Replacing the ACA with a GOP plan

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BLADEMDA

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If we leave politics aside (I know it's difficult) the key issue is Medicaid expansion. All these proposals do away with the Medicaid expansion in one way or the other leaving the poorest Americans without healthcare (again). Block grants are effective but the budget for those grants must be sufficient to cover all those poor citizens needing help with healthcare.

I pay the ACA tax on my income and investments. I don't like it any more than the next person but should we leave the poorest citizens without healthcare of any kind?
 
http://www.cnbc.com/2017/03/01/none...t-plans-match-what-trump-said-commentary.html

I'm not sure any of the replacement plans are better than the existing ACA. I agree the ACA needs to be fixed but it's a complicated law with many facets.
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They are better because they come from republicans and don't have Obama's name attached.

Neither party wants to admit that healthcare is largely an insoluble problem-given political realities and public expectations.


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Many poor gullible people who voted for Trump will now have to deal with the results of their choice.
These are people who never had insurance before the ACA ,who were somehow made to believe that the ACA was bad for them since Barak Hussein Obama signed it 🙂
 
...should we leave the poorest citizens without healthcare of any kind?
Let them reap what they sow. It's the way politics and voting work.

Meanwhile I'm going to eat cake. I didn't mind the ACA tax too much, but if they insist on getting rid of it maybe I'll also get another Rolex I don't need.
 
No negotiation with pharma or medical device companies in any of those plans? No mechanism for dealing with futile expensive care? FAIL like all other ideas both dems and repubs have come up with.


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At this point I'm doubtful the GOP can pass any of these so called replacement plans. But, I never thought Trump could win the election so I'm not counting him out on getting 51 votes in the Senate to pass one of these so called plans.

I hate paying taxes as much if not more so than the next guy. My taxes went up substantially under Obama vs Bush. But, the country is broke and the poor need healthcare.

Neither party is serious about fiscal responsibility and the ballooning deficit. While I would like a fairer tax code any tax cuts must be budget neutral. As for the ACA the tax associated with that law should be used exclusively to pay for Medicaid expansion. I do think an "HMO type Medicaid system" run by the Statss would be more efficient than the current system.
 
What Republicans want to do to Medicaid
GOP leaders have long said that they believe Medicaid is fiscally unsustainable and a spending cap is necessary *to cut federal spending* and fix its finances. The bill released Monday finally puts those ambitions into official, detailed legislative language.

Starting in 2020, the Republican plan would change how the program is financed. Right now, the federal government’s commitment is open-ended, depending on how many people are enrolled and how much care they receive. (Currently, upwards of 70 million people are covered by Medicaid.) States are required to match a certain percentage of those federal funds.

Under the GOP plan, states would receive a set amount from the federal government for each person eligible for the program. Any costs above that cap would fall on the states. States would receive a different amount for different populations; they would receive more money for each blind and disabled person, for example. The federal spending cap would increase ever year through a formula that is based on overall health care costs.

The new plan does appear to include an olive branch to senators in expansion states worried about their constituents. It would maintain the generous federal funding for that population established by Obamacare — but only if the people are enrolled by 2020 and as long as they never go more than a month without being eligible for Medicaid.

The Republican bill includes some other provisions aimed at doctors and hospitals in the states that did not expand Medicaid under Obamacare, providers who have therefore not seen the same increase in insured customers.

Those states would receive a boost in federal funding, which they can use to increase payments to providers that treat Medicaid patients. The bill would also immediately undo Obamacare’s cuts to Medicaid payments for hospitals that treat a disproportionate share of poor and uninsured patients. For states that did expand Medicaid, those cuts would not be repealed until 2020.

http://www.msn.com/en-us/news/polit...t-medicaid/ar-AAnVdpX?li=BBnb7Kz&ocid=msnbcrd
 
What the Republican plans fail to do: 1. Create lower drug prices. The out-of-control pharmaceuticals are entirely unleashed to make even more profits since there is no increase in competition and now a roll back of taxes. 2. Instead of a government promoted mandate for healthcare, now it once again becomes optional, with no penalties to those that refuse to pay for health care, yet continue to use the health care system. 3. Fails to reduce malpractice litigation by not imposing any caps on pain and suffering nationwide
 
My state didn't accept the Medicaid expansion...probably out of spite...since this is a Republican plan they will play along nicer and the people here will probably have a little better health coverage as a result. I anticipate my patients (pain management) will be happy with this because they don't know they got gipped the first time around.

