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The Affordable Care Act II - Because Mr. Obama Loves You All


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Access to health care isn't just about paying for it. And socialized medicine doesn't guarantee access.

 

Of course it guarantees access. It doesn't guarantee timely access.

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totally 100% in favor of universal coverage for all americans as the minimum. we have advanced as a species far enough that it is easily in reach as long as ppl dont be incredibly petty selfish jerks about it. we appear still a ways off from that but slowly zeroing in as the wildly swinging pendulum keeps us missing the target. hold still you fkr

 

totally fine with socialized medicine if thats the ultimate solution. would be totally fine if a market based systems could deliver that, unfortunately weve learned it cant, not on its own

 

totally fine with better tiers of care as you can afford more for your policy. must have minimal standards including preventative medicine, but it is reasonable to allow ppl to purchase much better options. id rather a poor or needy person have a relatively crappy team of doctors than no doctors

 

we shouldnt be competing based on health care. that says way more about us as individuals and as a collective than it does about our paranoia created antipathy to those lazy poor people

Edited by Meathead
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Canada has one MRI scanner for every 200,000 people. The US has one MRI scanner for every 40,000 people. Montreal has something like thirty MRI scanners, total. And I know single buildings with more MRI scanners than all of Montreal.

 

Access to health care isn't just about paying for it. And socialized medicine doesn't guarantee access.

 

Which is why I often pay for medical treatment...

 

Until the new health minister changed the rules so private health providers can no longer charge for their services.

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Until the new health minister changed the rules so private health providers can no longer charge for their services.

 

One of the things that any sort of government-controlled system ultimately requires is that transactions outside that system be labelled as "black market" and forbidden.

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totally fine with better tiers of care as you can afford more for your policy. must have minimal standards including preventative medicine, but it is reasonable to allow ppl to purchase much better options. id rather a poor or needy person have a relatively crappy team of doctors than no doctors

 

You say this now because you believe that any doctor has a minimum level of competency.

 

An emergency room doctor told me to walk off a broken foot with just ibuprofen. Her reasoning was that I was able to walk on it with a cane, so it's not that bad. My real doctor put me on 5 weeks of disability and said walking on it made it worse after using an ultra-sound. (x-ray didn't show the stress fracture.)

 

Now imagine a system where x-rays take weeks and ultra-sounds aren't available outside of maternity wards...

 

...I would have been better off waiting for better care, because the bad doctor convinced me I was fine -resulting in me aggravating the injury worse.

 

One of the things that any sort of government-controlled system ultimately requires is that transactions outside that system be labelled as "black market" and forbidden.

 

School vouchers will destroy the public school system because no one will want to attend them if given the choice...

Edited by unbillievable
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i dont remember saying any dr is competent. drs make mistakes, some of them shouldnt be drs. still, i know we have the capability to define and enforce minimal standards that most drs will meet, and the resources to provide drs to everyone. we certainly have enough doctors and would have even more if we made preventative medicine a priority

 

we should be proud we have advanced far enough to provide health care for everyone. we dont just let ppl starve anymore bc we have such a ridiculous abundance of food that our conscience made it obvious we had to feed the hungry with our leftovers. we are basically at that point with health care. we shouldnt be competing on the basis of who gets basic comprehensive health care

 

i realize im repeating myself here but now is the time it needs to be pointed out. i would prefer we dont screw this up. a-gain.

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Anthem is a big get and if you look at AHIP who is a major player, they don't seem to have major grievances with the GOP bill and really aren't that far off. I believe that if this goes through you'll see smaller tax credits for higher income folks and larger tax credits for lesser income earners.

 

My guess is that there will be assurances that tort reform and competition across state lines and some sort of lessening of Medicaid to appease the Freedom Caucus and larger tax credits for lower income earners to assuage the concerns of the centrists.

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People ridiculing freer healthcare markets as a way to help the poor rarely mention stuff like this:

 

 

 

C6kYb-yVsAA-vAp.jpg Click on to enlarge

Are they saying that all items increased by 23%, then, subtracting ~58%, to arrive at ~35% decrease in cell phone service, or I am reading this wrong? The use of the word "relative" is the problem here. I mean "all times" implies all items, cell phone service included.

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Any rigid ideological stance from the GOP will be destined to fail with the healthcare bill. Here is another centrist Senator who is threatening to withhold support from the bill as currently written, and he believes that there should be more assistance provided.

 

If you go on a purely market driven bill then you'll lose the centrists, if you go too heavy with assistance for the lower income folks you'll lose the hard right. Quite the conundrum. There is going to have to be compromise within the GOP to pass the bill or else we'll end up keeping Obamacare.

