ACA (Obamacare) v2.0

[I Shrugged]

What should be done to Obamacare?

Keep pre-existing conditions protection. I think that is a certainty, and a good thing.

Allow insurance companies to sell whatever coverage people want to buy
Allow plans to be multi-state
Remove the mandate?
Remove the federal government from the process?

There used to be a lot of variety. Now in many states there is next to no choice. That has to revert back.

[Tyler]

I imagine the starting point for discussion will be Ryan's plan:

https://abetterway.speaker.gov/_assets/ ... yPaper.pdf

It covers all of your points, and includes a few more such as universal up-front subsidies to help offset the cost of coverage. Seems pretty reasonable, IMHO.

[ochotona]

This sounds good:

"Policies
Protections for Patients

o Pre-existing Condition Protections

No American should ever be denied coverage or face a coverage exclusion on the basis of a pre-existing
condition. Our plan ensures every American, healthy or sick, will have the comfort of knowing they can never
be denied a plan from a health insurer."

But in practice, does it mean, "For you Sir, a special price, $7500 per month!"

[Tyler]

But in practice, does it mean, "For you Sir, a special price, $7500 per month!"

If you take the Continuous Coverage section at face value:

o Continuous Coverage Protections
Our plan also proposes a new patient protection for those Americans who maintain continuous coverage.
Already in place for the employer market, this protection would apply to those in the individual market as well.
This is how it works: If an individual experiences a qualifying life event, he or she would not be charged more
than standard rates – even if he or she is dealing with a serious medical issue.

This new safeguard applies to everyone who remains enrolled in a health insurance plan, whether the individual
is switching from employer-based health care to the individual market, or within the individual market.

This provision is modeled after a 1996 law – the Health Insurance Portability and Accountability Act, commonly
known as HIPAA – that offers pre-existing condition protections when patients move from one job to
another. In other words, without this protection even those individuals who maintained continuous coverage
in the group market were not rewarded and were rated by insurers each time they enrolled in a new plan. This
often resulted in an increase in premium costs for individuals and families. Extending these protections to the
individual market is a simple but important reform that will encourage Americans to enroll in coverage and stay
enrolled.

Basically, you can switch plans and pay the standard rate even if you're very sick provided you maintain continuous coverage.

[ochotona]

I am going to write to my peeps Cruz, Cornyn, and Culberson and quote this language. I am all for it.

[Xan]

Keep pre-existing conditions protection. I think that is a certainty, and a good thing.

If you're looking for "insurance" for a pre-existing condition, then you're not looking for insurance, you're looking for a handout. We can debate whether somebody should give you the handout or not, but let's be honest here. That's not what insurance is.

[Benko]

Keep pre-existing conditions protection. I think that is a certainty, and a good thing.

If you're looking for "insurance" for a pre-existing condition, then you're not looking for insurance, you're looking for a handout. We can debate whether somebody should give you the handout or not, but let's be honest here. That's not what insurance is.

Glad someone said it. And I'm probably for the handout (depending), but we need to be clear what we are talking about.

[Tyler]

If you're looking for "insurance" for a pre-existing condition, then you're not looking for insurance, you're looking for a handout. We can debate whether somebody should give you the handout or not, but let's be honest here. That's not what insurance is.

True. But the payer/provider industrial complex hasn't been true "insurance" for a very long time, well before the ACA was created. No matter what you want to call it, as long as the only way for a consumer to have a fair seat at the medical treatment table is through an insurance provider, then I think it's perfectly reasonable that people on the individual market are afforded the same preexisting condition and portability rights as those who purchase coverage through an employer. I'm happy so see that politicians have come around on that.

[MachineGhost]

Keep pre-existing conditions protection. I think that is a certainty, and a good thing.

If you're looking for "insurance" for a pre-existing condition, then you're not looking for insurance, you're looking for a handout. We can debate whether somebody should give you the handout or not, but let's be honest here. That's not what insurance is.

That's true which is why we shouldn't do away with the individual mandate. The problem isn't that per se (well besides the sloppy Supreme Court rationale) but the lack of choices in insurance.

Penalizing people with $7600 month a coverage because they forgot one $100 month payment is just another expensive problem that will have to be dealt with when it turns into the inevitable Black Swan.

[MachineGhost]

Keep pre-existing conditions protection. I think that is a certainty, and a good thing.