I stopped taking the Obamacare plans, too many of them were set up like this: you get 7 office visits a year and they paid $80 towards your office visit without negotiating a contract price, so for a $150 level 3 encounter the patient has to pay $70 each visit and then $150 after the 7 allotted office visits run out. And after the patient spent $10,000 of their own money they might start paying for procedures and diagnostic tests. And prescription medication coverage was poor too so even if you're willing to leave a patient on a pain medication-only regimen, they're paying $100/month for pain pills. Couldn't refer any of them to surgeons because they couldn't afford to pay for surgery. I told my patients they would be better off finding a PCP willing to prescribe because at least that other doctor would also be checking their other health issues, ie more value for their costs.
 
If we leave politics aside (I know it's difficult) the key issue is Medicaid expansion. All these proposals do away with the Medicaid expansion in one way or the other leaving the poorest Americans without healthcare (again). Block grants are effective but the budget for those grants must be sufficient to cover all those poor citizens needing help with healthcare.

I pay the ACA tax on my income and investments. I don't like it any more than the next person but should we leave the poorest citizens without healthcare of any kind?

If the poor lose out on health insurance, wont the hospitals and doctors suffer as well? Since they'll just go in the ED, get whatever treatment/operations they need, and won't be able to pay?
 
http://www.cnbc.com/2017/03/01/none...t-plans-match-what-trump-said-commentary.html

I'm not sure any of the replacement plans are better than the existing ACA. I agree the ACA needs to be fixed but it's a complicated law with many facets.

Although I'm a Conservative GOP member I believe the poorest Americans should get some level of basic healthcare.
Agree. It broke my heart to see that we are only contributing less than 1% of income, and how much that means for millions of Americans. I am not for wealth redistribution, paying one's "fair share" of taxes and other socialist brain shampoo, but shame on the republicans! One can judge a society by how it treats the less fortunate, the minorities, those who don't have a strong political voice, the canaries in the mine, and that crappy Medicaid is so little for us and so much for millions of people.

Of course, it was the 3.8% capital gains surtax that pissed of the billionaires. I guess $38K for the poor from every million of passive income is way too much to ask, when one is already paying only half the taxes salaried people do.

This was an opportunity for the republicans to keep what was good and fix everything that was wrong with Obamacare, for example by taking the existing money and spending it in smarter ways. Instead, they weren't able to come up with a better system in 8 years (!!!), and they have proven that all they care about are their pockets.
 
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Come on. We all know why certain poor people in this country vote against their own self interest. I'm torn because part of me says "let them reap what they sow" but they other part of me knows that poor people (including the ones voting against themselves) need care
 
If the poor lose out on health insurance, wont the hospitals and doctors suffer as well? Since they'll just go in the ED, get whatever treatment/operations they need, and won't be able to pay?
They already do that now.

Effect of Medicaid Coverage on ED Use
Amy N. Finkelstein, Ph.D., Sarah L. Taubman, Ph.D., Heidi L. Allen, Ph.D., Bill J. Wright, Ph.D., and Katherine Baicker, Ph.D.
New Engl J Med 2016; 375:1505-1507. October 20, 2016. DOI: 10.1056/NEJMp1609533
 
Agree. It broke my heart to see that we are only contributing less than 1% of income, and how much that means for millions of Americans. I am not for wealth redistribution, paying one's "fair share" of taxes and other socialist brain shampoo, but shame on the republicans! One can judge a society by how it treats the less fortunate, the minorities, those who don't have a strong political voice, the canaries in the mine, and that crappy Medicaid is so little for us and so much for millions of people.

Of course, it was the 3.8% capital gains surtax that pissed of the billionaires. I guess $38K for the poor from every million of passive income is way too much to ask, when one is already paying only half the taxes salaried people do.

This was an opportunity for the republicans to keep what was good and fix everything that was wrong with Obamacare, for example by taking the existing money and spending it in smarter ways. Instead, they weren't able to come up with a better system in 8 years (!!!), and they have proven that all they care about are their pockets.


They have to please certain groups of ppl so their hands are a bit tied id say.
 
If the poor lose out on health insurance, wont the hospitals and doctors suffer as well? Since they'll just go in the ED, get whatever treatment/operations they need, and won't be able to pay?

