Replacing the ACA with a GOP plan

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[Twiggidy]

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.

Agree. It's very difficult to have this conversation when people deny a large bullet point in that conversation

 

[GravelRider]

Survival of the Fittest is at play. If you are not fit, you don't survive. Don't turn to me to sustain your life when you choose to disregard evolutionary principles

Then I guess your husband is screwed. Survival of the fittest, right? It doesn't sound like he's too ripe for survival if he depends on bronchodilators. Suck it up, cupcake, and find a new husband.

 

[Twiggidy]

I see alot of new comments as anger at politics dressed in personal problems.

 

[deleted171991]

Combivent costs us $70 co-pay via CVS Pharmacy. The PBM paid over $400 for their contribution.

Which is to say you're don't know what you're discussing. Facts come in handy for these types of discussions unless of course you're shilling for Donna Brazile, Debbie Wasserman Schultz and the other identity politics, "moralists"

It's all ad hominem with you. Re-read my post, and chill. (I wasn't saying an inhaler costs a couple of bucks, I was saying how much it should cost in 2017.)

I am actually advocating for not against sick people. I am a free market guy, and hate many of the aspects of socialism, but when free markets don't work and we are talking about essential stuff (such as food, shelter, clothes, healthcare, education etc.), it's the government's role to step in and fix it. I would love to have a better law than the ACA, unfortunately I don't see it coming soon, given what republicans came up with after 8 years. All I see is pandering to billionaire interest groups, and not to the people of this country. Last time I checked, the Constitution wasn't prefaced with "We, The Corporations"; it could as well be, since corporations are now assimilated to "persons".

 

[Twiggidy]

The big key word hasn't really been used yet, but FFP almost hinted towards it.

TAXES

If you want a good public health care system, be prepared to pay a significant amount in taxes (same goes for schools, public transport, etc). No matter how much you want to bash Western European systesm for their "wait times" they still have it right when it comes to taking care of their citizens. And of course, the wealthier Europeans can use a private system if they please. Yeah, you may make less money as a doctor in those countries but you also have less debt coming out medical school. These are all things FFP was getting at.


In this country we don't want to pay taxes AT ALL, especially if the taxes are benefit someone else and really especially if that person has darker skin and doesn't pray to my God. Instead of having good public school systems that benefit everyone, this country would rather throw money at private schools so their own does well. To hell with those other kids. I want my private insurance so I can go to my boutique hospital and dictate how I'm cared for and if not, I'll sue. Hell no do I want to pay 50% in taxes so we all have health coverage and a functional health system.

 

[Twiggidy]

And maybe....just maybe if the black guy didn't have an obstructionist House and Senate for 8 years then maybe, just maybe the ACA would have been better.....but now that it's another guy, it's "Oh let's work together to get a better bill".....that's when i start to lean into that "reap what you sow" camp.

 

[deleted171991]

The big key word hasn't really been used yet, but FFP almost hinted towards it.

TAXES

If you want a good public health care system, be prepared to pay a significant amount in taxes (same goes for schools, public transport, etc). No matter how much you want to bash Western European systesm for their "wait times" they still have it right when it comes to taking care of their citizens. And of course, the wealthier Europeans can use a private system if they please. Yeah, you may make less money as a doctor in those countries but you also have less debt coming out medical school. These are all things FFP was getting at.


In this country we don't want to pay taxes AT ALL, especially if the taxes are benefit someone else and really especially if that person has darker skin and doesn't pray to my God. Instead of having good public school systems that benefit everyone, this country would rather throw money at private schools so their own does well. To hell with those other kids. I want my private insurance so I can go to my boutique hospital and dictate how I'm cared for and if not, I'll sue. Hell no do I want to pay 50% in taxes so we all have health coverage and a functional health system.

I only hinted at it because I did not realize something important (which you just helped me to), because I don't tend to think like that: in this country, as much as we all declare to be Americans, a lot of people think along interest groups, whether based on race, religion, ethnicity, wealth etc., but still interest groups. Group conscience dwarfs national conscience for too many people. And that's why the country is so divided. And I don't know what can fix it, except for tolerance and compassion and positive feelings, and I don't see them coming soon.

And now we're back to politics, so I'm done here.

 

[RadOncDoc21]

The big key word hasn't really been used yet, but FFP almost hinted towards it.

