Trump presidency

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ucim
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Re: Trump presidency

Postby ucim » Mon Jun 26, 2017 8:58 pm UTC

arbiteroftruth wrote:K-R is thinking of "pre-existing condition" like this: you have cancer, you know you have cancer, you are presently in need of treatment for the cancer you have right at this moment...
Even so, you're covered by your insurance from work. They are paying for treatment, using money from all the others in the pool who don't. But then you lose your job...because you have cancer. (Or for any other less ferric reason). You are no longer eligible for insurance from your workplace. You get a job somewhere else, but their insurance company sees you have cancer and won't pay for treatment. The first insurance company won't pay for treatment because you're no longer with them.

This is the kind of thing the pre-existing conditions clause was meant to alleviate. (It's not the only way; single payer does it too, but that's not what we're discussing).

Now, where is the second company going to get the money to pay for your treatment? Again, it comes from the pool of people who don't have cancer but are paying premiums. We need that pool of people to make this work, and that in part is what the mandate is about. We mandate auto insurance; the reasoning is similar (though admittedly not identical).

I suppose it's reasonable to ask if this is a problem we (as a people) want to solve, because if we don't, then there's no point in having this discussion. Call a spade a spade, and all.

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Last edited by ucim on Mon Jun 26, 2017 9:01 pm UTC, edited 1 time in total.
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Re: Trump presidency

Postby morriswalters » Mon Jun 26, 2017 9:00 pm UTC

Try the Wikipedia article on the subject. I would also suggest looking at the term insurable risk.

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Re: Trump presidency

Postby arbiteroftruth » Mon Jun 26, 2017 9:27 pm UTC

ucim wrote:Even so, you're covered by your insurance from work. They are paying for treatment, using money from all the others in the pool who don't. But then you lose your job...because you have cancer. (Or for any other less ferric reason). You are no longer eligible for insurance from your workplace. You get a job somewhere else, but their insurance company sees you have cancer and won't pay for treatment. The first insurance company won't pay for treatment because you're no longer with them.

This is the kind of thing the pre-existing conditions clause was meant to alleviate. (It's not the only way; single payer does it too, but that's not what we're discussing).


Sure, but that's a case of solving the wrong problem. The problem isn't that you need the new insurance company to cover the pre-existing condition. The problem is that you never should have lost coverage from the first insurance company. They accepted the risk of having to cover you if you got sick, so they shouldn't be freed from that obligation just because you lost your job. A more appropriate solution would be something like requiring insurance companies to allow former employees of a company to keep the same plan at the same premium, just that now they have to pay the premium themselves. There are loose ends to that approach that I'm not addressing here, but the point is that's the more appropriate avenue to explore.

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Re: Trump presidency

Postby freezeblade » Mon Jun 26, 2017 9:38 pm UTC

We should really split this into a healthcare/insurance market topic instead of hashing it out here in the Trump Thread, I doubt Trump even did so much as read the preamble or executive summary of the AHCA (can we wordfilter this to Trumpcare?).
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Re: Trump presidency

Postby KnightExemplar » Mon Jun 26, 2017 9:39 pm UTC

K-R wrote:
For #1: Maybe its moronic to expect insurance companies to cover preexisting conditions. But you haven't actually put forth an argument yet.
It's insurance. You insure against the risk of something happening. You can't insure against the risk of a pre-existing condition, because it's already happened. That's like getting into a crash and then going to buy car insurance.


I appreciate the update. ucim covered the primary issue however. I'm going to try my best to repeat the argument (but keep it short).

For dumbass reasons, most American health care insurance is tied to your job. Which means that if you get a chronic condition (Diabetes is a big one), and then switch jobs... the new Health-care policy will reject you (Pre-Obamacare)

So lets say you "paid in" from 1990 through 2006. Then you get Diabetes in 2006. The crash of 2007 happens and you lose your job (and therefore your health insurance). You get a new job a month later, but the new health care insurance says "Diabetes is a Pre-existing condition". Which means, as a consumer, you just got fucked for 16 years (from 1990 through 2006). You paid in while healthy, and then "the system" drops you as soon as you do something as normal as switching jobs.

This is a worst-case scenario, but this was a major problem during the Great Recession of 2007 and 2008, as lots of people lost their jobs and/or switched careers.

-------

Republian measures try to tackle this issue directly. Most of the Republican plans provide a way around the above situation by saying "If you were on insurance in the last X months... then the new insurance company has to take you despite preexisting conditions". The Democrat's approach is "Make it illegal to not have insurance (sorry for 2x negative)"... and then "Make all forms of 'preexisting condition'" excuses also illegal.
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Re: Trump presidency

Postby speising » Mon Jun 26, 2017 9:46 pm UTC

So, can someone explain something for me: when Trump first issued the travel ban in january, it war for the explicit reason to give the immigration office 90 days in which to come up with updated rules and procedures, to increase safety. The ban was only (officialy) supposed to be a stop gap during this time.
A lot more than 90 days have passed since then. So why is the ban even still on the table?
Surely the immigration office was able to review their procedures in the meantime, or were all their officers completely overwhelmed by the masses of islamic visa requests?

