Obamacare

Richard09 wrote:

Of course Obamacare is a steaming pile of shit. It's a Republican plan which would have been shit if implemented as intended. On top of that, the Republicans, including their partisans on SCOTUS, have spent the last several years sabotaging it at every turn.

The only worse system we've seen so far is what the US had before Obamacare. But don't worry, Trump is going to fix things.

Since this has been announced as a "Day One priority," one wonders exactly what is being contemplated to replace it.  Trump's campaign website is frustratingly vague:

Donald J. Trump wrote:

However, it is not enough to simply repeal this terrible legislation. We will work with Congress to make sure we have a series of reforms ready for implementation that follow free market principles and that will restore economic freedom and certainty to everyone in this country. By following free market principles and working together to create sound public policy that will broaden healthcare access, make healthcare more affordable and improve the quality of the care available to all Americans.

Any reform effort must begin with Congress. Since Obamacare became law, conservative Republicans have been offering reforms that can be delivered individually or as part of more comprehensive reform efforts. In the remaining sections of this policy paper, several reforms will be offered that should be considered by Congress so that on the first day of the Trump Administration, we can start the process of restoring faith in government and economic liberty to the people.

Congress must act. Our elected representatives in the House and Senate must:

1.  Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.
2.  Modify existing law that inhibits the sale of health insurance across state lines. As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state. By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.
3.  Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. Businesses are allowed to take these deductions so why wouldn’t Congress allow individuals the same exemptions? As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.
4.  Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate. These accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty. These plans should be particularly attractive to young people who are healthy and can afford high-deductible insurance plans. These funds can be used by any member of a family without penalty. The flexibility and security provided by HSAs will be of great benefit to all who participate.
5.  Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.
6.  Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.
7.  Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Congress will need the courage to step away from the special interests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers.

#1 will of course throw 21 million Americans off insurance.  Not a good start.  Plus, it insures high costs going forward as uninsured people will continue to use emergency rooms for basic healthcare.
#2 involves different state insurance commissioners, and I know from 25 years in the business that insurance regulations vary widely from state to state.  If Mississippi's insurance is cheaper, does that mean a Massachusetts doctor has to accept Mississippi's reimbursement rates?  This is an unbelievable mess, as they're about to find out.
#3 is partially allowed now, if healthcare costs reach a certain threshold of income.  If by "fully deductible" he means 100% deductible for everyone, how does this differ from single-payer socialized medicine?  Well, I'll tell you how - it excepts the high cost uninsured, which will continue to escalate costs for the insured.
#4 is in place now.  However, by making them heritable he takes the high-income population permanently out of the pool, raising the costs on the rest of us.
#5 is a result of the idiot system we have now, with insurers paying one price ("negotiated") and uninsured patients paying a higher unnegotiated price.
#6 I have no opinion on.  I suspect the poor states in The South will cut Medicaid and pocket the savings.
#7 is pure fantasy, as long as Big Pharma owns Congress.

So, good luck.  Day One?  No, this effort will take decades, if not millenia to accomplish.  And require a complete rethink of congressional funding.

Not sure DeMint is factoring in the difficulty involved.

Quote :

In just over a month, President-elect Trump will be sworn into office and become the 45th President of the United States. He has vowed that within the first 100 days of his administration he will work with Congress to repeal and replace Obamacare.

Reversing Obamacare is not easy. The law itself must be repealed in its entirety. Thousands upon thousands of pages of regulations must be canceled and rewritten. New policies need to be crafted, policies that advance free enterprise and not big government. It’s going to take top experts, scholars, and researchers to formulate this alternative.

That’s where the Heritage Foundation comes in.

Heritage has a complete, detailed plan to repeal Obamacare immediately. Already, some of our foremost scholars and experts (including our founder Ed Feulner) are working as part of the Trump transition team to pave the way for a conservative administration. We stand ready to educate and advise key presidential and congressional players on how to successfully repeal and replace Obamacare.

Leftist and Establishment types are trying to fight repeal and water it down. It’s imperative that we act quickly and refuse to compromise our principles. Find out how you can advance conservative victories in 2017.

I guess the present Obamacare isn't ENOUGH of a giveaway to the insurance companies to "advance free enterprise."

NPR just interviewed some Republican Senator who said scrapping the Affordable Care Act and opening up the markets across state lines would lower costs for everybody.

The interviewer reminded him that some state had already tried this, and not a single insurer - zero - came into the state market. It just wouldn't have been profitable for them.

The Senator hemmed and hawed, and said "I'm a businessman, not an insurance person" but in his experience competition ALWAYS lowers costs. "It ALWAYS does," he affirmed, somewhat less surely.



The Trump Administration is about to embark on a Grand Experiment on a truly epic scale, the results of which everybody but the Republicans can predict with great accuracy.

I heard that interview as well. Almost felt sorry for him when he had to admit he was the subject of an ethics investigation as well.

NoCoPilot wrote:

...opening up the markets across state lines would lower costs for everybody.

...competition ALWAYS lowers cost...

This is  what the insurance companies have been trying to do for decades. Their goal is to remove the ability of states to regulate insurance within their borders. As always, competition is exactly what the the industry does NOT want. Under the current regulatory model, insurance companies can compete in any state they want to; they just have to follow the law. And that is the problem: the laws in some states prevent the industry from making a rapid race to the bottom so that the only insurance available is worthless to the consumers but highly profitable to the corporations.

Every time you hear a Republican say "free market", run and hide.

_Howard wrote:

Every time you hear a Republican say "free market", run and hide.

When it comes to economics, they are completely clueless. When you understand that "free market" should mean "free, flat, fair competition", you understand immediately that an effective free market depends on government regulation to enforce the "flat, fair" part, because otherwise the situation rapidly descends into oligarchy (at best) or monopoly. Not one of those bozos - not a single one - has ever grasped that simple truth.

richard09 wrote:

Not one of those bozos - not a single one - has ever grasped that simple truth.

