions regularly, including childbirth when they can't afford a hospital visit if needed.

OK, let there be a public system for ALL. Let that public system provide this coverage you think is important. For everyone, including those who also have private insurance. If their private insurance lacked some coverage you think everyone needs, that can be covered by the public system.

So, given that the public system covers everything (within the budget limits) which is essential, why can't you put up with private insurance companies providing anything people want to pay for privately? and let them choose? Why do you have to dictate to them what this optional system covers?

to buy private insurance to be covered for something of their choice? which might exclude something else they don't need coverage for? How can that be a "disaster"?

It was a disaster when insurance companies contrived plans that covered nothing but vague promises that weren't ever intended to pay out.

You mean fraud? You mean free choice has to be denied to us because sometimes there's fraud? The state has to make all our choices for us in order to protect us against the possibility of fraud?

And individual people, without the time or expertise to understand the legalese found themselves making years of payments without any coverage.

So . . . So all business has to be outlawed because sometimes individuals don't understand the technical terms? As long as we're going to allow people to make choices, what is wrong with letting them decide what insurance to pay for? Even if there needs to be some safeguards or rules about the legalese, why does this mean consumers are denied freedom to make choices?

Why can't they be allowed to choose what insurance they want? i.e., what is to be covered and what is not?

What if all they can afford is coverage for A, B, and C, but X and Y would make it too expensive. What is wrong with letting them buy coverage for A, B, and C, but exclude X and Y? You're saying they can't buy any coverage at all, unless they pay the extra thousands per year to be covered for X and Y which they don't want coverage for?

One of the crazy myths of the anti-pool mindset is that if a lot of people have to buy coverage for sex change operations, but only a few people use it, the price for that coverage is prohibitive. That's not how math works.

So you mean no one can be allowed to choose individual items to buy, but the government dictates everything they will buy and forces them into a "pool" of products, collectively, for which they pay one large price (based on their income level?) and are prohibited from ever choosing single items to pay for separately?

If transgender surgery is covered and only 1000 people out of 360,000,000 use it, it is not an expensive coverage.

But the benefit from it is also too small to justify the high cost. If so few people "need" it, then there's no point in providing it at society's expense (unless the cost per individual case is low enough).

If the cost for one case is disproportionately high, then the cost for all the cases is also too high, even if there are only a dozen or so cases. Because the lower total cost is due only to the very small number treated, which makes it not worth the cost. There has to be a benefit which is proportional to the cost, whether the total number and cost is very high or very low.

Let individuals privately pay for exotic treatments, according to their choice, based on what private providers can offer, and let private insurance offer whatever is profitable for them and worth the cost to the consumers.

And if the cost comes down some day, maybe it will become affordable for society to provide it, within the budget limits. Have a public system, with providers paid a salary, and let them decide at what point cost limits force them to make the tough choices about which treatments to deny and which ones to provide because they are cost-effective. Protecting life and limb, long-term, is the highest priority.

If contraception is covered but you don't use it, the incredible net cost savings bring the overall rates down, not up.

Do that in the public system, but not imposed onto all private insurance.

None of your examples offers any rationale why private insurance must be forced to provide any particular "basket" of covered items. If "bundling" some items together into one package offered to consumers is efficient, then the companies will do this anyway, without any law forcing them to do it. The individual consumers need not have any one "basket" of items forced upon them which they choose not to have. If they pay for some coverage they want, and other extras are tossed in by the company, then this also requires no law from the state to impose it, if there's a net benefit to the provider and consumer.

The cost of coverage is based on use. If it's a thing nobody uses, it's not expensive.

There's no need to provide it if "nobody" uses it. Or if you mean only a tiny number use it, then it's their individual problem, not a social problem needing the state to provide it.

Let the public system cover whatever the providers, paid a salary, choose to treat as cost-effective within the budget limits. Don't prescribe to them that they must cover plastic surgery or other questionable services, except as the providers may decide it is necessary, to save life & limb, long-term, within the budget limits.