With the ACA imposing higher and higher out of pocket cost. Most liberals don't realize 70% of hospital bills sent to patients NEVER GET PAID because of cost sharing. So those payments With insurance don't pay their share of costs.

Meaning hospitals are fading non payments from patients regardless if they have insurance or not.
 
If the poor lose out on health insurance, wont the hospitals and doctors suffer as well? Since they'll just go in the ED, get whatever treatment/operations they need, and won't be able to pay?

So to do that math all you have to do and look at the conditions of city hospitals around the country (ie, the hospitals that people with money and insurance already make sure to avoid). Sure in an emergency you can go there and get cared for by residents, but your basic health care. No no. Sorry about your luck sir. And yes, most states have county/city systems but those are funded by.....yep, you guessed it. Medicaid. Yes, that thing "Trumpcare" wants to scrap. You will see lines of people outside clinic doors and the ones who don't have the patience to wait will go and wait and wait and wait in ER just to get sent home for what wasn't urgent.

The big kicker, which if you read all the "keep Obamacare" stories are if something REALLY bad happens to you, ie, Cancer. Poor people who get cancer are ****ed. Now, the won't be able to afford to get anything. And you can't go to the ER for chemo/radiation.

That was the real kicker for getting rid of the "mandate" to please the base and no longer dub it Obamacare. Now it's packed with all the tax credits that poor people can't use because they can't afford health insurance in the first place. And spare me the "don't buy and iPhone, buy health insurance" BS. That's just a reincarnation of the 1980s Reagan Welfare Queen. It's code. We all know what that really means and who it's directed at.
 
Agree. It broke my heart to see that we are only contributing less than 1% of income, and how much that means for millions of Americans. I am not for wealth redistribution, paying one's "fair share" of taxes and other socialist brain shampoo, but shame on the republicans! One can judge a society by how it treats the less fortunate, the minorities, those who don't have a strong political voice, the canaries in the mine, and that crappy Medicaid is so little for us and so much for millions of people.

Of course, it was the 3.8% capital gains surtax that pissed of the billionaires. I guess $38K for the poor from every million of passive income is way too much to ask, when one is already paying only half the taxes salaried people do.

This was an opportunity for the republicans to keep what was good and fix everything that was wrong with Obamacare, for example by taking the existing money and spending it in smarter ways. Instead, they weren't able to come up with a better system in 8 years (!!!), and they have proven that all they care about are their pockets.
U must get subsidize health care from employer or making over 1 million if u are contributing 1% of ur income to ur health expenses

As self employed last year. My premiums for family of 4 on individual market with Florida blue cross was $1400/month PLUS a $7200 high deductible. And that was just for a EPO (a cross between hmo and PPO). A full PPO would have cost me $1700/month.

So 1% of my income. So my premiums alone would have been $17k for the year plus the $7200 deductible. I would have had to make 1.7 million for it to be 1% of my income. Which I obviously didn't come close.

The 3.8% surtax doesn't touch the billionaires.

Remember it's on EARNED INCOME.

that's the joke of the surtaxes. Billionaire do not pay extra Medicare taxes. Because they aren't earning income. It's mainly tax exempt muni bonds dividends etc that aren't exposed to the Medicare taxes.
 
That's been going on for years, even well before ACA.
Yes. And that's what I wanted to point to liberals who think the ACA is saving money. It's just cost shifting. Nothing being saved. Hospitals still getting shafted with patient cost sharing bills sent to patients who won't pay or don't have the means to pay.
 
The joke of the ACA is the exchanges. The obama administration was extremely careful not to collect data on "newly insured previously uninsured" paying into the ACA exchanges. Notice they purposely didn't add any data.

I betcha 90% plus of the 11 million enrolled ALREADY HAD HEALTH INSURANCE. The obama administration just like to inflate the numbers and pad their stats.

Do the math how the obama administration got to the millions "gaining health care" via the ACA

6.2 million young adults added via the parents plan.
11 million on ACA exchanges.
8 million via Medicaid expansion.

1. Young adults are dirt cheap to insure. 95% of young adults can be insured for less than a night at the clubs. Plus if u were likely insured under ur parents plans PRE ACA is u were a full time student up to age 25 anyway with the vast majority of insurers. So 6.2 million young adults ain't gonna to be affected by a repeal.

