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Obamacare & Healthcare in America (was Tales of People Screwed by...)


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#3441 HockeyDon

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Posted 24 September 2019 - 08:15 AM

View PostTraveler, on 23 September 2019 - 07:44 AM, said:

You certainly do. The employer tax deduction of $280b/y pays for a LOT of coverage.

Is it really that much?

Holy hell.
Well, fuck.

How can I be expected to distinguish BS from reality when so much of my reality is utter BS?!

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#3442 Traveler

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Posted 24 September 2019 - 10:06 AM

Te google don't lie. At least not all the time. :)
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#3443 LFC

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Posted 24 September 2019 - 10:09 AM

Trump and the Republicans have decided what their next assault on Obamacare will be.

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There is an extremely simple and potentially bipartisan idea that could dramatically cut the uninsured rate in America: enrolling people automatically in health insurance.

A new study examined the difference in coverage rates among people who were able to automatically reenroll in their Obamacare plan in California and people who were not. They found people without the option to automatically reenroll in an insurance plan were much less likely to stay insured through the marketplace than people with the automatic option. About 30 percent less likely, according to Coleman Drake at the University of Pittsburgh and David Anderson at Duke University who published their study as a research letter in JAMA Internal Medicine.

They framed their findings in the context of the Trump administration’s consideration of ending automatic reenrollment (which is standard on the Obamacare marketplaces). The unavoidable implication is that more people would end up without health insurance. From Drake and Anderson:

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Elimination of automatic reenrollment would likely be associated with decreases in the number of enrollees who remain insured through the marketplaces. As an opt-out policy, similar to that used in other health insurance markets such as Medicaid, automatic reenrollment may be associated with increases in continuity of coverage in the marketplaces by reducing administrative barriers to reenrollment.

While the Trump administration considers, for whatever reason, ending a policy that keeps people insured, the truth is automatic enrollment is about the bare minimum the United States could do to make sure its citizens have health coverage.

In the abstract, it’s a no-brainer. It crosses ideological lines. As a group of progressive and conservative health policy experts wrote in Health Affairs last year, automatic enrollment could be one useful way to replace the individual mandate (now repealed) in making sure younger and healthier people sign up for insurance and keep Obamacare premiums down.


Weird. Anything that's a "no-brainer" sounds like it's tailor made for Trump. :D
" 'Individual conscience' means that women only get contraceptives if their employers, their physicians, their pharmacists, their husbands and/or fathers, pastors, and possibly their mayors, Governors, State Secretaries of Health, Congressmen, Senators, and President all agree that in that particular case they're justifiable." --D.C. Sessions

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#3444 LFC

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Posted 26 September 2019 - 03:59 PM

Ron Paul submits a piece at TAC that proves he knows nothing about the issues with health insurance. He also can't do the maths so well.

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Was it only 10 years ago that the Tea Party forced Republicans to give more than lip service to the principles of limited government, individual liberty, and free markets?

Back then, even establishment Republicans felt pressure not just to oppose President Obama’s agenda but to repudiate the big-government conservatism of past Republican administrations.

Now, even former Tea Party champions are embracing budget-busting spending deals, new taxes in the form of tariffs, and gun control. The latest sign that the Tea Party is dead is that Republicans, after abandoning the effort to repeal and replace Obamacare, are now using real problems in the health care system to justify new federal mandates.

The legislation in question is Republican Senator Lamar Alexander’s Lower Health Care Costs Act (LHCC). The LHCC is designed to address the problem of surprise medical billing that President Trump has called out. This is where surgical patients are faced with huge, unexpected bills because one or more members of their surgical teams were “out of network.” Patients are not informed that insurance may not cover all the costs of their surgeries until they receive their bills. Many Americans have experienced financial difficulties because of surprise billing, which is a result of government policies that encourage over-reliance on third-party payers. This in turn has led to the rise of health maintenance organizations and the concept of “in-network” and “out-of-network” providers.

Since Congress caused the problem, Congress should fix it. However, the LHCC is a cure that’s worse than the disease. This bill would “fix” surprise medical billing by imposing a system of government-mandated price controls. When footing the bill for out-of-network charges, insurance companies would only have to pay the median in-network rate—an amount substantially less than the market price of health care services.