TAXES

If you want a good public health care system, be prepared to pay a significant amount in taxes (same goes for schools, public transport, etc). No matter how much you want to bash Western European systesm for their "wait times" they still have it right when it comes to taking care of their citizens. And of course, the wealthier Europeans can use a private system if they please. Yeah, you may make less money as a doctor in those countries but you also have less debt coming out medical school. These are all things FFP was getting at.


In this country we don't want to pay taxes AT ALL, especially if the taxes are benefit someone else and really especially if that person has darker skin and doesn't pray to my God. Instead of having good public school systems that benefit everyone, this country would rather throw money at private schools so their own does well. To hell with those other kids. I want my private insurance so I can go to my boutique hospital and dictate how I'm cared for and if not, I'll sue. Hell no do I want to pay 50% in taxes so we all have health coverage and a functional health system.

Not completely sure, but I know at least one billionaire who didn't pay taxes for over 20 years, however our taxes are now paying his salary for making our lives worst.

 

[Twiggidy]

Not completely sure, but I know at least one billionaire who didn't pay taxes for over 20 years, however our taxes are now paying his salary for making our lives worst.

I had coffee so I'm gonna chill for a minute a slide politics out of the mentions so FFP comes back, although a discussion of US Health care is hard to have without mentioning politics. Anywell, taxes is a the meat of this and a big reason why our health system is the way it is. A big reason people didn't want ACA in the first place was because it was going to levy taxes.

Regarding the rise in ACA premiums, yes, but just about all insurance premiums go up. That's nothing new. When it happened with ACA it just became ammunition.

 

[d9sccr]

The big key word hasn't really been used yet, but FFP almost hinted towards it.

TAXES

If you want a good public health care system, be prepared to pay a significant amount in taxes (same goes for schools, public transport, etc). No matter how much you want to bash Western European systesm for their "wait times" they still have it right when it comes to taking care of their citizens. And of course, the wealthier Europeans can use a private system if they please. Yeah, you may make less money as a doctor in those countries but you also have less debt coming out medical school. These are all things FFP was getting at.


In this country we don't want to pay taxes AT ALL, especially if the taxes are benefit someone else and really especially if that person has darker skin and doesn't pray to my God. Instead of having good public school systems that benefit everyone, this country would rather throw money at private schools so their own does well. To hell with those other kids. I want my private insurance so I can go to my boutique hospital and dictate how I'm cared for and if not, I'll sue. Hell no do I want to pay 50% in taxes so we all have health coverage and a functional health system.

This quite frankly isn't true. I don't think there are many people that would love to keep all their money, but common sense dictates that some amount of that has to be taxed to provide numerous services. Bringing race, religion, gender, sexual preference, etc. into the argument is a predictable left-ist argument and doesn't hold true a lot of people. The bigger issue is our spending, there's no way around it. The only country that comes even close to the amount of taxes collected is China who has 1 BILLION more people than the USA. We overspend on everything, receive terrible results, and yet the status quo remains. The military dumped billions into the F-35 to end up with really nice looking paper weights, our social programs that were made to help the unfortunate run rampant with abuse and have become a self perpetuating cycle, we spend more on healthcare than the next several other countries combined, and the list goes on and on. Our government's interventions have rarely, if ever, been shown to improve current situations.

Politicians needs to stop pandering to lobbyists and if they don't, we, the people, should be voting them out of office. In reality, to tackle these issues, I think it's going to take things eliminating career politicians, doing away with lobbyists, etc to improve the country's standing on these issues.

And if you're posting in this forum you already or soon will be paying 50% or more in taxes.

And maybe....just maybe if the black guy didn't have an obstructionist House and Senate for 8 years then maybe, just maybe the ACA would have been better.....but now that it's another guy, it's "Oh let's work together to get a better bill".....that's when i start to lean into that "reap what you sow" camp.

You're once again bringing race into a place where it has no context. Obama and the democrats pushed ACA through the House and Senate without either Republican support or that of the country. Republicans were happy to be obstructionists and the country was happy to see it happen b/c that's not the way this is supposed to work. I fully expect the same thing to happen to the current leading party if they force legislation through in the same way and it's not because Trump is white.

 

[Twiggidy]

This quite frankly isn't true. I don't think there are many people that would love to keep all their money, but common sense dictates that some amount of that has to be taxed to provide numerous services. Bringing race, religion, gender, sexual preference, etc. into the argument is a predictable left-ist argument and doesn't hold true a lot of people. The bigger issue is our spending, there's no way around it. The only country that comes even close to the amount of taxes collected is China who has 1 BILLION more people than the USA. We overspend on everything, receive terrible results, and yet the status quo remains. The military dumped billions into the F-35 to end up with really nice looking paper weights, our social programs that were made to help the unfortunate run rampant with abuse and have become a self perpetuating cycle, we spend more on healthcare than the next several other countries combined, and the list goes on and on. Our government's interventions have rarely, if ever, been shown to improve current situations.