2. The 11 million on the ACA exchanges. Like I said 90%-95% of them HAD INSURANCE PRE ACA. The obama administration didn't want to collect any of this data. I could have easily canceled my off market health plan and enrolled in ACA exchanges and be considered a "new enrolled " by the obama administration. But am I really a newly insured? Nope. That's why the obama administration didn't want the public to know most were just switching over and not many newly insured paying into the system.

3. Medicaid expansion. Yup. That's about the only success of the ACA. Of course. Success is easy when it's a freebie giveaway.

But the obama administration didn't want to focus on Medicaid expansion. Cause they knew the public wouldn't go for just the Medicaid expansion numbers. They had to inflate the ACA exchanges to make it look like the middle class was being helped.

Last but not least. They said less uninsured. Of course less uninsured. Cause the majority of the newly insured is because of the economy. Most newly insured gained health insured via employers. Duh. That makes sense. But the previous White House just wanted to inflate all the health care numbers to tag it to the ACA as a measure of success.
 
The 3.8% surtax doesn't touch the billionaires.

Remember it's on EARNED INCOME.


that's the joke of the surtaxes. Billionaire do not pay extra Medicare taxes. Because they aren't earning income. It's mainly tax exempt muni bonds dividends etc that aren't exposed to the Medicare taxes.
You are wrong. It changed in ~2013. It's the lesser of the net investment income, or the MAGI above $125K-250K (depending of filing status).

For somebody making tens of millions/year, that can be over a million in extra taxes. Also, let's not forget that cushy long-term capital gains are exempted from AMT, so that 3.8% is really upsetting for wealthy people.

https://www.fidelity.com/viewpoints/personal-finance/new-medicare-taxes

"Tax on net investment income
In the past, taxpayers weren’t required to pay Medicare tax on income generated from investments such as capital gains, dividends, and taxable interest. Since 2013, however, you could owe a 3.8% Medicare tax on some of or all your net investment income.

The amount you owe is based on the lesser of your total net investment income or the amount of your MAGI that exceeds $200,000 for individuals, $250,000 for couples filing jointly, or $125,000 for spouses filing separately.

In other words, you owe the 3.8% tax on the amount by which your investment income exceeds the income thresholds, or, if your wages alone already are higher than the income thresholds, you'll owe tax on the lesser of net investment income or MAGI that exceeds the thresholds."
 
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Why did they vote against their self interest? And which specific interest is that?
I assume this is kind of rhetorical. We know the reasons for this. And I don't think he was pointing out a "specific interest", I think he was talking about their "self-interest" in general, which in this case refers to economics. Poor conservative states receive far more federal entitlement money than the wealthier states that pay out more than they receive. Yet those poorer states generally vote for anti-entitlement politicians, and according to most, (if not all) polls, job availability is almost always the reason for that. And whatever they attribute that too, they definitely see lots of extremely well educated Asian and brown people achieving the American dream that they themselves seem to have missed out on, despite generation after generation of American pedigree. When someone tells them that unfair foreign trade policies, over immigration, and emphasis on future technologies (requiring advanced education), are the problem, they'll probably vote for the guy who promises less immigration, less globalism, and emphasis on old manufacturing.

Whether foreigners and globalization are reasons for their decline or not, xenophobia and prejudice are a major tool used by conservatives to convince people that their lots will improve if only the government would focus less on "the other" and more on them. Small town folks also aren't exposed to much diversity. Throw in right-wing radio hacks telling them that Muslims want "Sharia law" in America, liberals want mass immigration from countries with weird religions or cultures and don't want to make people assimilate, and that businesses won't move to their towns because they pay too much in taxes for "urban" areas, and it's not hard to see why many people think the way they do.
 
I assume this is kind of rhetorical. We know the reasons for this. And I don't think he was pointing out a "specific interest", I think he was talking about their "self-interest" in general, which in this case refers to economics. Poor conservative states receive far more federal entitlement money than the wealthier states that pay out more than they receive. Yet those poorer states generally vote for anti-entitlement politicians, and according to most, (if not all) polls, job availability is almost always the reason for that. And whatever they attribute that too, they definitely see lots of extremely well educated Asian and brown people achieving the American dream that they themselves seem to have missed out on, despite generation after generation of American pedigree. When someone tells them that unfair foreign trade policies, over immigration, and emphasis on future technologies (requiring advanced education), are the problem, they'll probably vote for the guy who promises less immigration, less globalism, and emphasis on old manufacturing.

