Obamacare after Obama

JumpinJack said:

I agree that the ACA is not working. It's imploding before our eyes. But it wasn't working before, either. As will always be the case, every system works for SOME, both now and before. Before, over 40 Million people didn't have access to healthcare. In the world's leading country, the "exceptional" America, that is unacceptable, IMO.

I don't have the answer. Do you? Does Paul Ryan?

I think single payer or universal health care might be a good answer, even with the high cost....as long as the ins. cos. are out of the picture except for those who elect to buy private insurance (like Canada and Great Britain). Because of the impetus to the economy without the ins. cos profit and admin costs sucking breath out of the economy. I also think that would address health care costs. But the down side, besides high taxes, would be fewer providers. BUT...many in the ACA market already have access to far fewer providers, because of the limited provider and drug lists (one way that ins cos are protecting their profits; if you can't go to the dr., there will be no claim).

As for higher taxes, each of us would end up paying less because of lower health care costs.

Just a thought. The ACA has been a disaster for the economy and for many, though. (Although, as I said, it works for SOME....paid for by others.)

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The very idea that all medical care should be covered by insurance is the big problem. Imagine what would happen if all car or home maintenance costs were covered by insurance - would those insurance costs go up or down? Insurance should cover only the rare, unexpected and costly events in life not the routine maintenance costs. Adding any middle man, public or private, is not going to lower the cost of anything. Insurance costs should be based on actuarial risk factors not your current income.

Ancient Herald said:

So it's a double jeapardy tax then. A tax them and tax them again tax.

Thanks socialism,

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No. Employers aren't taxed on health care they provide their employees. They get a tax BREAK. But if they provide cadillac plans to their employees, that extra cost of the plan is taxed.

Such plans are usually provided to executives.

Saucey said:

Hope I do not get sick.. Maybe I can go to Cuba. The American libs always said they have it better down there.

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Yes, Cuba has free health care for al, or almost free. No worries about care when you get cancer, how to pay for premiums, worrying about out of pocket or coinsurance payments, how to pay for the birth of a baby, worry about not having insurance. That's a remarkable feat for a poor, underdeveloped country. Cuba has other problems, of course. But health care doesn't seem to be one of them.

ttwtt78640 said:

The very idea that all medical care should be covered by insurance is the big problem. Imagine what would happen if all car or home maintenance costs were covered by insurance - would those insurance costs go up or down? Insurance should cover only the rare, unexpected and costly events in life not the routine maintenance costs. Adding any middle man, public or private, is not going to lower the cost of anything. Insurance costs should be based on actuarial risk factors not your current income.

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Well, maybe that's the answer. Some would argue the ACA with high deductibles does just that. But no, it doesn't, because the cost of the catastrophic plans prevents paying for ordinary medical costs.

Insurance being involved at all is the problem, as I see it.

I'm old enough to remember when insurance wasn't something that everyone had. Maybe not even most. Maternity costs weren't covered. Many things weren't covered. How was this possible? This was possibley because the costs of health care were low enough for most people to pay for it out of pocket. Where I lived, I remember that when my sister got pregnant, her doctor's fee for the pregnancy was $1,200 for the entire nine months. Then the hospital had a flat fee. Then there were vitamins. That's it. A working couple could pay for that out of pocket. Pregnancy was not covered by insurance.

Once insurance gets involved, medical care costs skyrocket.

The same thing has happened with dental care in the last couple of decades. Not long ago, dental insurance was not common. An exam was a reasonable price. Crowns were always expensive, but nowhere near what they are now. And dentists would take payment plans.

Then dental insurance became common. Costs skyrocketed. What used to be $50 for an exam AND cleaning is now over $200. So it becomes necessary to have insurance to pay for the high costs that are caused by the insurance. It's a Catch-22.

JumpinJack said:

Yes, Cuba has free health care for al, or almost free. No worries about care when you get cancer, how to pay for premiums, worrying about out of pocket or coinsurance payments, how to pay for the birth of a baby, worry about not having insurance. That's a remarkable feat for a poor, underdeveloped country. Cuba has other problems, of course. But health care doesn't seem to be one of them.

