# Healthcare!



## TLDR20 (Mar 19, 2017)

Who is ready to talk about healthcare?

I'm particularly interested in hearing people defend the GOP's attempts at repealing the ACA, via reducing coverage and increasing costs for the poorest and oldest among us.

I'd also be interested to hear someone talk about how this bill will at all mesh with POTUS's promises that everyone would still be covered, those on Medicaid wouldn't be affected, and all the other straight up bullshit he promised that he is clearly going back on.

Let's hear it people. Let's hear how this will be better for the average Trump voter, or really average American.

Bonus points if you can defend some of the absolutely bullshit minutiae, like lottery winners taking up six pages...


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## pardus (Mar 19, 2017)

Well I can see this is going to be a fun thread!


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## TLDR20 (Mar 19, 2017)

pardus said:


> Well I can see this is going to be a fun thread!



We had a 60 page thread thrashing Obamacare. I'd like to see this go that route.


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## Marine0311 (Mar 19, 2017)

I'll sub to the thread as I admit I don't know much about the subject. I would like to hear in depth opinions of others and I'll do my own research too.

1. I can go with everyone having healthcare.
2. How is it paid for?

.02 for now.


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## pardus (Mar 19, 2017)

TLDR20 said:


> We had a 60 page thread thrashing Obamacare. I'd like to see this go that route.



Power to you mate.

I just hate political staunchness almost as much as I hate religious staunchness.


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## Ooh-Rah (Mar 19, 2017)

I wish @TLDR20 would stop holding back and state how he really feels!  LOL

I will admit that I have done zero research on Obama Care and even less on Trump's plan.

Why?  Because I have always had a company sponsored health plan and didn't care. That school of thought is either selfish, ignorant, or normal. 

Looking forward to good dialog in this thread, one thing this site seems to do well is challenge my emotional feelings on a topic and force me get fact based before I engage.


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## Kraut783 (Mar 19, 2017)

Well....here is at least a place to start.

Q&A: The facts on the Republican health care bill


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## Muppet (Mar 19, 2017)

Wait, where's my popcorn and milk shake? Let me find a recliner, kick back and watch.....

M.


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## Ex3 (Mar 19, 2017)

I'm a freelancer, I have to purchase my own insurance. ACA (Obamacare) has worked out just fine for me; my rates went down initially and have gone up a little every year but that happened before ACA. I don't qualify for any subsidies. I had a surgical procedure performed a few years ago that went fine. Did the program need work? Yes, but it shouldn't be gutted out of spite.

The only thing I see with Trumpcare - yeah I'm calling it that - is that the people that are the most vulnerable will likely lose care or their rates will go through the roof. AND people like me that can afford to pay our way will now get subsidies. So it's like Robin Hood in reverse, brilliant. :wall: I think some blue collar folks that voted from Mr. Trump hoping for a better America are realizing that they got sold a bill of good. They will be the ones that are going to be most affected by the changes the Trump is putting forth. 
The Trumpcare Conundrum
The Shocking Verdict on Trumpcare


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## ThunderHorse (Mar 19, 2017)

All I know about Obamacare is that coverage costs under it in Arizona doubled for CY 2017.


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## Diamondback 2/2 (Mar 20, 2017)

As much as I hate the idea, I think it's time for a national health care system. Not saying do away with private, but something like the Canucks have for the masses, and if you want better, buy your own.

I think the idea of forcing people to buy, is stupid. I also think a one size fits all will never work. Cover the masses and allow for those who can afford, to buy what they want.

$.02


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## Blizzard (Mar 20, 2017)

Alright, I'll bite...kind of.   Here are some of my general thoughts on the topic...

All the politicians are off base and none of the proposed solutions will have any impact on the core problem of health care (stick with me for a min.).  Obamacare was half-baked and we don't need another half-baked solution.

First, we need to be clear on the difference between health care and health coverage/insurance; they aren't the same thing and the terms should not be used interchangeably.  Health care refers to the actual services provided to a person.  Health coverage /insurance refers to the medical insurance used to pay for a portion or, in some cases, all of the services provided.

What are our politicians really trying to solve for - health care or health coverage?  So, far it appears to be health coverage.  To me, that's not the issue.

The primary issue is whether people receive the care they need, when they need it.  Secondarily, is the issue of managing the continued increases to the cost of care.  Every proposal so far, including Obamacare, suggests the solution to  is to provide everyone with health coverage.  I disagree completely and it certainly does nothing to solve the rising costs of care.  And, despite not having coverage, millions of Americans still receive health care services when they seek it out (uncompensated care).

This is an incredibly complex issue, so there is not a short, simple answer.  That said, to be truly effective, any solution needs to address and result in changes to behaviors and expectations of consumers, providers, payers, and the government.   So, consider the following when viewing proposals:

1.  *Consumers:*  Americans are insulated from the direct costs of care.  We don't ask, as we do with other goods and services, if the extra benefit of service justifies the cost.  This leads to increased cost and utilization.

In addition, rather than take responsibility for maintaining their physical condition, people generally assume the medial system will cure any health problems that arise.  Expectations are often unrealistic regarding the medical system’s ability to repair damage that has occurred over time and/or as a result of abuse (lifestyle choices).  Bottom line:  Americans typically expect no expense will be spared to remedy their problem.

2.  *Providers:*  Physicians play a key role in deciding what medical resources are used.  Because of the threat of malpractice suits and the desire to use new technology, doctors can often be pushed in the direction of doing more than providing only the necessary and effective care.

In addition, despite an increase in the supply of doctors, the distribution of doctors from one part of the country to another remains uneven.  Although the supply of many specialties is far greater than needed, particularly in urban areas, the supply remains inadequate to meet needs in other areas.  Little has been done to address this.

3.   *Payers:*  By simply paying the bills, payers (usually insurance companies…but not always) encourage consumers to use the system in an inefficient way, with little regard or understanding of costs.  Consumers have little incentive to examine cost-effectiveness or quality of care.  Traditional insurance has also directed its payment system to the treatment of disease rather than prevention or early intervention.   While there has been some movement on this issue by plans over the past several years, the tendency to emphasize care for illness over prevention results in both increased costs and reliance on health care.

4.  *Government:*  Government action contributes to, rather than helps, the cost problem.  The legal environment in this country has led to the practice of defensive medicine.  The threat of a lawsuit encourages doctors to provide more services than they would if they did not fear being sued for malpractice.  This results in higher provider fees and premium costs.

Where the federal government could take a leadership role is in defining common data collection formats.  Failure to do so has led to inconsistency, as individual states establish state-specific requirements that are often not comparable to those of other states.  This leads to data deficiencies that often limit the analysis of the cost-effectiveness of accepted, new, and emerging technologies and standards of practice.

A couple more considerations to the cost equation:
*
New technologies:*  Generally speaking, medical devices today do not provide dramatic potential for curing or preventing a major category of disease.  Instead, as shiny and sophisticated as they may be, they tend to only marginally improve the ability to treat disease.  Obviously, a number of technologies are beneficial in improving patient welfare by reducing pain and risk but more often these are diagnostic technologies that enhance the ability to identify medical problems but don't add greatly to the ability to improve a patient’s health.

And the elephant in the room:

*Demographics:*  The population of the U.S. is aging rapidly.   The age group growing most rapidly is senior citizens 85 years and older.  This group makes greater use of the health care system than any other age groups.   In addition, because of chronic or debilitating diseases related to aging, their care often includes more high-cost services, rehabilitation, and/or care and medication use over a long period of time.  These demographic increases in chronic care groups have placed a greater demand on the health care system.  The demand, of course, is followed by an increase in the supply of services that, in turn, leads to increased costs.   This topic is not popular to discuss, especially for politicians.  However, it's an important part of the equation that needs to be discussed as part of any proposed solution.

As mentioned, none of the proposals I've seen discussed address the issues above nor will they help reduce health care costs.  Rather they will serve to exacerbate them.

One of the more interesting concepts I read proposed providing tax incentive back to consumers for the purchase of private policies and eliminating employer offered plans altogether.  I'll see if I can track down a link or two.


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## TLDR20 (Mar 20, 2017)

I obviously have my opinions, but they do fall somewhat short of universal coverage provided by the government.

I do think that every person should have access to insurance. I think the idea that polluting the paying population with sick people will increase the risk pool ignores reality. The more people paying the cheaper it should be. 

I am mostly an in agreement with @Diamondback 2/2, where I think everyone should have basic coverage, for emergencies,  preventative care, maternity and childcare, and hospice. Then outside of that you can buy private insurance to supplement. IMO that would cover most of the bases. Do I think IV drug abusers should be getting heart transplants? No, my empathy has limits, but I do think that our most vulnerable, who are often the working poor, should have free access to the things outlined above, and paid access to other things.

