Health Care Reform

[Primula Baggins]

It actually is not correct, because what was being voted on was an amendment rather than a bill.

[Cenedril_Gildinaur]

Well, before the vote the NY Times was trumpeting the ACA as so successful that this vote would destroy something great. After the vote the NY Times is describing it as a law in peril that needs to be fixed and the Republicans have failed to do anything. The bill favored by the congressional Republicans is really just watered down ACA, which is in turn based on Romney's original plan.

The one good thing about an otherwise depressing bill is that it eliminated the mandate. That was described as stripping people of their insurance, but what it really did was give people the option of foregoing insurance. Supporters of the ACA describe it as a success because now 80% of people are insured - yet the ACA mandates people buy insurance so it should be 100%. Penalties apply for not having insurance. That 20% is actually very telling.

I would like a bill that actually does something, not ACA or the bill favored by the Republicans, but something that actually does something. Something like treat the causes of high prices.

[yovargas]

Well, before the vote the NY Times was trumpeting the ACA as so successful that this vote would destroy something great. After the vote the NY Times is describing it as a law in peril that needs to be fixed and the Republicans have failed to do anything.

While I have not read the articles you're referring to, somehow I doubt this is a fair reading. I suspect the actual gist of the message was more like, ACA has some serious problems, but repealing it would be much worse. Regardless of one's personal view of the bill, it is true that:

- the bill is forcing many people to pay a lot of money for often terrible insurance
- the bill is saving many people huge amounts of money by covering treatment for their serious conditions

Any discussion about ACA, and govt health care in general, that doesn't factor in both these very real and significant pros and cons is not worth listening to. IMO.

[Inanna]

I think I have read almost every news piece written by NY times on the topic these last 2 weeks (news piece, not opinions). The angst was not on the perfectness of the ACA, the angst was on the impact the new legislation would have on people - the millions who would lose insurance and so on.

[Cenedril_Gildinaur]

Yes, the ACA does benefit some. To deny that would be an absurdity. The question is if it does more good than harm. That is the same as the question of if the Republican replacement does more harm than good.

About those millions who would lose insurance, how many are those who would say "finally I am not forced to buy insurance so I am dropping my insurance"?

[yovargas]

About those millions who would lose insurance, how many are those who would say "finally I am not forced to buy insurance so I am dropping my insurance"?

Probably a lot. I know one personally and she's quite liberal. But I think it's a silly question because you could say the same about every tax. The better question is, is the lives being saved and improved do to increased insurance access worth the financial burdens? At this point, even the Reps seem to agree that the answer is Yes, considering they couldn't agree to repeal the supposedly awful bill.

(PS - to make it clear, I hate the mandate. I think it's an awful solution to the problem. But for now, it seems to be a better solution then no solution because lives are legitimately being saved.)

[Cenedril_Gildinaur]

Actually ... the Obamacare insurance isn't that good an insurance. Most insurance added a few provisos to conform but still basically offer regular insurance.

Part of using insurance is finding a doctor who accepts the insurance. An insurance that isn't widely accepted isn't a very useful thing to have.

[Primula Baggins]

It's insurance I'm allowed to buy. That makes quite a difference to me. And it would cover me if I had another round of cancer, with no yearly limit that could bankrupt us. All of that is Obamacare. None of that was available to me before Obamacare. And there are millions of people like me.

[Inanna]

Yes, the ACA does benefit some. To deny that would be an absurdity. The question is if it does more good than harm. That is the same as the question of if the Republican replacement does more harm than good.

About those millions who would lose insurance, how many are those who would say "finally I am not forced to buy insurance so I am dropping my insurance"?

The numbers who would "lose" insurance were made up of the following constituents:
1. Poor people because Medicaid was being rolled back (reduced funding)
2. Sick people because their health insurance costs would balloon (because the 3 times rule was being changed to five times rule)
3. Poor & sick people because federal subsidies paid to insurance companies for keeping those premiums low was being rolled back (the tax used to pay for that would have been cancelled)

None of these numbers came from healthy people opting not to buy insurance.

[River]

The individual mandate was/is considered the only mechanism by which the more popular parts of the reforms could happen: no nonsense about pre-existing conditions, no more sudden recissions of policies, no lifetime caps, and so on. It would be a shame if those practices come back. My husband, my kid, and myself are doing just fine but I've got other people in my family who'd be screwed. Either their premiums would be totally out of reach or, like Prim, no one would actually sell them a policy. It's not like these people did anything wrong. Unless you believe that people get things like childhood cancer or autoimmune diseases because they deserve it.

