The Dismantling of ObamaCare - Ongoing Updates.

[Ann H]

Health care is a can't win situation in the US because everybody wants the other guy to make it cheaper, but doesn't want to do anything themselves.

Bingo. Unless they want to dive deep into the drivers of high health care costs, any "reform" is simply rearranging the deck chairs.

I have been in the health insurance business 36 years, and it's been that way those entire 3.5 decades. Pivot from one answer to another, disrupt the market, then pivot in another direction.... ACA was the biggest disruption, but others like HIPAA, MSA/HSA, HMO/PPO, etc., actually rewrote the market in their times.

It's time to talk about COSTS, and why your hospital bill is $3,000 for Medicaid, $5,000 for Medicare, $9,000 for some commercial plans, $12,000 for other commercial plans, and $180,000 actual billed price. In prior years, the "cash price" in that scenario would have been double the commercial insurance price, but now it's usually lower. So, the market could possibly heal itself in this particular facet of the problem.

Then there are the other facets of this grossly out-of-shape system.

 

[davephx]

I know I will have to duck and dive into a foxhole after this but...

I don't see what is so bad about a single payer system. We have the most expensive healthcare in the world - and not the best - trying so hard to have like 100 health insurance companies, each with $million salaries to a bunch of chiefs, huge numbers of employees and their only goal is to maximize net profits for shareholders.

Also, could have massive savings but eliminating the need for some staff at State insurance commissioners, eliminate health licensing staffs and eliminate the need for agents and zillions of commissions. Just national web sign up or at libraries etc. Maybe everyone pays a nominal amount.

Yes, taxes will have to increase, but we already have some of the lowest income tax rates in the world for the wealthy with the highest wealth gap. I was a tax supervisor at then a "Big 8" CPA firm with a top federal tax rate of 70% for decades or 50% max tax on earned income over $52k (pre-1986) and the economy did very well. We also have no VAT or national sales tax that many countries have on top of their higher income tax rates.

I have been visiting frequently for 15 years (Toronto primarily) with lots of friends who like the Canadian Health Care System. I am sure there are some problems we could modify, but I also had two of my own experiences.

One trip had a terrible toothache and needed a root cancel. Dentist close to my hotel was great, and the cost was less than half that I had paid years ago in the U.S. Of course, I paid full costs since I have no Canadian insurance.

Another trip I got very sick from food poisoning (major restaurant chain) and was amazed at the short wait and low-cost visit (without insurance) at an urgent care clinic.

As others have correctly pointed out, all the current proposals do almost nothing to reduce costs; the fight is over who pays the costs of health care and the $billions in insurance execs pay and profits to shareholders.

This is not the socialized system of the U.K etc., but simply single payer with government employees with advanced computer systems to help - replacing the high costs of insurance companies with wealthy exec and high shareholder profits.

Overall I am totally supportive of the free enterprise private system, except with the total failure of health care coverage and costs. ObamaCare had many positive aspects but did nothing significant to curb costs. To get to Obamacare took 10+ years of fighting and was passed only by Dems. Now the R's have tried 60+ times to kill it over another eight years, without any "replace" solution that makes any more sense than Obamacare.

I now duck for cover.

 

[russelltw]

Nothing gets better until we decide to live more healthy lifestyles. You cannot continue to eat like the vast majority of Americans and expect that yet another pill for the doctor will help you feel better.

I cannot tell you how many times a potential client tells me they are taking 3+ meds, are overweight, have type II diabetes then finish the sentence with "other than that, I am healthy." No, no you are not. Stop taking your meds and see how you feel. Look around at any public place and see how many people are overweight or obesely overweight.

If everyone would take that smart phone they carry around all the time and use one of those calorie counters (fat secret is one I use), they would realize that they under estimate how many calories they consume, and gross over estimate how many calories they burn with "exercise." But hey, taking a pill (of 4 pills) is much easier to do...

We drink way too many of our calories in the form of sugary drinks. I have seen several friends lose a ton of weight (a close female family friend lost 70 lbs), just by cutting out sugar.

When I went through a similar situation, I cut out processed foods. My 2 rules were if it will rot in a few days, I cannot eat it. Number 2 was if my great great great great grandmother would not recognize it as food, don't eat it (sorry Oreos).

We are the real problem. Eat real food, eat less of it, and move around. That is the answer for our problem. Getting off soap box now.

 

[junkman]

I see all 3 on this page as having valid points. Rates are a function of claims. Claims are a function of utilization and price. We have had a near 10% trend for years. Our response at the agent level has been to change plan design and have the employee pay more of the premium. I remember delivering my 1st premium that at $103 and change broke the $100 mark. We thought the world would end.