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Re: Trump presidency

Postby elasto » Mon Jun 26, 2017 9:47 pm UTC

KnightExemplar wrote:The Democrat's approach is "Make it illegal to not have insurance (sorry for 2x negative)"... and then "Make all forms of 'preexisting condition'" excuses also illegal.

Which, of course, is effectively how single-payer systems work: You can't not have insurance (you can't not pay your taxes) and insurers can't deny you coverage (because everyone is automatically covered).

It's true, the American healthcare system is really distorted because of the deep discounting going on - both with insurers getting deep discounts on drugs/treatments and employers getting discounts from insurers. Anyone trying to go it alone is heavily penalised - and then the 'pre-existing' whammy is the avalanche that breaks the camel's back...

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Re: Trump presidency

Postby ucim » Mon Jun 26, 2017 9:58 pm UTC

arbiteroftruth wrote:The problem isn't that you need the new insurance company to cover the pre-existing condition. The problem is that you never should have lost coverage from the first insurance company.
Yes, in this particular case. But losing a job isn't the only way to lose insurance coverage; it's just the most prominent one. So, the issue is more general than the insurance being tied to a job (which allows the job to bargain prices down better than an individual).

Republicans are "fixing" health insurance. Democrats were fixing health care delivery (and was a work in progress - interrupted and sabotaged to make it look bad). Trump will sign anything that destroys whatever the Obama administration was doing. At this point no consideration is being paid to the overall issue of health care delivery, and who deserves health care in the first place.

I don't think a thread split is warranted yet; the discussion is about clarifying the underlying issues of health {care/delivery/insurance} as it pertains to the Trump administration, not in and of itself.

elasto wrote:Which, of course, is effectively how single-payer systems work:
...with an important(?) difference, that being that there are multiple companies (payers) involved that can run their businesses how they see fit, subject to the (significant) laws involved.

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Re: Trump presidency

Postby KnightExemplar » Mon Jun 26, 2017 10:23 pm UTC

speising wrote:A lot more than 90 days have passed since then. So why is the ban even still on the table?


Actually, a big worry is that the Supreme Court is going to "punt" the question. When they start the hearings, they'll most likely make that very same argument and then dismiss the case without setting precedent.
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Re: Trump presidency

Postby LaserGuy » Mon Jun 26, 2017 11:04 pm UTC

arbiteroftruth wrote:People here are using two different definitions of the term "pre-existing condition", and are consequently talking past each other.

K-R is thinking of "pre-existing condition" like this: you have cancer, you know you have cancer, you are presently in need of treatment for the cancer you have right at this moment. There is no "risk" to pool with other people; there is only the 100% certainty that you definitely need cancer treatment.


Typically, if you were treated for a condition within the past ~5 years or so, then that would be considered a pre-existing condition and you could be denied coverage. For cancer in particular, depending on what type of cancer you had, it could be longer, because cancer is the gift that keeps on giving. Or if you have a condition like childhood asthma or celebral palsy or something, you might never be able to get coverage.

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Re: Trump presidency

Postby morriswalters » Tue Jun 27, 2017 12:43 am UTC

The legal outcome is the issue of importance. Does he have the authority to do what he did and if so what limits are there to the process.

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Re: Trump presidency

Postby K-R » Tue Jun 27, 2017 5:54 am UTC

KnightExemplar wrote:Republian measures try to tackle this issue directly. Most of the Republican plans provide a way around the above situation by saying "If you were on insurance in the last X months... then the new insurance company has to take you despite preexisting conditions". The Democrat's approach is "Make it illegal to not have insurance (sorry for 2x negative)"... and then "Make all forms of 'preexisting condition'" excuses also illegal.
Right, because this is all so much more sensible than making insurance something you just go and buy, instead of it being tied to a job, and making insurance actually make things cheaper for you instead of just making them more expensive for everyone else.

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Re: Trump presidency

Postby Dauric » Tue Jun 27, 2017 11:20 am UTC

K-R wrote:...and making insurance actually make things cheaper for you instead of just making them more expensive for everyone else.


Unfortunately any kind of market-based medical insurance system will do the bolded, simply by increasing the amount of money in the system to be used to purchase healthcare without necessarily increasing the amount of available healthcare (doctors, hospitals, nurses, etc.)