What's wrong with having people buy only what they think they need at the moment, is that you then get people signing up for coverage only when they expect a payout, creating cost for everyone in the end.

No, it's only the private system which pays for it. Let those consumers and the private companies figure out what works effectively. It's their problem, not society's.

Do you really think insurance companies won't raise your overall premium if they are forced to give maternity coverage only to those who sign up when pregnant? If they, in other words, are forced to give payouts without ever getting revenue?

Have the public system provide basic maternity services, within the budget limits, to produce the best long-term net social benefit.

Then leave the private system alone to do whatever works best for the companies and the customers. They will figure it out. It's not society's problem what extra services people seek from private providers or insurance.

Don't be naive. Insurance works by having long term pay-in to cover the pay-outs. If you're allowed to sign up when you're 39 weeks pregnant, get the coverage and then go back to "only having the coverage you need," either prices go up for everyone to cover the payouts, even those without that coverage, or you lose the ability to get coverage when you have existing conditions.

If it doesn't work, then the companies won't offer it. They'll require coverage under terms that insure that they make a profit, but also try to keep the cost down in order that customers can pay it. If some kinds of coverage are not profitable, then those won't be provided.

But meanwhile, let the public system be restricted to basic prevention and treatment which is cost-effective.

IF we share costs for everything, then the premiums are lower for us all than if we picked and chose.

There are plenty of "share" arrangements which the companies and customers can choose which will be cost-effective. This does not preclude some customers picking and choosing certain special coverage, where it works for both them and the company.

An opera singer can pay for special insurance to cover his/her voice care but maybe not require sex-change coverage.

If we pick and choose, then EITHER premiums are sky-high and yes the insurance companies will spread it around as if you had coverage for stuff you don't want because we know they're not going to lose money on this OR . . .

That's fine, because the customers are paying only what they think it's worth it to pay for, and there is competition between the companies, so they have the incentive to reduce the price when it's possible. In some cases the customers will be dismayed and drop the policy and feel they got ripped off, but insurance is really a gamble anyway, so it's up to the players to decide when it's not worth it.

In gambling, "the house" has to come out ahead one way or another, so the gamblers are mostly making a sacrifice, or paying a cost, in return for some "peace of mind" reward they hope to get. This is something subjective which the state really should leave up to the individual players and not pretend it can clean up and fix by tinkering with it.

. . . OR those who discover cancer will never be able to get on and will die from lack of medical care.

No, again, let the public system provide the basic services which are cost-effective, cancer prevention etc., with limited budget, providers paid a salary, no fee-for-service, with the cost-cutting decisions to be made by the providers, as they see the need. There are preventive and life-saving treatments which the providers can be trusted to use which will provide reasonable protection against unnecessary deaths.

This public system can provide the minimum reasonable coverage, beyond which there is no guarantee the health care system can provide to everyone. The private insurance and exotic treatments are a gamble, at high cost, which can be partly successful if allowed to operate separately at profit to the providers, left to free choice, and private responsibility for the outcomes.

There's no libertarian 3rd way.

There's no perfect freedom. But the best way is always one which optimizes the degree of free choice. So, have a low-cost public system which provides the basics only, the minimum protection to all, within the cost limits, and then a free-choice private system for everyone who wants more and will gamble for something better at their own expense.

There's no insurance company in the world who will promise to keep your coverage free from the effects of losses on other policies.

But some will do better than others at preventing cost-shifting, and those which are able to do this are entitled to profit from it. The customers can make these choices. As with any business, customers miscalculate, settle for less than perfect. They will seldom choose the optimum perfect plan, or "the best of all possible worlds," but the overall result is better if they are left free to make the choices, rather than society, except for a low-cost basics-only public system.

Especially for mental health which often strips a person of their savings before they realize they need a doctor.

Let the public system provide cost-effective mental health coverage. Let the providers make the difficult decisions within the limited budget.