Politicians needs to stop pandering to lobbyists and if they don't, we, the people, should be voting them out of office. In reality, to tackle these issues, I think it's going to take things eliminating career politicians, doing away with lobbyists, etc to improve the country's standing on these issues.

And if you're posting in this forum you already or soon will be paying 50% or more in taxes.



You're once again bringing race into a place where it has no context. Obama and the democrats pushed ACA through the House and Senate without either Republican support or that of the country. Republicans were happy to be obstructionists and the country was happy to see it happen b/c that's not the way this is supposed to work. I fully expect the same thing to happen to the current leading party if they force legislation through in the same way and it's not because Trump is white.

Quite simply....you dont think race is involved becasue I can make a 2-1 odds guess that your race doesn't effect you everyday.

 

[pgg]

And maybe....just maybe if the black guy didn't have an obstructionist House and Senate for 8 years then maybe, just maybe the ACA would have been better.....but now that it's another guy, it's "Oh let's work together to get a better bill".....that's when i start to lean into that "reap what you sow" camp.

He had 2 years with a Democrat House and Senate to get it written "right" ... they didn't. Let's not blame the ACA on the Republicans.

In fairness, right now we're at the start of 2 years of Trump plus a GOP House and Senate and I have little faith they'll get it right either.

 

[Twiggidy]

Well that's what I would like to know because I'm just a naive race baiting 1%er who has health insurance ....so what is "Right". That's basically getting back to the OP which is needed at this point.

What should the ACA / Obamacare/ AHA / Trumpcare ....whatever want to call it, be? I'd love to hear it because all I'm hearing is how both are so bad

 

[IlDestriero]

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.

If you're going to eat cake in front of them, at least get something (1) worth the calories and (2) that they won't even recognize.
I'd recommend SS or white gold Patek or Vacheron.
Or ultimate stealth Grand Seiko.
-Thinking "Wow that's a nice watch... oh, it's just a Seiko..."


--
Il Destriero

 

[GravelRider]

He had 2 years with a Democrat House and Senate to get it written "right" ... they didn't. Let's not blame the ACA on the Republicans.

In fairness, right now we're at the start of 2 years of Trump plus a GOP House and Senate and I have little faith they'll get it right either.

Obama tried to get a bipartisan bill through Congress, but the Tea Party and Mitch McConnell happened. If you recall, there was the so-called "Gang of Six" made up of republicans and democrats that were trying to find compromise on a bill. The republican participants were threatened by McConnell. Bipartisan support of healthcare reform fell through and politics took over again. Obama had no choice, but to force a partisan bill through Congress. Eric Cantor in the House and Mitch McConnell in the Senate pushed a political strategy of obstructionism from the very first days of Obama's presidency. That strategy, along with the Tea Party, helped them to win midterm elections and has contributed to much of the dysfunction in Washington. The Trump presidency is the climax of that political play.

 

[pgg]

Agree. It's very difficult to have this conversation when people deny a large bullet point in that conversation

There's not much to talk about when the only two reasons the Democrats acknowledge as factors in Clinton's loss are racism and stupidity.

What should the ACA / Obamacare/ AHA / Trumpcare ....whatever want to call it, be? I'd love to hear it because all I'm hearing is how both are so bad

1) Provision of zero-deductible healthcare for everyone under the age of about 21 or 23.
2) Medicare-ish coverage for everyone else
3) Significant co-pays for all elective procedures (including "quality of life" procedures like joint replacements)
4) Tort reform to essentially eliminate jury trials and punitive / non-economic damages.
5) Private insurance for people who think they need it or want it

Paid for by
1) large funding cuts to the military (mainly procurement)
2) increasing the age at which social security benefits are paid
3) taxing capital gains as regular income
4) new* tax brackets starting at very high income levels ... perhaps >$1M and >$10M


* not really "new" considering that there was a 90% bracket for (inflation adjusted) $2M+ back in the Eisenhower days

 

[d9sccr]

Quite simply....you dont think race is involved becasue I can make a 2-1 odds guess that your race doesn't effect you everyday.

