Why Do Repubs Accept a Weak President

code1211 · May 14, 2019

Greenbeard said:
I don't know, I'm undecided on government price controls.

If we want a system built on private insurance markets that doesn't exclude people who actually need care, the ACA's framework is the only game in town. The prototypical state (Mass), where people actually care about having a market-based system that works, has the most insurer competition and the lowest marketplace premiums in the country, all while having some of the best care providers in the country.

Assuming you're talking just about the insurance part of the law, I've recommended in a dozen threads plenty of changes to increase affordability. Reinsurance, expansion of the premium tax credits and cost-sharing reductions (in recognition of the fact that the price tag of the ACA has come in hundreds of billions under budget), expanding insurer competition, moving more lives into the marketplaces, etc. All of which would make coverage more affordable and expand participation.

Most of the ACA is about "actual care." That's why clinical quality and patient safety has improved under it. It's why the health care delivery system has be re-organizing itself for the past decade. The care delivery reforms are arguably the most important piece of the law, but I'd be amazed if they get 1/100th of the ink spilled on the insurance market reforms.

So it sounds like healthcare is changing and improving every day.

Change is good if done in response to the previous experience. Opposing change because it's change seems odd in view of this.

Were the changes in the healthcare delivery systems directed by provisions of the ACA or were they the result of private sector innovations and evolution to better methods?

code1211 · May 14, 2019

What if...? said:
So, do you have a breakdown of how much those wage increases are from trumps policies and how much is the result of minimum wage increases? Millions of lower income folks got raises WAY above 3.4%.

That's only a percent or so more than it has been for a long time.

So I suspect that trump is claiming something that he didn't actually do. Again.

It happened when Trump was in office.

It didn't happen for the previous decade.

Do the math.

code1211 · May 14, 2019

What if...? said:
We'll see how it shakes out now that the tax cut sugar rush is over.

There's always been a correction when it wears off before.

I suspect military action between now and the election. That's always good for an incumbent.

Well, Paul Krugman provided orgasmic bliss to the democrats by predicting a depression following the election of Trump from which there would be no recovery.

He missed by just a tad. That is, if "a tad" means wrong on every point in every way and every word presented.

You echo his prediction in your warning of a dire consequence.

In the mean time, in the real world, things are pretty good. Better than they've been in about a decade in some cases and about a half a century in others and better than ever before in others.

In passing, military action has been underway for this whole century.

code1211 · May 14, 2019

What if...? said:
They were ****ing awesome in the days leading up to the housing crash too.

So color me unimpressed.

A little drab, but if that is your color preference, so be it.

Greenbeard · May 14, 2019

code1211 said:
Were the changes in the healthcare delivery systems directed by provisions of the ACA or were they the result of private sector innovations and evolution to better methods?

It's not an either/or proposition. The ACA set the policy stage for reforming the delivery of care and changing the business model under which providers have historically operated. It used every tool at its disposal--policy, money, convening, regulation, technical assistance--to push the market. (Major Affordable Care Act Delivery and Payment Reforms) The private sector still has figure out how to do it, but their financial upside is now in containing costs, not ballooning them. The market has been re-shaping itself to deliver care better and smarter and that's due to the ACA.

The ACA brought the ACO concept into existence and now those are now covering tens of millions of lives with incentives from both the public and the private sector:Recent Progress In The Value Journey: Growth Of ACOs And Value-Based Payment Models In 2018.

code1211 · May 14, 2019

Greenbeard said:
It's not an either/or proposition. The ACA set the policy stage for reforming the delivery of care and changing the business model under which providers have historically operated. It used every tool at its disposal--policy, money, convening, regulation, technical assistance--to push the market. (Major Affordable Care Act Delivery and Payment Reforms) The private sector still has figure out how to do it, but their financial upside is now in containing costs, not ballooning them. The market has been re-shaping itself to deliver care better and smarter and that's due to the ACA.

The ACA brought the ACO concept into existence and now those are now covering tens of millions of lives with incentives from both the public and the private sector:Recent Progress In The Value Journey: Growth Of ACOs And Value-Based Payment Models In 2018.

It sounds as if the ACA still addresses the payments and any changes in the actual care is a private sector concern. The private sector usually does a pretty good job if it is allowed to explore options.

As I understand it, the cost of healthcare continues to increase in the US. Is there any correction of the rise in the healthcare costs anticipated?

Greenbeard · May 15, 2019

code1211 said:
It sounds as if the ACA still addresses the payments and any changes in the actual care is a private sector concern. The private sector usually does a pretty good job if it is allowed to explore options.

It sounds like that because that's what I just said in what you quoted. The ACA led the way in changing the business models underpinning care delivery, which is why the industry has been re-organizing and re-thinking the best ways to deliver care. As I said, that's arguably the most significant thing it does and yet very little popular attention gets paid to it.

As I understand it, the cost of healthcare continues to increase in the US. Is there any correction of the rise in the healthcare costs anticipated?

I don't know what you mean by "correction." The goal of reform is to bend the cost curve, slowing growth in line with the rest of the economy so resources stop disproportionately flowing into health care relative to other sectors of the economy going forward. That is happening. Health care cost growth over the last decade has been the lowest since they started tracking that statistic sixty years ago. Health care costs today are about $700B (or $2,000 for every single man, woman, and child in the country) below where pre-ACA cost growth trends would have put them. Whether that will be sustained is TBD, but the ongoing efforts to get the ACA--including the reforms to care delivery--thrown out don't bode well.

Moderate Right · May 15, 2019

calamity said:
He's been embarrassed by Kim. And, he lacks the stones to confront Putin. Under every definition, Trump is weak. But, yet the Right loves his weak ass.

Imagine their howls if Obama handed Kim an IOU of $2 Million and received a comatose American in return, one who died less than a week later. no less.

Imagine Obama kissing Putin's ass on global TV and then calling him to say, "You're in clear Vlad; no collusion!" All that then to be followed by lying to the American people about Russian interference in the election.

Right. They would all stroke-out.

Now, ask this. Why are they OK with it when it's their own guy making the country look wimpy?

No need to worry. That week president of eight years was replaced by Trump.

code1211 · May 16, 2019

Greenbeard said:
It sounds like that because that's what I just said in what you quoted. The ACA led the way in changing the business models underpinning care delivery, which is why the industry has been re-organizing and re-thinking the best ways to deliver care. As I said, that's arguably the most significant thing it does and yet very little popular attention gets paid to it.

I don't know what you mean by "correction." The goal of reform is to bend the cost curve, slowing growth in line with the rest of the economy so resources stop disproportionately flowing into health care relative to other sectors of the economy going forward. That is happening. Health care cost growth over the last decade has been the lowest since they started tracking that statistic sixty years ago. Health care costs today are about $700B (or $2,000 for every single man, woman, and child in the country) below where pre-ACA cost growth trends would have put them. Whether that will be sustained is TBD, but the ongoing efforts to get the ACA--including the reforms to care delivery--thrown out don't bode well.

It seems like spending on healthcare has increased as a percent of the GDP over time.

It might be good to examine what has changed in that period to inflate the costs so dramatically.

In 1960, healthcare costs were about 5% of the much smaller GDP and now it has risen to about 17+% of GDP.

The Healthcare industry seems to continue to take a bigger and bigger bite of a bigger and bigger pie.

• U.S. health expenditure as GDP share 1960-2019 | Statistic