Re: single payer, I don't know conceptually whether or not it matters who pays claims. At some level, economics have to come into play at the buyer level. All parties involved have their own objectives and modify actions to max out their objectives under whatever the rules are. Our elected officials take lots of money from the lobbyists and the money appears to affect decisions. How else can you account for people looking you straight in the face and deny science for example?

Carriers have a big infrastructure set up to administer claims. They will not go down without a fight. We know that price controls don't work and that no matter what rules are in place, the wealthy will have access. I talked to a person who winters in Boca Raton where the community maintenance dues are $4,000/month and green fees are in addition. He has a Doc that charges $2400/yr to be on call. Ongoing bills are on a fee for service basis. This person generally doesn't sit in the ER waiting for his turn.

I note that a friend of mine pays $175/month for insulin. Insulin is an old drug ant the original patent is long expired. Drug companies have made minor changes that have not made a more effective drug but have extended the patent and kept the price high.

My friend is an accomplice. She is obese, out of shape, old and continues to suck down massive numbers of Honey Buns and Cokes. Her children have learned from her and work jobs that will keep them forever broke as is she while following Mom's exercise and eating patterns. Sad. They are good people.

I don't see a national get healthy movement as happening. Yes, you can make yourself healthy but it is difficult to get others to do it. I define food as nothing I can't pronounce, nothing out of a box or can and 70-90% raw depending on how strict I am. All else that people eat is defined as "garbage". The choice is simple. Eat food or eat garbage. Health stats really change for the better at 90% but it feels stark when a cheat is a piece of fish on a huge salad.

That said, I watched one friend whose liver was shutting down to the point of considering a liver transplant have a complete reversal by juicing,eating raw and taking supplements. The wholistic healer got sued twice by the authorities and run out of TN. Fortunately, AL isn't far and they apparently have more accommodating laws.

I also talked to a lady that thinks insurance carriers are evil because her friend that was a truck driver and had cancer ran out of benefits and died. I told her that it was a harsh reality that carriers would manufacture and sell whatever contract a person wanted to buy. They know what total claims are and price accordingly. If you want the coverage, then buy the policy with coverage but don't expect the carrier to pay more than agreed to in the contract. I've quoted some trucking plans and the employer specified limits because many drivers wouldn't pay for more even with the employer picking up a big chunk.

 

[somarco]

I don't see what is so bad about a single payer system.

Perhaps it is because you really have not studied countries where SP exists. Give us an example or more of places where SP really works.

Don't start with Cuba . . .

You mention Canada, which really has 10 separate plans, not one. Population by province range from 500,000 to 13,600,000. Overall population is 35,000,000. About the same as California.

Europe has 51 countries/states, each with their own health care system. Populations range from 450 (Vatican city) to 80,000,000 (Germany).

The US has 320,000,000 people. About 43,000,000 are covered by Medicare, 62,000,000 on Medicaid, 155,000,000 get health insurance through their employer and 22,000,000 have individual plans. Another 10,000,000 have coverage through the VA.

That's about 90% of the population covered by insurance.

So you are suggesting we scrap all that to set up a single payer system for 10% of the population?

Medicaid, Medicare and the VA are mismanaged and under-funded. Some will say the private health insurance system (group and individual) is broken but it worked a lot better and at lower costs before Obamacare.

Or do you suggest scrapping all of the above and institute SP for all 320,000,000 citizens and non-citizens and then expect it to work better than any of the above listed SP systems that have a significantly lower population?

massive savings but eliminating the need for some staff at State insurance commissioners, eliminate health licensing staffs and eliminate the need for agents and zillions of commissions.

Care to throw out a number associated with these MASSIVE savings?

replacing the high costs of insurance companies with wealthy exec and high shareholder profits.

What is the cost associated with these line items expressed as a percent of premiums? Feel free to show your work.

I don't see a national get healthy movement as happening.

True, but there are people on this forum that talk about how healthy they are, and they ride bikes several times a week for many miles. Yet they are foolish enough to believe that nothing serious will ever happen to them and they refuse to buy full coverage Obamacare insurance.

 

[Ann H]

Re: single payer, I don't know conceptually whether or not it matters who pays claims.

Great point. I understand why DavePhx feels that single payer is the answer, and others may feel the same way. But it's rearranging the deck chairs on the top level, with the underlying problems still existing.

