Healthcare!

TLDR20

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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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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.
 
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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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. O_o: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
 
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
 
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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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...
 
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.
 
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"! :-o
Here's a quote for a family of three making $60K in NY. Oscar | Smart, simple health insurance.
 
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.

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.
 
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.

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.

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...
 
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.
 
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.

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

The ACA allows people to purchase private insurance.

Medicaid is not private insurance. It is a government program

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

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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