In theory all that money would go towards improving the availability of healthcare, there's certainly the demand for it. However it turns out that the 'entry costs' to being in the medical field (not only things like education costs, student loans, etc. but also a willingness to get covered in every bodily fluid possible and being potentially exposed to every disease known and unknown, as well as taking on the weight of responsibility for the health and well being of other human beings) are significant enough that despite all the money being poured in to the healthcare market people aren't flocking to join the medical profession in proportion with the increasing demand.

Grand upshot is a pool of money used exclusively for healthcare that is divided across a relatively static amount of product. Pumping more money in to a 'free market' healthcare system just puts upward pressure on prices across the board.
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Re: Trump presidency

Postby sardia » Tue Jun 27, 2017 12:00 pm UTC

K-R wrote:
KnightExemplar wrote:Republian measures try to tackle this issue directly. Most of the Republican plans provide a way around the above situation by saying "If you were on insurance in the last X months... then the new insurance company has to take you despite preexisting conditions". The Democrat's approach is "Make it illegal to not have insurance (sorry for 2x negative)"... and then "Make all forms of 'preexisting condition'" excuses also illegal.
Right, because this is all so much more sensible than making insurance something you just go and buy, instead of it being tied to a job, and making insurance actually make things cheaper for you instead of just making them more expensive for everyone else.

https://fivethirtyeight.com/features/mi ... nal-chess/
McConnell made a unpopular bill because it fulfills the GOPs longstanding goal of trimming welfare spending, tax cuts for the rich, and overall spending reductions.

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Re: Trump presidency

Postby Dauric » Tue Jun 27, 2017 12:21 pm UTC

sardia wrote:
K-R wrote:
KnightExemplar wrote:Republian measures try to tackle this issue directly. Most of the Republican plans provide a way around the above situation by saying "If you were on insurance in the last X months... then the new insurance company has to take you despite preexisting conditions". The Democrat's approach is "Make it illegal to not have insurance (sorry for 2x negative)"... and then "Make all forms of 'preexisting condition'" excuses also illegal.
Right, because this is all so much more sensible than making insurance something you just go and buy, instead of it being tied to a job, and making insurance actually make things cheaper for you instead of just making them more expensive for everyone else.

https://fivethirtyeight.com/features/mi ... nal-chess/
McConnell made a unpopular bill because it fulfills the GOPs longstanding goal of trimming welfare spending, tax cuts for the rich, and overall spending reductions.


And even if it fails the majority of Republicans supporting it can go back to their core constituencies and say "Hey look, -I- kept my promise to vote to repeal The Affordable Care Act and adhered to other planks of the party, it's those evil commie-socialist Democrats that stopped it from happening."
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Re: Trump presidency

Postby KnightExemplar » Tue Jun 27, 2017 2:56 pm UTC

K-R wrote:
KnightExemplar wrote:Republian measures try to tackle this issue directly. Most of the Republican plans provide a way around the above situation by saying "If you were on insurance in the last X months... then the new insurance company has to take you despite preexisting conditions". The Democrat's approach is "Make it illegal to not have insurance (sorry for 2x negative)"... and then "Make all forms of 'preexisting condition'" excuses also illegal.
Right, because this is all so much more sensible than making insurance something you just go and buy, instead of it being tied to a job, and making insurance actually make things cheaper for you instead of just making them more expensive for everyone else.


Why do you think The Affordable Care Act made Insurance Marketplaces, and then gave tax incentives to make insurance plans on these internet marketplaces cheaper?

We can't just make job-based health care plans illegal. But we can at least try to build up marketplaces so that people can actually buy health care plans outside of a job. A big worry is that Trump has been screwing the Health Care Marketplaces at the moment. Remember, these marketplaces are a thing that the free market has failed to create. Which is why Obama made a law and then commanded a federal agency to make one.

That also means that there will be resistance from people in general to participate in the marketplaces initially. All this uncertainty over whether or not marketplaces will continue to exist, or their changing rules... or the loss of funding / tax incentives just breaks the whole plan.

---------------

In any case, changing insurance plans throughout your life shouldn't cause your chronic conditions to suddenly turn into preexisting conditions. That's something even Republicans agree upon with their current bills (which is why the Republican House plan allows you to "chain" your insurance through "continuous coverage provision"). Everyone sees the preexisting condition issue as a problem. The main difference is implementation of protections.

Democrats don't think that the Republican plan would work... Republicans don't want to be forced into paying for things. But everyone agrees its a problem. Even the "ultra-conservative House Plan" provides protections continuous coverage provision which is itself designed to mitigate the "Preexisting Conditions" issue.