Whether foreigners and globalization are reasons for their decline or not, xenophobia and prejudice are a major tool used by conservatives to convince people that their lots will improve if only the government would focus less on "the other" and more on them. Small town folks also aren't exposed to much diversity. Throw in right-wing radio hacks telling them that Muslims want "Sharia law" in America, liberals want mass immigration from countries with weird religions or cultures and don't want to make people assimilate, and that businesses won't move to their towns because they pay too much in taxes for "urban" areas, and it's not hard to see why many people think the way they do.


woke like you read about....
 
There is something DEEPLY messed up with a healthcare system that charges 3,300 USD a year, and yet a simple doctor's visit for nonspecific pain and minimal lab workup (no metabolic panel, or CBC) ends up costing 270.00 USD (after a 20.00 USD copay). Paying cash one could negotiate a better price than that, but no, MUST HAVE INSURANCE. Insurance my ass.
 
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I'm all for keeping medicaid and using taxes on passive income to fund it but the system needs major reform. I'm sorry to say that we really do need a 2-tier system however bad that sounds. Everyone needs a baseline of care including access to primary care, generic meds and emergency surgery but medicaid should not cover many things it does now with zero exceptions, because we cannot afford 100k/yr drugs and going to the ER for your cold twice a month.


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There is something DEEPLY messed up with a healthcare system that charges 3,300 USD a year, and yet a simple doctor's visit for nonspecific pain and minimal lab workup (no metabolic panel, or CBC) ends up costing 270.00 USD. Paying cash one could negotiate a better price than that, but no, MUST HAVE INSURANCE. Insurance my ass.

Yeah. That markup is for the medicaid patient that pays a 2 dollar copay for office visits and 20 dollars for surgery. Also pays for the medicare patients that put in 1 dollar for every 3 they use. Where do you think that money comes from?


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We need an n-tier system. Everybody should get almost free/cheap basic non-heroic second-world care for most diseases, and everything else should be with significant co-/insurance, and certain things only out of pocket. It works beautifully in many Western European countries, as most of us know. Of course, that wouldn't permit keeping grandma alive so that the family can fly in to say goodbye (what a waste at a populational level), or getting the craziest treatments just to prolong life by a few months.

We don't need hospitals that look and function like 4-5 star-hotels, with corresponding unreasonable expectations from the population. We need hospitals that serve their function, and offer 3 star-care at 2 star-prices, and 5 star-care at 5 star-prices. As it happens in most of the civilized world, which has similar or better outcomes at half the cost in GDP.
 
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We need a VA-like system of government-run hospitals for everyone on "public" insurance. It can be free for any US citizen, taxpayer run but with a bare-bones formulary, 4 patients per room, almost-impossible to sue and very limited elective procedures. If you want private insurance you gotta pay out of pocket.


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Reserved for comment after I take my exams. This sort of topic requires at least 30 minutes of research.
 
We need an n-tier system. Everybody should get almost free/cheap basic non-heroic second-world care for most diseases, and everything else should be with significant co-/insurance, and certain things only out of pocket. It works beautifully in many Western European countries, as most of us know. Of course, that wouldn't permit keeping grandma alive so that the family can fly in to say goodbye (what a waste at a populational level), or getting the craziest treatments just to prolong life by a few months.

We don't need hospitals that look like 5-star hotels. We need hospitals that serve their function, and offer 3-star care at 2-star prices.

we also need medical eduction that doesn't put someone in the hole for 2-300k, and of course medical-malpractice reform-are there any other countries in the world that have a similar set-up?
 
We need a VA-like system of government-run hospitals for everyone on "public" insurance. It can be free for any US citizen, taxpayer run but with a bare-bones formulary, 4 patients per room, almost-impossible to sue and very limited elective procedures. If you want private insurance you gotta pay out of pocket.


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I think you've just described one of the successful Western European models.
 
the VA almost killed my husband. I made him get a job with a large corporation that provides health insurance. He was self employed until I started medical school and we got married. We have nothing good to say about the VA considering what we experienced.

Repeal ACA. Our copayments are astronomical, our Rx orders are expensive (my husband pays $70 copay) for bronchodilator and all in all, ACA screwed middle class folks and we arent even middle class!