Free preventative care alone would in the long term decrease healthcare costs. Yes it would cost us money up front. But a healthier population uses less resources than an unhealthy one, which means less cost in the long term. 

My last thing is that none of these are overnight fixes. My issue is that people look at healthcare as a right now fix it issue. It isn't most of the time. 

One thing I want to point out is that health care is also not a typical consumer marketplace for one important reason. Healthcare literacy or lack thereof. People simply do not have the literacy in healthcare to understand their options fully. No amount of explaining can bridge that gap. Most people do not understand and are almost incapable of understanding why they don't need antibiotics for the cold, let alone why they need an MRI vs a CT scan...


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## Devildoc (Mar 20, 2017)

Trump's plan, or whoever came up with this debacle before us, is nothing more than change for change's sake.  I am fully onboard with repealing the ACA and replacing it, but this thing, it ain't it.

I wish I knew the answers.  But I know what we had before the ACA wasn't working, the ACA did/does not work, and this won't, either.

I will say that those of us in healthcare are the loudest (or should be) critics of ANY plan because we are at that thin margin where the rubber meets the road and we have seen what works and doesn't work.


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## Ex3 (Mar 20, 2017)

Everyone has great ideas here!

I think the coverage I opted for this year could be a good model to follow. The deductible is relatively high at $7500 but NO deductible is required to see a primary care doctor ($25 copay), a specialist - MD, PT or mental health ($50 copay), or go to an urgent care ($100). Basic tests like blood work and x-rays are also covered. Generic drugs are free, specialty drugs are $50.

The deductible kicks in when something bigger (ie more expensive) is needed like an MRI, surgery, chemo or if you end up in the ER.

we know that preventive care saves money and lives in the long run.
and if people pay into the healthcare system, they should feel like they can use it for preventative care - if a guy feels a funny lump in balls but thinks "I haven't met my deductible yet, maybe it'll go away"!  
Here's a quote for a family of three making $60K in NY. Oscar | Smart, simple health insurance.


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## Blizzard (Mar 20, 2017)

TLDR20 said:


> My issue is that people look at healthcare as a right now fix it issue. It isn't most of the time.


When I first read this statement, I read "most people look at healthcare as a right".  A much different and significantly more controversial statement.



TLDR20 said:


> One thing I want to point out is that health care is also not a typical consumer marketplace for one important reason. Healthcare literacy or lack thereof. People simply do not have the literacy in healthcare to understand their options fully. No amount of explaining can bridge that gap. Most people do not understand and are almost incapable of understanding why they don't need antibiotics for the cold, let alone why they need an MRI vs a CT scan...


Interesting.  Do most consumers know a lot about cars?  homes?  etc.   Do they educate themselves on these major purchases?  Why doesn't the same behavior exist when it comes to something so critically important as their personal health.

To use your term, health care literacy or lack thereof" exists because consumers are insulted from the cost of care, even at the most basic level.  As an example, how much does your provider charge for a basic office visit?   Have you asked (not "you" specifically, but as more of  a generic rhetorical question)?  Are they priced competitively?  If a test or additional service is ordered, how much will that add to the bill and will it change the treatment or effectiveness of care in a meaningful way?  Most consumers cannot answer these basic questions and that is very problematic.  This behavior can and must be changed.


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## TLDR20 (Mar 20, 2017)

Blizzard said:


> When I first read this statement, I read "most people look at healthcare as a right".  A much different and significantly more controversial statement.
> 
> 
> Interesting.  Do most consumers know a lot about cars?  homes?  etc.   Do they educate themselves on these major purchases?  Why doesn't the same behavior exist when it comes to something so critically important as their personal health.
> ...



The difference is your house and car are not your life, literally. People can understand write ups on cars, have people that easily can explain a house fix. I can explain your heart to you in baby language, but that doesn't explain why physiologically you need x procedure in a way that you can really say no to the procedure. You also can't shop for care especially in a hospital setting. 

Most family practice doctors won't accept a patient without insurance, so asking what they charge is a non issue, because you cannot be seen without insurance...


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## Ooh-Rah (Mar 20, 2017)

Here is something that is making big news in Minnesota since we are home to Mayo Clinic.  They have announced that they will give priority to patients with private insurance  vs. public programs.  Would Obama/Trump care fall under the public programs category?

The governor of course is giving the "I'm outraged!" speech, but in the end healthcare is a business.  What are they to do?  (see the bolded below)

Dayton concerned by Mayo Clinic favoring privately insured patients

Mayo to give preference to privately insured patients over Medicaid patients

_Gov. Mark Dayton and Lt. Gov. Tina Smith both expressed concern Friday about a Mayo Clinic policy that in some cases gives priority to privately insured patients over people on public programs._

_In a series of statements over the course of the week *Mayo officials have emphasized* they've *provided* health *services* worth over *$2 billion *to Medicaid, Medicare and uninsured patients that were *unreimbursed*._


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## TLDR20 (Mar 20, 2017)

Ooh-Rah said:


> Here is something that is making big news in Minnesota since we are home to Mayo Clinic.  They have announced that they will give priority to patients with private insurance  vs. public programs.  Would Obama/Trump care fall under the public programs category?
> 
> The governor of course is giving the "I'm outraged!" speech, but in the end healthcare is a business.  What are they to do?  (see the bolded below)
> 
> ...



Obamacare is not insurance. It is a law that allows more people to purchase private insurance.

The ACA allows people to purchase private insurance. It also expanded access to Medicaid.

Medicaid is not private insurance. It is a government program

Medicare is not private insurance. It is a government program.


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## Ooh-Rah (Mar 20, 2017)

TLDR20 said:


> Obamacare is not insurance. It is a law that allows more people to purchase private insurance.
> 
> The ACA allows people to purchase private insurance.
> 
> ...



So therein lies part of the problem, the more liberal leaning talk radio stations up here are ranting that this is an assault on Obama Care by "Big Medical".  Either they (the talk radio folks) do not know what they are talking about, or they are simply trying to get people riled up.  I lean towards a combo of both.


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## TLDR20 (Mar 20, 2017)

Blizzard said:


> When I first read this statement, I read "most people look at healthcare as a right".  A much different and significantly more controversial statement.
> 
> 
> Interesting.  Do most consumers know a lot about cars?  homes?  etc.   Do they educate themselves on these major purchases?  Why doesn't the same behavior exist when it comes to something so critically important as their personal health.
> ...



Again not a personal you; do you have the time or ability to take a biochem class this month before you decide on whether or not to take a diagnostic test, how about an in depth(400-500 level) physiology class? How about a microbiology class before deciding if you need to get antibiotics? That is the kind of education you need to truly understand basic care decisions. There is no car and driver or HGTV for healthcare. There is real education.

88 percent of Americans are healthcare illiterate.


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## Ooh-Rah (Mar 20, 2017)

TLDR20 said:


> 88 percent of Americans are healthcare illiterate.



While I don't necessarily disagree with you.  Where are you getting that number and what does it represent?

I admit that I am illiterate in regards to the Obama/Trump plans because I don't have a personal interest in those plans.  But...I am very up on what my company sponsored plan do and do not provide for me.


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## TLDR20 (Mar 20, 2017)

Ooh-Rah said:


> While I don't necessarily disagree with you.  Where are you getting that number and what does it represent?
> 
> I admit that I am illiterate in regards to the Obama/Trump plans because I don't have a personal interest in those plans.  But...I am very up on what my company sponsored plan do and do not provide for me.



There is a hyperlink I added, it didn't stick the first time.


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## Blizzard (Mar 20, 2017)

TLDR20 said:


> The difference is your house and car are not your life, literally. People can understand write ups on cars, have people that easily can explain a house fix. I can explain your heart to you in baby language, but that doesn't explain why physiologically you need x procedure in a way that you can really say no to the procedure. You also can't shop for care especially in a hospital setting.


Agree, ones health should take precedent over home or car.  Yet, it doesn't.

But I disagree with the idea that one needs to be an expert to understand health impacts and procedures.   Consumers do, however, need to be informed. Sites like www.mayoclinic.org, www.webmd.com, etc. can aid consumers with this to some extent but, of course, they are not a substitute for care.  They can aid in allowing consumers to ask informed questions.  Just as when setting up an effective security/defense, becoming informed on health care issues requires a multi-layered approach.  Providers play a role, the consumer plays a role, etc.   Most health care scenarios don't require the urgent decisions of an emergency room (which, by the way, should not serve as a primary care provider).