--------------

And really, that's something I find hilarious. If Democrats really want to "talk policy", then they should really be focusing on why "continuous coverage provision" is insufficient to protect against preexisting conditions. Democrats are becoming the "party of no". At least very tacitly admit that the Republicans tried, but they don't go far enough or something.
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Re: Trump presidency

Postby moiraemachy » Tue Jun 27, 2017 3:31 pm UTC

KnightExemplar wrote:Remember, these marketplaces are a thing that the free market has failed to create. Which is why Obama made a law and then commanded a federal agency to make one.
Honest question: why? Every time someone explains to me how the average american gets health insurance, it feels something is missing. I always assumed there must be some huge tax incentive for companies to provide healthcare plans, and that it specifically excludes stuff like defined contribution models ("here's 100 bucks, use it to buy health stuff of your choice, then show us the receipts").

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Re: Trump presidency

Postby KnightExemplar » Tue Jun 27, 2017 3:46 pm UTC

moiraemachy wrote:
KnightExemplar wrote:Remember, these marketplaces are a thing that the free market has failed to create. Which is why Obama made a law and then commanded a federal agency to make one.
Honest question: why? Every time someone explains to me how the average american gets health insurance, it feels something is missing. I always assumed there must be some huge tax incentive for companies to provide healthcare plans, and that it specifically excludes stuff like defined contribution models ("here's 100 bucks, use it to buy health stuff of your choice, then show us the receipts").


My understanding is that its a historical artifact back when US Income Tax was 90%+ for the top bracket.

Instead of giving money to the employee, companies would provide benefits, like paying for your health care. That way, it didn't "count as income" it wouldn't be taxed away. Yeah, US Tax brackets used to be YUUUUUGGE.

Of course, our taxes don't work like that anymore. But the "system" remains in place because of cultural momentum.
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Re: Trump presidency

Postby freezeblade » Tue Jun 27, 2017 3:52 pm UTC

moiraemachy wrote:
KnightExemplar wrote:Remember, these marketplaces are a thing that the free market has failed to create. Which is why Obama made a law and then commanded a federal agency to make one.
Honest question: why? Every time someone explains to me how the average american gets health insurance, it feels something is missing. I always assumed there must be some huge tax incentive for companies to provide healthcare plans, and that it specifically excludes stuff like defined contribution models ("here's 100 bucks, use it to buy health stuff of your choice, then show us the receipts").


I feel like it's more of a "it's always been done this way, I don't see what's wrong with it" combined with a bit of "and people who don't work are just lazy moochers, so why should we do anything to help them, they should just get a job to get coverage, like everyone else."

Definitely a bit of classism in there.
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Re: Trump presidency

Postby sardia » Tue Jun 27, 2017 3:55 pm UTC

I was listening to Nate and Claire talk about who was a hard no, vs maybes vs totally lying. They really called out Ted Cruz as a craven wretch. "Cruz is definitely lying when he says that Cruz opposes the healthcare bill" or "Ted Cruz voted for the man who called his father a murderer of JFK. Of course he's going to vote for this bill". I was surprised how principled Rand Paul is. They think he actually does oppose the bill on principle alone.

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Re: Trump presidency

Postby LaserGuy » Tue Jun 27, 2017 4:27 pm UTC

KnightExemplar wrote:And really, that's something I find hilarious. If Democrats really want to "talk policy", then they should really be focusing on why "continuous coverage provision" is insufficient to protect against preexisting conditions. Democrats are becoming the "party of no". At least very tacitly admit that the Republicans tried, but they don't go far enough or something.


You mean the provision that creates a disincentive for healthy people to get coverage and drives up costs for sick people? The provision creates an incentive for people to maintain coverage once you have it, but if you lose coverage (eg. you get sick and lose your job for an extended period of time), then you end up having to pay a premium to get coverage again and your insurer can still deny you for having a pre-existing condition. It's the worst of both worlds.

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Re: Trump presidency

Postby KnightExemplar » Tue Jun 27, 2017 5:48 pm UTC

LaserGuy wrote:
KnightExemplar wrote:And really, that's something I find hilarious. If Democrats really want to "talk policy", then they should really be focusing on why "continuous coverage provision" is insufficient to protect against preexisting conditions. Democrats are becoming the "party of no". At least very tacitly admit that the Republicans tried, but they don't go far enough or something.


You mean the provision that creates a disincentive for healthy people to get coverage and drives up costs for sick people? The provision creates an incentive for people to maintain coverage once you have it, but if you lose coverage (eg. you get sick and lose your job for an extended period of time), then you end up having to pay a premium to get coverage again and your insurer can still deny you for having a pre-existing condition. It's the worst of both worlds.


Its certainly better than pre-Obamacare, where you only had to lose your job for a single day and then you'd be denied for having a pre-existing condition. Under the Republican House plan, you have a "grace period" where you are still protected, as long as you ensure that you can get coverage within that grace period.