Aaah, so you see exactly why pooling is needed to keep our citizens healthy and safe.

Only for the basics and cost-effective services to save life and limb and basic prevention. But beyond a certain cost level, the decisions should be private only, letting individuals make the choices, taking what private providers offer, with some gambling on what works or what is worth the extra cost.

The private system can also do some "pooling" if it's efficient. The competitive market can produce some good results with the more costly or exotic medical care.

Why are you willing to see it here and not with broken bones or cancer?

For whatever is cost-efficient. Much medical care gets too costly, so at some point it has to be private only, and not made an entitlement at society's expense. The most costly exotic treatments are not a basic right which everyone is entitled to.

It's inevitable that there will be limits at some point and that some conditions, for some cases, will not get all the treatment that is technologically possible.

I do not dispute this.

I advocate for comprehensive basic health care by pooled resources.

Health care beyond basic makes sense to have two-tiered. Or three. No objection.

https://www.youtube.com/watch?v=RaDacB_O30g

 

[Rhea]

OK, let there be a public system for ALL. Let that public system provide this coverage you think is important. For everyone, including those who also have private insurance. If their private insurance lacked some coverage you think everyone needs, that can be covered by the public system.

So, given that the public system covers everything (within the budget limits) which is essential, why can't you put up with private insurance companies providing anything people want to pay for privately? and let them choose? Why do you have to dictate to them what this optional system covers?

Wow, you would have saved yourself a lot of typing by reading what I said.
I have always supported/promoted two-tier health. Public care for all basics, private insurance for the wealthy to cover whatever they want to buy coverage for. If Dolly Parton can insure her boobs (she does) more power to her.

https://www.youtube.com/watch?v=RaDacB_O30g

I cannot watch videos. The invisible hand of the free market says I don't deserve to. You'll have to type out what's in it if you want me to know.

 

[Jason Harvestdancer]

I think lumpen actually has a good idea this time. A dual track plan, one fully public and one fully private.

It give you everything you want. You get the fully public system, with all of the fully public payments and all of the government certifications and approvals. All the things that liberals claim we can't do without, and all the thing conservatives pretend they can do without but don't mean it. It will be the UHC dream that people have had for decades.

The downside is that it also gives me what I want. It gives me access to the other track. For some reason, the idea of giving me a fully private track is so abhorrent that it is enough to sink a dual track proposal. Even though the dual track proposal has everything you want on the government track. It seems that the argument in favor of UHC is more than simply an attempt by the advocates of that system to have "free" healthcare. There is for some strange reason a desire to ensure that everyone else is in a controlled and regulated system as well, a desire to control and regulate everyone else.

 

[Tom Sawyer]

Ya, there's nothing about UHC which rules out private insurance as well. It's sort of like how you can have Medicare and the VA and yet still manage to buy yachts for insurance company executives. If you want to have a system where you can pay extra to go to the front of the line and the whole issue with the system is deciding where you want to place yourself on the cost vs wait time scale, then that's not a problem.

 

[Jason Harvestdancer]

The proposal ins't simply "pay extra to move to the front of the line." Just as Track One shifts healthcare sharply in one direction, Track Two shifts it sharply in the opposite direction. Neither is anything like what we have now.

 

[RavenSky]

I hope people watched this. Bernie crushed Cruz.

http://www.cnn.com/2017/02/07/politics/obamacare-cruz-sanders-highlights/index.html

It's very telling that while Bernie is still out there fighting the good fight, Hillary is silently sitting in her corner tail between her legs, nursing her wounded pride. Goes to show she never had what it took to lead in the first place.

Bernie is still a Senator. Hillary is not.

 

[Rhea]

I think lumpen actually has a good idea this time. A dual track plan, one fully public and one fully private.

It give you everything you want. You get the fully public system, with all of the fully public payments and all of the government certifications and approvals. All the things that liberals claim we can't do without, and all the thing conservatives pretend they can do without but don't mean it. It will be the UHC dream that people have had for decades.