And you'd be wrong. I make no claim it's not "involved" but it's not the sole or even main reason for people not wanting to hand over more and more of their paycheck to the federal government or the reason Obama was unable to get anything done.

 

[pgg]

Obama tried to get a bipartisan bill through Congress, but the Tea Party and Mitch McConnell happened.

Not so fast ...

As you'll recall, what I wrote was:

He had 2 years with a Democrat House and Senate to get it written "right" ... they didn't. Let's not blame the ACA on the Republicans.

However the bipartisan efforts (whether they were sincere or not) fell through is irrelevant. In the end, the ACA was a PURELY Democratic product and it was passed by them. They could've written anything they wanted and made it law.

You can't blame the GOP for the ACA being such a hot mess.

 

[Twiggidy]

There's not much to talk about when the only two reasons the Democrats acknowledge as factors in Clinton's loss are racism and stupidity.




1) Provision of zero-deductible healthcare for everyone under the age of about 21 or 23.
2) Medicare-ish coverage for everyone else
3) Significant co-pays for all elective procedures (including "quality of life" procedures like joint replacements)
4) Tort reform to essentially eliminate jury trials and punitive / non-economic damages.
5) Private insurance for people who think they need it or want it

Paid for by
1) large funding cuts to the military (mainly procurement)
2) increasing the age at which social security benefits are paid
3) taxing capital gains as regular income
4) new* tax brackets starting at very high income levels ... perhaps >$1M and >$10M


* not really "new" considering that there was a 90% bracket for (inflation adjusted) $2M+ back in the Eisenhower days

Ok finally, a healthy discussion...

but aren't some of these provisions what they originally wanted? i specificially remember that #2 being a point of contention in my residency with anesthesia attendings basically saying if that passed anesthesiologists would go out of business, or were they lying? and if so why would they lie about that? I think 4 will be damn near impossible given all the lawyers in Congress many who probably made a living doing that very thing. and 5 was always on the table. Obama said time and time again that ACA would be an option and if you had your own insurance you could keep it. now maybe i'm wrong, but it really seemed all your suggestions where in the original proposal in some shape or form. but now we have this thing where you won't be required to buy insurance but if you do you get tax credits but the majority of people who need to use ACA can't afford to buy insurance in the first place. i specifically remember an insurance company wanting ridiculous amount per month as a premium because she has a little bit of TR and a had a previous back issue......but she chose an iPhone (lol)...i mean, waited until she got her job when we moved. when i got my first job I had to get my own insurance and i have (knock on a Redwood tree) no medical issues and I paid $100 a month for next to nothing being covered. I only got i just to have something and not pay the $85 penalty. and that was me with doctor money being cheap

 

[deleted162650]

ACA would be an option and if you had your own insurance you could keep it

As someone who lost the plan they had pre-ACA, I can say that part was false.

 

[Twiggidy]

Not so fast ...

As you'll recall, what I wrote was:



However the bipartisan efforts (whether they were sincere or not) fell through is irrelevant. In the end, the ACA was a PURELY Democratic product and it was passed by them. They could've written anything they wanted and made it law.

You can't blame the GOP for the ACA being such a hot mess.

whoa whoa whoa....remember those Blue Dog Democratss though.....that was part of the problem. You had Southern Democrats who were worried about what would happen back in their district if ACA passed and many of them lost their seats because it passed. Now that probably proves your point but it wasn't full Democratic Support in both chambers

 

[Twiggidy]

As someone who lost the plan they had pre-ACA, I can say that part was false.

but without violating privacy laws or HIPPA (i think I was just redundant)....why? did your insurance say you're dropped because ACA was about to pass and they said you can just get on that because that's strange to me...but then again, I have health insurance i don't use so i don't know how these guys work

 

[d9sccr]

Well that's what I would like to know because I'm just a naive race baiting 1%er who has health insurance ....so what is "Right". That's basically getting back to the OP which is needed at this point.

What should the ACA / Obamacare/ AHA / Trumpcare ....whatever want to call it, be? I'd love to hear it because all I'm hearing is how both are so bad

Sorta the crux of the issue...it comes down to whether or not you think healthcare is a right and that everyone should get it. If not, going back to what we had before seems likely.

If you think healthcare is a right, the harder question is how much healthcare is a right? It's a fantasy to think everybody is going to have access and be able to afford the best healthcare we can provide. It's probably possible to provide effective healthcare, but at what cost? Would you personally be content to hand over 55% or 60% or back to 70% of your salary so that your patients receive adequate healthcare? (Don't forget, you get to pay your rising premiums out of pocket on top of that because you surely will be making too much money to qualify for any subsidy.) This comes back to what I alluded to before, the government doesn't effectively spend the outrageous amount of money it collects. I personally don't care to continue giving money to an entity I don't feel is effectively using it.