When I was unemployed, I bought a policy on my state's exchange. COBRA was far too expensive. The policy I bought was unsubsidized. Some of the terms weren't as generous as my former policy but the premiums were about 50% lower and the network was actually broader. And, when I got employed again, my employer-subsidized policy was more or less identical to that exchange policy. Same deductible, same co-pay and co-insurance structure, but I paid less out of pocket because my employer picked up the rest. I'm glad the option existed. I'm not sure how we would have handled it if COBRA was the only choice. It really was that bad.

[Griffon64]

We got our insurance through ACA for about a year because it had better coverage, more providers, and was less expensive than what my workplace offered.

I switched jobs and the insurance through my employer is better now because they impose additional fees if you do not do a yearly checkup through a healthcare provider that sends the numbers back to headquarters so they can check your blood pressure, blood sugar, cholesterol and BMI and impose additional fees if you don’t meet requirements.

As far as the ACA goes:

The ACA allow people who were previously denied coverage to obtain coverage. That is where I draw the line of whether insurance does more good than harm. Any alternative that places coverage out of reach for people who need it and who pay a reasonable amount of their income towards it does more harm than good. In my opinion.

Like River said the individual mandate is unfortunately an important part of making it work. To make insurance affordable for the population at large, you need sick and healthy people participating. You need the payout per person to be less than the buy-in per person ( less than, not equal to, because we’re into for-profit healthcare here ). And you can only do that and still help people meet their healthcare needs if healthy people participate.

Look, back in the day I was on the “personal responsibility” and “I don’t want to pay more because other people get fat and rack up healthcare costs” wagon for a little bit, because I grew up and lived in a echo chamber and so didn't know better. But since I’m not stupid or myopically stubborn in my convictions I listened to enough real people talk - citizens, politicians, healthcare professionals, insurance professionals, actuarial professionals, etc, to draw the conclusion that it is best for my personal standard of living and happiness if as many people as possible have access to healthcare. Why? There's two parts to it. First, healthy people can participate in the economy, and economic participation is good for everyone. Healthy people can care better for relatives if they need to, and are just generally better positioned to have happy lives. Every year that I pay more into health insurance than I take out I am thankful for my good health and good fortune and I wish those less fortunate than me godspeed on their journeys of recovery.

Finally, I found that being so razor-focused on perceived unfairness and being so mean-spirited towards people who got dealt a worse lot in life than me through no fault of their own was making me miserable. I found that letting go of that selfish anger made me a happier, more contented person. Life, liberty and the pursuit of happiness. Not possible if you’re a prisoner of your own thoughts.

For me, the ideal solution for healthcare is properly managed single payer. I want to be free to start my own business or freelance or find a really good employer without having to worry about what the health plan looks like, how to provide coverage for my employees, or what will happen if I get a “pre-existing condition” before I’m back in a properly covered hamster wheel.

[Frelga]

IAWG

It is possible to find flaws with anything. The chance of something human-invented having flaws in 100%. A corollary to that is that anyone can point out a flaw. That doesn't mean that they can propose a solution, or even that removing the flaw is a good idea. Acting on the impulse of "Hey, that plug in the dam looks so dumb, let's take it out" is usually swiftly followed by a giant oops.

What we had before ACA was a horrible mess, that kept people chained to jobs they hated instead of starting out businesses and discouraged people from seeking medical attention because that would create a pre-existing condition. Sure, younger and healthier, or just poorer, people could decide not to have health insurance at all. Some of them lost that gamble and ended up with debts, bankruptcy, disability, or a funeral. Some of them ended up with their entire medical costs paid by the taxpayers, or if they ended up on disability or welfare, their living expenses as well.

The ACA does require younger, healthier people to buy into the insurance pool. As pointed out above, that is necessary if we are to provide affordable coverage to anyone who is not young and healthy. ACA also requires the insurance companies to sell policies that actually cover care, so you don't end up paying hundreds of dollars in premiums and then tens of thousands in health care costs anyway. It also requires the insurance companies to sell policies easily sorted into a few tiers, which makes it easy to compare policies from different insurers.

