Magox

Ted Poe who just quit the Freedom caucus It's going to be interesting to see what happens, you can see that the pressure is on the Freedom Caucus, as it is becoming clear that they are getting most of the blame for failing to advance the bill that repeals large portions of Obamacare. I've noticed in interviews over the past 2 days a change in some of their members tone, they desperately want a redo. The question is will they continue to be intransigent nincompoops that they've been or will they agree to advance the ball into the Senate's hand, where they'll have ample opportunity to give their input.

I agree with that, which is why I have major issues with the mainstream media and the tv/radio hucksters. They feed people fear, demagoguery, partial truths without context and outright untruths. It's all about the ratings and $$ when it comes to these folks.

They are in no mood to work with Republicans. Republicans did the same thing to Democrats but it appears that the Democrats are going to take it to a whole new level.

To a degree. I think this goes for just about any sort of multilateral negotiation, if you know that in order to strike a deal that compromise needs to be had, then you identify those that are willing to negotiate in good faith and work with those, the rest...... Well, they are a lost cause and there is no need to bring them into the fold. Unless and only unless they are willing to become a constructive force that understands and recognize the realities that exist in order to strike a deal.

The House leadership needs to worry less about what might clear the Senate, and concentrate more on winning passage in the House. The Freedom Caucus are feeling the heat, they are getting the most blame for this debacle and rightfully so. Yes, Ryan should have gone about it differently, and yes Trump should not have been such an ill-informed nincompoop when it comes to policy matters, but these goons should have known that voting for the reconciliation bill in the house was not a vote on the final product but a vote to move the ball forward. They failed miserably on that front. We'll see how much they are willing to compromise. If I were on Trump's team, I'd quickly try to find those that are willing to negotiate in good faith and that aren't completely divorced from political realities, those who aren't and are ideological purists that are the my way or the highway types, plan without them and cut them out of the process.

If you want to spend a good couple hours reading this, which I highly suggest anyone who has an interest in learning what is driving healthcare costs, then I recommend you read Steven Brill's Bitter Pill There is no one answer, its for a wide variety of reasons, such as the cost of the underlying product going up, lack of price transparency, doctors recommending unnecessary tests (which is a cash cow for medical providers) , end-of-life-care demand is higher than in other countries, cost shift clawback policies and how hospitals charge patients (see chargemaster in the article, super interesting). Of course none of this talks about all the other things that we can do to bring down premiums which has more to do with insurance reform, but the real driver of higher prices has to do with the underlying product, which is that the cost of providing care has been skyrocketing. One of the solutions that has been suggested is to incorporate compensating Medical providers with more of a medical outcome model as opposed to strictly volume and per service fee.

I think Leahy is beginning to buckle and backtrack the pressure he's receiving from liberal activists. Let me tell you, they are red hot right now and they are demanding no cooperation whatsoever with Republicans.

There is little doubt that there are winners. Many people tend to view these things from their ideological points of views that truly are abstract in nature, but once you begin to see the actual human impact up close, it does provide some perspective to it all, at least it did for me. I recognize the good that expansion of coverage does for many families and society, the problem as you noted with this particular law is that those who don't qualify for subsidies often times have to pay unreasonable prices, and the other problem as you also pointed to is that the networks are tiny. The quality of doctors and access to care is much smaller than it was pre ACA.

Of course there is, to believe this is as good as it gets is silly.

Sure, but there is a better way.

Basically with the ACA is that there were lots of winners and losers. Middle class was the big loser. The big winner was those making less than $24,000 a year, over the age of 40. And those with Pre existing conditions who couldn't get coverage.

If you and your wife are pretty healthy, then maybe a short-term health plan would make sense. They don't cover most pre existing medical conditions, but generally have much larger networks than the ACA plans and they come in at a much lower price. Which makes sense because their risk pool is much healthier.

There are many criticisms that I have with the law, but the unfairness of the whole subsidy system and how premiums have dramatically increased in many regions is downright egregious. The media knows this is a problem but they don't highlight it. All responsible parties understands that this has to be reformed, the question is does politics allow it to be addressed effectively?

It could work. But now you are asking for all Medical Providers to not have any choice in the reimbursement rates. They would all be mandated to accept a lower reimbursement rate, which eliminates any choice. Plus, now you are talking about subsidizing the entire US population, countries with a 10th of our population are having huge financial stresses partially due to their healthcare system, what do you think a country of fat asses of a population of over 350 Million would do to our budget? Bernie Sanders plan would cost $33 Trillion, which is essentially what you were discussing. You know how Bernie wants to tax the hell out of rich people, right? Even if you had it his way, which won't happen any time soon, he'd still be over $18 Trillion short over the next decade. It's not a realistic proposal.