I know too many people like us who were screwed by ACA and we take good care of ourselves - we arent obese, non smokers, etc, etc, etc

ACA is hurting all of us. kill it
its not the ACA, its the cost of healthcare. look at the rate increase yearly pre aca and post aca... they are both unsustainable.

Obesity, smoking, futile care, prescription prices and med-mal are driving up the prices.

My employer and myself combine to pay $21k for a HDCP without the HSA contribution.

its broken. everyone (insurance co, hosp, admin, doc, rn, cleaners, construction workers, lab, medical device manf) wants to make money off it and someone is going to get screwed. right now its the consumer. in 10 years it may be the docs even though were only 5% of healthcare cost.

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the VA almost killed my husband. I made him get a job with a large corporation that provides health insurance. He was self employed until I started medical school and we got married. We have nothing good to say about the VA considering what we experienced.

Repeal ACA. Our copayments are astronomical, our Rx orders are expensive (my husband pays $70 copay) for bronchodilator and all in all, ACA screwed middle class folks and we arent even middle class!

it

How much should a bronchodilator be? A movie ticket is $18 around here.
 
25-30% of every healthcare dollar is spent on a person's last year of life. Adjust that spending so it's geared towards quality of life instead of solely duration and the problem becomes infinitely easier to tackle.
 
I assume this is kind of rhetorical.

I try to assume less and less in the wake of this election.


We know the reasons for this. And I don't think he was pointing out a "specific interest", I think he was talking about their "self-interest" in general, which in this case refers to economics.

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.

(The other just-as-wrong but widely parroted narrative is that they're racist rednecks who hate and fear brown people.)

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.

After every election, we spend a lot of time focusing on the swing states and the 1-2% of voters within those states that tipped the balance. But the GOP base in states like Utah and Texas didn't go to Trump because of economics.


It's a crazy world we live in. I never thought I'd be the guy routinely defending Trump voters.

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.
 
Obesity, smoking, futile care, prescription prices and med-mal are driving up the prices.
Smoking, at least, reduces healthcare costs because smokers tend to die young.

The best fiscal policy for healthcare in this country would be to prescribe mandatory pack-a-day habits to every man, woman, and child in the country. 😉
 
I try to assume less and less in the wake of this election.




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.

(The other just-as-wrong but widely parroted narrative is that they're racist rednecks who hate and fear brown people.)

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.

After every election, we spend a lot of time focusing on the swing states and the 1-2% of voters within those states that tipped the balance. But the GOP base in states like Utah and Texas didn't go to Trump because of economics.


It's a crazy world we live in. I never thought I'd be the guy routinely defending Trump voters.

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.

People do things against their own self interests all the time. It is what makes the human species unique.

Racism, nativism, nationalism, whatever the heck you want to call it played a very significant role in this election. It was not the only factor, but denying the importance of it in Trump's campaign is extraordinarily naïve.
 
How much should a bronchodilator be? A movie ticket is $18 around here.
A couple of bucks. It's not like it's rocket-science to produce in 2017.

Which reminds me: that's one area where the federal government should have intervened. Every time there is an essential basic drug that nobody wants to make at decent prices, just because of profit (think epipen, vaso, you name it) or liability (think droperidol) or other issues (think thiopental), the government should produce it at a low profit level. Having shortages of and/or overpriced basic drugs is ridiculous for such a developed country. Healthcare is one area where the government has to be socialist, Big Pharma be damned. They already make billions on their newest drugs; at least the old ones should be available at "non-US" prices.

Same goes for all the crap that's 10 times more expensive just because it's "FDA-approved". If the monopoly dictates ridiculous prices for essential items, make governmental copycats at low profit. A few thousand Chinese workers will lose their jobs, a few hundred megamillionaires will make less, but tens of millions of Americans will get cheaper care.

.............

Sorry, I was telling you of my dream where I lived in a country where politicians actually served the electorate. Back to sleep.
 
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the VA almost killed my husband. I made him get a job with a large corporation that provides health insurance. He was self employed until I started medical school and we got married. We have nothing good to say about the VA considering what we experienced.

Repeal ACA. Our copayments are astronomical, our Rx orders are expensive (my husband pays $70 copay) for bronchodilator and all in all, ACA screwed middle class folks and we arent even middle class!

I know too many people like us who were screwed by ACA and we take good care of ourselves - we arent obese, non smokers, etc, etc, etc

ACA is hurting all of us. kill it
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.
 
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