The issue I take with these two bills/laws is that both lead down the path of single payer that's going to make a very real split in what you can and can't get, further dividing the country.

 

[Twiggidy]

Side note: I just looked at my final paystub from 2016 and realized I paid 16k for health insurance through my employer that neither I or my wife use. If I were smart I wouldn't not elected that, used condoms, and prayed to not get cancer.

 

[pgg]

whoa whoa whoa....remember those Blue Dog Democratss though.....that was part of the problem. You had Southern Democrats who were worried about what would happen back in their district if ACA passed and many of them lost their seats because it passed. Now that probably proves your point but it wasn't full Democratic Support in both chambers

So in 2009, after riding the wave of absolutely crushing Democrat presidential/Senate/House victories into office, the Democrats didn't pass the healthcare plan they really wanted because ... southern democrats were worried about re-election?

And somehow their cowardice and inability to do what they believed in is the GOP's fault?

And a law that was passed without any votes from Republicans is the GOP's fault?

Come on. It's called Obamacare for a reason. He and his party own it. The good, the bad, all of it.

 

[GravelRider]

Not so fast ...

As you'll recall, what I wrote was:



However the bipartisan efforts (whether they were sincere or not) fell through is irrelevant. In the end, the ACA was a PURELY Democratic product and it was passed by them. They could've written anything they wanted and made it law.

You can't blame the GOP for the ACA being such a hot mess.

Is the ACA such a "hot mess?" Was what we had before so terrific? Is it not at least an incremental improvement to what we had before?

Healthcare has become such a partisan issue in the name of politics. In order to put something forward that works, you need everyone to participate and compromise. Even if the ACA were a panacea for our breaking healthcare system, the Republicans would be dismantling it purely in the name of politics. In fact, many of the most important aspects of the ACA are included in the current sh*tty Republican proposal. I guess the ACA is still a "hot mess," though...

Obama wanted single payer. Even with a democrat controlled congress, there would have been no way to push that through. Plus you need buy-in from all the industry players. Is the insurance industry just going to hang it up and say "well, we had a good run" or the pharmaceutical industry just going to give away their next Lipitor for free?

Until we have a functional government that goes beyond politics and convenient obstruction, healthcare will continue to be a "hot mess." Trump actually said it best: Nobody knew that healthcare could be so complicated.

 

[pgg]

but aren't some of these provisions what they originally wanted?

Sure. And they could've done it. They had the votes.

They just lacked ... Courage? Conviction? Interest? Something.

Say what you will about the Tea Partiers (and I'd probably agree with you about them because there's plenty of crazy in that corner) but they know what they want and they fight for it.

i specificially remember that #2 being a point of contention in my residency with anesthesia attendings basically saying if that passed anesthesiologists would go out of business, or were they lying?

I wrote "medicare-ish" not medicare for exactly that reason. Its reimbursement model would be inadequate for keeping doctors of all specialties and hospitals solvent if it was the primary form of insurance in the country. It's not perfect. But it's a fine foundation for building something better that covers more people.

 

[Twiggidy]

Sorta the crux of the issue...it comes down to whether or not you think healthcare is a right and that everyone should get it. If not, going back to what we had before seems likely.

If you think healthcare is a right, the harder question is how much healthcare is a right? It's a fantasy to think everybody is going to have access and be able to afford the best healthcare we can provide. It's probably possible to provide effective healthcare, but at what cost? Would you personally be content to hand over 55% or 60% or back to 70% of your salary so that your patients receive adequate healthcare? (Don't forget, you get to pay your rising premiums out of pocket on top of that because you surely will be making too much money to qualify for any subsidy.) This comes back to what I alluded to before, the government doesn't effectively spend the outrageous amount of money it collects. I personally don't care to continue giving money to an entity I don't feel is effectively using it.

The issue I take with these two bills/laws is that both lead down the path of single payer that's going to make a very real split in what you can and can't get, further dividing the country.

Personally, and this is just me, I think very BASIC health care coverage is a right. You should be able to go to a doctor and get care and possibly surgery if needed. I'm not saying, "boutique, delivery champagne to your room" hospital care. I'm saying, evaluation, diagnosis, and treatment. A country should take care of it's citizens especially the ones that don't have the means to take care of themselves (different discussion). If you have money to buy better, faster, boutique care, then more power to you. Just like I think every child has the right to an education.