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Do you have a direct link to their propaganda office or did you just read that on the huffinton and puffington post? lol
Communist countries are only good at two things: Secrecy and espionage.

Going back to the OP, here's what I like from this slate:

1. I like O'Malley's push for value-based insurance design, which is a smarter way of using cost-sharing to be more than just a barrier to care. Clinton's 3 office visits (currently required of catastrophic-level plans but not others) is a small gesture but good, and I imagine the lower OOP max for prescription drugs would be helpful for many. I'd prefer to see broader use of HSAs than new tax credits for out-of-pocket spending, though I don't think raising the contribution limits will matter much (most people don't max out their contributions today). I'd like to see the rules for HSAs reformed such that all silver and bronze plans can be paired with one but no one seems to be suggesting that yet. I'm forgetting which advocacy group proposed this, but another approach to affordability would be to tie premium and cost-sharing subsidies to the gold tier of plans (instead of the silver tier, as it currently done). That would be expensive and I don't think it's clear yet that this is actually necessary but it's something to keep in mind.

2.Clinton has the most complete approach to rising prescription drug costs so far, but Bush's points about FDA reform are worth broader consideration.

3. O'Malley's the best on continuing the push to reform care delivery; not entirely surprising, given that his state has perhaps the most well-rounded approach to reform in the country right now. The preliminary results from his state's global budget experiment for hospitals were published in NEJM this month and were surprisingly good. But his proposal leaves lots of room for state-level innovation and flexibility in recognition of the fact that different models will work better in some markets than others.

4. I'm not sure any of them are getting price transparency right yet. If we're pushing HSAs and asking consumers to be price conscious and shop, they need comparative price information immediately. But that isn't as simple as a hospital or doctor posting a price, since the price for a consumer will vary based on the insurance plan they purchased. So insurers need to be providing interactive tools that allow consumers to compare prices across facilities.

5. Anti-trust enforcement is more critical now than ever, so good on O'Malley and Clinton for pushing it.

6. I like Rubio and Bush's approach, capping the employer tax exclusion (a more efficient and less politically assailable mechanism for achieving the same thing as the Cadillac tax).

7. On Medicaid and Medicare, the reforms that have begun need to be continued. I'd be interested in hearing more about O'Malley's "Medicare Essential" concept, though.

8. Tweaks to insurance market rules (the family glitch, surprise billing) are a good idea. Tearing down the existing consumer protections is not.

Obamacare after Obama

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depends largely on who wins the presidency, and the makeup of congress. short term : a Republican congress and president might actually repeal the law outright. it's more likely that they'll just sabotage it so that it can't work, though. that's what they're doing to public schools in my state rather than just privatizing the whole thing in one fell swoop. look for them to try to privatize Medicare, as well, though that will be an uphill battle. if they do it, they'll leave the current system in place for everyone over 55, and they'll **** younger workers who can't be bothered to vote or even to pay attention.

if a Democrat wins, the law will pretty much stay as is. it will fail on its own eventually due to poor design and cost, and then maybe in a few decades we'll consider a first world health care distribution system when everyone is tired of worrying about getting sick because they can't afford it. we should have listened to Truman and solved this before it became a big problem.

It sounds from this AP article (What to know about 'BernieCare,' Sanders' health overhaul) that Sanders' staff have at least tacitly confirmed for the AP that the plan he pushed in the Senate is the one he's running on now, though I still find it odd the topic isn't covered on the issues page of his campaign site.

But that at least means we can add the details of his vision to the discussion.


So there, that's the version of single-payer that's on the table here.

He's fading quickly now but it's probably worth pointing out that Carson is now out with his plan, such as it is: Prescription for Empowerment. It's pretty half-baked but essentially posits that everybody should have a high deductible health plan and his version of an HSA (this despite bemoaning "exorbitant increases in premiums, deductibles and co-pays" under the ACA earlier in the document).