On the contrary, the entire Republican Party is financied by, sustained by, promoted and supported by businesses which rely on that exact government-created monopoly.

Not at all. If there was true free-market competition, properly regulated, it would not degenerate into monopoly. That's my point.

richard09 wrote:

Not at all. If there was true free-market competition, properly regulated, it would not degenerate into monopoly. That's my point.

Exactly. And one of the primary reasons for business regulation is the prevention of monopolies. The promotion of a "free market" is antithetical to democracy. There is not, nor has there ever been, a true free market outside of agrarian economies. And today's corporations are one-hundred percent opposed to any regulations which suppress monopolies.

Yes, the Republicans are bought and paid for by big business, but many of them have no idea what the consequences of their actions are. Many of them actually incorrectly believe that a corporate free from any regulation is a good idea.

And they have human rights.

And religious beliefs.

Did you happen to catch Senator Steve King on NPR yesterday?  His interview was nothing short of astonishing.

Steve King wrote:

STEVE KING: It's my opinion that if we repealed Obamacare and did nothing, we're still far better off. Almost everybody I know would be happier if Obamacare had never been passed and we hadn't made any changes in health care.

ROBERT SIEGEL: Donald Trump's adviser Kellyanne Conway recently told an interviewer, we don't want anyone who currently has insurance to not have insurance. Would that be for you the test of a new law or the test of what happens after Obamacare is repealed - no one who's gotten health insurance through Obamacare losing it under its repeal and replacement?
STEVE KING: I think that's a fine and shining ideal, but it wouldn't be my standard. We have about 20 million people that they say would be pushed off of Obamacare if we just repealed it and did nothing. I look at the numbers on the 20 million. It's about 10.8 million that were pushed onto Medicaid, and so I don't really look at Medicaid as a health insurance policy that you own.

I would argue there is no constitutional - you have no right to a health insurance policy. Whatever our hearts tell us, we can provide those things, but there's not a right to them.

Steve King wrote:

ROBERT SIEGEL: Should insurance companies be required to offer insurance to people regardless of a prior condition? Should that provision of Obamacare survive, whatever the Congress does?
STEVE KING: If we guarantee people that we will - that there will be a policy issued to them regardless of them not taking the responsibility to buy insurance before they were sick, that's the equivalent of waiting for your house is on fire and then buying property and casualty insurance. And that defeats the insurance concept of it, and it defeats the personal responsibility requirements necessary to have an efficient health care system.

Steve King wrote:

STEVE KING: Let me go out on a limb here, Robert. I think most of the Republicans agree with me, but there's probably a majority of them that don't have the political will because they're afraid of the criticism that will come. And as I listen to their dialogue, they're afraid of the criticism.

They're - when I say let's repeal Obamacare and be done with that, and let's march down through these changes one at a time, not one big bill but one at a time - and I don't want to have a Republican bill that we have to pass to find out what's in it. I think at this point, they need to have more will. But I think if you take them down to where their heart of hearts is and their logical brain(?!?!) is, the majority of them will agree with me.

Quote :

I would argue there is no constitutional - you have no right to a health insurance policy.

But that's technically true, isn't it?

Yes, and entirely beside the point.

I didn't think his statement was all that "astonishing".

Even the part you added — I can understand how that line of thinking works. Which is why the private insurance model is a stupid model to serve as the foundation of a universal healthcare program.

Yeah, I'd agree with that.

I'd also point out that the United States is the only advanced nation in the world that doesn't guarantee healthcare.

Steve King says that "almost everybody I know would be happier if we hadn't made any changes to healthcare."  That's because he doesn't know any old or sick or poor people.  

Kinda makes you wonder who he's representing in Congress, doesn't it?

The only people I've met who complain about the ACA are people whose assets disqualify them from any subsidies and are being required to pay $16,000 for two healthy adults. The Trumpenproletariat will probably never connect their loss of health insurance with the GOP. It'll be still be Obama's fault.

I can only *wish* we could get insurance for $8000 each! We were looking at $2300/mo each. That's $55,200 per year.

Jeezus, man. That's awful. Honestly. I feel for you.

We ended up dropping dental, vision, and prescription drug coverage. We had to go with a really high deductible ($5500/ea.) before coverage kicked in.

Basically, it's just catastrophic coverage.

And it's still $1200/mo/ea.

It's worth mentioning that members of congress get excellent health care supplied by the government. Perhaps a good idea would be to remove that benefit and make them buy insurance like so many other people have to do.

Or give everybody the same insurance as Congress.

kilo wrote:

... the private insurance model is a stupid model to serve as the foundation of a universal healthcare program.  

Yes, it's the only product that you buy hoping never to use. And if too many people use it, the cost goes up.

It's the opposite of standard capitalism -- which is why it's inherently not a private industry. It only makes sense as a government program.

But it's even worse than that, in the United States. The US is the only nation on Earth that allows prescription drugs to be marketed direct to consumers. The pharmaceutical industry makes its money -- lots and lots of money -- by keeping the American populace sick -- or thinking they're sick -- so lots and lots of drugs can be purchased by the insurance industry on their behalf.

What was it we recently posted here? Something about "patients have become just a delivery vehicle, a way for one huge industry to suck huge profits out of another industry."

And of course, Big Pharma is a huge contributor to Congress, Republicans and Democrats alike, so no legislation that eats into their profits is ever going to go anywhere.

But I don't believe Donald is serious about reforming healthcare anyway. Look at his own situation. He has no personal physician. He had to find a quack to sign his own letter of fitness to run for the presidency.