TLDR20 said:


> Most family practice doctors won't accept a patient without insurance, so asking what they charge is a non issue, because you cannot be seen without insurance...


Why is that?   I'm not entirely sure that's a true statement but, for the sake of discussion, let's say that it is.  From a provider perspective, insurance is a method of reimbursing the patient for fees paid to the doctor; it's not a substitute for payment.  Requiring insurance coverage in order to receive services only exacerbates the problem of delivery of health care services; the core problem.


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## TLDR20 (Mar 20, 2017)

Blizzard said:


> Agree, ones health should take precedent over home or car.  Yet, it doesn't.
> 
> But I disagree with the idea that one needs to be an expert to understand health impacts and procedures.   Consumers do, however, need to be informed. Sites like www.mayoclinic.org, www.webmd.com, etc. can aid consumers with this to some extent but, of course, they are not a substitute for care.  They can aid in allowing consumers to ask informed questions.  Just as when setting up an effective security/defense, becoming informed on health care issues requires a multi-layered approach.  Providers play a role, the consumer plays a role, etc.   Most health care scenarios don't require the urgent decisions of an emergency room (which, by the way, should not serve as a primary care provider).
> 
> ...



I think you have that backwards. Insurance pays the provider for services, these fees are agreed upon via an prearranged agreement. They only take insurance because it guarntees at least partial payment(via a copay)

Your ideas about improving health literacy are great, the problem is people don't understand what they read. 88%. Print media(including websites) is the least understandable.


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## Blizzard (Mar 20, 2017)

TLDR20 said:


> I think you have that backwards. Insurance pays the provider for services, these fees are agreed upon via an prearranged agreement.


Agree.  My statement was not worded well.

Insurance may cover part or, in rare cases, perhaps all the fees associated with the services provided.  But, regardless of coverage, the consumer is still ultimately always responsible for the services provided.  Point is, insurance can be used to subsidize payment for services but the consumer is still ultimately responsible for covering the costs of those services.  That's probably a more clear statement of what I was really attempting to convey.


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## TLDR20 (Mar 20, 2017)

Blizzard said:


> Agree.  I may not have worded it well (should've removed "patient").
> 
> Insurance may cover part or, in rare cases, perhaps all the fees associated with the services provided.  But, regardless of coverage, the consumer is still ultimately always responsible for the services provided.  Point is, insurance can be used to subsidize payment for services but the consumer is still ultimately responsible for covering the costs of those services.  That's probably a more clear statement of what I was really attempting to convey.



For most/all of the plans that qualify under the ACA, primary care physicians are covered for routine care, with a small co-pay. That means routine physicals, vaccinations, sick visits, lab work. All covered almost 100% via insurance.


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## Devildoc (Mar 20, 2017)

TLDR20 said:


> Your ideas about improving health literacy are great, the problem is people don't understand what they read. 88%. Print media(including websites) is the least understandable.



Not only do they often not understand, most people just don't care to research beyond Dr. Google. 

Education happens different ways:  consumers can be more health literate, and consumers can read publically-reported data that various alphabet soup agencies mandate (ARHQ, NDNQI, etc.).  To the latter I think it is fucking ridiculous to think that a patient with chest pain is going to stop by his laptop or whip out the smart phone to determine which local hospital has the fastest door-to-EKG time.  But that's a different soapbox and a different thread.


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## ThunderHorse (Mar 20, 2017)

Basically we have some people in here going: people are just too willfully ignorant to know what kind of care they need and the coverage they need.

As far as the care is concerned:  I pay the medical provider to explain to me why I need a specific procedure so that bad shit doesn't happen.  It is your job to bring me up to speed if you happen to be the MD in the room.

I've had health insurance my whole life thanks to my mother's awesome employer based coverage and then the Army.  

Is healthcare a right?  If you are brought to an ER I'd say yes.  

Is health coverage a right?  Privilege, you have to pay for it.

Elimination of state borders when it comes to insurers would be a start.  Require a baseline coverage that providers must fulfill for those with pre-existing conditions.

Did the ACA actually make healthcare less expensive?  In some places yes, in some places no.


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## Diamondback 2/2 (Mar 20, 2017)

I will say that I do think there needs to be some regulations on the cost aspects of health care. $5 aspirin and $20 bandaids are causing alot of the problems.  My best bud, shattered his arm in motor cycle wreck. He was in Thailand,  and they pinned his shit back together,  he stayed in a luxury suet for a few days, treated like royalty and probably some of the best medical care in the world. No medical insurance and it cost him $10k, it would have cost a couple hundred grand here in the United States. Now I get the employee cost difference,  I get the space and time cost difference and I get the mark up to cover costs. But no, a aspirin doesn't cost $5, and a bandaid doesn't cost $20, and an x-ray doesn't cost $1,500.

$.02


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## TLDR20 (Mar 20, 2017)

Diamondback 2/2 said:


> I will say that I do think there needs to be some regulations on the cost aspects of health care. $5 aspirin and $20 bandaids are causing alot of the problems.  My best bud, shattered his arm in motor cycle wreck. He was in Thailand,  and they pinned his shit back together,  he stayed in a luxury sweet for a few days, treated like royalty and probably some of the best medical care in the world. No medical insurance and it cost him $10k, it would have cost a couple hundred grand here in the United States. Now I get the employee cost difference,  I get the space and time cost difference and I get the mark up to cover costs. But no, a aspirin doesn't cost $5, and a bandaid doesn't cost $20, and an x-ray doesn't cost $1,500.
> 
> $.02



It does when two of the biggest buyers of drugs in our country, Medicaid and Medicare are prohibited by law from negotiating the costs of those drugs. We can thank the GOP for that gem, which was part of the Medicare expansion under GWB.


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## Diamondback 2/2 (Mar 20, 2017)

TLDR20 said:


> It does when two of the biggest buyers of drugs in our country, Medicaid and Medicare are prohibited by law from negotiating the costs of those drugs. We can thank the GOP for that gem, which was part of the Medicare expansion under GWB.



I wasn't aware of that, and think that's dumb as shit. Basically health care needs to be completely reworked from the laws and regulations stand point. 

Now if we could stop the lobbyists and special interest donation from happening we may get somewhere.

Trying to blame the left or the right on health care, is like debating who was more evil, Saddam or Osama.


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## Devildoc (Mar 20, 2017)

Diamondback 2/2 said:


> I wasn't aware of that, and think that's dumb as shit. Basically health care needs to be completely reworked from the laws and regulations stand point.
> 
> Now if we could stop the lobbyists and special interest donation from happening we may get somewhere.
> 
> Trying to blame the left or the right on health care, is like debating who was more evil, Saddam or Osama.



It is a house of cards, and each card has a name:  GOP, DNC, lobby, laws, litigation, insurance companies, Big Pharma....pull one of those cards out, the whole thing will collapse.  None of the parts is particularly interested in reform.

Lower costs?  Allow Medicare/Medicaid to negotiate drug prices.  Make the insurance companies have the balls to say, "we aren't going to pay over $1 per aspirin; anything over that, you eat the cost." 

It CAN happen, but too many piggies sucking at the teat of Big Medicine.


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## Dienekes (Mar 20, 2017)

I could not agree with Blizzard more. Coverage is a big deal, but considering the problem as a whole, it's like putting a band-aid on the plague. What really needs to be attacked is healthcare costs. Why in the living hell does a saline solution aka saltwater cost so damn much?

Consider pharmaceutical companies. Yea we've all heard about recouping the R&D costs, etc, but has anyone considered that American pharmaceutical companies basically supply most of the world? Well when medicines are kept low cost by price controls in so many countries (most importantly Europe and Canada) but the US, it's the American consumer that bears the burden.

Why do doctors get paid so much? Well, they earned it. They took on $100k+ of debt to learn to take care of your ass and then had to go through residency. But why does med school cost so much in the first place? 

There are so so so many factors that go into healthcare costs that I don't know if anyone could know it all, yet all anyone wants to talk about is coverage. I can tell you if that $2k hospital visit just to go to the ER for a quick fix was to drop to $200 there wouldn't be such a coverage problem, but insurance companies want to make money too so they have to charge you out the ass because they are getting charged out the ass because the hospital is getting charged out the ass because the hospital suppliers are getting screwed. Add into the mix the tremendous healthcare illiteracy and defensive medicine practices already mentioned, and you have a shit show. But no, lets let the American taxpayer pick up the bill. This is a quagmire that will take years and serious crises to fix


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## Lefty375 (Mar 20, 2017)

TLDR20 said:


> Who is ready to talk about healthcare?
> 
> Im particularly interested in hearing people defend the GOP's attempts at repealing the ACA, via reducing coverage and increasing costs for the poorest and oldest among us.
> 
> ...