So that means under the Republican Plan, we would be responsible for building up a savings account for unexpected emergencies... especially to buy an "interim" health-care plan while in between jobs. I do realize that not everyone has a personal emergency fund, but pushing some responsibility to the individual isn't necessarily a bad thing IMO.

Its undoubtedly a weakening of The Affordable Care Act's current pre-existing condition protections. (IE: making it straight-up illegal). But the question is now if premiums and deductibles are too high for even healthy people. Or in some cases: insurance companies are deciding the risk is too great and just leaving the market all together.

The goal of the Republican plan is to weaken pre-existing condition regulations, while leaving some degree of protection in place. With weakened regulations, it is easier for companies to enter the marketplace and actually provide coverage. Under current The Affordable Care Act law, many counties (such as Pinal County, Arizona) have NO insurance plans what so ever. Perhaps the regulation (as written) is too strong, and needs to be weakened so that insurance companies can actually find it profitable to cater towards Pinal County

-------------

Because for the people of Pinal County, Arizona, its currently the worst of both worlds. There are ZERO plans available for you, AND you are forced to pay the "I don't have insurance penalty" under The Affordable Care Act. Arguably some of this is Trump's problem because Trump isn't making it clear whether or not he'd pay the risk-pool money that supports the whole system.

Insurance companies are SUPPOSED to get $$$ from the Federal Government whenever they take on a "high risk" patient. But since Donald Trump has been ambiguous at best whether or not he'd actually support this provision of the Affordable Care Act... a lot of insurance companies are just pulling out of unprofitable / sick counties all together

In short: there are lots of problems everywhere, and I'm not necessarily against trying a new thing (like rolling back preexisting condition protections). But I can definitely say that Donald Trump isn't helping.
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Re: Trump presidency

Postby ucim » Tue Jun 27, 2017 7:19 pm UTC

KnightExemplar wrote:Or in some cases: insurance companies are deciding the risk is too great and just leaving the market all together.
Let's be clear on this; the risk isn't from health care, it's from the new administration; to wit, Trump's deliberate interference with the system that was in place, in order to cause it to collapse.

When you cause a calamity, you get no credit for predicting it.

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Re: Trump presidency

Postby sardia » Tue Jun 27, 2017 7:21 pm UTC

GOP just delayed the vote. It's still not dead but it'll give the public more time to digest just how awful the bill is.

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Re: Trump presidency

Postby SDK » Tue Jun 27, 2017 7:22 pm UTC

ucim wrote:When you cause a calamity, you get no credit for predicting it.

Yes you do Trump does.
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Re: Trump presidency

Postby Thesh » Tue Jun 27, 2017 7:26 pm UTC

ucim wrote:
KnightExemplar wrote:Or in some cases: insurance companies are deciding the risk is too great and just leaving the market all together.
Let's be clear on this; the risk isn't from health care, it's from the new administration; to wit, Trump's deliberate interference with the system that was in place, in order to cause it to collapse.


That's not entirely true.

http://www.latimes.com/business/hiltzik ... story.html
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Re: Trump presidency

Postby KnightExemplar » Tue Jun 27, 2017 8:08 pm UTC

ucim wrote:
KnightExemplar wrote:Or in some cases: insurance companies are deciding the risk is too great and just leaving the market all together.
Let's be clear on this; the risk isn't from health care, it's from the new administration; to wit, Trump's deliberate interference with the system that was in place, in order to cause it to collapse.

When you cause a calamity, you get no credit for predicting it.

Jose


I'd say its about... 70% Trump's fault (refusing to enforce individual mandate. Wishy-washy with regards to the high-risk pool paybacks to insurance companies. etc.), 10% other people's fault (ex: Republican Governors who refused to participate in Medicare expansion), and maybe 20% fault of the system in general (be it the ACA itself, or historical problems that were inherited by the ACA).

I don't think anybody has ever claimed that The Affordable Care Act is perfect, and the intent of the bill was to be a starting point for the change of our Health Care System overall. Ideally, people work on the 20% that wasn't working.
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Re: Trump presidency

Postby DaBigCheez » Tue Jun 27, 2017 8:35 pm UTC

KnightExemplar wrote:So that means under the Republican Plan, we would be responsible for building up a savings account for unexpected emergencies... especially to buy an "interim" health-care plan while in between jobs. I do realize that not everyone has a personal emergency fund, but pushing some responsibility to the individual isn't necessarily a bad thing IMO.