If you're looking for "insurance" for a pre-existing condition, then you're not looking for insurance, you're looking for a handout. We can debate whether somebody should give you the handout or not, but let's be honest here. That's not what insurance is.

This would all be moot if everyone was covered and stayed covered. Which is another failure of Obamacare, IMHO.

The mandate is not a failure, they just set the penalty too low and to go up too slow over time. In the next few years (if not repealed) the penalty fee will cost as much as the Bronze plan without tax subsidy which should induce people to buy the plan instead.

Employer insurance needs to end once and for all and have us go to a single national risk pool. Hello, is anyone listening up there in D.C.

[ochotona]

Keep pre-existing conditions protection. I think that is a certainty, and a good thing.

If you're looking for "insurance" for a pre-existing condition, then you're not looking for insurance, you're looking for a handout. We can debate whether somebody should give you the handout or not, but let's be honest here. That's not what insurance is.

I'm not asking for a handout. I'm just asking that they don't cherry-pick the risk pool. You could get rid of a lot of gynecological claims if you just got rid of all of the "gynes", then you'd stil have 48% of premium payers left! Wouldn't that be a good deal for the insurance co? OK, we'll insure women, but no gyne claims.

OK 55 year old, we'll insure you, but excluding conditions you didn't have when you were 25. What?

Life happens! By a certain age, most people have pre-existing conditions. That's a fact.

[MachineGhost]

This would all be moot if everyone was covered and stayed covered. Which is another failure of Obamacare, IMHO.

The mandate is not a failure, they just set the penalty too low and to go up too slow over time. In the next few years (if not repealed) the penalty fee will cost as much as the Bronze plan without tax subsidy which should induce people to buy the plan instead.

Employer insurance needs to end once and for all and have us go to a single national risk pool. Hello, is anyone listening up there in D.C.

My point, exactly.

Scratch that, it looks like the "shared responsibility payment" is only going to be capped at the cost of the Bronze level. So that flaw is not going to be fixed. Incredibly dumb.

[MachineGhost]

Another dumb flaw:

[MachineGhost]

I can't wait!

[WiseOne]

This would all be moot if everyone was covered and stayed covered. Which is another failure of Obamacare, IMHO.

The mandate is not a failure, they just set the penalty too low and to go up too slow over time. In the next few years (if not repealed) the penalty fee will cost as much as the Bronze plan without tax subsidy which should induce people to buy the plan instead.

Employer insurance needs to end once and for all and have us go to a single national risk pool. Hello, is anyone listening up there in D.C.

My point, exactly.

+1. I see a lot of problems that would be introduced if the Ryan plan were to replace Obamacare, and the lack of mandatory coverage is probably the biggest. In order to have a risk pool that makes sense, you need: 1) healthy as well as sick people participating, and 2) as large a membership as possible, to spread risk adequately.

What I hope they do is not to completely repeal Obamacare, but to review it point by point and clean up the problems. Unless they're willing to put in place something like the Gyroscopic Investing Plan, from a thread whose title I can't remember: A single-payer, government funded policy that covers everyone for catastrophic costs (e.g. >$50,000/year), and a combination of private, minimally regulated insurance and (most critically) transparency in pricing and true free market competition for routine expenses. Medicare could become that catastrophic costs policy, and Medicaid could be offered by states (with federal government block grants) as the equivalent of private insurance for the poor/disabled.

One thing we really need to get away from is the idea that insurance is needed to cover routine medical expenses. We don't blink at dealing with home and car repairs, buying clothes to keep up our work appearance, updating our home appliances and smartphones as needed etc. You can buy plans to cover some of these things, but hardly anyone does, and for good reason. Why should health care be any different?

[MWKXJ]

The problem *is* the insurance; adding more or different insurance schemes will not fix America's healthcare, IMHO.

There's at least one field of medicine with procedures that decrease in cost year over year: cosmetic surgery. The reason? Insurance is not involved in these transactions. If a patient needs a new smile, said patient lays the cash on the table. There is no dishonest haggling between insurer and provider, the pricing is upfront and not subject to inflation via insufficient counter-offering by the insurer. If the provider's cost for a procedure is too high, patients will more than likely take their money elsewhere until said provider lowers their pricing. There is no "wedge" between patient and provider, inflating costs.

Further, a cash-based system removes the curated list of "allowable" procedures which is the cause of so much of the pain of today's doctors' visits. Cash is cash. If a patient does not have cash, said patient can appeal to family, the local religious community, social media, etc., for the funds for bare-bones charity service.