I always seem to agree with your point of view. We might differ on this topic, but it's way too broad right now. A good start would be a topic like, "is healthcare a right?".


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## TLDR20 (Mar 20, 2017)

Dienekes said:


> I could not agree with Blizzard more. Coverage is a big deal, but considering the problem as a whole, it's like putting a band-aid on the plague. What really needs to be attacked is healthcare costs. Why in the living hell does a saline solution aka saltwater cost so damn much?
> 
> Consider pharmaceutical companies. Yea we've all heard about recouping the R&D costs, etc, but has anyone considered that American pharmaceutical companies basically supply most of the world? Well when medicines are kept low cost by price controls in so many countries (most importantly Europe and Canada) but the US, it's the American consumer that bears the burden.
> 
> ...



You are ignoring a key component in your post. If everyone was covered the hospitals wouldn't have to build in loss to their costs. They wouldn't have to plan to have someone only pay 212 dollars or a 2500 dollar bill. That cost is passed on to the insured currently.

People need to look past the "it's an entitlement" mentality. As our population continues to grey, there will be an ever increasing part of our GDP going to health costs. This is a fact. There are ways to better lower costs. One is through universal coverage. Another would be to allow the government to negotiate or regulate costs. Europe does it, why the fuck don't we? You know who doesn't pay an astronomical amount for medical supplies and medicine? Other parts of the government. The military and VA can and do negotiate the costs for supplies and medications and it is cheaper.

Sometimes there is a place for the power of a government to regulate. IMO this is one of those things. Otherwise you have a hamstrung Medicare/Medicaid system that is forced to pay the average cost +7percent. If you are a business wouldn't you then just charge everyone more so the average price goes up? We would all love a world in which businesses were malevolent and acted in our best interest. But that is certainly not the case, with a few exceptions in the pharmacology world.



Lefty375 said:


> I always seem to agree with your point of view. We might differ on this topic, but it's way too broad right now. A good start would be a topic like, "is healthcare a right?".



I don't know the answer to that. I think that it is more nuanced. Healthcare is treated as a right in the US if you injured or in an accident and go to the ED, but that is more related to the professional codes of physicians than anything else. 

It isn't guarnteed anywhere in the constitution, but then again they literally could not have foreseen a future filled with what we have today, they were still bloodletting... 

My answer is I don't know. My opinion though is health care is a right.


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## Grunt (Mar 20, 2017)

TLDR20 said:


> My answer is I don't know. My opinion though is health care is a right.



As to whether or not it's a right...I do not know. But, it is certainly the "right and decent" thing to provide. Costs are out the roof and that's what needs to be addressed. We pay truckloads of money to insurance companies and then they pick and choose what they want to pay and complain about doing it the entire time. IMO, that's what needs to be addressed pronto quicko.


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## Diamondback 2/2 (Mar 20, 2017)

I think basic health care should be a right. But yet I take issue with people who intentionally do stupid things that ruin their personal health and then demand to be cared for. Smoking, alcoholism, drugs, obesity, etc.


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## TLDR20 (Mar 20, 2017)

Diamondback 2/2 said:


> I think basic health care should be a right. But yet I take issue with people who intentionally do stupid things that ruin their personal health and then demand to be cared for. Smoking, alcoholism, drugs, obesity, etc.



I agree with you to an extent. Fuck man you have turned liberal!

My only caveat is some things are addictive as fuck. Opioid addictions aren't always a personal choice. You could take narcs the way they are prescribed and end up with an addiction to opioids...


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## Grunt (Mar 20, 2017)

TLDR20 said:


> Opioid addictions aren't always a personal choice. You could take narcs the way they are prescribed and end up with an addiction to opioids...



Opioids could have a thread or two of their own. They are their own special kind of hell for many.


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## Il Duce (Mar 20, 2017)

TLDR20 said:


> I agree with you to an extent. Fuck man you have turned liberal!
> 
> My only caveat is some things are addictive as fuck. Opioid addictions aren't always a personal choice. You could take narcs the way they are prescribed and end up with an addiction to opioids...



Yeah, I look at a lot of the healthcare as a 'right' stuff more in a public policy context - what policies give the best returns on investment or prevent the most loss to public resources.  Although I might not want to pay for a drug addict, smoker, or other citizen making bad personal choices if the alternative is $50,000 of public money for treatment or $500,000 for jail/ER costs/law enforcement expenses I feel like there is a moral argument on public grounds.  I feel very similarly about a lot of criminal justice reforms - it's less to me about sympathy for the individuals and more about how to best manage costs to the public - both direct and indirect.


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## Diamondback 2/2 (Mar 20, 2017)

TLDR20 said:


> I agree with you to an extent. Fuck man you have turned liberal!
> 
> My only caveat is some things are addictive as fuck. Opioid addictions aren't always a personal choice. You could take narcs the way they are prescribed and end up with an addiction to opioids...



I have a few liberal leaning opinions, but generally lean to the conservative/constitutional side of things. As I said, I think basic health care should be a right and wouldn't be apposed to constitutional amendment to ensure citizens basic medical needs are met.

That said my conservative belief is that people who make poor life choices, should face the consequences of their choice. If you smoke cigarettes for 30 years and destroy your lungs. I think that's on you to fix, not the government or the tax payers.

Drugs and alcohol addiction sucks and I'm all for community rehabs and assisting people who want help. But unfortunately, many don't want help and don't care about their health enough to stop, in those cases it's on them.

I like personal responsibility and accountability. Yes some things are out of your control and we need to have compassion. But without accountability, people turn into sucking the system for all its worth shit heads.


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## racing_kitty (Mar 20, 2017)

TLDR20 said:


> I agree with you to an extent. Fuck man you have turned liberal!
> 
> My only caveat is some things are addictive as fuck. Opioid addictions aren't always a personal choice. You could take narcs the way they are prescribed and end up with an addiction to opioids...



I'd actually accuse you both of leaning libertarian on that aspect.  Do what you will, just don't make me pay for it, i.e. overeat and binge drink, etc.


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## Scarecrow (Mar 21, 2017)

Out of curiosity - what are the main reasons for opposition to universal healthcare in the US?

Here in Australia we have universal, and also the option of purchasing our own private health coverage and getting a rebate for it on our tax returns to help cover the premiums. I can't speak for other Commonwealth nations but it has worked here just fine.


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## SpitfireV (Mar 21, 2017)

I don't know about the tax side but I suspect much is the same here. 

Am happy to provide an opinion on our system if anyone wants a comparison. I won't make judgements on which is better.


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## Red Flag 1 (Mar 21, 2017)

.


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## Devildoc (Mar 21, 2017)

Scarecrow said:


> Out of curiosity - what are the main reasons for opposition to universal healthcare in the US?
> 
> Here in Australia we have universal, and also the option of purchasing our own private health coverage and getting a rebate for it on our tax returns to help cover the premiums. I can't speak for other Commonwealth nations but it has worked here just fine.



It's a cultural thing.  The country was founded because of taxation without representation; the whole idea of taxes--specifically non-Constitutionally mandated use--is always contentious.  Just like gun ownership.

No one denies that everyone should be able to access and pay for healthcare.  Everyone agrees.  But that is where the road diverges, because then the argument becomes "who is paying for it?"


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## kb2012 (Mar 21, 2017)

Scarecrow said:


> Out of curiosity - what are the main reasons for opposition to universal healthcare in the US?
> 
> Here in Australia we have universal, and also the option of purchasing our own private health coverage and getting a rebate for it on our tax returns to help cover the premiums. I can't speak for other Commonwealth nations but it has worked here just fine.



Well the issue with universal healthcare even in first world countries is that the money runs out. Look at Spain. They have universal healthcare but their government can't afford it. It becomes an issue of how much can you tax to actually cover the costs and how much are people actually willing to pay in taxes. Additionally, a lot of developed countries with universal coverage still have major coverage gaps in rural areas (Russia and Mexico are prime examples, although them being developed nations is arguable), and the effective insured rate is equal to or less of that of the US. Private insurance purchased in addition to public is typically very expensive and the top 10% or so of a nation can actually afford it. Everyone else is plagued with long wait times or short, very rushed visits. 

