Welcome, Guest. Please login or register.

Login with username, password and session length

 
Advanced search

1063291 Posts in 70675 Topics- by 18562 Members - Latest Member: Mikkosh
Jump to:  
Pages: 1 2 3 4 5 6 [7] 8  All   Go Down
Print
Author Topic: GOP Health Care  (Read 2923 times)
0 Members and 1 Guest are viewing this topic.
BGuttman
Mad Chemist

*
*
Online Online

Location: Londonderry, NH, USA
Joined: Dec 12, 2000
Posts: 49839
"Almost Professional"


View Profile
« Reply #120 on: Mar 15, 2017, 09:00AM »

My 2002 Volvo recommends oil changes every 7500 miles.  But it uses 6.5 liters of oil (normal engines use around 3.5).  The contamination in the larger sump builds more slowly.

But an oil change doesn't really affect a car insurance.  It affects the warranty.  Your car warranty will be voided if you fail to do regular maintenance.

Still, health insurance covering checkups is the "stitch in time" philosophy.  It's a lot easier to treat hypertension with drugs than to do the hospitalization for a heart attack.

Also, lower income folks who can't afford doctor visits will postpone seeking treatment until it can't be avoided.  And then they are in the Emergency Room, where it costs around 10x what it would cost if treated in a doctor office earlier.

And the new GOP plan targets the poor folks by reducing Medicaid drastically.
Logged

Bruce Guttman
Solo Trombone, Hollis Town Band
Section Ldr, Merrimack Valley Philharmonic Orch.
Baron von Bone
Fear is the Mind-Killer.

*
Offline Offline

Location: Athens, GA (USA)
Joined: Jul 16, 2002
Posts: 17878
"Reality Junkie"


View Profile
« Reply #121 on: Mar 15, 2017, 09:13AM »

You brought it up.  Now that it's not working for you, suddenly it's our fault.

Yet another demonstration that these issues often aren't as much about information or communicating reason and such as they are psychology and sociology, and in some cases it's unfortunately utterly pointless to try and work with the former rather than the latter, and in most cases it's still the weaker of the two paradigms in terms of having any actual effect on anyone.
Logged

- Feeding a troll just gives it a platform and amplifies its voice.
 
- Science is what we have learned about how to keep from fooling ourselves.  - Richard Feynman
- He who knows not and knows not that he knows not is a fool.   - Confucius
Piano man
*
Offline Offline

Location:
Joined: Feb 10, 2006
Posts: 9537

View Profile
« Reply #122 on: Mar 15, 2017, 11:01AM »

It's amazing you guys are talking about oil changes, when I was only making a point about the health insurance.
What in the world do you expect? You made a snide little rejoinder designed to ridicule what someone else said (complete with a bright little LOL! at the end), and it turned out that the person you were ridiculing knew far more about the subject than you did. It's of a piece with your habit of forming confident opinions on subjects about which you know little.

And your underlying point about car insurance and health insurance is wrong, as well.

Quote
Car insurance doesn't cover oil changes, while health insurance does cover hundreds of preventative maintenance.

If you're talking about collision and liability insurance, there's no reason to include oil changes, because they're insuring against accidents and not repairs. But warranties (dealer or third-party) are analogous to health insurance, and it would make perfect sense for them to pay for oil changes. It's a predictable cost that can be added to the premium at no greater cost to the driver than paying out-of-pocket. The insurer probably gets a better price due to economies of scale than the driver would. And it reduces the likelihood of catastrophic repair claims by making the driver more likely to properly maintain the car.

These are all analogous to health insurance. Insurance companies give you a break on preventative care because they want you to have it.

Quote
Health insurance just needs to cover catastrophic conditions only. Way cheaper.

Well, most people seem to disagree on that, since one of the biggest complaints about Obamacare was high deductibles. Trump campaigned on lowering deductibles,, which is the opposite of what you want.

Besides, 'catastrophic insurance' isn't a universally good product for everyone. We have very high out-of-pocket costs. If we ever had to meet them, it would be a setback but not ruinous. But if a family is making $30-40K per year, having only catastrophic coverage could drive them into bankruptcy.


Logged

"What gets us into trouble is not what we don't know, it's what we know for sure that just ain't so." --Mark Twain
B0B
*
Offline Offline

Location:
Joined: Jun 27, 2008
Posts: 5179

View Profile
« Reply #123 on: Mar 15, 2017, 12:35PM »

Well, most people seem to disagree on that, since one of the biggest complaints about Obamacare was high deductibles. Trump campaigned on lowering deductibles,, which is the opposite of what you want.