To exclude insurance from medicine a law could be passed which forces upfront pricing for all medial procedures, and, forces procedures to be paid for in full during time of service. The mandate that emergency rooms be forced to accept patients regardless of the ability to pay could be abolished and instead, such unpaying patients be directed to a third-tier triage service, which is little more than a journeyman doctor with a duffel bag full of instruments. A tort reform could be put in place stating that anyone sent to third-tier triage forfeits the right to a malpractice lawsuit. The journeyman triage doctor benefits from this arrangement by gaining experience on those without much to lose while working toward the goal of becoming experienced enough to start a practice.

Maybe the above is ridiculous, but certainly not any more so than doubling-down on the same insurance scam which led to the healthcare crisis in the first place. Also, given that America founding stock is now nearly a minority in the country of their inheritance, a single insurance pool for all, including Latin America's burgeoning detrital population of illegal immigrants, is untenable; too many people see the well fed, 400-pound latina with six kids in tow at the local health and human services building to relinquish four-figure charity come April 15th. Single payer healthcare was meant for homogeneous cultures, i.e., extended families, and that paradise is lost.

[Pointedstick]

http://www.cnn.com/2016/11/11/politics/ ... l?adkey=bn

Trump told the paper he was reconsidering his stance after Thursday's meeting with President Barack Obama, who urged him to protect parts of the law. Trump said he would like to keep the provision forbidding discrimination based on pre-existing conditions and to allow young Americans to remain on their parents' healthcare plans.

AKA the most popular parts of the law.

"Either Obamacare will be amended, or repealed and replaced," he said, acknowledging that it was Obama, who met with Trump in the Oval Office for 90 minutes, who encouraged him to reconsider. "I told him I will look at his suggestions, and out of respect, I will do that."

That position is not entirely new -- he did say as much at least once during the primaries. But the statement, three days after Americans elected him president, is a fresh sign that he may be willing to distance himself from some of his campaign positioning, such as calling for the immediate repeal and replace of Obamacare.

I am absolutely shocked to learn that Trump plans to govern as a canny moderate, and not some kind of slavering neo-fascist.

[MachineGhost]

I am absolutely shocked to learn that Trump plans to govern as a canny moderate, and not some kind of slavering neo-fascist.

Heil Trumpster!

[Tyler]

Trump told the paper he was reconsidering his stance after Thursday's meeting with President Barack Obama, who urged him to protect parts of the law. Trump said he would like to keep the provision forbidding discrimination based on pre-existing conditions and to allow young Americans to remain on their parents' healthcare plans.

AKA the most popular parts of the law.

It's funny how things that were already part of the Republican replacement plan are now sold as Trump compromises thanks to Obama. Well, at least conciliatory rhetoric is good politics and a healthy development right now.

[ochotona]

Ordinary folks don't care where the solutions come from, nor who takes political credit for them. We just want the freakin' results.

[MachineGhost]

Ordinary folks don't care where the solutions come from, nor who takes political credit for them. We just want the freakin' results.

Meanwhile, low information, low IQ, coddled-always-winners Millennials riot, destroy property and forment violence because "Adolf Trump" is a racist, misogynist, bigamist, sexist, xenophobicist, anti-immigrationist, anti-safe spaceist, anti-xxxxxxxxxxxist plus the devil incarnate and thus want the state electors to undemocratically throw their vote for Slick Hilly on Dec 19.

And the above is exactly why we have an Electoral College. The sheer irony is lost on these ignorant twits.

[MachineGhost]

[rickb]

What's the point you're trying to make with this graph? It apparently shows the average cost of employer sponsored policies, not policies from the exchanges. The rate of growth is (approximately) 100% from 2000 to 2008, and more like 50% from 2008 to 2015.

Is your point that ACA is a good thing since the rate of increase in policy prices has dropped significantly?

[MachineGhost]

What's the point you're trying to make with this graph? It apparently shows the average cost of employer sponsored policies, not policies from the exchanges. The rate of growth is (approximately) 100% from 2000 to 2008, and more like 50% from 2008 to 2015.

Is your point that ACA is a good thing since the rate of increase in policy prices has dropped significantly?

I made no point. The facts speak for themselves: employer-provided insurance costs more even without accounting for the Obamacare subsidies. I would assume it a platinum-level benefits comparison.