The downside is that it also gives me what I want. It gives me access to the other track. For some reason, the idea of giving me a fully private track is so abhorrent that it is enough to sink a dual track proposal. Even though the dual track proposal has everything you want on the government track. It seems that the argument in favor of UHC is more than simply an attempt by the advocates of that system to have "free" healthcare. There is for some strange reason a desire to ensure that everyone else is in a controlled and regulated system as well, a desire to control and regulate everyone else.

You are pushing the falsehood that people on a 100% private track don't cost the system any money. Since the scholars understand that it's false, it's why it's not included. The public universal basic health care plan based on country-wide taxes to support is cheaper than people with no insurance. I, as a person who would probably have a second-tier health care option, benefit from not having uninsured people using the emergency room after letting health problems exacerbate due to lack of primary provider access. I also benefit from not having sick people around my community. And I benefit from not paying for their children when they become disabled due to lack of care and/or die. Edited to add in case it wasn't clear to you as it is to scholars: any system with an "all private" option will include those who go "all private" to have no insurance at all, or those who think they can pay it but end up can't or those who buy a private plan that never really covers them. Don't fool yourself thinking the third rail would not include these - the ones who end up in ER for an ear infection.


hang on, let me back up... _if_ my goal were to let the poor people get sick and die so we could be rid of them quicker and improve the gene pool, I might advocate for an option to let people not participate in insurance pools, which causes the price of the pool to rise, making sure the less financially endowed can't get in. And _if_ I wanted to reverse the current law that anyone presenting at an ER gets care and instead make them go away and die without care, followed by not wanting to provide food and housing assistance to their dependents, THEN it would make great sense to me to have a completely private track. Using this tack, I could drive up costs of care, "prove" to everyone that universal care doesn't work, and finally get the solution of them dying asap. But since it is NOT my goal to get poor people dying asap by complaining about how expensive it is to keep them from dying, while ironically using the argument that I'm rich enough to not need to insurance-pool care, then this is not one of the options I discuss.

This idea that a 3rd rail "all private" option should exist _only_ works if you are okay turning sick poor or stupid people away from ER rooms to die. If you are not okay with that, then it is cheaper to have universal basic coverage for all, paid by all, and add-ons available to those wealthy enough to buy add-ons.

So back to realistic non-monstrous plans...

The most cost effective solution to providing humane care for all while providing for perks and bennies for the wealthy is a two-tier system wherein tier one is paid by all according to their means and available to all according to their need; and tier two is available according to means - the fancier doctor, the private room, the spa recovery.

Tier two, really should be paying cash. Because having a tier two "insurance" policy is really just an admission that you want other people to pay for your care, which the wealthy find abhorrent, right? Bootstraps and all that. If you really believe in your bootstraps, you save up and pay cash. If you argue that under universal health care you "shouldn't have to pay for things you don't use," then you have argued that ANY insurance is beneath you, because it pays for things you don't use. You should save up. Unless you were deluding yourself in the first place about your firm belief in not paying for things you don't use.

 

[Jason Harvestdancer]

Those same poor people that you are talking about would have access to Track 1, the fully public plan. That is the flaw in your counter-argument. Unless you think that somehow a second track would somehow make the first track inaccessible.

 

[Rhea]

Those same poor people that you are talking about would have access to Track 1, the fully public plan. That is the flaw in your counter-argument. Unless you think that somehow a second track would somehow make the first track inaccessible.

The third track makes the first track inaccessible.

Here's how.

Your proposal that a third rail exists that is "private only" indicates that these people would not pay into the UHC track. This is shown by the claim, "For some reason, the idea of giving me a fully private track is so abhorrent that it is enough to sink a dual track proposal." This is you on your private track not contributing to the UHC track.

