Replacing the ACA with a GOP plan

[pgg]

Simple- the drug company would claim its a major breakthrough drug thats the biggest advancement in the field for the last 30 years (which is true). However the population using it is not large (those with stage 4 disease probably numbers only a few thousand a year). Therefore to recoup billions in R&D the drug has to be expensive.

Now of course they are probably still gouging the US customers and selling it at a 30% discount overseas. But whether it's 30k a month or 50k doesn't really matter- it would be hard for medicaid like programs to cover but they do.

Universal healthcare means rationing. There's no way around the need to deny extraordinarily expensive and/or low benefit* care.

Hence the simple solution - basic healthcare for all, plus private insurance for those who want it and can pay for it.

This then goes back to being a problem solved by a free market. If a company thinks it's worth it to spend $billions on a drug in return for X years of patent protections and sales to the wealthier insured, they'll do it.

While on patent, the people on the public plan simply wouldn't get the new drug and they would die. But dying is what everyone with that disease has done for millions of years. That's not a "worse" outcome than the status quo. In time the drug becomes less expensive and they get it also. Thus is progress made.



* low benefit = either small average benefit or low probability of a large benefit

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[aneftp]

Negative.

My husband's employer offered United Healthcare prior to implementation of ACA. UHC pulled out of his employer HR benefits offerings, a major retail corporation in the USA. He doesnt make much money but we needed the health coverage. In early January 2016 the employer HR benefits corporate office was scrambling to find another health plan. We were in limbo for 2 weeks. They finally had a contract signed with Blue Cross Blue Shield of (X State) in middle America.

Copayments shot up from one month to another, specialty physician copays went from $30 to $50 (he sees a pulmonary specialist) and the bronchodilator Combivent costs us a $70 copay from $20.

Thanks to ACA

This isnt new information. United Healthcare is the largest health plan and they walked away from participating with ACA Exchanges as did other health plans

We all agree that ACA Exchanges are a farce. Obama pushed ACA threw Congress without Members of Congress reading the legislation all to create his legacy...

This isnt about providing health coverage to the poor. Its about all Americans having health coverage

The obama administration had to promote the ACA exchanges. They had to push it that the middle class was benefiting from it. Or else all they had left to promote was the free Medicaid. And no way they can sell the ACA with just the free Medicaid.

 

[pgg]

I agree - breakthrough cancer drugs are rare. Lets give a more mundane example. Severe psoriasis (say 40% of your body surface area) isn't going to kill you but it's miserable for quality of life and also raises several cardiovascular risk factors. Some of the newer drugs in the last 10 years are way more effective and safer than older generation drugs. They also run about 60k a year and there are hundreds of thousands of Americans on these, both on private insurance and medicaid/medicare (so probably a bigger expense overall than a particular late stage cancer). Should we deny coverage for this?

A public plan should absolutely deny it, until it's off patent / generic or the price is otherwise lowered.

 

[doctalaughs]

Universal healthcare means rationing. There's no way around the need to deny extraordinarily expensive and/or low benefit* care.

Hence the simple solution - basic healthcare for all, plus private insurance for those who want it and can pay for it.

This then goes back to being a problem solved by a free market. If a company thinks it's worth it to spend $billions on a drug in return for X years of patent-protected protections and sales to the wealthier insured, they'll do it.

While on patent, the people on the public plan simply wouldn't get the new drug and they would die. But dying is what everyone with that disease has done for millions of years. That's not a "worse" outcome than the status quo. In time the drug becomes less expensive and they get it also. Thus is progress made.



* low benefit = either small average benefit or low probability of a large benefit

I agree 100% -- but Americans refuse to accept this simple truth. Rationing, "death panels" and multi-tiered healthcare is the ONLY solution to our problems but despite being extremely obvious we continue to insist otherwise.


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[GravelRider]

I agree 100% -- but Americans refuse to accept this simple truth. Rationing, "death panels" and multi-tiered healthcare is the ONLY solution to our problems but despite being extremely obvious we continue to insist otherwise.


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"Death panels" is a great example of where partisan politics came in and created a frenzy over creating the ACA. There was a portion of the bill that was going to pay physicians for providing counseling to Medicare patients about living wills, advanced directives, and end-of-life care options. It was subsequently removed from the bill after the public histrionics from the right. Thanks Sarah Palin.

Oh yeah, but I guess partisan politics had nothing to do with some of the failures of the ACA.

 

[doctalaughs]

"Death panels" is a great example of where partisan politics came in and created a frenzy over creating the ACA. There was a portion of the bill that was going to pay physicians for providing counseling to Medicare patients about living wills, advanced directives, and end-of-life care options. It was subsequently removed from the bill after the public histrionics from the right. Thanks Sarah Palin.