Personally, I think this new administration could change underlying health issues. Trump wants to increase jobs and American infrastructure. He could motivate businesses with tax incentives to create healthy food restaurants, especially those who have playlands for kids or appeal to teenagers. Same thing for healthy choices at the grocery store and convenience stores. There could be a massive ad campaign to help. For instance, in the 1950's and 1960's every fashionable American smoked cigarettes, and now it's deplorable to society. At one time we all ate trans fats, and now it's anathema. It's possible to turn around a generation, until they scoff at chips and donuts. It has not occurred in America yet, but it is certainly possible. Some other cultures don't have this kind of junk food. I had the pleasure to know some people from other countries and other cultures, and they would gag on some of our food. I remember one person who said Ketchup was so sugary sweet that he couldn't stomach it.

 

[TN_agent]

The government farm subsidies (corn, wheat, soy) need to stop, if we can get a Congress with enough intestinal fortitude. The food industry is a powerful lobby though, and they sure love using cheap wheat, soy, and corn products as filler in all the junk food they produce. Eliminate the artificial cheapness of those ingredients, you are going to reduce their appearance in our food supply.

I also don't think any carbonated beverages should be able to be purchased with food stamps. There was just an article about this. They final did a study and almost 5% of food stamp dollars go for soda, a substance with literally no nutritional value. Another 5% on other sweetened beverages like gatorade, koolaid and sweet tea. The food lobby is saying it would be hard to put that into place. Give me a break, everything is computerized now, all the grocery systems know the difference between beer and juice by the bar code, would be simple to implement.

 

[VolAgent]

Great point. I understand why DavePhx feels that single payer is the answer, and others may feel the same way. But it's rearranging the deck chairs on the top level, with the underlying problems still existing.

Personally, I think this new administration could change underlying health issues. Trump wants to increase jobs and American infrastructure. He could motivate businesses with tax incentives to create healthy food restaurants, especially those who have playlands for kids or appeal to teenagers. Same thing for healthy choices at the grocery store and convenience stores. There could be a massive ad campaign to help. For instance, in the 1950's and 1960's every fashionable American smoked cigarettes, and now it's deplorable to society. At one time we all ate trans fats, and now it's anathema. It's possible to turn around a generation, until they scoff at chips and donuts. It has not occurred in America yet, but it is certainly possible. Some other cultures don't have this kind of junk food. I had the pleasure to know some people from other countries and other cultures, and they would gag on some of our food. I remember one person who said Ketchup was so sugary sweet that he couldn't stomach it.

We are not alone in the bad lifestyle bandwagon. We simply got their before most other nations.

Global Obesity Levels - Obesity - ProCon.org
WHO | Obesity and overweight

I would say widespread obesity is driven by two main factors. Abundant access to cheap empty calories while more nutritionally dense calories are more expensive. Societies where people can afford individual transit and everything is so spread out as to discourage walking and mass transit, which generally requires walking to and from the stop/station.

For most of history, the difficulty was in acquiring enough calories to survive. Now we are faced with an overabundance of calories and have to make more intelligent decisions on which to eat. Something new to most of humanity.

 

[STIBROKER]

I would say widespread obesity is driven by two main factors. Abundant access to cheap empty calories while more nutritionally dense calories are more expensive.

You Won't Believe How Much Food Stamp Recipients Spend On Soda

SNAP recipients spent more money — more than $1.9 billion total — on sweetened beverages, frozen prepared foods, desserts, high-fat dairy, and salty snacks than they did on fruits, vegetables, milk, bread, and crackers, which totaled nearly $1.4 billion.

 

[VolAgent]

You Won't Believe How Much Food Stamp Recipients Spend On Soda

SNAP recipients spent more money — more than $1.9 billion total — on sweetened beverages, frozen prepared foods, desserts, high-fat dairy, and salty snacks than they did on fruits, vegetables, milk, bread, and crackers, which totaled nearly $1.4 billion.

It would not surprise me in the slightest. It is cheap, it tastes good, and it is what they are use to eating. For the vast majority of people who receive SNAP I bet their only experience eating fruits and vegetables was school lunch. After that, who would want to eat fruits and vegetables?

The one thing that baffles me about so many people is they think they can get out of paying for the poor. They can't, you are going to pay one way or the other, so why not pay in a way to change things? Most of our "factory" employees now receive government assistance. Walmart and fast food restaurants. Those have become the major employers of low skilled workers.

You can pay for education, or you can pay for a criminal justice system, welfare system, and healthcare system. I suppose you could trying going all dystopian and abandoning the poor, although I doubt any such system would survive the constant riots and unrest.

Many states are paying to incarcerate per prisoner half or more what a new teacher is paid. Obviously you will never completely eliminate crime and thus prisoners, but it may be time to rethink our spending priorities.

These States Have the Highest Cost Per Prisoner | InsideGov