Your point about spending is absolutely correct. We spend something like 53% of discretionary spending on the military and like 5% on healthcare. Half of the the 30% goes to the military which Trump wants to increase because he vows to strengthen and expand the military.

Look, if I can go to school for free, go to professional school for free (so long as I"m admitted), get good health care and walk out without a bill....then take ALL my money, but I'm an admitted "Feel the Burn" kind of guy that lives in a 2 bd apt still. So I'm not like most MDs in many ways.

 

[VA Hopeful Dr]

One of the biggest issues that neither the ACA nor the GOP plan address is cost. Until we tackle that, the rest is never going to be fixed long term.

 

[pgg]

Is the ACA such a "hot mess?" Was what we had before so terrific? Is it not at least an incremental improvement to what we had before?

Yes.

No.

No.


You complain about partisanship yet all you do is blame the obstructionist, unreasonable GOP. When I point out that the Democrat majority from 2009-2011 could've done ANYTHING at all, could've passed true reform, given the finger to insurance companies, passed a single payer law, changed the tax code to pay for it, and passed tort reform ... your response is that partisan politics and Republicans got in the way. That Obama/Democrats couldn't do it, and insurance companies wouldn't stand for it, and pharmaceutical companies would stop R&D and we can't have that.

(The simple answer to insurance co objections is simply "screw em", and part of the complex answer to pharmaceutical co objections is FDA reform that makes drug development so expensive.)

 

[Twiggidy]

Politics, capitalism, and health care is a stew that probably shouldn't be simming, but it does in the US.

 

[GravelRider]

Sorta the crux of the issue...it comes down to whether or not you think healthcare is a right and that everyone should get it. If not, going back to what we had before seems likely.

If you think healthcare is a right, the harder question is how much healthcare is a right? It's a fantasy to think everybody is going to have access and be able to afford the best healthcare we can provide. It's probably possible to provide effective healthcare, but at what cost? Would you personally be content to hand over 55% or 60% or back to 70% of your salary so that your patients receive adequate healthcare? (Don't forget, you get to pay your rising premiums out of pocket on top of that because you surely will be making too much money to qualify for any subsidy.) This comes back to what I alluded to before, the government doesn't effectively spend the outrageous amount of money it collects. I personally don't care to continue giving money to an entity I don't feel is effectively using it.

The issue I take with these two bills/laws is that both lead down the path of single payer that's going to make a very real split in what you can and can't get, further dividing the country.

It has nothing to do with whether or not healthcare is a right. That sort of conversation gets very philosophical and I'm not sure our politicians are bright enough for that kind of debate. Everything comes down to controlling costs. As healthcare costs continue to climb higher, even basic healthcare become unattainable for a large group of people. Combine that with an ever widening income gap and you have a significant portion of the population that cannot afford even basic care. Is that the society we want to live in?

For all of its warts, the ACA slowed the rise in costs. That is what our goal should be because for all of the talk about NAFTA and China, it is the cost of healthcare that has handcuffed our economy and caused significant wage stagnation.

 

[Twiggidy]

Yes.

No.

No.


You complain about partisanship yet all you do is blame the obstructionist, unreasonable GOP. When I point out that the Democrat majority from 2009-2011 could've done ANYTHING at all, could've passed true reform, given the finger to insurance companies, passed a single payer law, changed the tax code to pay for it, and passed tort reform ... your response is that partisan politics and Republicans got in the way. That Obama/Democrats couldn't do it, and insurance companies wouldn't stand for it, and pharmaceutical companies would stop R&D and we can't have that.

(The simple answer to insurance co objections is simply "screw em", and part of the complex answer to pharmaceutical co objections is FDA reform that makes drug development so expensive.)

But what I'm saying in reply to that is that the Democrat majority wasn't a true majority because of the so called conservative Democrats. It splits the party which has been the internal criticism of the Democrats for years (and a GOP advantage). So they ended up having to compromise within their own party in order to compromise with the GOP. The same is playing out with the GOP right now which is why even they can't agree on Ryan's plan

 

[GravelRider]

Yes.

No.

No.


You complain about partisanship yet all you do is blame the obstructionist, unreasonable GOP. When I point out that the Democrat majority from 2009-2011 could've done ANYTHING at all, could've passed true reform, given the finger to insurance companies, passed a single payer law, changed the tax code to pay for it, and passed tort reform ... your response is that partisan politics and Republicans got in the way. That Obama/Democrats couldn't do it, and insurance companies wouldn't stand for it, and pharmaceutical companies would stop R&D and we can't have that.