Oh yeah, but I guess partisan politics had nothing to do with some of the failures of the ACA.

Eh both parties are to blame as no one will overtly address the desperately needed rationing issue.

The main problem with the ACA is at the heart it's truly nothing more than a redistribution plan - take money from middle to upper class Americans who have employee coverage and redistribute that to expand medicaid and subsidize obamacare for lower income individuals. That's why you saw so many Americans who had "good" coverage suddenly change to ridiculous deductibles and skimpy coverage. Those who work (and vote more often) saw through this deception- that's why the ACA is hated by so many.

Instead of doing redistribution, we should have expanded medicaid and coverage for the poor, and slashed medicare coverage for the old by eliminating costly benefits and futile end-of-life care like those cited above, creating a true 2-tier system - all the bells and whistles if you pay extra, inferior but efficient care if you don't. We spend enough on medicaid / medicare already. We just do it extremely poorly so the answer is NOT to divert more money to expand these bloated programs. Things would work fine as long as we acknowledge it WILL be inferior care for goverment programs- if you want more then BUY it. That's the key we can't seem to admit.


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[GravelRider]

Eh both parties are to blame as no one will overtly address the desperately needed rationing issue.

The main problem with the ACA is at it's heart it's truly nothing more than a redistributionist plan - take money from middle to upper class Americans who have employee coverage and redistribute that to expand medicaid and subsidize obamacare for lower income individuals. That's why you saw so many Americans who had "good" coverage suddenly change to ridiculous deductibles and skimpy coverage. Those who work (and vote more often) saw through this, and that's why the ACA is hated by many.

Instead of doing redistribution, we should have expanded medicaid and coverage for the poor, and slash medicare coverage for the old by eliminating costly benefits and futile end-of-life care like those cited above, creating a true 2-tier system. We spend enough on medicaid / medicare already. We just do it extremely poorly so the answer is not to move money around to expand these programs. Things would work fine as long as we acknowledge it WILL be inferior care for goverment programs- if you want more then BUY it. That's the key we can't seem to admit. But that would be too efficient for the government.


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Partisan politics is both parties. The "death panel" example just so happens to originate from the kooky Tea Party wing of the republicans. Until BOTH parties are willing to put partisan politics aside, this issue will never be solved. You can make proposals all you want, but any good idea from one side can and will be squashed by the other side in the name of politics.

We both agree that paying for physicians to counsel people on end-of-life issues is a great idea. However, look at how easy it was for a politician to squash that idea simply in the name of politics. It is an effective and humane way to ration care, which conservatives should be supportive of, but aren't out of political convenience.

 

[cbrons]

You think like selfish young people: we are healthy, we don't need it, why do we have to pay for it? Because there is something, in any civilized nation, called social solidarity, where the young help the old, the healthy help the sick, the have mores those who have less. That's one difference between a nation and an association of selfish arseholes: a conscience.

Praise your gods that you are not obese, not a smoker, or drinker, or drug user, especially that you are relatively healthy. The latter can end in an instant, and then your life will change radically, especially in this country.

Btw, my copays are expensive, too, so I buy what I need from Costco and Walmart for much less. I can't remember the last time I used my insurance for meds. That's why I say we need to fix some basic things that are wrong with American healthcare. Everybody having compulsory basic health insurance is not one of those things. The main reason ACA is expensive is exactly that it was not compulsory enough, so that a lot of healthy young people opted not to buy into it. The solution is not to repeal ACA, it's to fix the parts that don't work well.

How do you think those famous European health insurance systems work? They are compulsory at basic level, so a lot of healthy people pay into them without needing them, hence the social solidarity component, like with Social Security or Medicare. That's the part that was not done well with ACA, allowing people to refuse health insurance. And it got fscked up by all the greedy middlemen from private insurance companies. We need a compulsory governmental single-payer basic health insurance system for essential care, a Medicare just for the basic stuff and for under 65 people, or a similar highly-regulated and limited-profit private one. Big companies don't play nice, so whoever trusts and doesn't properly regulate them (which should include breaking them up once they dominate a regional market) is in their pockets.

The way to fix healthcare is not by repealing one of the few steps we have made towards a more solidary system, but by fixing what we all know is wrong: malpractice, middlemen, and quasi-monopolies running the show.

I agree with some of this (strongly disagree with the collectivism part). But I think a much better health care model would similar to Singapore.

 

[deleted171991]

I agree with some of this (strongly disagree with the collectivism part). But I think a much better health care model would similar to Singapore.