Taiwan's system has no gatekeeper system (designed to keep people who don't actually need healthcare from getting it and wasting money) and as a result their offices are plagued with too many people, not enough doctors, and individuals can see specialists without a referral and bounce around between multiple doctor's until they get the opinion they want. On an unrelated note, Taiwan has some of the best healthcare management systems in the world. All of your information (medical history, prescriptions, etc.) is loaded onto a smart card that stores information. In order to see a doctor, you simply swipe your health card (which if I'm not mistaken is your ID card) and all of your medical history comes up and your billing information is already stored so the facility can bill the government for it. 

In all honesty, universal coverage sounds like a great idea and it's a noble cause, but it has its own problems. My main problem with Obamacare is that yes, millions more Americans are insured, but their plans are often low premium, high deductible, meaning for an average year, they're still paying all of their medical costs out of pocket unless something catastrophic happens, but even then most of these plans cover a low percentage (50%-70%) and you're still plagued with massive debt following a catastrophic event.

In case anyone is wondering about my credentials, I have a bachelors in Economics and did my senior capstone in Health Economics.



Devildoc said:


> It's a cultural thing.  The country was founded because of taxation without representation; the whole idea of taxes--specifically non-Constitutionally mandated use--is always contentious.  Just like gun ownership.
> 
> No one denies that everyone should be able to access and pay for healthcare.  Everyone agrees.  But that is where the road diverges, because then the argument becomes "who is paying for it?"



At the end of the day, the taxpayers pay for it. Any public hospital, by law, is required to take any and all patients who walk through the door, regardless of their ability to pay. This is called "uncompensated care". At the end of the fiscal year, the government received bills from hospitals for uncompensated care and reimburses the hospitals for most of that amount. If they didn't, public hospitals wouldn't comply with the law. So effectively, everyone in the US can receive healthcare, but it ultimately gets paid for by the taxpayers anyways. Obamacare was designed to solved the "free rider" problem, similar to Romney's law in Massachusetts, but in order to do that, everyone had to have coverage. In order to do that, the government had to subsidize it. In order to do that, the government had to raise taxes, reduce uncompensated care payments, reduce payments for readmissions for Medicare due to hospital related causes, among a host of other things.

@TLDR20 I haven't read too much of this thread, but I can tell you're opposed to repealing and replacing Obamacare. But if you look at many Republican plans (specifically Hatch/Upton/Burr, I believe) they actually keep a lot of Obamacare regulations. The main difference is the individual mandate and how it's being paid for. Any fiscal conservative worth a shit is smart enough to realize that reducing or eliminating Medicare payments to hospitals for second and third visits when the patient contracted an illness from that same hospital is a good thing, or that using existing technology that still works for government sponsored healthcare instead of buying the latest greatest medical tech is a good thing, or that closing the Medicare prescription donut hole is a good thing. But conservatives and liberals disagree on the major theme that underlies most of our debate today as our budget outweighs our tax revenue, which is how (and ultimately who) is going to pay for it.

I do believe in the free market and letting competition drive down costs. As of right now, each state has their own unique medical insurance regulations for minimum coverage, conditions covered, etc. That's the beauty of our country, where individual states can suit the needs and wants of their citizens. But the downfall is that insurance cannot cross state lines. For an insurance company to operate in all fifty states, they have essentially fifty different subsidiaries. This means 50 times the overhead, which gets passed on to consumers. Also, breaking it up into fifty different pieces virtually eliminates an economies of scale that could be realized from having major insurance companies operate nationally. Obviously what we don't want is the industry to become more monopolized than it already is, but I believe we could regulate it responsibly like we do utility companies and keep a few major players in the game (and keep a watchful, non-intrusive eye on them) in order to lower costs.


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## Devildoc (Mar 21, 2017)

kb2012 said:


> At the end of the day, the taxpayers pay for it. Any public hospital, by law, is required to take any and all patients who walk through the door, regardless of their ability to pay. This is called "uncompensated care". At the end of the fiscal year, the government received bills from hospitals for uncompensated care and reimburses the hospitals for most of that amount. If they didn't, public hospitals wouldn't comply with the law. So effectively, everyone in the US can receive healthcare, but it ultimately gets paid for by the taxpayers anyways. Obamacare was designed to solved the "free rider" problem, similar to Romney's law in Massachusetts, but in order to do that, everyone had to have coverage. In order to do that, the government had to subsidize it. In order to do that, the government had to raise taxes, reduce uncompensated care payments, reduce payments for readmissions for Medicare due to hospital related causes, among a host of other things.



Well, yes, and no.  The misconception is that anyone can walk into an ED regardless of being able to pay and get care.  That is not true.  EMTALA is very specific.  The problem is, the hospital and the providers don't want the liability for doing a medical screening exam and sending them on their merry way if the doc thinks the patient doesn't need the ED, only to be burned by the zebra in the herd of horses.  Hence, a $150 pregnancy test that cost $1 at the Dollar Store.  Outside the ED, even in public hospitals, they can turn away patients because of capped beds, census, or if they do not provide whatever service the patient needs.  But you are right in that public hospitals must received patients regardless of their ability/inability to pay.


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## Kraut783 (Mar 21, 2017)

Scarecrow said:


> Out of curiosity - what are the main reasons for opposition to universal healthcare in the US?
> 
> Here in Australia we have universal, and also the option of purchasing our own private health coverage and getting a rebate for it on our tax returns to help cover the premiums. I can't speak for other Commonwealth nations but it has worked here just fine.



Your country has a population of 23.13 million people and started universal health care a while ago, in the 80's I think......we have population of 316.5 million people and are trying to jump into a universal health care system from an established system....there's going to be some bumps in the road.

I'm all for it, but our government has a great way of screwing up a good idea. The closest thing we have to a universal health care type system is the VA (roughly), and as a whole, its a mess....IMHO.


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## Scarecrow (Mar 21, 2017)

Thank you all for the responses.

Looking back at my post, it may have come across as a 'our way is better than your way', but I did not mean it that way. What works for one does not always work for another.

Very complex topic and I look forward to learning more about it and the different viewpoints here.


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## Kraut783 (Mar 21, 2017)

Scarecrow said:


> Thank you all for the responses.
> 
> Looking back at my post, it may have come across as a 'our way is better than your way', but I did not mean it that way. What works for one does not always work for another.
> 
> Very complex topic and I look forward to learning more about it and the different viewpoints here.



No worries...I have been fortunate to have spent time in your country, I truly love it.  You guys have done some great things socially, I really like your student loan programs too.  

We are just late to the game, and having difficulties....


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## kb2012 (Mar 22, 2017)

Scarecrow said:


> Thank you all for the responses.
> 
> Looking back at my post, it may have come across as a 'our way is better than your way', but I did not mean it that way. What works for one does not always work for another.
> 
> Very complex topic and I look forward to learning more about it and the different viewpoints here.



Oh no, I didn't take it like that at all. It's understandable that a lot of people from other countries look at issues in the US (not just healthcare) and say "It's working fine here, why don't they do the same thing?"


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## Isiah6:8 (Mar 22, 2017)

TLDR20 said:


> Who is ready to talk about healthcare?



It is my opinion that if the ACA is not repealed and replaced the program could go defunct as early as Q1 2018.  As more providers back out of the program, some states will be left with zero providers.  The actuaries that are the brightest are telling their companies to get the hell out of this (UNH first more now) due to the losses they are modelling and realizing. 

Some data: Sharp Decline in Competition Across ACA Exchanges, Experts Predict
_With so many insurers dropping out of several ACA exchanges due to substantial financial losses, CMS has taken some steps to stabilize the markets such a request for information on patient-steering concerns.  More than half (55%) of rating regions may have two or fewer carriers in 2017, Avelere's analysis found. The projections were made by calculating next year's competition levels by comparing current carriers' 2016 participation to the reduced levels some have announced for 2017, including Aetna, Humana, UnitedHealth, and some co-ops.  In contrast to the 36% of rating regions predicted to have only one or fewer companies offering plans next year, Avalere found that in 2016, only 4% of rating regions had one or fewer. The firm concluded that seven states (AK, AL, KS, NC, OK, SC, WY) will have just one carrier per rating region in each rating region in the state in 2017.
_
So the impact of decreased competition has been massive premiums and deductible rate hikes.  This flows through to the state level:
Tennessee insurance commissioner: Obamacare exchange 'very near collapse'
ObamaCare’s Meltdown Has Arrived

With the majority of Americans living paycheck to paycheck and not having anything in savings, they are unable to pay the high deductible's and are more likely to go without insurance until something happens to them.  Then sign up and get the treatment they need. 

By adding hi risk pools back in which takes care of the 3:1 underwriting requirement and coupling with HSA accounts and no more "defined-benefit" plans, there will probably be more people insured at a lower cost for what they need insurance for.   I think the repeal replace will actually benefit the individual because I do not believe ACA is sustainable in the current form.