(The simple answer to insurance co objections is simply "screw em", and part of the complex answer to pharmaceutical co objections is FDA reform that makes drug development so expensive.)

Why didn't the GOP work with the democrats on the ACA? I'll answer for you...politics. It's the same reason the democrats won't work with the republicans now. You're portraying the GOP as some noble, innocent bystander in what is wrong with the ACA. Something as incredibly complex as healthcare NEEDS cooperation from everyone. There needs to be complete compromise from all interested parties. Until that happens, everything that is put forth will be a failure.

What we are seeing in Washington is that unilateral party rule and severe partisanship does not work in democracy. Democracy needs compromise in order to work and until politicians are willing to take risks and compromise, we will absolutely never be able to solve a problem as complicated and passion-invoking as healthcare.

 

[doctalaughs]

Personally, and this is just me, I think very BASIC health care coverage is a right. You should be able to go to a doctor and get care and possibly surgery if needed. I'm not saying, "boutique, delivery champagne to your room" hospital care. I'm saying, evaluation, diagnosis, and treatment. A country should take care of it's citizens especially the ones that don't have the means to take care of themselves (different discussion). If you have money to buy better, faster, boutique care, then more power to you. Just like I think every child has the right to an education.

Your point about spending is absolutely correct. We spend something like 53% of discretionary spending on the military and like 5% on healthcare. Half of the the 30% goes to the military which Trump wants to increase because he vows to strengthen and expand the military.

Look, if I can go to school for free, go to professional school for free (so long as I"m admitted), get good health care and walk out without a bill....then take ALL my money, but I'm an admitted "Feel the Burn" kind of guy that lives in a 2 bd apt still. So I'm not like most MDs in many ways.

Ok. I have a new cancer drug. It will give you a 20% long term survival rate for an otherwise terminal disease. The other 80% will live an extra year or two beyond what we had before. Oh, but the drug costs 50k a month and you'll be on it the rest of your life if it works.

Does your "basic" health coverage cover that? Because healthcare is all about decisions like this now, and thats a real example.




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[RadOncDoc21]

Ok. I have a new cancer drug. It will give you a 20% long term survival rate for an otherwise terminal disease. The other 80% will live an extra year or two beyond what we had before. Oh, but the drug costs 50k a month and you'll be on it the rest of your life if it works.

Does your "basic" health coverage cover that? Because healthcare is all about decisions like this now, and thats a real example.




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I think the first question is why does the drug costs so much and who determines the cost? This is why regulations are in place to prevent such a market especially in regards to healthcare.

 

[deleted171991]

I think the first question is why does the drug costs so much and who determines the cost? This is why regulations are in place to prevent such a market especially in regards to healthcare.

That's relatively simple. Because it's basic healthcare, it shouldn't pay more than X dollars/year (and/or Y/lifetime) in benefits, where X and Y are calculated based on funding and healthcare data. You reach your cap, tough luck; you're on your own again, or you fall back on your supplemental private insurance.

Even parents are not legally obliged to support their children beyond the age of 18. Everything must have a limit.

 

[doctalaughs]

I think the first question is why does the drug costs so much and who determines the cost? This is why regulations are in place to prevent such a market especially in regards to healthcare.

Simple- the drug company would claim its a major breakthrough drug thats the biggest advancement in the field for the last 30 years (which is true). However the population using it is not large (those with stage 4 disease probably numbers only a few thousand a year). Therefore to recoup billions in R&D the drug has to be expensive.

Now of course they are probably still gouging the US customers and selling it at a 30% discount overseas. But whether it's 30k a month or 50k doesn't really matter- it would be hard for medicaid like programs to cover but they do.


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[pgg]

You're portraying the GOP as some noble, innocent bystander

Hardly.

I'm much more Democrat than Republican on most issues.

in what is wrong with the ACA.

Sorry, I just can't wrap my brain around how a law passed without them is somehow their fault.

I don't blame the 133 (mostly Democrat) Senators and Representatives who voted against the Iraq Resolution for kicking off that multi-year debacle, either.

Any success or failure of the ACA is entirely a credit or demerit to the party that wrote it and passed it. 219 ayes from the Ds, 1 from the Rs.