Besides, 'catastrophic insurance' isn't a universally good product for everyone. We have very high out-of-pocket costs. If we ever had to meet them, it would be a setback but not ruinous. But if a family is making $30-40K per year, having only catastrophic coverage could drive them into bankruptcy.

The biggest issue with high deductible health care plans is actually that they might help small problems BECOME expensive ones. If you have to pay for everything, and it is pretty expensive, then minor or small problems often go overlooked. The issue is judged against the cost. Except that the issue isn't understood unless investigated, so mostly the high deductible raises the bar for when people will actually seek treatment. Numerous studies confirm this.

So you don't get something small looked at when it's small, if it gets bigger... it also gets more expensive and hazardous. Thus actually being far more costly to both the person and the provider in the long run.

The was a doctor who put his family on such a plan a few years back... and a good doctor. Think he taught at harvard. Even as a doctor... he was making calls, against his own health, that if he were the doc instead of the patient he would advise against. And for good reason. He found his family was at much higher risk as every decision was compared to the cost, and the costs kept coming.


That approach is great for the free market... but healthcare isn't a free market. Nor does it actually work as it is guessed it would... and by guessed, that guess is made mostly on philosophy of those who don't know the market, nor the issues involved.
Logged
Piano man
*
Offline Offline

Location:
Joined: Feb 10, 2006
Posts: 9537

View Profile
« Reply #124 on: Mar 15, 2017, 01:17PM »

There are two opposite issues with insurance deductibles. As you're saying, out-of-pocket costs cause people to forgo care.

But having medical care paid by someone else besides the consumer keeps it from functioning as a natural market. People who don't have to pay out of pocket don't pressure providers on price the same way they would another product, and when insurers try to impact pricing by pressuring providers, it upsets consumers because it reduces their choices. HMOs were designed to solve this problem, and people seemed to hate them.

The idea that we must avoid 'socialized medicine' at all costs presupposes that there's anything like a functioning capitalist market in the first place. Some of the best reforms would be market based and deregulatory, but the beneficiaries of the closed market would fight this tooth and nail.
Logged

"What gets us into trouble is not what we don't know, it's what we know for sure that just ain't so." --Mark Twain
bhcordova
Wielder of the Cat Litter Scoop

*
*
Offline Offline

Location: Nacogdoches, TX, USA
Joined: May 18, 2000
Posts: 7014
"Carpe Felix"


View Profile WWW
« Reply #125 on: Mar 15, 2017, 01:57PM »

Are you talking market based for health care or market based for insurance?
Logged

Billy Cordova, MBA
Forum Administrator
bcordova@tromboneforum.org

Beware the Jabberwock, my son! - Lewis Carroll

Do not meddle in the affairs of dragons for you are crunchy and taste good with ketchup - Anon.

St. Cecilia, pray for us.
Douglas Fur
*
Offline Offline

Location: Seola Creek, USA
Joined: Jul 4, 2014
Posts: 818

View Profile
« Reply #126 on: Mar 15, 2017, 02:28PM »

Are you talking market based for health care or market based for insurance?

Neither one but "a combination of ingredients well known to  doctors." To get back to my core theory. The market needs to have a balance between buyer and seller. Both parties need to be able to say "yay or nay" to a deal for it to work. If our MD says my daughter has to have a emergency appendectomy I'm not able to say no or wait for a sale to come along.

Where the market can be effective is in programs like Medicare advantage where the buyer and seller are equals when they make a deal.

If we used this as a model were there is healthcare for everyone, and the administrative structures of the existing Medicare and insurance providers are used we'd pay less to get good care for all.

DRB
Seola Creek
Logged
Piano man
*
Offline Offline

Location:
Joined: Feb 10, 2006
Posts: 9537

View Profile
« Reply #127 on: Mar 15, 2017, 04:15PM »

Are you talking market based for health care or market based for insurance?

I'm primarily talking about medical care delivery. There are factors that create artificial shortages in medicine, mostly due to the ministrations of the AMA (Milton Friedman called them a 'cartel'). The insurance market is meaningful, but somewhat marginal--if every insurance company were non-profit and simply charged back for the underlying costs of the care, we would still be spending too much on medical care.