You have opened the door for anyone who thinks they "shouldn't have to pay for other people" to choose this track. And also for people who are so poor they have trouble paying to also choose this track. Food today v. medicine tomorrow. Looking at those cases seperately:

Those who think they are too smart to be in a pool - You make no allowance for those who are making a terrible decision. So all the ones who think they are rugged individualists will not pay into UHC. maybe because they are healthy now (pushes up cost of UHC to the rest, bumping some into category two described below) and maybe because they are foolish enough to think a bare-bones policy will actually cover them. Those people wioll eventually get sick. And while patting themselves on the back for ruggedly getting out of paying in, they drive to the ER for the care they now need and should have been insuring for, or for care they thought their clever private plan covered, but actually never did. This drives up costs for the rest of us, unless we are willing to bar the ER door and send them home to become sicker and become disabled or die. When they are disabled, we don't pay for them because that would cost money, so now their kids starve.

Or category 2, those who were barely able to afford UHC when all participated, but when momentarily healthy people decline to contribute, they are priced out and become those who take a risk with bad or no insurance and end up at the ER for regular health care, and we either refuse them and send them home to die, or we pay more than we could have by just all contributing in the first place.

You seem to be describing some legislation that says, "you can be in the third rail, only if you're as smart and clever as me so you'll never be without the excellent coverage like that I will buy for myself." Good luck writing that in a way that excludes the people I've described above from joining your third rail. You can't. That's why it doesn't work, and never has. That's why people are in the ER seeking health care, and that's why people die from 100% preventable causes, and become disabled from 100% preventable causes.

If you want to try your hand at showing us how it would be written to give you a third rail but exclude those who would become a burden by choosing it, I'm all ears. I don't think you can.

 

[Jason Harvestdancer]

I see your objection. "Since I'm choosing Track 2, I shouldn't have to pay for Track 1." Except I don't include that in my proposal.

 

[T.G.G. Moogly]

In a recent interview with O'Reilly, Trump said he and the Republicans would have something on the table by late 2018. What!? He said there are many statutory issues involved that have to be investigated. But here's the deal, when the only thing repeatedly standing in the way of repeal of the ACA was Obama, it didn't get repealed. But it still isn't repealed and Trump says it won't happen until late 2018 at the earliest. So who's trying to fool who?

The republicans are as far from having any comprehensive legislation on Healthcare as they have ever been. And the reason is because they've never wanted any, don't today, and never will, despite all rhetoric to the contrary.

The ACA forced their hand and they're still trying to bluff.

 

[jonatha]

I see your objection. "Since I'm choosing Track 2, I shouldn't have to pay for Track 1." Except I don't include that in my proposal.

This is of course how UHC works in Canada (as I understand it), and (such as it is) in the United States (Medicare).

Not sure about the UK...

 

[Elixir]

In a recent interview with O'Reilly, Trump said he and the Republicans would have something on the table by late 2018. What!? He said there are many statutory issues involved that have to be investigated. But here's the deal, when the only thing repeatedly standing in the way of repeal of the ACA was Obama, it didn't get repealed. But it still isn't repealed and Trump says it won't happen until late 2018 at the earliest. So who's trying to fool who?

The republicans are as far from having any comprehensive legislation on Healthcare as they have ever been. And the reason is because they've never wanted any, don't today, and never will, despite all rhetoric to the contrary.

The ACA forced their hand and they're still trying to bluff.

"Late 2018"? You mean just in time to offer ANOTHER lie to the toothless base that elected Cheato? Sounds like they're already circling the wagons against the overdue housecleaning of Congress that people want more than ever, now that "The Swamp" is densely inhabited by billionaire predators.

 

[Shadowy Man]

In a recent interview with O'Reilly, Trump said he and the Republicans would have something on the table by late 2018. What!? He said there are many statutory issues involved that have to be investigated. But here's the deal, when the only thing repeatedly standing in the way of repeal of the ACA was Obama, it didn't get repealed. But it still isn't repealed and Trump says it won't happen until late 2018 at the earliest. So who's trying to fool who?