Isn't having funds to deal with unexpected emergencies largely the point of insurance, all the usual US weirdness around the insurance system aside?
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Re: Trump presidency

Postby cphite » Tue Jun 27, 2017 8:38 pm UTC

ucim wrote:
KnightExemplar wrote:Or in some cases: insurance companies are deciding the risk is too great and just leaving the market all together.
Let's be clear on this; the risk isn't from health care, it's from the new administration; to wit, Trump's deliberate interference with the system that was in place, in order to cause it to collapse.

When you cause a calamity, you get no credit for predicting it.

Jose


The system doesn't need any help from Trump to collapse.

Granted, Trump isn't helping things... but the system was in a downward spiral long before Trump was elected or even nominated. It would be in that same downward spiral no matter who was elected. And frankly, it's really not all that surprising that it's failing, given how it was implemented.

Insurance works by having a pool of people pay into it, so that money is available to cover expenses. One of the problems with the ACA plans is that the pools are simply too small. The less people you have, the more they need to put in to make it sustainable. Another problem is that the ACA greatly increased the minimum requirements for plans... this sounds like a good thing on paper, but the reality is that the more a plan covers, the more has to be paid into it to make it sustainable.

As a result, a lot of people have found themselves paying much higher premiums under the ACA, and to make it worse, have such high deductibles that they might as well not even have coverage in the first place. This, in turn, pushes a lot of people - especially younger and healthier people - to forego coverage entirely. When you combine smaller pools with the fact that the pool you have trends towards sicker people, you get what we have today: More and more companies deciding that they either cannot manage the risk, or cannot sustain their plans at all.

One solution would be to allow insurers to sell across state lines, at least for the individual market. This would create much larger coverage pools, which would reduce the amount of money needed per buyer to be sustainable. Another fix would be to relax the minimum requirements of coverage; allow people to choose plans that cover less, and therefore cost less. Allow people to buy bare bones insurance that only covers hospitalization if they want that. Allow people to decide, for themselves, what kind of coverage they need.

An even better solution would be to create a national public option; basically an extension of Medicare that would be open to anyone in the country. Pay for it with a combination of tax money and fees, with waivers for people below an income threshold or who are in hardship. Again, you'd have an even larger pool of insured, which would allow for even lower payments to maintain sustainability. As an added bonus, if the overall insurance market continues to degrade, this would lay the foundation for a national single payer system.

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Re: Trump presidency

Postby KnightExemplar » Tue Jun 27, 2017 9:03 pm UTC

DaBigCheez wrote:
KnightExemplar wrote:So that means under the Republican Plan, we would be responsible for building up a savings account for unexpected emergencies... especially to buy an "interim" health-care plan while in between jobs. I do realize that not everyone has a personal emergency fund, but pushing some responsibility to the individual isn't necessarily a bad thing IMO.

Isn't having funds to deal with unexpected emergencies largely the point of insurance, all the usual US weirdness around the insurance system aside?


Well yeah. But Health Care insurance protects you from unexpected health care emergencies (or developments).

Perhaps we should be using unemployment insurance to cover unemployment problems (and spend the money from unemployment insurance on interim Health Care coverage to prevent your chronic conditions from becoming a pre-existing condition). Which exists of course.

cphite wrote:have such high deductibles that they might as well not even have coverage in the first place.


Note cphite: this was the explicit design of the ACA. By encouraging high-deductibles, we encourage price shopping on consumers.

Check out the Surgery Center of Oklahoma, which only exists now because high-deductables are a thing. We consumers now actually care about the prices of our surgeries and stuff because the high-deductibles (and percentage-based costs) force us to care about the prices we pay. The free market is beginning to offer price transparency in an online fashion, in part because of the new scheme of deductibles under the ACA.

Under the old system of "Co-pays", we pay $50 no matter the "actual" cost of our surgeries or whatnot. I know doctors who complained about their peers who'd do unnecessary surgeries, taking advantage of the "copay" system. I mean, if a surgery costs a flat copay for the consumer... then price really doesn't matter.

Anyway, I expect that future plans will remain "high-deductible". Republicans really like that feature of The Affordable Care Act, and are likely to increase benefits to high-deductible plans. IIRC, they plan to increase limits on the HSA for example.
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Re: Trump presidency

Postby ucim » Wed Jun 28, 2017 3:18 am UTC

cphite wrote:The system doesn't need any help from Trump to collapse.
The system is (or was) a work in progress. It was expected to need adjustments. Unadjusted, any system would collapse; this includes the democracy of the United States, which has been adjusted bigly, twenty-seven times, and present politics shows it's still in danger.

It's not fair to shoot the kneecaps and then say the dancer was incompetent.