I had to look it up: https://en.wikipedia.org/wiki/Healthcare_in_Singapore

 

[cbrons]

I had to look it up: https://en.wikipedia.org/wiki/Healthcare_in_Singapore

An important thing to note here is that citizens have a higher subsidy compared to non-citizens and there is nothing that is "Free" for anyone. Everyone has to pay something. And there isn't anyone going to the ER for primary care complaints.

 

[nimbus]

I had to look it up: https://en.wikipedia.org/wiki/Healthcare_in_Singapore

Thanks for the link. The scale is tiny and it's funded largely through payroll deduction. Here we have millions upon millions of jobless.

"In 2012, there were a total of 10,756 hospital beds in the 25 hospitals and specialty centres in Singapore. The 8 public hospitals comprise 6 acute general hospitals (SGH, NUH, CGH, TTSH, KTPH & AH), a women's and children's hospital (KKH) and a psychiatry hospital (IMH).[6]"

 

[GravelRider]

https://www.washingtonpost.com/news...sks-why-men-should-pay-for-prenatal-coverage/

This is why we will never get anywhere with healthcare reform. Men don't have to pay prenatal care? So do the GOP wingnuts still believe in the immaculate conception or that a stork brings babies? Do they have any clue about how insurance works? I'm sorry, the GOP has really become obstinate in recent years. It also severely contradicts their stance on abortion.

 

[aneftp]

https://www.washingtonpost.com/news...sks-why-men-should-pay-for-prenatal-coverage/

This is why we will never get anywhere with healthcare reform. Men don't have to pay prenatal care? So do the GOP wingnuts still believe in the immaculate conception or that a stork brings babies? Do they have any clue about how insurance works? I'm sorry, the GOP has really become obstinate in recent years. It also severely contradicts their stance on abortion.

U do realize they went the opposite direction with the ACA. Women get no cost (meaning it's free and regardless of deductible, zero out of pocket ) tubal ligation as part of obama directing hhs in 2012 (before his re election).

So why did obama direct hhs to give women zero cost tubal ligation? Yet men have to pay out of pocket for vasectomy? The liberals know they cannot even defend this behavior. It's aren't we for "equality?" Why do women get invasive tubal ligation zero cost? And men don't?

So don't go on about GOP wingnuts when the liberals are just as crazy themselves. Many liberals have become so elitist, their ideology has gotten the best of them and common sense doesn't even apply to the liberal mind with fair policy

So explain to me why women get zero out of cost care for reproductive rights and men don't??!

 

[GravelRider]

U do realize they went the opposite direction with the ACA. Women get no cost (meaning it's free and regardless of deductible, zero out of pocket ) tubal ligation as part of obama directing hhs in 2012 (before his re election).

So why did obama direct hhs to give women zero cost tubal ligation? Yet men have to pay out of pocket for vasectomy? The liberals know they cannot even defend this behavior. It's aren't we for "equality?" Why do women get invasive tubal ligation zero cost? And men don't?

So don't go on about GOP wingnuts when the liberals are just as crazy themselves. Many liberals have become so elitist, their ideology has gotten the best of them and common sense doesn't even apply to the liberal mind with fair policy

So explain to me why women get zero out of cost care for reproductive rights and men don't??!

You didn't explain the reasoning behind the idea that men shouldn't pay for prenatal care. So the baby is only part of the woman's body when it's politically convenient? When we are talking about abortion and a non-viable fetus, it's precious life, right?

 

[aneftp]

You didn't explain the reasoning behind the idea that men shouldn't pay for prenatal care. So the baby is only part of the woman's body when it's politically convenient? When we are talking about abortion and a non-viable fetus, it's precious life, right?

As self employed. I paid a maternity rider for my wife ($150 extra a Month) prior to ACA being passed. In addition to the regular health premiums.

Responsible people do it.

So yes. It's part of life.

We men get charged higher for life insurance. We get charge higher for car insurance (especially up to age 30)

Women use health services more.

So why aren't younger women paying more for car insurance compared to younger men? Maybe it's because younger women are less likely to use car insurance because they are deemed less risky? Same principal applies to women who are of child baring ages.

Once the ACA got passed. Almost all insurers pulled
Out of the individual maternity rider market
By sept 2010. They also pulled out of the pediatric only market in 2010 as well.

The ACA wreck havoc on the individual market for responsible AMT tax paying self employed people.

 

[chocomorsel]

What the hell happened to that lady with COPDer husband? She was funny. Till GravelDigger turned her own argument against her!!! That s hit was funny as crap. Shut her up never to be seen again.
I scrolled thru two pages looking for a comeback. And was left disappointed. Haha!!! Maybe she took in a couple of Syrian refugees after all!!!