 

[Twiggidy]

Ok. I have a new cancer drug. It will give you a 20% long term survival rate for an otherwise terminal disease. The other 80% will live an extra year or two beyond what we had before. Oh, but the drug costs 50k a month and you'll be on it the rest of your life if it works.

Does your "basic" health coverage cover that? Because healthcare is all about decisions like this now, and thats a real example.




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This is where capitalism starts to rear its head. I can't for one second be mad at Big Pharma CEO A because he's trying to make a buck for his company He's running a business. That's why he's supposed to do. I also don't know how much it cost to make said drug because that's a factor as well. It is basic economics. It's devilish, but still economics.

The thing is poor person A/even middle class person A will have whatever coverage they can or can't afford. That's gets them something. If you get terminal cancer, that's is crappy luck, but the something will buy you time to get your affairs in order. Yes, it sounds like the Sarah Palin "Death Panels" quote but the fact is that it's actually a reality. There's a reason Magic Johnson is still alive and other who got infected in his era are not.

People will never be able to get the best stuff without money, not as long as like you said, drug companies look for profit.

 

[doctalaughs]

That's relatively simple. Because it's basic healthcare, it shouldn't pay more than X dollars/year (and/or Y/lifetime) in benefits, where X and Y are calculated based on funding and healthcare data. You reach your cap, tough luck; you're on your own again, or you fall back on your supplemental private insurance.

Even parents are not legally obliged to support their children beyond the age of 18. Everything must have a limit.

I happen to agree. Even private insurance needs a lifetime cap. It's unreasonable to expect society to bear an unlimited burden of expensive treatments, even if they are life-saving.

But thats not the way it is. Imagine the news stories of a life-saving cancer drug being withheld because the patient is on medicaid.

Now should we allow that person having a pre-existing super expensive cancer to then go ahead and buy private insurance (obviously a huge loss to the insurer)?


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[Twiggidy]

Simple- the drug company would claim its a major breakthrough drug thats the biggest advancement in the field for the last 30 years (which is true). However the population using it is not large (those with stage 4 disease probably numbers only a few thousand a year). Therefore to recoup billions in R&D the drug has to be expensive.

Now of course they are probably still gouging the US customers and selling it at a 30% discount overseas. But whether it's 30k a month or 50k doesn't really matter- it would be hard for medicaid like programs to cover but they do.


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Even when that drug goes generic, the population that needs it probably won't be able to afford it, but the hit to Medicaid will be much less. But what they'll do is decide to not pay for something else to make up for it.

 

[GravelRider]

Simple- the drug company would claim its a major breakthrough drug thats the biggest advancement in the field for the last 30 years (which is true). However the population using it is not large (those with stage 4 disease probably numbers only a few thousand a year). Therefore to recoup billions in R&D the drug has to be expensive.

Now of course they are probably still gouging the US customers and selling it at a 30% discount overseas. But whether it's 30k a month or 50k doesn't really matter- it would be hard for medicaid like programs to cover but they do.


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"Breakthrough" drugs like that account for a relatively small percentage of healthcare spending. They make the news because of the obscene pricing, but that's not the major issue. Let's worry about what constitutes "basic" care before we start talking about what a few months of human life are worth.

 

[Man o War]

Health care is a unique topic of discussion, it's very emotional and personal to many people in ways other topics are not.
I say one of the main reasons we don't have President Clinton right now is her attempts to fix healthcare as First Lady and not school lunches. Lots of people never forgot that.

 

[dhb]

It's funny how rosy people in the US imagine the EU heathcare system to be,while over here people with no knowlege on the matter speak of the US system as the worst system in the world 🙂

 

[Twiggidy]

The moral of the entire story will be some new form of ACA will go through but a bunch of people will lose their health insurance. Those who can't afford to buy anything will be holding on for dear life (maybe literally) until they're 65.

 

[doctalaughs]

"Breakthrough" drugs like that account for a relatively small percentage of healthcare spending. They make the news because of the obscene pricing, but that's not the major issue. Let's worry about what constitutes "basic" care before we start talking about what a few months of human life are worth.

I agree - breakthrough cancer drugs are rare. Lets give a more mundane example. Severe psoriasis (say 40% of your body surface area) isn't going to kill you but it's miserable for quality of life and also raises several cardiovascular risk factors. Some of the newer drugs in the last 10 years are way more effective and safer than older generation drugs. They also run about 60k a year and there are hundreds of thousands of Americans on these, both on private insurance and medicaid/medicare (so probably a bigger expense overall than a particular late stage cancer). Should we deny coverage for this?


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