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## kb2012 (Mar 22, 2017)

Kraut783 said:


> No worries...I have been fortunate to have spent time in your country, I truly love it.  You guys have done some great things socially, I really like your student loan programs too.
> 
> We are just late to the game, and having difficulties....



A social program that I am totally on board with, and I'm surprised not many states do this (and my home state, Georgia, of all places does) is state funded tuition. In GA we have the HOPE Scholarship. It's funded through the GA Lottery and the state of GA will pay 90% of your tuition at any public college (I don't think they cover private colleges) as long as you maintain a 3.0 GPA. I took full advantage of this and graduated with $3k in student loan debt.


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## Devildoc (Mar 22, 2017)

Kraut783 said:


> No worries...I have been fortunate to have spent time in your country, I truly love it.  You guys have done some great things socially, *I really like your student loan programs too*.
> 
> We are just late to the game, and having difficulties....



I don't think the government should be in the business of bankrolling college, but that's another thread.



kb2012 said:


> Oh no, I didn't take it like that at all. It's understandable that a lot of people from other countries look at issues in the US (not just healthcare) and say "It's working fine here, why don't they do the same thing?"



For the same reason people in the US look at other counties and ask the same thing.  I think it's easy--and dangerous--to play that game, but that gets us in trouble (well, democracy works here, why can't we make it work in whatever country).

I do think, however, there is good reason to have dialogue on what other countries do/don't do, why things work/don't work, but you (not 'you' you) need to have the discussion with the history and culture in context.


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## kb2012 (Mar 22, 2017)

Another issue with the individual mandate is that tax penalties come out of the yearly tax refund. If you state you do not have insurance on your taxes, they simply take the penalty out of your taxes. If you're a high income individual, then you have to pay. Millions of low income Americans that receive tax credits for having children and EITC and receive thousands back in a refund every year, and it's often viewed as no money "out of pocket" for the penalty since it's coming from money they haven't yet received and didn't necessarily work for (I made this much this paycheck and now I have to pay out of pocket for this penalty).


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## Isiah6:8 (Mar 22, 2017)

kb2012 said:


> Another issue with the individual mandate is that tax penalties come out of the yearly tax refund. If you state you do not have insurance on your taxes, they simply take the penalty out of your taxes. If you're a high income individual, then you have to pay. Millions of low income Americans that receive tax credits for having children and EITC and receive thousands back in a refund every year, and it's often viewed as no money "out of pocket" for the penalty since it's coming from money they haven't yet received and didn't necessarily work for (I made this much this paycheck and now I have to pay out of pocket for this penalty).



Do you actually think that people are checking the box that says they are uninsured?  Given how tight the elections are across the board is there really going to be a rush to send the IRS to penalize the poorest who are trying to get around paying an extra tax?  Here is a pretty good scenario I am stealing:

An independent contractor, say a bricklayer living on $40,000 a year, is unlikely capable of covering a $2250 annual Deductible for his “Silver” plan, to say nothing of his $6600 out-of-pocket maximum in 2017, should he be injured, should he need to utilize his health insurance, regardless of whether he qualifies for federal subsidies for his $425 monthly premiums.

So what’s the end game?

He’s going to go without health insurance.

He’s going to pay the $695 tax under the ACA (which may be as high as $1000 should he appropriately pay the 2.5% of his AGI per the ACA provisions)…. We’ll at least he doesn’t have a wife and two kids, or his penalty would be $2085, calculated at $695 per adult and $347.50 per child!

He’ll sign up for an ACA plan only if (or when) he gets hurt.

The question is, will he check that box on his tax form come April, confirming that he is uninsured?

If not, will the IRS come calling to confirm that he’s covered by an ACA-compliant plan?

And if they do, will he be charged that tax in an audit of his 2017 federal tax return?

And if he happens to avoid that audit in ‘17, what about in ’18, when another round of Insurers likely exit the ACA program, and he finds himself living in a county where there are no ACA-Compliant offerings to be had?

Will this administration seriously consider taxing its least affluent citizens for failing to purchase a product that they have no means of affording, and on a more practical level, a product that they may have no access to in the first place?


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## kb2012 (Mar 22, 2017)

Keep in mind I'm not defending the ACA, but I do think it needs to be judged fairly.

The poorest of the poor, if they fall under the income threshold (which I believe is 140% of the FPL, which is the maximum to which you qualify for a 100% subsidy) are exempt from the penalty. I'm not sure if there was a time restriction on that (I know they pushed all of these regulations through in phases, so they may introduce a penalty later on). So the IRS will not tax the least affluent citizens, but more than likely it will hit the middle class hard, as with your example at the top.

Also, every individual I've talked to who hasn't checked the box (this is a handful of people, so there may be some sampling error) has still gotten letters from the IRS stating they know that the individual was not insured and they assessed the tax penalty on them. The big problem with spotty reporting and accountability I've seen and heard of is people who are offered insurance by their employer, who by definition of the law are forced to take that insurance and cannot sign up for the exchanges, are able to get away with lying on the exchanges by saying their employer does not offer them coverage so they can sign up for a plan there.

In addition, what you have described is known as the free rider problem. It's harder to fix now because insurers cannot deny coverage due to pre-existing conditions (i.e. your example of getting injured and then getting insurance), but I believe insurers still have the right to install a waiting period on coverage so you can't essentially buy coverage today and use it today because you got injured yesterday. I may be wrong but I'm fairly certain they still maintain that right.


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## Isiah6:8 (Mar 22, 2017)

They do maintain the right, you are correct as far as I know.  I know you are not defending, and I should preface with my stance is only due to my thoughts that it is not sustainable in its current form.  

I will be very interested to see if there is a push to penalize those who got a letter because that to me sounds like something big gov't would be dumb enough to do, and a quick way to lose a lot of votes.  I say that because I think that is a huge issue that is coming up.  I will steal a snippet from a PM who I work with who wrote on this:

_There are 25 incumbent Democrats seeking reelection (out of 33 contested seats) in 2018, all of whom conceptually cast the “deciding vote” in the 2010 passage of the Affordable Care Act. Should Senate Majority Leader McConnell and the Republicans fail to secure the eight Democratic votes necessary to REPLACE the ACA, Trump and the Republicans may simply revert and postpone the repeal of the tax and coverage provisions of the ACA, thereby allowing the ACA to effectively remain in place until 2018.  In this scenario, per previous observations, the economics of the ACA exchange offerings would presumably continue to unravel. At this point, the Republicans may then look to run in 2018 against the Democrats as obstructionists and “owners” of the problem once again (intending to secure the requisite 60 votes necessary to move forward with their plans “at the ballot box” rather than “across the aisle”).
_
My personal views are that we should help take care of everyone we can and that health coverage should be something every American has access to, I do not know who will front the bill nor have I worked out who should.  I keep struggling with that in my head of what I think is morally right and what is realistically feasible.


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## kb2012 (Mar 22, 2017)

Well hopefully some Democrats will get on board. Even all of the ultra-liberal economics professors I had in college were smart enough to realize that the ACA is robbing Peter to pay Paul. And with the crazy results of this election, a growing number of blue states are being contested. The Democrats will have to please their constituency or lose their seats.


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## Isiah6:8 (Mar 22, 2017)

kb2012 said:


> Well hopefully some Democrats will get on board. Even all of the ultra-liberal economics professors I had in college were smart enough to realize that the ACA is robbing Peter to pay Paul. And with the crazy results of this election, a growing number of blue states are being contested. The Democrats will have to please their constituency or lose their seats.



You took the words out of my mouth.  It will be interesting to see for sure.  I think that there are some very good things in the ACA (no lifetime limits on coverage, staying on parents insurance until 26, etc), and just whatever comes forward from all this is more sustainable.


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## Blizzard (Mar 23, 2017)

Interesting observation in the complete repeal vs Republican replacement debate:
https://www.nytimes.com/2017/03/21/...th-gop-plan-than-with-simple-repeal.html?_r=0



> The Congressional Budget Office recently said that around 24 million fewer Americans would have health insurance in 2026 under the Republican repeal plan than if the current law stayed in place...
> 
> ...But one piece of context has gone little noticed: *The Republican bill would actually result in more people being uninsured than if Obamacare were simply repealed. *Getting rid of the major coverage provisions and regulations of Obamacare would cost 23 million Americans their health insurance, according to another recent C.B.O. report. In other words, one million more Americans would have health insurance with a clean repeal than with the Republican replacement plan, according to C.B.O. estimates.


With that in mind, if you're going to light the match, burn the fucker down.