As is the case with all forms of federally imposed price controls, the bill would create both dangerous shortages and a bevy of perverse incentives. Most notably, insurers would be incentivized to eliminate higher-priced providers from their networks. In doing so, they could manipulate pricing metrics by relabeling those high-cost providers as “out-of-network.” Insurance companies will save money, but hospitals will be forced to restrict access to health care services, and patients will be hung out to dry.


So what's Paul's big solution? Private arbitration. Note that he thinks that a 34% reduction in surprise billing costs is "whopping."

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Another way to rectify the problem is through arbitration—private market negotiations between care centers and insurance companies. New York has gone this route, and according to the National Bureau of Economic Research, it reduced out-of-network billing costs by a whopping 34 percent.


Going to Kaiser, a dependable source of information, we're told that...

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The average price tag for a surprise bill related to care at an emergency department was $628 in 2016, up from $220 in 2010, according to the study. The average surprise bill for inpatient admissions increased from $804 in 2010 to $2,040 in 2016. (Hellmann, 8/12)

Great! So in 2016 surprise bills on average would be reduced to $414 (compared to $220 in 2010) for ER care and to $1,346 (compared to $804 in 2010) for inpatient admissions. This is what "success" looks like in Paul's world. It looks like a solution that helps some but generally doesn't work very well to me. It certainly hasn't been successful enough to justify rolling it out to the entire nation.
" 'Individual conscience' means that women only get contraceptives if their employers, their physicians, their pharmacists, their husbands and/or fathers, pastors, and possibly their mayors, Governors, State Secretaries of Health, Congressmen, Senators, and President all agree that in that particular case they're justifiable." --D.C. Sessions

"That's the problem with being implacable foes - no one has any incentive to treat you as anything more than an obstacle to be overcome."

"The 'Road to Serfdom' is really all right turns." --Progressive Whisperer

""The GOP ... where every accusation is also a confession." --Progressive Whisperer

#3445 LFC

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Posted 06 October 2019 - 11:07 AM

Not sure if this is 100% true but somebody's using it to run for Congress.

Posted Image
" 'Individual conscience' means that women only get contraceptives if their employers, their physicians, their pharmacists, their husbands and/or fathers, pastors, and possibly their mayors, Governors, State Secretaries of Health, Congressmen, Senators, and President all agree that in that particular case they're justifiable." --D.C. Sessions

"That's the problem with being implacable foes - no one has any incentive to treat you as anything more than an obstacle to be overcome."

"The 'Road to Serfdom' is really all right turns." --Progressive Whisperer

""The GOP ... where every accusation is also a confession." --Progressive Whisperer

#3446 golden_valley

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Posted 06 October 2019 - 11:25 AM

View PostLFC, on 26 September 2019 - 03:59 PM, said:

Ron Paul submits a piece at TAC that proves he knows nothing about the issues with health insurance. He also can't do the maths so well.




So what's Paul's big solution? Private arbitration. Note that he thinks that a 34% reduction in surprise billing costs is "whopping."




Going to Kaiser, a dependable source of information, we're told that...



Great! So in 2016 surprise bills on average would be reduced to $414 (compared to $220 in 2010) for ER care and to $1,346 (compared to $804 in 2010) for inpatient admissions. This is what "success" looks like in Paul's world. It looks like a solution that helps some but generally doesn't work very well to me. It certainly hasn't been successful enough to justify rolling it out to the entire nation.

This impulse to send any dispute to court or arbitration fails to recognize that those two solutions require the already injured person to jump through many hoops, maybe incur legal costs, and experience delay and uncertainty while going through the process. The reason the surprise bills happen is that the insurers and medical providers hold all the information while the patient has none until the bill shows up. All this is not justified by some abstract assumption that government regulation is bad in all cases.

