Discussion in 'General Discussion' started by Genghis Khan, Dec 22, 2007.
It's inevitable within the next 10 years IMO.
That's the main thing I didn't like about the ACA is that we were forced to get health care because of it. Well, we all get paid through waivered services for taking care of my brother and the only insurance offered by our employer has very high deductibles. Thankfully, they passed a law here saying that if you're a personal care assistant, which we all are, you get tax exempt status and if you have that, you're not forced to pay a penalty fee if you don't get health insurance.
There's an interview with Trump where he says how bad high deductibles are because you have to get a really horrible injury that costs a lot in hospital fees for health care with high deductibles to even pay off. So what I'm wondering is this. Is he trying to get it so deductibles aren't so damn high?
No. You pay too much for your pharmaceuticals, equipment, training and services. The complete medicare chain in U.S. yields biggest profit margins, compared to the rest of civilized world (as LC would call it). For example Germany also has Bayer, Siemens, elite universities and hospitals yet none of the problems U.S. have. In U.S., the system is set-up to favour wealthy people,if you have prime packages there'll be no queues, and no shortage of staff, drugs and tools for immediate deployment. In Western or North Europe you have to wait, but you'll get great service once you pop out of the queue. Queues are long but not problematic, if you require treatment that can't wait for two or three months then you're seriously fucked up and should be placed under hospital care, which is another category. I know it's hard for people to accept that they have to wait while depressing thoughts are running in their mind, but if doctor says that it's fine for you to get a CT scan in 2 months, you should accept that. If situation gets complicated, you use ER services. No need to fund a system that provides certain group a luxury of having next week treatment in a hospital with hotel level of service and Star Trek design of surgical procedure chambers, while one third of your country has limited access to any service for a given procedure.
Well, the ACA had to do something to get healthy people (like yourself) to enter the market. If you're going to maintain the existing infrastructure but force that infrastructure to take on patients that, quite frankly, will cost the company money, they had to give them people from whom they'd make a fair bit of cash. Deductibles were rising before the ACA was implemented and many experts (admittedly not all experts) believe deductibles would be the same or higher if the ACA didn't exist.
I think deductibles are stupid in general, but hey. I live in a much different world, health-care wise.
As for what Trump wants to do...well, Trump, much like many of his other policy proposals, has never really said what he wants. He has promised the moon, but the plan came up from the House of Representatives. The plan passed by the House would do quite a few things - lower the ceiling for Medicaid, for example (reversing the ACA's increase of who qualifies for Medicaid). A big part of the plan was repealing taxes that the ACA implemented to pay for the credit given to low-income earners. Limits on how much an insurer could charge older people would be increased, allowing them to charge old people more. According to the bipartisan Congressional Budget Office, somewhere around 23 million people would lose healthcare, while providing a tax cut for anyone making $50k+ a year, while increasing the financial burden on the people who make less than $50k/year. The CBO estimates that under the American Health Care Act (AHCA, the Republican plan), deductibles would increase more rapidly than they are currently, while premiums would increase at the same rate until 2020, when they may slow. It would reduce the federal deficit by $119 billion by 2027.
As Zare has noticed, the US system is incredibly rigged to allow people who have more money to access better health care services. The ACA tried to level the playing field - it probably failed to do that as much as people wanted, but it was an attempt and it certainly provided health care for some people. I know quite a few Americans who were never allowed to get health coverage beforehand who were able to get coverage under the ACA.
It doesn't? That's news to me. With its mixture of mandatory and private healthcare, it's the ultimate class-dependent system. If you're privately insured, which you can only be with certain income levels, you get good treatment. If not, you can wait for for treatment for 8 hours in an understaffed hospital with no word, and nobody gives a fuck if you're dying or not.
15% of U.S. can't even reach that hospital.
These aren't people without money. All normalized, red pie slice would be about 2000 to 3000e net monthly.
I'm arguing that's it's better to have system that has waits and impolite staff than system that allows above to happen. I can't just believe that people are systematically dying due to negligence in German state hospitals.
Anyway, I'm not saying that US system should be like German or any other, that's not my angle. LC says rigged, better term than 'corrupt' I used, so it needs complete reevaluation and redesign. Same with guns, I don't know what exactly they should do, but they should do something, because Americans are shooting themselves and Swiss are not. Simple as that.
No iterative change, tweak of deductibles or anything of the kind will help.
So, it sounds like the ACA helped some people, but made it challenging for others.
It made it a pain in the ass for anyone self employed ... and for people who like to see a particular doctor.
It's flaw is being so damn convoluted .. which is the flaw of the replacement plans so far
What would your ideal solution be?
Why so? Btw, I don't know how it used to be in detail, just curious.
It forces them to get health insurance, which is a rather significant expense for many self employed people. I seem to recall that small businesses are exempt until they have X employees from having to offer employee insurance, but then those people have to get it themselves.
So that person would handle any situation by paying a full 'market' price if the need arose? I think I'm right by assuming that if you don't have insurance, any individual treatment will be charged with maximum cost. So you're running a one man show, working your ass off and you intentionally don't want to have health insurance, to max your profits? Ok. But to be fair, you need to allow people to get and use any kind of drugs on themselves then. If the system doesn't care about that magnitude of reckless behaviour to your own body, why should it stop you from poking yourself with a needle.
It's not that and it really never forced anyone to get insurance, the penalties for not getting insurance were always pretty low and they have never really gone after collecting those penalties short of taking it out of a tax refund .. which most anyone self employed is not getting anyway unless they have the worst accountant in the universe
What has made it a pain in the ass is that it eliminated many plans that did not have the "essentials" according to the law, but not according to most people's reality ... drove up costs and limited choices.
Pre-Obamacare, I would call my agent, tell him what doctors we see and what general coverage we want, I would get back 6 or 7 plans to choose from.
Last year, I had 1 plan to choose from that has none of our doctors in it, so we pretty much pay full price to see anyone. The other option is get new doctors, but we have been seeing the ones we have for years and like them .. I have an ongoing medical condition and the guy I see has helped me a great deal. My wife likes her OBYGN and I think having a comfort and trust level with a doctor is important.
There was allegedly a second plan that Obamacare automatically enrolled us in, I looked it up and it was a little cheaper, but the nearest doctor I could see was 300 miles away, nearest hospital was 200 miles
So now I pay 4x as much for coverage that is useless unless there was some major emergency and even then ... I cannot use it at the hospital that is literally a 5 minute walk from my house.
that is going to get worse as you see insurance companies pull out of the exchanges (Anthem just pulled out of a few yesterday)... because they make no sense to be in.
I'll answer that what I would like to see it be a bit later ... need to do some work at the moment
If a lot of people are forced to change physicians because of insurance system change, that's really bad. The personal relationship is a huge factor.
Mine? I don't have one.
Damn, shit is really heating up with North Korea. I wonder how well the new sanctions will help if at all.
'President Strange loves the bomb', as a Swiss newspaper titles today.
Well, it's obvious the sanctions aren't working with Kimmy's recent threats against Guam. What is obvious and very scary is that we are going to war with this madman. I just don't see any way out of it.
And how about Kim's not going to do jack shit?
Edit; btw :
The Guam threat seems like baiting to me.
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