That's what's wrong with this country. Too many people with the it's all about me, me, me attitude. Capitalism at its finest, even in healthcare. Very unfortunate for a supposed "first world" country. Once you become "civilized" shouldn't you also worry about your neighbors well being?

 

[aneftp]

The real issue with healthcare is no one really wants to pay for it till they need it....insurance. Even if we go two tier health system (single payer plus private insurance like the Germans)

Germans have a 8% citizen health tax and employer 7% health tax up to around $80k USD. Any one who makes more than that can opt for private insurance (after paying their fair share of the 7%). Sound fair?

I'm all for that.

But I betcha the 65% of Americans will commercial insurance and the 15% of Americans with medicare will not want to be stuck with a very limited access to facilities a la medicaid patients. How can we convince 80% of Americans who have access to 90% of physicians who take both commercial and medicare that they will be severely limited in their access just like medicaid?

We can't.

Than those who make more than the $80K may want to pay extra for private care. I suspect 10% of Americans would opt for private access. Than it becomes a jealously issue.

The American mentality of health care can't be change. Not in this current political environment.

 

[deleted126335]

Absolutely not. And this is coming from the biggest ass_hole on this forum....

Don't sell yourself short. You are not the biggest ass_hole on this forum. You are the biggest ass_hole on SDN. At least since Old Fart was Banned. Love you both.

 

[Pooh & Annie]

This highlights a very Democrat attitude: that it's smart and natural to vote for the party that's more likely to give you stuff. And that poor people especially should vote for the party that gives them stuff. And if a poor person doesn't vote for the party that's going to give them stuff then obviously they must be stupid (more enlightened Democrats might just say they're merely uneducated and in need of guidance). This idea of what government is and should be is abhorrent to many who vote Republican. Even poor ones.

I respect your opinion as much as anyone, but I'm not sure how you reckon that a wealthy democrat thinks it's "smart and natural" to vote for the party that "gives you stuff." For a wealthy democrat (like for example, a physician), the truth is quite the opposite. Wealthy voters who "want stuff" will be voting republican.

Moreover, economics isn't necessarily the most important issue for many voters on that side. Lots of them are very religious and care more about abortion, religion in schools (as long as it's not Islam), 2A rights, opposition to gay marriage, a hard line on the War On Drugs and crime in general, military spending, and of course court appointees.

We don't have to guess on this one. There's real data. They weren't voting on god or guns, they were voting on jobs and immigration.

And I didn't really think that 5 months after the election that most of the smart Democrats I know would still think they lost the election because Trump voters just stupidly voted against their own best interest.

I don't get this one. Of course I think they did. If I thought voting Trump was in the country's best interest, I would have voted for him. I spent months on this very forum arguing with doctors that were Trump supporters. Why do I have to think the poor people are stupid? This is the identity politics that pundits love to use. This side "thinks poor people are stupid", that side "hates women", this side "hates minorities", that's side "hates America"... I can think of individual politicians that might have some of these opinions, but I don't think any major party does.

 

[doctalaughs]

I respect your opinion as much as anyone, but I'm not sure how you reckon that a wealthy democrat thinks it's "smart and natural" to vote for the party that "gives you stuff." For a wealthy democrat (like for example, a physician), the truth is quite the opposite. Wealthy voters who "want stuff" will be voting republican.

The only problem with this argument is a political party can't really "give you stuff" that you already own (your own money). Stealing less of your wages via decreased taxation or reducing forcible re-distribution of dollars (essentially the heart of Obamacare) is not the same thing as expanding entitlement programs that benefit one group but come from OPM (other peoples money).

Not that I think the GOP plan is good. And not that I support Trump - he's a dangerous impulsive egomaniac and we can agree on that.



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[GravelRider]

The only problem with this argument is a political party can't really "give you stuff" that you already own (your own money). Stealing less of your wages via decreased taxation or reducing forcible re-distribution of dollars (essentially the heart of Obamacare) is not the same thing as expanding entitlement programs that benefit one group but come from OPM (other peoples money).

Not that I think the GOP plan is good. And not that I support Trump - he's a dangerous impulsive egomaniac and we can agree on that.



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I don't like paying taxes, but I'm not so sure taxation is stealing. You are perfectly free to find an uninhabited island or planet and live there by yourself. Our tax code needs fixing, but the mindset that taxation is stealing is wrong.

 

[deleted480308]

I don't like paying taxes, but I'm not so sure taxation is stealing. You are perfectly free to find an uninhabited island or planet and live there by yourself. Our tax code needs fixing, but the mindset that taxation is stealing is wrong.

