Author Topic: Obamacare/Trumpcare  (Read 3675 times)

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Re: Obamacare/Trumpcare
« Reply #60 on: March 13, 2017, 11:22:49 PM »

Offline fairweatherfan

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I think the reason that Trump is supporting this is that ultimately he's not an ideas guy or even a results guy - he's a sales guy. This is the plan in front of him, it's consistent with the promise to get rid of Obamacare, so he wants to sell it. The alternative would be an embarrassing public rebuke of Congress (which he wants on his side), or coming up with his own idea, which, haha, seems unlikely.

The Trump-friendly media are doing everything they can to detach the bill from his reputation though - outlets like Breitbart are constantly attacking the bill but always linking it to Paul Ryan and other Congressional Rs rather than Trump.

Re: Obamacare/Trumpcare
« Reply #61 on: March 14, 2017, 09:25:03 AM »

Offline indeedproceed

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I think the reason that Trump is supporting this is that ultimately he's not an ideas guy or even a results guy - he's a sales guy.

I've noticed a lot of his machinations make more 'sense' if seen through this context. It's rarely about the image at hand, it is almost always about 1) who won or lost or 2) the optics of another issue

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Re: Obamacare/Trumpcare
« Reply #62 on: March 14, 2017, 10:01:24 AM »

Offline Vermont Green

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I'm not sure if this link will work if you're not a member of MedPage Today, but this is an excerpt of the story:

https://www.medpagetoday.com/Washington-Watch/repeal-and-replace/63773?xid=nl_mpt_DHE_2017-03-11&eun=g845009d0r&pos=1

Quote
As the White House, Congress, and the public examine the Republicans' plan for replacing the Affordable Care Act (ACA), one thing analysts are looking at is how much of the ACA isn't actually touched by the proposal.

The answer: A lot, according to Timothy Jost, JD, emeritus professor at the Washington and Lee University School of Law in Lexington, Va."I think probably 90%-95% of ACA remains in place," Jost said in a phone interview. "The ACA covered so much ground, and nobody who had ever actually looked at ACA could have seriously thought you could repeal it, but basically this is limited to three titles of the ACA."

Other than insurance and tax provisions, many of the ACA's titles remain untouched, including those that emphasize public health and preventive care -- for example, provisions increasing coordination between preventive care task forces, increased educational outreach about prevention, and research on optimizing delivery of public health services.

The ACA also established a national healthcare workforce commission and increased funding for the National Health Service Corps. Other parts of the law deal with improving access to innovative therapies, strengthening the Indian Health Service, improving transparency in government activities, and increasing healthcare services in the community. None of these were addressed in the House GOP bill, either.

The biggest changes in the replacement plan have to do with all the taxes being repealed in the Republican plan, including a medical device tax and a tax on tanning salons, as well as a tax on higher income earners, according to Jost.

"The best way to think about this bill is it's a massive tax cut, particularly for the wealthy, with $300 billion in tax cuts for people making more than $250,000 a year, and a bill to cut Medicaid spending," he said. "The private market reforms are pretty much incidental."


But hey, at least the CBO projects a $337 billion in savings over the next 10 years or so.  Probably because elderly and poor patients will lose access to care over time and die a lot sooner.  As cruel as that sounds, it saves money.  Brought to you by the GOP.

Thanks for posting this.  It is a good perspective.  My daughter works at a large hospital in NYC.  I asked her what her colleagues think.  She said everyone thinks it is a disaster.  Does anyone besides Paul Ryan actually think this will be an improvement?

So you eliminate the mandate and reduce assistance (Medicaid), you end up with less insured.  OMG, who knew this was so complicated (yes, sarcasm).  I believe the cost (premiums) reduction is because this bill lowers the floor for what is an allowable policy.  Larger deductibles/copays + less coverage = lower premiums over time.  OK, fine.  This is not a surprise, but if you figure in the out of pocket costs together with the premium costs, it is still a wash.