 

So I've been reading and hearing the concerns from both sides and here is where I believe a compromise can be found.

 

Concessions from the centrists:

 

A) The bill right now ends the expansion of Medicaid in 2020, Move it to the end of 2018.

 

B) Means test the advanced tax credits. As of right now individuals earning $75,000 get the same advanced tax credit as someone earning $12,000 (which is the Medicaid income threshold) They could lower that amount to $55,000 and gradually phase it out as the way it is written.

 

Concessions from the right:

 

A) As of right now the average assistance provided for Medicaid users is approximately about $6000. Under the current GOP plan, if you don't qualify for Medicaid by just a hair, the average assistance is about $3000. Which means there is a huge drop off. And with the ideological market based driven guys there would be an even larger drop off. No matter what your ideological beliefs are, I'm discussing possible solutions that can at least garner 50 votes, never mind the 60 votes for now. So the solution could be to increase the advance tax credits for lower incomes to a max of $5000 gradually going down as income goes higher.

 

In other words right now as written it is solely age based. Make it aged along with income.

 

Other things that need to be done that cannot go through Reconciliation:

 

A) Tort Reform

B) Allowing carriers to compete across state lines

C) Eliminate Community based rating

D) Eliminate Minimum essential benefits

E) Eliminate the employer mandate

 

 

These provisions would allow carriers to create plans that could fit the needs of the patients. High deductibles, low deductibles, pretty much any design that the customer would want. For young people I would think that high $10k deductible plans with ER, doctor, prescription copays would be very popular and probably could get with their tax credit at a next to nothing cost. This would go along way in helping drive down premiums

 

In order to get these things you have to get 60 votes.

 

Right now the Democrats will resist 100% of the way, there is virtually no incentive for them to go along with the GOP. The question is once the repeal goes through, if it goes through. That's it, this is the law. So what will they do? Can you get a handful of them once they realize this is now the law of the land and actually be constructive to work along to make it a law that more closely mirrors what they'd like? Or do they allow Republicans to fall flat on their faces and potentially politically die with this law? We know that will be leaderships view. But you could probably convince a few Democrats to go along with it.

 

So what are the concessions that can be given to Democrats to get their votes?

 

A) Keep the taxes on earners making over $250,000 in the ACA. This will be a good carrot stick, plus it will lower the cost of the entire bill and add a lot less to the deficit.

 

B) Trump has been talking and meeting up with the Democrats about reducing pharmaceutical costs, my guess is that they want price controls. Deep down that's what Trump wants too even though Price, Ryan and most Republicans don't want this.

 

C) Keep the FFM exchange where the purchase of plans are taking place. Repubs should be in favor of exchanges anyway

 

D) Increase the subsidies provided to people with pre existings which are delivered to the states so that they can administer it. To be honest, it would be better to have carriers create their own Pre ex risk pools regulated by the states. In any case, even the Freedom caucus is ok with assistance provided to the states for pre Ex.

 

The plan should be that if Democrats don't want to be a part of compromising and going along with the bill, there should be an explicit threat made that in the following years reconciliation (because you can only do one a year), that the rest of the things that Republicans want that usually take 60 votes will be pushed through the arcane provision that I recently learned where you could have Pence override the Parliamentarian, which still you'd have to get to at least 50 votes.

 

Of course, wobbly Senate Repubs would be wise to go along with it because without these added market based provisions the US individual healthcare system would take a huge crap and Repubs would get politically wiped.

 

Just trying to think this through in what would be politically viable to get through the house, then the senate under the so-called phase 1 and the phase 3.

Edited by Magox
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People ridiculing freer healthcare markets as a way to help the poor rarely mention stuff like this:

 

 

 

C6kYb-yVsAA-vAp.jpg Click on to enlarge

And what conclusions do you want people to draw from this?

Any rigid ideological stance from the GOP will be destined to fail with the healthcare bill. Here is another centrist Senator who is threatening to withhold support from the bill as currently written, and he believes that there should be more assistance provided.

 

If you go on a purely market driven bill then you'll lose the centrists, if you go too heavy with assistance for the lower income folks you'll lose the hard right. Quite the conundrum. There is going to have to be compromise within the GOP to pass the bill or else we'll end up keeping Obamacare.

 

So I've been reading and hearing the concerns from both sides and here is where I believe a compromise can be found.

 

Concessions from the centrists:

 

A) The bill right now ends the expansion of Medicaid in 2020, Move it to the end of 2018.

 

B) Means test the advanced tax credits. As of right now individuals earning $75,000 get the same advanced tax credit as someone earning $12,000 (which is the Medicaid income threshold) They could lower that amount to $55,000 and gradually phase it out as the way it is written.