All govts stealing doesn't mean none of them are

 

[doctalaughs]

I don't like paying taxes, but I'm not so sure taxation is stealing. You are perfectly free to find an uninhabited island or planet and live there by yourself. Our tax code needs fixing, but the mindset that taxation is stealing is wrong.

It depends on how the taxes are structured. When citizen A's wages are arbitrarily taken at a much higher amount than citizen B, and then used to benefit mostly citizen B not A I would define that as stealing.

On the other hand a consumption tax on luxury goods (even a huge one) would be perfectly reasonable. A tax on passive income is also somewhat reasonable, as are local taxes that more directly benefit the people in the community collecting them. Income tax is just forcible wealth distribution and even worse if not structured as a flat tax.


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[Man o War]

It depends on how the taxes are structured. When citizen A's wages are arbitrarily taken at a much higher amount than citizen B, and then used to benefit mostly citizen B not A I would define that as stealing.

On the other hand a consumption tax on luxury goods (even a huge one) would be perfectly reasonable. A tax on passive income is also somewhat reasonable, as are local taxes that more directly benefit the people in the community collecting them. Income tax is just forcible wealth distribution and even worse if not structured as a flat tax.


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Agree completely. How do you define "luxury goods"? I'd like to see a system where consumption is taxed beyond basic needs (food and medicine would be exempt for example), which would encompass more than luxury goods. This should provide enough revenue to decrease income tax significantly.

 

[deleted162650]

My opinion is that taxes should be viewed as a sort of membership fee for having the privilege of living in a given country. You want to live in a place where your rights are secure, you have nice schools, roads, hospitals, police, fire military, education, etc.? Great, that will cost you X dollars per year. Shouldn't matter how much you make. Think of it like a country club. Doesn't matter if you are a professional making 250K or a hedge fund manager making millions, the membership fee is the same for the same benefits.

I'll accept a break for the poor though. Like it or not - society needs "poor" people to function. There needs to be people to fill the low wage jobs that are necessary for civilized life to work. These people need to be able to afford the basics so long as they are contributing members of society.

I like the idea of consumption taxes on top of the "membership fee" as well. Tax me on what I choose to spend - not what I make.

 

[GravelRider]

It depends on how the taxes are structured. When citizen A's wages are arbitrarily taken at a much higher amount than citizen B, and then used to benefit mostly citizen B not A I would define that as stealing.

On the other hand a consumption tax on luxury goods (even a huge one) would be perfectly reasonable. A tax on passive income is also somewhat reasonable, as are local taxes that more directly benefit the people in the community collecting them. Income tax is just forcible wealth distribution and even worse if not structured as a flat tax.


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Oh I agree, but the simple concept of taxation itself is not stealing.

Consumption taxes make sense, but are difficult to pass. We are a nation of consumers. Look what happened when Bloomberg tried to tax soda. That continues to follow him around to this day. NYC has been trying to tax plastic grocery bags to get people to use reusable shopping bags, but there has been quite an uproar over that.

 

[deleted162650]

NYC has been trying to tax plastic grocery bags to get people to use reusable shopping bags, but there has been quite an uproar over that.

Well they could just be like CA and outright ban free plastic grocery bags.

 

[nimbus]

Well they could just be like CA and outright ban free plastic grocery bags.

The stupid part is there are still free plastic bags all over the produce aisles and plastic packaging all over the store. Literally tens of thousands of free plastic bags. But the ones at the register cost $0.10.

 

[Scotty_G]

Seattle was like that too and were very serious :0

 

[doctalaughs]

Agree completely. How do you define "luxury goods"? I'd like to see a system where consumption is taxed beyond basic needs (food and medicine would be exempt for example), which would encompass more than luxury goods. This should provide enough revenue to decrease income tax significantly.

Groceries, basic clothing items, medicine, transportation and housing up to a certain modest dollar amount. I dont think that would be too hard to agree on. I would have no problem with a 50% consumption tax after that. If you want to spend your money on a boat, 3rd vacation house and rolls royce you should pay. But if you take my wages to supplement the iphone someone is buying in lieu of healthcare I'm less happy (the uproar over that comment was hilarious).


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[GravelRider]

But if you take my wages to supplement the iphone someone is buying in lieu of healthcare I'm less happy (the uproar over that comment was hilarious).


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Oh it was hilarious. What was even funnier is that it was a dig at Trump's base and they didn't even realize it.

That's actually a good point, though. Why am I paying for Jason Chaffetz's top notch healthcare?