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## TLDR20 (Mar 23, 2017)

Blizzard said:


> Interesting observation in the complete repeal vs Republican replacement debate:
> https://www.nytimes.com/2017/03/21/...th-gop-plan-than-with-simple-repeal.html?_r=0
> 
> 
> With that in mind, if you're going to light the match, burn the fucker down.



Burning it down would burn the people who signed it down. There are way too many popular provisions in the ACA. Preexisting condotions, coverage on parents plans until 26. People love a lot of that. They(middle class and upper middle class Republican voters) aren't going to be pleased when their 21 year old graduates college and doesn't have health insurance.


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## kb2012 (Mar 23, 2017)

Blizzard said:


> Interesting observation in the complete repeal vs Republican replacement debate:
> https://www.nytimes.com/2017/03/21/...th-gop-plan-than-with-simple-repeal.html?_r=0
> 
> 
> With that in mind, if you're going to light the match, burn the fucker down.



Keep in mind that being insured is just a label. Just because you have insurance, what good is it with a $5,000 deductible, when you're spending $3,000-$4,000 out of pocket in medical expenses anyways? You're still paying that amount out of pocket with a high deductible, but now you're forced to pay these premiums, which are on the rise. Yeah, you "have insurance" but what good does it to you if you never get to use it? It does nothing to actually reduce out of pocket medical expenditures. Sure, it could come in handy if you get in a nasty car wreck or have a freak accident, but it's important to remember that even though these are big headline stories, they're not as common in proportion to the 99% of the healthcare utilization in this country, which is general medical services like a family practice or the occasional referral to a specialist. And even if you go see a specialist, insurance won't kick in unless you meet your deductible, and then you're still on the hook for the first 5 grand.

My point is this: The reason the law was put into place was because healthcare was "unafforable" and "millions of Americans were uninsured", but having insurance doesn't mean shit unless it's good insurance. It's a freakin political tagline; that's it. They want to be able to say "I helped millions of Americans get covered under health insurance!" They're still broke though. Healthcare in general is still unafforable.



TLDR20 said:


> Burning it down would burn the people who signed it down. There are way too many popular provisions in the ACA. Preexisting condotions, coverage on parents plans until 26. People love a lot of that. They(middle class and upper middle class Republican voters) aren't going to be pleased when their 21 year old graduates college and doesn't have health insurance.



You're not being fair. The Hatch/Upton/Burr plan keeps all of those provisions in. 

https://energycommerce.house.gov/si...files/114/20150205-PCARE-Act-Side-by-Side.pdf


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## Devildoc (Mar 23, 2017)

kb2012 said:


> Keep in mind that being insured is just a label. Just because you have insurance, what good is it with a $5,000 deductible, when you're spending $3,000-$4,000 out of pocket in medical expenses anyways? You're still paying that amount out of pocket with a high deductible, but now you're forced to pay these premiums, which are on the rise. Yeah, you "have insurance" but what good does it to you if you never get to use it? It does nothing to actually reduce out of pocket medical expenditures. Sure, it could come in handy if you get in a nasty car wreck or have a freak accident, but it's important to remember that even though these are big headline stories, they're not as common in proportion to the 99% of the healthcare utilization in this country, which is general medical services like a family practice or the occasional referral to a specialist. And even if you go see a specialist, insurance won't kick in unless you meet your deductible, and then you're still on the hook for the first 5 grand.
> 
> My point is this: The reason the law was put into place was because healthcare was "unafforable" and "millions of Americans were uninsured", but having insurance doesn't mean shit unless it's good insurance. It's a freakin political tagline; that's it. They want to be able to say "I helped millions of Americans get covered under health insurance!" They're still broke though. Healthcare in general is still unafforable.



Most of this is catastrophic insurance, period. 

Until they deal with the insurance industry, tort/malpractice industry, regulatory/accreditation industry, pharmaceutical industry, and lobbying industry, it will remain unaffordable.

I am not always keen about my employer, and my insurance does increase every couple years, but it is not bad insurance, and still affordable, so I am better off than a lot of people.


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## Blizzard (Mar 23, 2017)

TLDR20 said:


> Burning it down would burn the people who signed it down. There are way too many popular provisions in the ACA. Preexisting condotions, coverage on parents plans until 26. People love a lot of that. They(middle class and upper middle class Republican voters) aren't going to be pleased when their 21 year old graduates college and doesn't have health insurance.


I'm admittedly not a fan of any of these proposals for the reasons mentioned in my initial post in this thread; primarily that they do nothing to actually address the fundamental cost issues associated with health care.  That said, there is no reason it couldn't be burnt down and rebuilt from scratch, with a little thought this time.  If there are provisions that are "popular", they could be written back into a new plan.


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## Isiah6:8 (Mar 23, 2017)

Devildoc said:


> I am not always keen about my employer, and my insurance does increase every couple years, but it is not bad insurance, and still affordable, so I am better off than a lot of people.



Quick opportunity to save some money if you can negotiate it:

It is very expensive for a company to insure their employees.  If you have a spouse who is working, use this as leverage.  Rough hand estimate the cost to a company to insure an employee as $5,179 for a single employee and $12,591 to cover a family per year (83% of the premium on the avg premium for single coverage; 72% for family).  Talk to your company or have spouse talk to theirs, and give them a win-win opportunity.  Your family will save the company money by not going on the company insurance, and in turn, they will write a check for the full amount of the insurance that your family pays.  Your family is covered, and the company is saving more money by not having you on their insurance. 

My wife and I looked at the coverage options and hers was much better than what mine was offering.  I brought this to my company, and they are more than happy to write a check every three months which pays for us to be insured on the best plan if we did not come on my firm's insurance plan and stayed on hers. 

Roughly 90% of employers are seeing rate increases, they want to save where they can whenever they can.


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## Devildoc (Mar 23, 2017)

Isiah6:8 said:


> Quick opportunity to save some money if you can negotiate it:
> 
> It is very expensive for a company to insure their employees.  If you have a spouse who is working, use this as leverage.  Rough hand estimate the cost to a company to insure an employee as $5,179 for a single employee and $12,591 to cover a family per year (83% of the premium on the avg premium for single coverage; 72% for family).  Talk to your company or have spouse talk to theirs, and give them a win-win opportunity.  Your family will save the company money by not going on the company insurance, and in turn, they will write a check for the full amount of the insurance that your family pays.  Your family is covered, and the company is saving more money by not having you on their insurance.
> 
> ...



If I was single, it's at almost no-cost.  My wife is at home (we homeschool), so there's that.  Still, it's 'only' $461/month.  I know others have it far worse.


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## TLDR20 (Mar 23, 2017)

kb2012 said:


> You're not being fair. The Hatch/Upton/Burr plan keeps all of those provisions in.
> 
> https://energycommerce.house.gov/si...files/114/20150205-PCARE-Act-Side-by-Side.pdf



He said burn it down from scratch and start over. How can I be more fair?


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## Isiah6:8 (Mar 23, 2017)

Devildoc said:


> If I was single, it's at almost no-cost.  My wife is at home (we homeschool), so there's that.  Still, it's 'only' $461/month.  I know others have it far worse.



Awesome! Ours is a little over $660/mo which isn't terrible comparatively but nice enough to not have to pay.


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## kb2012 (Mar 23, 2017)

TLDR20 said:


> He said burn it down from scratch and start over. How can I be more fair?



Because all of the serious replacement plans I've seen that they want to implement after Obamacare is dismantled includes those provisions. You're saying it's a bad idea to scrap the current plan because the new plans lack vital regulations, when in fact they preserve a lot of them.


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## Blizzard (Mar 23, 2017)

And just because is a plan provision is "popular", that doesn't mean it's affordable or the best approach.


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## TLDR20 (Mar 23, 2017)

kb2012 said:


> Because all of the serious replacement plans I've seen that they want to implement after Obamacare is dismantled includes those provisions. You're saying it's a bad idea to scrap the current plan because the new plans lack vital regulations, when in fact they preserve a lot of them.



You are missing the point trying to argue. He said completely repeal, that means completely.


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## Devildoc (Mar 24, 2017)

Why is healthcare expensive?

Here is the story I got when I came to work this morning:

Overnight a 450 lb woman was laying on her couch, watching TV.  She rolled off, called EMS, who brought her to the ED with back pain and head pain.  They called a "trauma alert," so the trauma team evaluated.  She got:  plain films (of everything), pan scan (CT of head, chest, abdomen).  By dawn's early light they found...0 injury.  She is being discharged with follow up with neurology (for the headache) and ortho (for the various aches and pains).