The ACA is what enables the existence of the gig economy companies, like Uber. The ACA is what makes my husband's business possible, because it is much cheaper for him to reimburse his tiny workforce for buying health insurance on the exchange than it is to pay for a health care plan. Sure, he could try not providing insurance at all, but it's hard enough to hire good people.

So sure, let's talk about ACA's flaws, but let's talk about them in context of what it replaced and move away from that.

[yovargas]

The ACA does require younger, healthier people to buy into the insurance pool. As pointed out above, that is necessary if we are to provide affordable coverage to anyone who is not young and healthy.

Unless somebody besides insurance companies is covering costs....

[Inanna]

IAWG squared.

[Cenedril_Gildinaur]

The ACA allow people who were previously denied coverage to obtain coverage. That is where I draw the line of whether insurance does more good than harm. Any alternative that places coverage out of reach for people who need it and who pay a reasonable amount of their income towards it does more harm than good. In my opinion.

I would say that is a little short sighted. Giving them coverage is a good thing, but anything that would enable it? Are you sure you mean that?

Look, back in the day I was on the “personal responsibility” and “I don’t want to pay more because other people get fat and rack up healthcare costs” wagon for a little bit, because I grew up and lived in a echo chamber and so didn't know better. But since I’m not stupid or myopically stubborn in my convictions I listened to enough real people talk - citizens, politicians, healthcare professionals, insurance professionals, actuarial professionals, etc, to draw the conclusion that it is best for my personal standard of living and happiness if as many people as possible have access to healthcare. Why? There's two parts to it. First, healthy people can participate in the economy, and economic participation is good for everyone. Healthy people can care better for relatives if they need to, and are just generally better positioned to have happy lives. Every year that I pay more into health insurance than I take out I am thankful for my good health and good fortune and I wish those less fortunate than me godspeed on their journeys of recovery.

My point isn't about personal responsibility, although I do believe in that. I believe in finding the cause and treating that. ACA is a symptomatic treatment at best. Symptomatic treatments only go so far before you need to do some changes to treat the symptoms all over again. Very early in this thread when I was proposing ways to treat the cause, and being told I was never proposing anything and that I was just opposing Obama, I was proposing ways to treat the cause.

The cost of healthcare has risen faster than inflation, which shows a sever market imbalance. I would prefer to find and treat that imbalance instead of the dangerously vague "anything has to be better since we have to do something" symptomatic treatments. Plus, if we do decide to treat the cause, we may find we no longer need to treat the symptom.

I'm picturing someone in the hospital for a broken bone, being treated with ever increasing dosages of painkillers. As the flesh gets infected and turns green, makeup is also added to the treatment regiment. And here I am saying "someone set the bone, for gods sake set the bone."

[Griffon64]

The ACA allow people who were previously denied coverage to obtain coverage. That is where I draw the line of whether insurance does more good than harm. Any alternative that places coverage out of reach for people who need it and who pay a reasonable amount of their income towards it does more harm than good. In my opinion.

I would say that is a little short sighted. Giving them coverage is a good thing, but anything that would enable it? Are you sure you mean that?

Right off the bat: I find statements like Are you sure you mean that? to be condescending crap I don't want to put up with. If you want a discussion, have it. If you want to snipe and snide your way around, find someone else to participate, I don't care to. I have enough nonsense to put up with in real life, I don't need to seek it out on the internet.

Also, how did what I wrote change during your reading into: quote, bold, anything, unbold, that would enable it question mark unquote??? I wrote "reasonable amount of their income" which to me is far from "anything". I can expand on what I meant with "reasonable amount" if you like. Or you can chase your own imagination of what I meant and argue against your imagination. Your choice, as long as you don't pretend your imaginations are things I said.

Look, back in the day I was on the “personal responsibility” and “I don’t want to pay more because other people get fat and rack up healthcare costs” wagon for a little bit, because I grew up and lived in a echo chamber and so didn't know better. But since I’m not stupid or myopically stubborn in my convictions I listened to enough real people talk - citizens, politicians, healthcare professionals, insurance professionals, actuarial professionals, etc, to draw the conclusion that it is best for my personal standard of living and happiness if as many people as possible have access to healthcare. Why? There's two parts to it. First, healthy people can participate in the economy, and economic participation is good for everyone. Healthy people can care better for relatives if they need to, and are just generally better positioned to have happy lives. Every year that I pay more into health insurance than I take out I am thankful for my good health and good fortune and I wish those less fortunate than me godspeed on their journeys of recovery.