The thing that I have not seen addressed (in the recent discussion of the Ryan plan) is the cost to hospitals of caring for these additional uninsured.  This cost is not magically going away either and so hospitals will need to charge insured patients more to cover it, insurance companies will need to pay higher costs and yes of course, premiums that the actual insured pay will increase.

We need the mandate.  It is not infringing on anyone's civil liberties to say you have to have insurance unless you are also going to allow hospitals to let these uninsured die in the waiting room (which of course will never happen and should't happen).  Remove the employer mandate and figure out a way to throw a bone to the religious right by eliminating birth control from the equation.  Republicans can claim victory and we can move on to the next over-promised policy change they want to work on.  I want to hear that infrastructure plan of Trump's.

Re: Obamacare/Trumpcare
« Reply #63 on: March 14, 2017, 10:33:10 AM »

Offline Fan from VT

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I'm not sure if this link will work if you're not a member of MedPage Today, but this is an excerpt of the story:

https://www.medpagetoday.com/Washington-Watch/repeal-and-replace/63773?xid=nl_mpt_DHE_2017-03-11&eun=g845009d0r&pos=1

Quote
As the White House, Congress, and the public examine the Republicans' plan for replacing the Affordable Care Act (ACA), one thing analysts are looking at is how much of the ACA isn't actually touched by the proposal.

The answer: A lot, according to Timothy Jost, JD, emeritus professor at the Washington and Lee University School of Law in Lexington, Va."I think probably 90%-95% of ACA remains in place," Jost said in a phone interview. "The ACA covered so much ground, and nobody who had ever actually looked at ACA could have seriously thought you could repeal it, but basically this is limited to three titles of the ACA."

Other than insurance and tax provisions, many of the ACA's titles remain untouched, including those that emphasize public health and preventive care -- for example, provisions increasing coordination between preventive care task forces, increased educational outreach about prevention, and research on optimizing delivery of public health services.

The ACA also established a national healthcare workforce commission and increased funding for the National Health Service Corps. Other parts of the law deal with improving access to innovative therapies, strengthening the Indian Health Service, improving transparency in government activities, and increasing healthcare services in the community. None of these were addressed in the House GOP bill, either.

The biggest changes in the replacement plan have to do with all the taxes being repealed in the Republican plan, including a medical device tax and a tax on tanning salons, as well as a tax on higher income earners, according to Jost.

"The best way to think about this bill is it's a massive tax cut, particularly for the wealthy, with $300 billion in tax cuts for people making more than $250,000 a year, and a bill to cut Medicaid spending," he said. "The private market reforms are pretty much incidental."


But hey, at least the CBO projects a $337 billion in savings over the next 10 years or so.  Probably because elderly and poor patients will lose access to care over time and die a lot sooner.  As cruel as that sounds, it saves money.  Brought to you by the GOP.

Thanks for posting this.  It is a good perspective.  My daughter works at a large hospital in NYC.  I asked her what her colleagues think.  She said everyone thinks it is a disaster.  Does anyone besides Paul Ryan actually think this will be an improvement?

So you eliminate the mandate and reduce assistance (Medicaid), you end up with less insured.  OMG, who knew this was so complicated (yes, sarcasm).  I believe the cost (premiums) reduction is because this bill lowers the floor for what is an allowable policy.  Larger deductibles/copays + less coverage = lower premiums over time.  OK, fine.  This is not a surprise, but if you figure in the out of pocket costs together with the premium costs, it is still a wash.

The thing that I have not seen addressed (in the recent discussion of the Ryan plan) is the cost to hospitals of caring for these additional uninsured.  This cost is not magically going away either and so hospitals will need to charge insured patients more to cover it, insurance companies will need to pay higher costs and yes of course, premiums that the actual insured pay will increase.

We need the mandate.  It is not infringing on anyone's civil liberties to say you have to have insurance unless you are also going to allow hospitals to let these uninsured die in the waiting room (which of course will never happen and should't happen).  Remove the employer mandate and figure out a way to throw a bone to the religious right by eliminating birth control from the equation.  Republicans can claim victory and we can move on to the next over-promised policy change they want to work on.  I want to hear that infrastructure plan of Trump's.