The republicans are as far from having any comprehensive legislation on Healthcare as they have ever been. And the reason is because they've never wanted any, don't today, and never will, despite all rhetoric to the contrary.

The ACA forced their hand and they're still trying to bluff.

"Late 2018"? You mean just in time to offer ANOTHER lie to the toothless base that elected Cheato? Sounds like they're already circling the wagons against the overdue housecleaning of Congress that people want more than ever, now that "The Swamp" is densely inhabited by billionaire predators.

Yes. They found that running on the repealing of Obamacare worked really well, so they want to do it again in 2018.

 

[Tom Sawyer]

Yes. They found that running on the repealing of Obamacare worked really well, so they want to do it again in 2018.

Ya, I assume that "late 2018" means December 2018, so the GOP needs to be re-elected or the absolutely superb plan to replace Obamacare with rainbows and unicorns will be steamrolled by the obstructionist Democrats who care more about their own partisan political agendas than they do about the health care of the American people.

 

[SimpleDon]

Yes, of course, the Republicans didn't have a plan to replace the ACA with something that is better and cheaper. Given their ideology of minimal government involvement, no cost controls and dedication to private, for profit businesses as alway delivering the lowest prices in any situation, there is no chance that they could deliver what they and Trump have promised.

I think that conservatives got trapped into believing their own propaganda again. When the ACA was passed they predicted that it would be plagued by out of control medical costs, premiums, private business bankruptcies and a ballooning federal government deficit from the government subsidies. When these things didn't happen conservatives just pretended that they were occurring.

They were then surprised when they found out that not only were people happy with the ACA, but that none of the evil that they predicted had actually come true.

I think that what the administration and the Republicans in Congress will do now is to continue to subject the ACA to a death of a thousand small cuts, hoping that they can injure it enough that people will get fed up with it. They were hugely successful in doing this with a single sentence in an unrelated bill to kill off the so-called risk channel that resulted in many coops folding, the withdrawal of private insurance companies from some risk pools and the spike in premiums last year.

 

[Rhea]

I see your objection. "Since I'm choosing Track 2, I shouldn't have to pay for Track 1." Except I don't include that in my proposal.

Then there is no difference between us. I propose that we all support UHC, and those of us who can afford to not use it buy our own doctors on our own dime, whether by cash or by private insurance.

Coincidentally this is exactly how schools can and should work also. We all pay for public schools and those of us who wish to and can afford it choose not to use them and go private or homeschool.

 

[SimpleDon]

The problems with the private, for profit insurance companies delivering health care is simple, costs are much higher. In a nutshell,

If you give a private, for profit insurance company one dollar, they will pay for 80 cents of medical care.

If you give Medicare one dollar, they will pay for 98 cents of medical care.

The numbers were similar for a community rate based non-profit coop like Blue Cross-Blue Shield was before Congress and Clinton broke it up and privatized it in the 1990's, 96 cents of medical care for a dollar in premiums.

Even the for profit insurance companies only charge ~5% added on to the medical costs to manage a corporation's self-insured program.

 

[Jolly_Penguin]

I still keep hearing from conservatives like Cruz that you shouldn't have a government beurocrat come between you and your doctor. But he prefers a for profit insurance adjuster to come between you and your doctor? Why is this obvious question never asked of him or those like him? At least the government beurocrat purports to have your health in mind rather than financial gain.

 

[Tom Sawyer]

I still keep hearing from conservatives like Cruz that you shouldn't have a government beurocrat come between you and your doctor. But he prefers a for profit insurance adjuster to come between you and your doctor? Why is this obvious question never asked of him or those like him? At least the government beurocrat purports to have your health in mind rather than financial gain.

Well, when you pay the for-profit insurance adjustor to come between you and your doctor, a portion of his fee goes to Cruz and his colleagues in the form of bribes campaign contributions. When you give it to a government bureaucrat, the people who make the laws don't get a dime. Clearly, one of those is an unacceptable situation.