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Re: Trump presidency

Postby sardia » Wed Jun 28, 2017 4:50 am UTC

https://fivethirtyeight.com/features/wh ... care-bill/
Nate's team brackets the likelihood of who will vote for the healthcare bill. 1 is vote no, 3 is will vote Yes.
Heller 1.1

Collins 1.2

Paul 1.5

Murkowski 1.710951013

Gardner 2

Capito 2

Lee 2.1

Cassidy 2.15

Johnson 2.3

Flake 2.52

Portman 2.5910234

McCain 2.667103512

Cruz 2.85

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Re: Trump presidency

Postby Zohar » Wed Jun 28, 2017 12:33 pm UTC

KnightExemplar wrote:We consumers now actually care about the prices of our surgeries and stuff because the high-deductibles (and percentage-based costs) force us to care about the prices we pay. The free market is beginning to offer price transparency in an online fashion, in part because of the new scheme of deductibles under the ACA.

This may be because I'm a newbie to American healthcare (though I doubt it), but when I recently had to get an endoscopy done it was pretty much impossible for me to understand how much it will cost me, and I made *a lot* of phone calls to try to understand that. I haven't gotten bills yet but I'm sure they'll come, and I have no idea for how much they will be, and I'm a pretty smart and vocal guy. Transparency is a long way off.
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Re: Trump presidency

Postby morriswalters » Wed Jun 28, 2017 12:35 pm UTC

KnightExemplar wrote:Check out the Surgery Center of Oklahoma, which only exists now because high-deductables are a thing.
Check out their pricing disclaimer. Particularly this
Once again, if you are scheduled for surgery at our facility and insurance is to be filed by us, these prices listed on our website do not apply to you.
Those prices are cash upfront with a high degree of uncertainty. If there is a problem, if you have to be hospitalized, or any of the numerous things that could happen once the surgeon cuts, you will have to be prepared to pay that additional amount which is, to all intents and purposes uncalculable.

As an example, my wife went in for a Laparoscopic cholecystectomy that should have been an outpatient procedure. For whatever reason while going after her gall bladder, they nicked her spleen. She almost bled out on the table, rather than walking out the door she spent 3 days in intensive care. She required later surgery to fix problems caused by the first surgery. It may have been malpractice and we could have sued, but we would have gone broke before the suit was settled. There was no way upfront to know how much it was going to cost.
KnightExemplar wrote:Under the old system of "Co-pays", we pay $50 no matter the "actual" cost of our surgeries or whatnot. I know doctors who complained about their peers who'd do unnecessary surgeries, taking advantage of the "copay" system. I mean, if a surgery costs a flat copay for the consumer... then price really doesn't matter.
Sure price matters. But the price you care about is where the body is buried. I've turned down jobs which didn't carry health care plans that served my families needs. Insurance plans offered by business are money on the table. Insurance companies operate at the scale where they can and do demand discounts on the services they pay for. This is precisely why I hire them and bleed current income to them constantly. The calculation is how much I am prepared to pay to cover me against the risks that I know exist. And how much the plan will force me to go out of pocket for to receive that service. These are the prices I worry about.

Look at a concept called pay for performance or outcome based reimbursement.

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Re: Trump presidency

Postby KnightExemplar » Wed Jun 28, 2017 1:05 pm UTC

morriswalters wrote:
KnightExemplar wrote:Check out the Surgery Center of Oklahoma, which only exists now because high-deductables are a thing.
Check out their pricing disclaimer. Particularly this
Once again, if you are scheduled for surgery at our facility and insurance is to be filed by us, these prices listed on our website do not apply to you.
Those prices are cash upfront with a high degree of uncertainty. If there is a problem, if you have to be hospitalized, or any of the numerous things that could happen once the surgeon cuts, you will have to be prepared to pay that additional amount which is, to all intents and purposes uncalculable.


But if a catastrophe happens, the typical high-deductible plan will cover catastrophes (ie: My "Bronze" plan covers 100% of my costs above $6000). However, I'm very interested in knowing the cost of my health care because my "High-Deductible Bronze" plan covers 0% of my costs below $3000, and only a % of the costs between $3000 and $6000.

In any case, it has become possible to actually price shop. Under a Co-Pay system, I wouldn't give a crap because it'd all be the same "Co-pay". (Note: Co-pays aren't banned under the ACA. They're just discouraged. There are tax-incentives to offer high-deductible plans)

Another note: pre-ACA, it was possible for insurance companies to only be regional (or worse: in-network only). So if your Ambulance Driver took you to the wrong "out-of-network" hospital, your insurance company would pay nothing, and the entire bill would be your responsibility. Because ACA banned this practice... forcing insurance companies to at least pay for some "out of network" costs. So regardless, it is now possible to use any health care plan in the country to pay for a surgery in Oklahoma.