 

Concessions from the right:

 

A) As of right now the average assistance provided for Medicaid users is approximately about $6000. Under the current GOP plan, if you don't qualify for Medicaid by just a hair, the average assistance is about $3000. Which means there is a huge drop off. And with the ideological market based driven guys there would be an even larger drop off. No matter what your ideological beliefs are, I'm discussing possible solutions that can at least garner 50 votes, never mind the 60 votes for now. So the solution could be to increase the advance tax credits for lower incomes to a max of $5000 gradually going down as income goes higher.

 

In other words right now as written it is solely age based. Make it aged along with income.

 

Other things that need to be done that cannot go through Reconciliation:

 

A) Tort Reform

B) Allowing carriers to compete across state lines

C) Eliminate Community based rating

D) Eliminate Minimum essential benefits

E) Eliminate the employer mandate

 

 

These provisions would allow carriers to create plans that could fit the needs of the patients. High deductibles, low deductibles, pretty much any design that the customer would want. For young people I would think that high $10k deductible plans with ER, doctor, prescription copays would be very popular and probably could get with their tax credit at a next to nothing cost. This would go along way in helping drive down premiums

 

In order to get these things you have to get 60 votes.

 

Right now the Democrats will resist 100% of the way, there is virtually no incentive for them to go along with the GOP. The question is once the repeal goes through, if it goes through. That's it, this is the law. So what will they do? Can you get a handful of them once they realize this is now the law of the land and actually be constructive to work along to make it a law that more closely mirrors what they'd like? Or do they allow Republicans to fall flat on their faces and potentially politically die with this law? We know that will be leaderships view. But you could probably convince a few Democrats to go along with it.

 

So what are the concessions that can be given to Democrats to get their votes?

 

A) Keep the taxes on earners making over $250,000 in the ACA. This will be a good carrot stick, plus it will lower the cost of the entire bill and add a lot less to the deficit.

 

B) Trump has been talking and meeting up with the Democrats about reducing pharmaceutical costs, my guess is that they want price controls. Deep down that's what Trump wants too even though Price, Ryan and most Republicans don't want this.

 

C) Keep the FFM exchange where the purchase of plans are taking place. Repubs should be in favor of exchanges anyway

 

D) Increase the subsidies provided to people with pre existings which are delivered to the states so that they can administer it. To be honest, it would be better to have carriers create their own Pre ex risk pools regulated by the states. In any case, even the Freedom caucus is ok with assistance provided to the states for pre Ex.

 

The plan should be that if Democrats don't want to be a part of compromising and going along with the bill, there should be an explicit threat made that in the following years reconciliation (because you can only do one a year), that the rest of the things that Republicans want that usually take 60 votes will be pushed through the arcane provision that I recently learned where you could have Pence override the Parliamentarian, which still you'd have to get to at least 50 votes.

 

Of course, wobbly Senate Repubs would be wise to go along with it because without these added market based provisions the US individual healthcare system would take a huge crap and Repubs would get politically wiped.

 

Just trying to think this through in what would be politically viable to get through the house, then the senate under the so-called phase 1 and the phase 3.

Basically the GOP sees this as a way to cut taxes for the wealthy

 

Dems and some Republicans oppose because it cuts health care for their voters.

 

How do you bridge that divide? I don't think you can.

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tell that to the mother who was crying frantically on the phone with me last week whose son can't find a PCP because he has medicaid. she seemed pretty concerned.

But at least he has healthcare coverage. He's one of the twenty million we've heard so much about that got healthcare coverage through B. O. care. He should be happy he has coverage. We were told there were 35 million Americans who did not have healthcare coverage. Many of them got their healthcare coverage through Medicaid. They should be very, very happy about it and very, very thankful to Nancy Pelosi, Harry Reid, and of course B. O. himself after whom this abortion was named.

 

A lot of people are going to drop their coverage once the mandate is lifted. So that will give the left and the media (but I repeat myself) a lot to talk about along the lines of "Trump throws millions of people off their healthcare insurance." "Millions and millions now don't have healthcare coverage" (to go with the 15 million who don't have it right now).

Edited by Nanker
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Democrats threatening to shut down government.

 

Wondering if MSM will cover the same way @GOP shutdown was covered: http://www.cbsnews.com/news/democrats-warn-gop-against-including-wall-funding-in-major-spending-package/?ftag=CNM-00-10aab7e&linkId=35412332

 

 

Remember the fit Democrats threw when the GOP did this? And how the media accused Republicans of putting thousands and thousands of people out of work and starving those on food stamps and other nonsense?

Good times.

And honestly, even if you don’t like this GOP bill (and actually many Republicans do NOT), this meltdown is popcorn-worthy:

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