My point isn't about personal responsibility, although I do believe in that. I believe in finding the cause and treating that. ACA is a symptomatic treatment at best. Symptomatic treatments only go so far before you need to do some changes to treat the symptoms all over again. Very early in this thread when I was proposing ways to treat the cause, and being told I was never proposing anything and that I was just opposing Obama, I was proposing ways to treat the cause.

Okay. What did you propose? Since you know enough about when you wrote what to refer to "very early in this thread" I assume you have the links handy, or even better, the arguments still in your head. I scanned through the first 10% of this thread ( my personal "very early" threshold ) and found your avatar once, on a post without anything I would call "ways to treat the cause". I might have missed your avatar while scrolling. Or your threshold of "very early" may be different than mine. But if you think your ideas are that much good, you would hopefully find them worth restating here to catch everyone up. I'm not going to scroll through more than 17 pages of this 174 page thread looking for posts.

The cost of healthcare has risen faster than inflation, which shows a sever market imbalance. I would prefer to find and treat that imbalance instead of the dangerously vague "anything has to be better since we have to do something" symptomatic treatments. Plus, if we do decide to treat the cause, we may find we no longer need to treat the symptom.

Absolutely agree. The rise of health care costs in this country is insane, out of bounds, and need to be treated. Immediately. Would like to hear your ideas on that. I'm pessimistic that the current political and even social climate in the U.S is capable of stemming these costs in any way.

I'm picturing someone in the hospital for a broken bone, being treated with ever increasing dosages of painkillers. As the flesh gets infected and turns green, makeup is also added to the treatment regiment. And here I am saying "someone set the bone, for gods sake set the bone."

Such vivid imagination! Was it an compound fracture? As a kid I had a closed, displaced fracture of my ulna on my dominant side. My parents, who never met a cent they wanted to spend on their children, told me to suck it up. I ended up in the doctor's office three weeks later with non-related double bronchitis, after being sent to school sick, and the school finally sent me home because I was just laying listless on the tile floor in my classroom, burning up with fever. My mom happened to mention that my arm has been a bit "sore". After the x-ray revealed the fracture, knitting together in the wrong way, my arm was broken and set properly. The arm was bit thinner than the other for a bit, but it healed up fine. As an adult I don't even have a bump of bone growth in the area anymore. My point to that sob story is a) sometimes even parents don't care to spend money on the health of their children, so how can we ever expect people to care about strangers, b) not all broken bones end up as green limbs, and c) let's hear how you would set this broken bone.

[Maria]

Sometimes you can't get to the cause and all you can do is treat the symptom. Reducing suffering can be pretty important, too.

[Primula Baggins]

I don't see the point in refusing to treat the symptoms of a disease until the cure is found. Meanwhile, a lot of patients die who could have been kept alive while waiting for the cure. Or is that pointless in your worldview, C_G? Should no stopgap solution to the healthcare problem be used until the perfect answer is found?

(And what if the perfect solution doesn't jibe with your political views?)

[Cenedril_Gildinaur]

I don't see the point in refusing to treat the symptoms of a disease until the cure is found. Meanwhile, a lot of patients die who could have been kept alive while waiting for the cure. Or is that pointless in your worldview, C_G? Should no stopgap solution to the healthcare problem be used until the perfect answer is found?

(And what if the perfect solution doesn't jibe with your political views?)

Symptomatic treatments have their place, but the cannot replace causal treatments. If they are used instead of causal treatments they provide short term relief at the cost of long term exacerbation of the problem. I actually remember back when HMOs were proposed as a solution to the healthcare coverage issue.

Romneycare-Obamacare-Trumpcare (and they are superficial variations on each other) are all symptomatic treatments, and no effort is being made to discover the root cause of healtcare costs rising at a rate faster than inflation. To extend my analogy of the broken bone, if the cause isn't treated, if the symptom of pain is remedied only with painkillers, if the symptom of discoloration is treated only with makeup, and if the symptom of odor is treated only with perfume, eventually the patient will lose the limb with the broken bone.

True, there are times when only the symptom can be treated, because you need to clear the symptom enough to see the cause. But you do need to see the cause in order to fix the actual underlying problem. If the underlying problem isn't fixed eventually the patient will die of septic shock and we'll have UHC.

[Frelga]

Oh, here we go again. The GOP is back to trying to repeal the ACA.

Everyone got their Senators on the speed dial by now, right?