I can't make this stuff up.


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## ThunderHorse (Mar 24, 2017)

Devildoc said:


> Why is healthcare expensive?
> 
> Here is the story I got when I came to work this morning:
> 
> ...


Natural selection used to make those choices for us...


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## Il Duce (Mar 24, 2017)

I thought this was a pretty readable explanation on how healthcare costs are much different than how we commonly discuss them: What the G.O.P. Doesn’t Get About Who Pays for Health Care


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## Devildoc (Mar 24, 2017)

Il Duce said:


> I thought this was a pretty readable explanation on how healthcare costs are much different than how we commonly discuss them: What the G.O.P. Doesn’t Get About Who Pays for Health Care



Quick and interesting read, but only tells part of the story.  Sure, for some, it's an investment (if you want to continue that analogy).  But for others, it's the expectation.  People show up to the ED or community clinic, they will say "It's free, I have Medicaid/Medicare."  So because it's free, they DO consume...over, and over, and over.  And they don't get their preventive maintenance (which is why in most cases they are at the ER or clinic).

I don't have the answers, for sure.


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## Il Duce (Mar 24, 2017)

Devildoc said:


> Quick and interesting read, but only tells part of the story.  Sure, for some, it's an investment (if you want to continue that analogy).  But for others, it's the expectation.  People show up to the ED or community clinic, they will say "It's free, I have Medicaid/Medicare."  So because it's free, they DO consume...over, and over, and over.  And they don't get their preventive maintenance (which is why in most cases they are at the ER or clinic).
> 
> I don't have the answers, for sure.



I was more struck by the initial explanation of GDP.  The implication to me was we really don't have the right ways of including healthcare into our economic assessments - because when the foundational ones were developed (like GDP) the role and impacts of healthcare weren't oriented to our modern economy.

I thought the authors efforts to put healthcare into different bins of GDP was meant to be an imperfect method - and really helped demonstrate how the lack of effective descriptors impacts policy.


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## Blizzard (Mar 24, 2017)

Disagree on the premise and title of the New Yorker article, II Duce.  Also, having the title call out the GOP as not getting it, as though the Dems have any better insight, is laughable.  I will be out of pocket for awhile but will try to get a response later tonight.


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## Salt USMC (Mar 24, 2017)

If you're a huge politics nerd, you can watch the healthcare debate live on C-SPAN
GOP Health Care Bill Still Short 216 Votes | Video | C-SPAN.org

The vote is expected to happen at 4pm EST


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## Il Duce (Mar 24, 2017)

Blizzard said:


> Disagree on the premise and title of the New Yorker article, II Duce.  Also, having the title call out the GOP as not getting it, as though the Dems have any better insight, is laughable.  I will be out of pocket for awhile but will try to get a response later tonight.



The title is definitely clickbait - but I thought the content was decent despite that.  It's always hard to take complex issues (economic theory, healthcare impacts) and build a succinct narrative - so I thought the article worth posting despite the flaws in the title and the incomplete nature.

I think it's fair to criticize GOP theories, policy, and legislation when that's what's being debated and voted on.


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## SpongeBob*24 (Mar 24, 2017)

I'm definitely missing a page...:blkeye:


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## Ooh-Rah (Mar 25, 2017)

Dems are getting their Meme on - they win this round, I think....

Democrats mock House Republicans for healthcare failure | Daily Mail Online


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## Il Duce (Mar 25, 2017)

Ooh-Rah said:


> Dems are getting their Meme on - they win this round, I think....
> 
> Democrats mock House Republicans for healthcare failure | Daily Mail Online
> 
> View attachment 18328



I read somewhere this was a Republican defeat - but not a Democratic win.  I think that makes a lot of sense.  The Republicans dominate all three branches of government - so the drama playing out in legislation like this is all within the Republican party.  Democrats just sit on the sidelines watching.  Interestingly there were a lot of similarities when Obamacare was passed - on the opposite side of the aisle.  The 'blue-dogs' like SEN Bayh of Indiana had much more to do with killing the public option than any Republican.

Thought this piece was a very good summary of the process and where President Trump and Speaker Ryan's strengths/weaknesses fell short: Inside the GOP’s Health Care Debacle


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## Ooh-Rah (Mar 25, 2017)

Posting this editorial from Star Tribune because it has always been one of the most pro-liberal/Obama papers out there.  Recently I have seen a change in its stance on guns/race relations and crime.  

Now an editorial criticizing the Obama version and saying something remotely positive about Trump?  

LOL - the only thing that makes sense to me is that the paper was recently purchased by Timberwolves owner, Glenn Taylor.  Maybe he is pushing a more balanced agenda...

Definitely worth a read!

 The Republican bill did not merit passage, but the challenge remains.
Health care setback shouldn't be an excuse to walk away from reform

<sorry I cannot cut/paste, their site blocks that on mobile devises>


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## Il Duce (Mar 25, 2017)

Ooh-Rah said:


> Posting this editorial from Star Tribune because it has always been one of the most pro-liberal/Obama papers out there.  Recently I have seen a change in its stance on guns/race relations and crime.
> 
> Now an editorial criticizing the Obama version and saying something remotely positive about Trump?
> 
> ...



I think the editorial is still operating with conventional wisdom - at least on policy - on the left.  While most Democratic politicians will spend most of their time criticizing the President and the other side of the aisle I think most folks in policy on the left recognize many of the shortcomings of Obamacare.  I read that the average premium increase last year was 22% for insurance on exchanges - but the rate has had significant variance by state (as high as 116% in Arizona and as low as -3% in a state I can't remember).  That's compared to I think somewhere between 8 and 16% increases the previous years.  The CBO and other analysts have generally predicted the exchanges are not going to collapse (or implode as I think the President said) across the nation - but there is very real danger in some states (I think Tennessee was the one highlighted - only one insurance provider on the exchange that may leave this year) of significant coverage gaps.

So, it means (from the policy positions on the left - the right likely disagrees) there are significant problems to be addressed in controlling costs, insuring access to a robust marketplace, and helping dilute the risk pools (which I've read is a main driver of pushing insurance providers out or causing them to increase premiums).  If nothing is done about those problems even if Obamacare doesn't collapse it will continue to deliver poorer returns.  When you take into account how significant Tom Price's DHHS is to helping administer Obamacare that downturn could be significantly sped up through executive and administrative action.

I think the political question for policy-makers becomes who gets blamed for Obamacare's failure to improve or if it gets worse?  Political analysts after the failed Trumpcare vote yesterday are saying the current administration and Republicans but I'm not so sure - and I think a lot of political wonks aren't either.  I listened to an interview on NPR with a journalist from the Atlantic who had done a ton of reporting in rural America about the voting of poor and working class whites who had benefited from Obamacare.  Many of the people she talked to and interviewed in-depth understood Obamacare fairly well - and understood their coverage.  They voted for President Trump believing he would improve Obamacare - they dismissed anything he said indicating they would lose coverage. 

What voters decide to believe does not necessarily correlate to the facts or strong analysis - I don't think any modern politician has better understood or been able to take advantage of that better than President Trump.


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## TLDR20 (Mar 26, 2017)

Economist write up on drug prices...

http://econ.st/2n1TbhL


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## ThunderHorse (Mar 30, 2017)

The need for reform continues as the ACA takes one in the shorts: Big Obamacare insurer Anthem seen as 'leaning toward exiting' many areas where it now sells plans


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## TLDR20 (Jul 21, 2017)

These Americans Hated the Health Law. Until the Idea of Repeal Sank In.

Echos some things I brought up earlier in this thread. 

People are dumb. Many believed the BS attack ads as truth and didn't even realize they had coverage thanks to the law.

My favorite/least favorite part of this article is towards the end, where a woman talks about how she would rather pay the fine than get insurance, while simultaneously not being able to afford something that insurance would cover. Not too mention, her diabetes is probably slowly killing her...


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## pardus (Jul 21, 2017)

ThunderHorse said:


> The need for reform continues as the ACA takes one in the shorts: Big Obamacare insurer Anthem seen as 'leaning toward exiting' many areas where it now sells plans



Leaning towards? 
Yawn. :whatever:
When they do what someone else thinks they might do, let us know...


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## ThunderHorse (Jul 22, 2017)

pardus said:


> Leaning towards?
> Yawn. :whatever:
> When they do what someone else thinks they might do, let us know...


Here you go: Aetna pulls out of Virginia's individual market, citing big Obamacare losses


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## pardus (Jul 23, 2017)

ThunderHorse said:


> Here you go: Aetna pulls out of Virginia's individual market, citing big Obamacare losses



That's more like it.


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