#3447 golden_valley

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Posted 08 October 2019 - 01:01 PM

A surprise bill:

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Rancho Palos Verdes resident Carrie Hassanzai contacted me the other day about her 18-year-old son, Ethan, who has cerebral palsy, autism, epilepsy and other serious ailments. He requires a shunt to drain fluid from his skull because of brain surgery.
“He is a severely, severely disabled child,” Hassanzai told me.
About a year ago, Ethan began vomiting and having what seemed like seizures. Hassanzai feared that her son’s shunt had become clogged — a potentially fatal complication.
She and her husband, Moe, a Los Angeles Police Department detective, rushed their son to the emergency room at Torrance Memorial Medical Center.
Hassanzai said the ER doctor on duty felt unsuited to handle the scope of Ethan’s issues. She asked where he’d had his earlier brain surgery — UCLA — and immediately contacted the Westwood facility.
“There was a pediatric neurosurgeon at UCLA, and he said they’d send an ambulance for Ethan,” Hassanzai recalled. “We didn’t know it would be an air ambulance.”
Ethan was flown 20 miles north, treated and released after two nights in UCLA’s intensive care unit.
Then came the bill for the air ambulance. A company called Reach Air Medical Services wanted $51,000 for the trip.

Anthem Blue Cross denied the claim, arguing that use of a helicopter wasn’t medically necessary. Hassanzai appealed. Months passed.

Parents rely on the medial people to provide advice. What are they supposed to do? Pull out their smartl phones and do some sort of comparison shopping for medical advice and transportation.

#3448 pnwguy

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Posted 08 October 2019 - 01:44 PM

"Doctor, tell me what you charge for this heart attack? Aw, that's too much. I'll go across the street to Legacy and get another quote. Rand Paul told me the free market always works best"

Nothing says "shithole country" more than the American system of healthcare delivery. And the hospital administrator is Dr. Bone Spurs.
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#3449 MSheridan

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Posted 08 October 2019 - 02:04 PM

View PostLFC, on 06 October 2019 - 11:07 AM, said:

Not sure if this is 100% true but somebody's using it to run for Congress.

Posted Image

Assertion 1 above is not true as stated, although were it watered down to assert that legislation passed in 1973 and signed by Nixon led to the vast expansion of the for-profit insurance market it would be true enough for all practical purposes.

https://www.snopes.c...t-1973-hmo-act/

#3450 LFC

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Posted 08 October 2019 - 02:08 PM

View Postgolden_valley, on 08 October 2019 - 01:01 PM, said:

Parents rely on the medial people to provide advice. What are they supposed to do? Pull out their smartl phones and do some sort of comparison shopping for medical advice and transportation.

According to the likes of Rand Paul and Paul Ryan, yes. This will foster competition and bring down prices. That's why we have the lowest cellular, internet provider, and prescription drug prices in the world.
" 'Individual conscience' means that women only get contraceptives if their employers, their physicians, their pharmacists, their husbands and/or fathers, pastors, and possibly their mayors, Governors, State Secretaries of Health, Congressmen, Senators, and President all agree that in that particular case they're justifiable." --D.C. Sessions

"That's the problem with being implacable foes - no one has any incentive to treat you as anything more than an obstacle to be overcome."

"The 'Road to Serfdom' is really all right turns." --Progressive Whisperer

""The GOP ... where every accusation is also a confession." --Progressive Whisperer

#3451 LFC

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Posted 11 October 2019 - 12:37 PM

Democrats in Colorado are trying to solve the health insurance problem that federal and state level Republicans have studiously fought to avoid.

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Colorado’s Democratic leadership isn’t waiting for the rest of the country to sort out where it stands on health care; it’s forging ahead with an idea to build on the Affordable Care Act at the state level.

This week, two state agencies in Colorado unveiled a plan that would establish a “public option” — of sorts — for health care in the state.

The plan creates a “state option,” a health insurance plan designed by the state that would be made available to all Colorado residents who buy their own individual health insurance. It’s not quite a “public option” because the state plan is not actually run by the government, like Medicaid are Medicare are. Instead, it would be administered through private insurance companies. But the state would set the rates the insurance companies pay health care providers through this plan.