No, the idea of separating the risk pools from sicker and healthier people wouldn't necessarily drive up the actual paid rates from the enrollee because they would/could do two things: A) Subsidized by the government (which is already in the conservative proposals) B) They the insurance providers and the government could look to see if they could price these enrollee's with Medicare reimbursement rates. What that means is that those Medical providers that are willing to accept plans offered through this program would have a reimbursement rate that of Medicare enrollees. All that means is that Medical providers that accept these plans accept less money from the insurer for those services, such as doctor visits, lab testing, ER services, hospital stays etc etc. Yes, you can parse things up if there is a mechanism to subsidize the plans. And the fact that you are bringing up tax codes, loopholes, deductions shows that you have the slightest clue in what I'm talking about, because the risk pool subsidy isn't income based but rather based on their medical condition. Why is that you are incapable of bringing anything rational to the table?

Still don't see how what you are talking about is related to a tax reform bill. This Tax reform bill has nothing to do with balancing the budget. What you are talking about would is more philosophical than what a tax reform bill would look like. Existing law is existing law, which is something that the previous Ryan bill tried to address by cutting close to a trillion dollars in Medicaid and subsidy expenditures under the ACA to help finance the cost of the tax cuts. What they are trying to do is make sure that the tax cuts are financed through reduced spending measures. In order for them to have enough political cover that could actually pass both the Senate and the house for a tax reform bill, it would need to be deficit neutral or at least close to being deficit neutral. To recap, the previous Ryan bill had over a trillion dollars worth of cuts which would have already financed about a Trillion dollars in tax cuts. Now, if they want to keep those tax cuts, they will have to find a trillion dollars elsewhere to finance them. Make sense?

What does this post have to do with this thread?

I'm talking about what I would do.

Of course not, what "conservative" could actually believe that tax cuts serve as a stimuli to the economy?

Clearly a tick of his

Well, it's that "principle" that is driving rates higher for everyone else. So while the goal may have been laudable, the outcome certainly wasn't. The solutions I provided would make it better for everyone.

One of the unintended consequences of not passing the Ryan Bill.

It depends, if the current administration actively looks to undermine the existing law, then I would agree. But if they allow the status quo or even do things to shore it up and it still keeps heading in the direction it is heading, then I would wholeheartedly disagree.

I don't believe that insurance companies should be mandated to cover all 10 minimum essential health benefits, I find it to be overly paternalistic, unnecessary and without doubt increase the costs of many people's insurance who have no need for many of these provisions such as maternity coverage and children's pediatric to name a couple. There are other such as rehabilitative and mental health services that in my view should be made available but not mandatory. That's not to say that these other services aren't necessary for some, but why make it mandatory? It's like auto insurance, there are services that are mandatory and others that aren't. The biggest problem with the ACA is that the incentives skew towards older sicker individuals and not towards younger people. Which means that you have risk pools that are filled with people with higher medical claims that in turn leads to higher premiums. Add that with some of the unnecessary minimum essential benefits, taxes, lack of competition and unfair subsidy distribution system, you have people in the middle class that are getting squeezed out of the market and paying exorbitant premiums. They could do as what Ryan wants to do which is create separate risk pools to place people with certain pre existing conditions into those pools. I posted this earlier but 5% of the sickest of the population accounts for 50% of all the medical costs. You could move a portion of those into these separate federally subsidized risk pools and that would lower the cost of the premiums for the remaining 95% of the population. It wouldn't work exactly that way but in concept that is how it would function. A few other things they could do are some pilot programs where they give customers the choice to either receive the current cost share reduction or programs of those funds shifted into private HSA's, which would incentivize consumers to shop around for medical prices which would create more of a demand for medical price transparency. Also, encourage medical providers through federal carrots to promote transparency. Add in some market based reforms such as tort reform and competing carriers across state lines. Encourage more investments in wellness programs. Take away the shackles off of carriers that they could provide plans to consumers of higher deductible plans that are rich with Doctor, prescription and ER copays. Young people generally don't need low deductible plans. A $10k deductible rich in copay benefits is perfect for someone under the age of 35. These sort of plans with the advanced tax credits would allow lower to middle income younger folks to get health plans below $75 a month premiums. That's the direction that I'd head in.

So let's try to define what Schumer was trying to say Of course this is all going based off the premise that he was being truthful, which is up for debate. But if he was, Schumer brings up two main conditions. A) Not to go along with the Freedom Caucus and B) Not to go with the Wealthy special interests. From my view what that means is A) We still want to give subsidies for lower and middle income folks, protect medicaid and still want to cover people with Pre existing medical conditiosn and B) Don't repeal the taxes on the wealthy. This is doable. They could come to a compromise to revamp the subsidies through a similar mechanism but not reduce the total expenditure, keep pre existing medical coverage and maybe go with the idea in creating separate risk pools for them and essentially keep Medicaid in place with a few minor reforms. And with the taxes, they could come to a compromise to not tax those making below $500,000 a year, right now it stands at $250,000. I do believe that Trump will not forget how the Freedom Caucus derailed his first major test. The guy is a major league narcissist, and to be defeated on this bill, it's gotta sting.