An Oklahoma surgery would be "out of network" (as defined by the ACA), so in my personal case, my "out of network" deductible is now $6000 and my maximum out-of-pocket is $12000. (A hefty amount, but I don't travel much and my plan covers basically every hospital in my city / state, so I don't really plan to be out-of-network personally). But still, the Oklahoma prices do in fact provide me some degree of leverage. I can always fly to Oklahoma and seek a cheaper surgery if the prices locally turn out to be absurd.

So the important issue here is simply the publishing of prices. I'd expect that hospitals in locations with lower cost of living will start taking advantage of the internet as well as transparent pricing, offering an online marketplace of health services. Medical tourism is a good thing, especially if its supported by the health care laws to encourage medical tourism within the country.

Sure price matters. But the price you care about is where the body is buried. I've turned down jobs which didn't carry health care plans that served my families needs. Insurance plans offered by business are money on the table. Insurance companies operate at the scale where they can and do demand discounts on the services they pay for. This is precisely why I hire them and bleed current income to them constantly. The calculation is how much I am prepared to pay to cover me against the risks that I know exist. And how much the plan will force me to go out of pocket for to receive that service. These are the prices I worry about.

Look at a concept called pay for performance or outcome based reimbursement.


Yeah... that wasn't working. That's why the ACA tried to design other market-based incentives.

There's a certain insanity to the health care system. I go to the doctor. The doctor reports to my insurance company the procedure she did. The insurance company then pays the doctor.

Insurance companies fund research looking for cheaper (but not necessarily better) care. Drug companies fund research looking for more profitable (but not necessarily better) care. The few independent research groups at public universities vested purely in the public interest are small... and typically only have 21-year old white college-educated males as test subjects. So the research is biased and/or crap, and nobody really trusts each other. Ugghhhhhh....
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Re: Trump presidency

Postby Zohar » Wed Jun 28, 2017 1:24 pm UTC

KnightExemplar wrote:In any case, it has become possible to actually price shop. Under a Co-Pay system, I wouldn't give a crap because it'd all be the same "Co-pay". (Note: Co-pays aren't banned under the ACA. They're just discouraged. There are tax-incentives to offer high-deductible plans)

Again, I doubt that claim, at least based on my experience. And as someone coming from a country with universal healthcare, the concept of shopping around for health is appalling.
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Re: Trump presidency

Postby CorruptUser » Wed Jun 28, 2017 1:27 pm UTC

Cheaper healthcare even if the same effect, is much better. Much, much better. You don't think that the average Joe benefits if a drug with the same effectiveness but 1/100th the cost of Sovaldi comes to market?

But really, it's very rare that cheaper methods come to market. Things are cheap because they are easy, and we researched the easy stuff long ago, so the cutting edge research will always be on the complicated stuff.

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Re: Trump presidency

Postby KnightExemplar » Wed Jun 28, 2017 2:03 pm UTC

CorruptUser wrote:Cheaper healthcare even if the same effect, is much better. Much, much better. You don't think that the average Joe benefits if a drug with the same effectiveness but 1/100th the cost of Sovaldi comes to market?

But really, it's very rare that cheaper methods come to market. Things are cheap because they are easy, and we researched the easy stuff long ago, so the cutting edge research will always be on the complicated stuff.


Except Drug companies have figured out that the easiest way to make a profit is to sell opiods then trick doctors into thinking it wasn't addictive.

That's the problem. There are all sorts of ways to increase profits without necessarily advancing the field of health. We need research institutions who are actually interested in helping people, not making a profit. (Or maybe a way to tie "profit" into "better care")

The creation of the "Patient-Centered Outcomes Research Institute" (started thanks to the ACA) helps. (IIRC, they don't have too many people in there. But apparently they simply hand out funds to other research groups to help direct research or something...)
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Re: Trump presidency

Postby Zohar » Wed Jun 28, 2017 2:10 pm UTC

That's not true, things *are* cheap, as evidenced by the fact most medications and procedures cost a lot less in comparable economies to the US. I take prescription eye drops that cost, without insurance, anywhere between $40-$100 for a 5ml bottle in the US. In Israel it costs $4 - the price is so low it's not even covered by insurance.

As for things being cheaper - yeah, of course I'd like stuff to be cheaper. But it's expensive in the US for no particular reason other than companies making as much of a profit as they can and consumers not having enough purchasing power. But the so-called free market hasn't really provided a good solution for that, and we have a lot of evidence from dozens of countries in the world that having universal healthcare and single-payer (and similar) systems are a good solution.
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Re: Trump presidency

Postby CorruptUser » Wed Jun 28, 2017 2:24 pm UTC

There's a very simple solution; allow people to purchase in different countries and resell here. And if Merck only sells, say, 10000 prescriptions to India to prevent resale, manufacture more, ship it to India, then ship to the US, and give Merck a check for the India price and insist that you aren't damaging any of their markets.


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