See, this is where you and the Ryan Republicans disagree. Freedom!

Re: Obamacare/Trumpcare
« Reply #64 on: March 14, 2017, 10:33:56 AM »

Offline KGs Knee

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We need the mandate.  It is not infringing on anyone's civil liberties to say you have to have insurance

Point of contention:  it is absolutely an infringement on my civil liberties to mandate I purchase a good or service from a private entity.  That is an inarguable matter.



Re: Obamacare/Trumpcare
« Reply #65 on: March 14, 2017, 10:53:14 AM »

Offline Moranis

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We need the mandate.  It is not infringing on anyone's civil liberties to say you have to have insurance

Point of contention:  it is absolutely an infringement on my civil liberties to mandate I purchase a good or service from a private entity.  That is an inarguable matter.
you have to have car insurance and are forced to buy countless other things.
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Re: Obamacare/Trumpcare
« Reply #66 on: March 14, 2017, 10:55:08 AM »

Offline gift

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We need the mandate.  It is not infringing on anyone's civil liberties to say you have to have insurance

Point of contention:  it is absolutely an infringement on my civil liberties to mandate I purchase a good or service from a private entity.  That is an inarguable matter.
you have to have car insurance and are forced to buy countless other things.

I didn't realize your civil liberties were determined by what else you are forced to do. Can you make a different argument please?

Re: Obamacare/Trumpcare
« Reply #67 on: March 14, 2017, 11:00:28 AM »

Offline gift

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Liberty issues aside (as if that's something that should be put aside), purchasing insurance is a mode of recouping loss and planning contingencies. It is not a proper method for funding a public service. If we deem health care to be a public service, we should treat it as such, and cut the insurance industry out of the exchange completely.

Re: Obamacare/Trumpcare
« Reply #68 on: March 14, 2017, 11:00:57 AM »

Offline KGs Knee

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We need the mandate.  It is not infringing on anyone's civil liberties to say you have to have insurance

Point of contention:  it is absolutely an infringement on my civil liberties to mandate I purchase a good or service from a private entity.  That is an inarguable matter.
you have to have car insurance and are forced to buy countless other things.

A) Not true at all.  Not where I live (NH).  Car insurance is not a requirement, except under certain conditions.

B) This is a terrible analogy.  Driving is a privilege, not guaranteed to you, that comes with stipulations.  I have a right to live without you or anyone else telling me what to buy.
« Last Edit: March 14, 2017, 11:07:15 AM by KGs Knee »

Re: Obamacare/Trumpcare
« Reply #69 on: March 14, 2017, 11:05:14 AM »

Offline KGs Knee

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Liberty issues aside (as if that's something that should be put aside), purchasing insurance is a mode of recouping loss and planning contingencies. It is not a proper method for funding a public service. If we deem health care to be a public service, we should treat it as such, and cut the insurance industry out of the exchange completely.

This is an argument I can understand.

But as I've maintained, it better not cost me more than what I already pay in health care costs.

As far as I can tell, the legislation currently in front of Congress isn't going to save me any money, and likely will just lead to further future increases in my premiums.  I can't say I've spent much of any time researching it, but I'll be surprised if it passes through the Senate, from what I have seen.

Re: Obamacare/Trumpcare
« Reply #70 on: March 14, 2017, 11:19:20 AM »

Offline indeedproceed

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B) This is a terrible analogy.  Driving is a privilege, not guaranteed to you, that comes with stipulations.  I have a right to live without you or anyone else telling me what to buy.

You have a right to live, but do you have a right to life saving healthcare if you can't afford it? That's what is really at the center of this.

DKC League
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like that is always lethal." - Evan 'The God' Turner

Re: Obamacare/Trumpcare
« Reply #71 on: March 14, 2017, 11:35:15 AM »

Offline gift

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B) This is a terrible analogy.  Driving is a privilege, not guaranteed to you, that comes with stipulations.  I have a right to live without you or anyone else telling me what to buy.