Colorado intends to get the program up and running by January 1, 2022, at the end of Gov. Jared Polis’s first term in office. Democrats swept the elections statewide in Colorado last November, claiming not just the governor’s office but majorities in both chambers of the state legislature as well. Polis, notably, campaigned on bringing a regional universal, Medicare-like health care option to Colorado in partnership with neighboring states in the western part of the United States. The idea echoed an increasingly popular movement among progressives, currently dominating debate among Democratic presidential candidates for public-run health care. Colorado overwhelming voted against establishing a state single-payer program in 2016 (though the politics of that were complicated).

This proposal is not Medicare-for-All, nor is it a state or regional version of it. Instead, Colorado is proposing something that looks similar to a health care system that Gov. Jay Inslee signed into law in Washington state earlier this summer, which also contracts private insurance companies to offer a state-designed plan.

As the national debate around health care goes in circles, this “state option” is part of a growing push in more liberal states to build on the Affordable Care Act.

" 'Individual conscience' means that women only get contraceptives if their employers, their physicians, their pharmacists, their husbands and/or fathers, pastors, and possibly their mayors, Governors, State Secretaries of Health, Congressmen, Senators, and President all agree that in that particular case they're justifiable." --D.C. Sessions

"That's the problem with being implacable foes - no one has any incentive to treat you as anything more than an obstacle to be overcome."

"The 'Road to Serfdom' is really all right turns." --Progressive Whisperer

""The GOP ... where every accusation is also a confession." --Progressive Whisperer

#3452 baw1064

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Posted 11 October 2019 - 12:46 PM

Worth noting that the Canadian single-payer system is run at the provincial level. It started in Saskatchewan and gradually spread to other provinces.
“Unless someone like you cares a whole awful lot, Nothing is going to get better. It's not.” --Dr. Seuss

#3453 LFC

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Posted 14 October 2019 - 05:04 PM

House Dems are actually trying to lower prescription drug prices. Read this first and then let's talk about costs.

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The centerpiece of House Speaker Nancy Pelosi’s plan to lower prescription drug prices — more direct Medicare negotiations with drug makers, with a hard cap on prices as a backstop — would save the federal government hundreds of billions of dollars, but fewer new drugs would come onto the market, according to a new analysis from the Congressional Budget Office.

The CBO report makes clear the tradeoff for more government intervention in the drug market: Cost savings for the government would equal less spending on research and development by drug companies, which will mean fewer new treatments. What we don’t know is how harmful, if at all, that would actually be.

Pelosi’s proposal, as Vox’s Li Zhou explained in more detail, would allow Medicare to negotiate with drug makers on at least 25 drugs annually and set a hard cap on the highest price the government would agree to pay for the drugs, using international prices as a reference when applicable. Drug makers that declined to participate in the negotiations would pay a massive tax and, as a result, CBO generally expects drug makers to play ball, though a few may decide to pull their drugs from the US market altogether.

The new CBO report projects Medicare would spend $345 billion less over 10 years under the Pelosi plan, most of that because of direct savings on prescription drug spending. At the same time, it anticipates eight to 15 fewer new treatments would be brought onto the US market over 10 years, as drug companies would lose an estimated $500 billion to $1 trillion in revenue.

For context, CBO expects 300 new drugs would be approved for sale in the United States over the same 10-year period. So we’re not talking about a dramatic contraction of the US drug market. But what we don’t know for sure is whether the decrease in drug development would mean fewer innovative breakthrough treatments or if drug makers would instead be discouraged from bringing treatments with marginal efficacy over existing drugs to the market.

The former would be a real problem and adversely affect the long-term health of American patients. The latter, on the other hand, would arguably mean a more efficient pharmaceutical market. The CBO report expressly does not draw a conclusion about which scenario would happen. It doesn’t try to resolve a tension between the increase in pharmaceutical use in the near term (because drugs are cheaper) and the long-term implications of fewer new drugs:

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The overall effect on the health of families in the United States that would stem from increased use of prescription drugs but decreased availability of new drugs is unclear.

Elsewhere in their report, the CBO analysts wrote of these potentially unrealized treatments: “It is difficult to know in advance the nature of these drugs or to quantify the effect of foregone innovation on health.”

So all we get is a big shrug on this critical issue, unfortunately, though it is admittedly an extraordinarily difficult question to try to answer.

There are some other interesting tradeoffs discussed in the CBO report. Prices in other countries are expected to rise because they help set the limits for the prices that can be charged in the United States under the Pelosi plan. List prices for new drugs debuting in the US might be set even higher, as one way to offset the mandated discounts under this proposal.

But this tradeoff — more savings, less innovation — is at the core of the debate about lowering drug costs. The CBO analysis reminds us that such an exchange is inescapable. The question we must still tangle with, one that would benefit from even more analysis in the coming months and years, is whether that exchange is worth making.


$345B savings for Medicare? But we lose 8 to 15 new treatments. OK, so that's $23-43B per treatment. BTW the average cost of bringing a new drug to market is, at a high estimate, is $2.7M but this study on the subject says it might actually be well below $1B. I have a feeling if we took just a small slice of those savings and put it into research at universities we might get a much better ROI. As they make discoveries you can be sure there will be no hesitation by pharma companies to jump in.
" 'Individual conscience' means that women only get contraceptives if their employers, their physicians, their pharmacists, their husbands and/or fathers, pastors, and possibly their mayors, Governors, State Secretaries of Health, Congressmen, Senators, and President all agree that in that particular case they're justifiable." --D.C. Sessions

"That's the problem with being implacable foes - no one has any incentive to treat you as anything more than an obstacle to be overcome."

"The 'Road to Serfdom' is really all right turns." --Progressive Whisperer

""The GOP ... where every accusation is also a confession." --Progressive Whisperer

#3454 baw1064

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Posted 14 October 2019 - 05:10 PM

Even if price controls are enacted, the prices in the US will almost certainly be higher than in any other country. So the idea of a company pulling its drugs out of the US market (or boycotting the US) is ludicrous.
“Unless someone like you cares a whole awful lot, Nothing is going to get better. It's not.” --Dr. Seuss

#3455 Traveler

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Posted 14 October 2019 - 07:57 PM

Oops. You just pointed out how inefficient they are at actually spending of R&D. That's the model after all.
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#3456 indy

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Posted 19 October 2019 - 03:47 PM

Quote

In 2019, the average price of health insurance rose above $20,000 for families that obtain their coverage through work. That’s according to the latest survey of employer benefits from the Kaiser Family Foundation, which found that premiums increased by 5 percent for the second year in a row.

Much of that cost was invisible to workers, who only paid $6,015 directly toward their own premiums on average (up 8 percent from the year before). Employers footed the rest.



Quote

Let’s start with taxes. Officially, Americans don’t pay very much of them. But that picture changes dramatically if you count private insurance premiums as a tax on labor.

If you do, Matt Bruenig of the People’s Policy Project has found that U.S. workers are some of the most highly taxed in the world—ahead even of the French and Finns, who, unlike us, get a decent welfare state with universal coverage as part of the bargain.


https://slate.com/bu...iser-study.html
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#3457 baw1064

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Posted 19 October 2019 - 04:19 PM

But people feel better about paying taxes to our upstanding corporate citizens than to the gubmint!
“Unless someone like you cares a whole awful lot, Nothing is going to get better. It's not.” --Dr. Seuss

#3458 D. C. Sessions

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Posted 19 October 2019 - 04:48 PM

View PostLFC, on 14 October 2019 - 05:04 PM, said:

$345B savings for Medicare? But we lose 8 to 15 new treatments. OK, so that's $23-43B per treatment. BTW the average cost of bringing a new drug to market is, at a high estimate, is $2.7M but this study on the subject says it might actually be well below $1B. I have a feeling if we took just a small slice of those savings and put it into research at universities we might get a much better ROI. As they make discoveries you can be sure there will be no hesitation by pharma companies to jump in.

You might want to look up the relative spending on drug development vs. advertising.
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#3459 JackD

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Posted 19 October 2019 - 07:18 PM

Also, don't forget to look at their profits.

#3460 AnBr

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Posted 19 October 2019 - 08:27 PM

View Postbaw1064, on 19 October 2019 - 04:19 PM, said:

But people feel better about paying taxes to our upstanding corporate citizens than to the gubmint!

Haven't you heard? Gubmint IS the problem!
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