You have a right to live, but do you have a right to life saving healthcare if you can't afford it? That's what is really at the center of this.

This runs the risk of becoming terribly philosophical, but do you have the right to live? Or do you have the right not to be killed? Is there a difference?

I once explored the notion that you have a right to live and ended up concluding that you have a right to private property. It's a rabbit hole.

Re: Obamacare/Trumpcare
« Reply #72 on: March 14, 2017, 11:42:37 AM »

Offline KGs Knee

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B) This is a terrible analogy.  Driving is a privilege, not guaranteed to you, that comes with stipulations.  I have a right to live without you or anyone else telling me what to buy.

You have a right to live, but do you have a right to life saving healthcare if you can't afford it? That's what is really at the center of this.

No.

Ideally, the exceptionally wealthy would be more philanthropic and provide for those who go without.  But they're not.  Also, ideally, the only people not buying insurance would be those that can afford health care without it.  But that is obviously not true, I went for 5-6 in my early 20's with no insurance.

But, taxpayers get stuck with the bill because of laws and oaths that force practitioners to treat everyone, even those that can't pay.  It's a weird mess of varying standards.

Practically, you can't have forced care without forced economic means of payment (insurance/single payer) for a number of reasons that in theory should not exist.  I'm fine with practitioners choosing to not treat people based on ability to pay, I realize that sounds cold hearted, but no one should have to perform any service for someone who can't pay.  I would have accepted my fate had something happened to me.

But I'm also fine with a single payer system that isn't going to over burden people with outrageous taxes.  I'm just extremely skeptical about how that will end up.  The US government has a long history of wasting tax dollars in ridiculous amounts.

Re: Obamacare/Trumpcare
« Reply #73 on: March 14, 2017, 11:45:44 AM »

Offline gift

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We need the mandate.  It is not infringing on anyone's civil liberties to say you have to have insurance

Point of contention:  it is absolutely an infringement on my civil liberties to mandate I purchase a good or service from a private entity.  That is an inarguable matter.
you have to have car insurance and are forced to buy countless other things.

A) Not true at all.  Not where I live (NH).  Car insurance is not a requirement, except under certain conditions.

B) This is a terrible analogy.  Driving is a privilege, not guaranteed to you, that comes with stipulations.  I have a right to live without you or anyone else telling me what to buy.

There are some who claim that driving is a right, not a privilege, since it is not explicitly delegated to the federal government. These powers default to the states (tenth amendment), and presumably, if not claimed by the states explicitly, are delegated to the people. If driving on public land, then driving would be a right to all citizens. It's a valid argument, though maybe not correct. It's certainly a right that is not generally acknowledged, but that is another issue.

Re: Obamacare/Trumpcare
« Reply #74 on: March 14, 2017, 11:51:57 AM »

Offline KGs Knee

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We need the mandate.  It is not infringing on anyone's civil liberties to say you have to have insurance

Point of contention:  it is absolutely an infringement on my civil liberties to mandate I purchase a good or service from a private entity.  That is an inarguable matter.
you have to have car insurance and are forced to buy countless other things.

A) Not true at all.  Not where I live (NH).  Car insurance is not a requirement, except under certain conditions.

B) This is a terrible analogy.  Driving is a privilege, not guaranteed to you, that comes with stipulations.  I have a right to live without you or anyone else telling me what to buy.

There are some who claim that driving is a right, not a privilege, since it is not explicitly delegated to the federal government. These powers default to the states (tenth amendment), and presumably, if not claimed by the states explicitly, are delegated to the people. If driving on public land, then driving would be a right to all citizens. It's a valid argument, though maybe not correct. It's certainly a right that is not generally acknowledged, but that is another issue.

It's terribly off-topic, but I don't think there is a single state that defines driving as a right.  If there were they wouldn't be able to justify driving aptitude tests, as that would be unconstitutional no different than the unconstitutionality of voting aptitude tests.