The simple way to look at it is that we spend much more money on health care (by population or as a percentage of the GDP) than most developed countries, but there are still a lot of people who don't have it. Tweaking the insurance industry might help a bit, but it won't really change it. You have to look at costs.

If you look at how much education is required to become a doctor, and how much it costs and how much they expect to make, we shouldn't reserve so much of medical care delivery to them. It's as if you had to go to an ASE-certified mechanic to get an oil change or new tires.

That's improved a little, with increased latitude in some states for Nurse Practitioners and PHysician's Assistants (usually over the fierce opposition of doctors), but there is room for lower level specialties in medicine, instead of mostly higher-level ones.
Logged

"What gets us into trouble is not what we don't know, it's what we know for sure that just ain't so." --Mark Twain
robcat2075

*
Offline Offline

Location: Dallas, Texas
Joined: Apr 19, 2009
Posts: 5111

View Profile
« Reply #128 on: Mar 24, 2017, 09:30AM »

I'm kinda surprised the GOP is having trouble getting to the goal line on this.

It turns out they aren't ideological enough to barrel through with repeal and no replacement but they are ideological enough to get hung up on repeal with even slight replacement.
Logged

Robert Holmén

Hear me as I Play My Horn


Get your Popper, Dotzauer, or Kummer play-alongs!
timothy42b
*
Offline Offline

Location: Colonial Heights, Virginia, US
Joined: Dec 7, 2000
Posts: 11654

View Profile
« Reply #129 on: Mar 24, 2017, 09:42AM »

It doesn't seem to have occurred to anyone that there just aren't that many ways to construct a health care insurance system.

They're going to all be variations on the same theme, which a substantial percentage on both left and right don't like (for opposite reasons.) 

"We're going to replace it with something better."

"okay, go ahead." 

"Oh crap."
Logged

Tim Richardson
Ellrod

*
Online Online

Location: North
Joined: Oct 30, 2001
Posts: 5832

View Profile
« Reply #130 on: Mar 24, 2017, 09:49AM »

It doesn't seem to have occurred to anyone that there just aren't that many ways to construct a health care insurance system.

They're going to all be variations on the same theme, which a substantial percentage on both left and right don't like (for opposite reasons.) 


All the schemes involve spreading the cost either through premiums or taxes. But, overall, it's too expensive. So you mandate the young and healthy to buy insurance or restrict coverage. The Dems prefer the former, the GOP the latter.
Logged
robcat2075

*
Offline Offline

Location: Dallas, Texas
Joined: Apr 19, 2009
Posts: 5111

View Profile
« Reply #131 on: Mar 24, 2017, 09:56AM »

As I see it, Obamacare could get passed because it was mostly about making the health care insurance business to act sensibly.

Any thing better than that will require getting the health care system itself to act sensibly. Pharma, doctors, hospitals... those are all bigger sacred cows than the insurance industry.

 
Quote

All the schemes involve spreading the cost either through premiums or taxes. But, overall, it's too expensive. So you mandate the young and healthy to buy insurance or restrict coverage. The Dems prefer the former, the GOP the latter.

This ignores the experience of other Western countries that cover everyone, for less per person than we are paying now in the US, with better outcomes than in the US. Even with their supposed waiting times and rationing and whatever... they get it done better for less.

It can be done. It probably can't be done in the low-regulation environment of the US.
Logged

Robert Holmén

Hear me as I Play My Horn


Get your Popper, Dotzauer, or Kummer play-alongs!
robcat2075

*
Offline Offline

Location: Dallas, Texas
Joined: Apr 19, 2009
Posts: 5111

View Profile
« Reply #132 on: Mar 24, 2017, 01:35PM »

Establishment pundit David Brooks...


The Trump Elite. Like the Old Elite, but Worse!


Quote
Legislation can be crafted bottom up or top down. In bottom up you ask, What problems do voters have and how can they be addressed. In top down, you ask, What problems do elite politicians have and how can they be addressed?

The House Republican health care bill is a pure top-down document. It was not molded to the actual health care needs of regular voters. It does not have support from actual American voters or much interest in those voters. It was written by elites to serve the needs of elites. Donald Trump vowed to drain the swamp, but this bill is pure swamp.

First, the new Republican establishment leaders needed something they could call Obamacare repeal — anything that they could call Obamacare repeal...

Quote
Second, Donald Trump needed a win. The national effects of that win seemed immaterial to him.

His lobbying efforts for the legislation were substance-free. It was all about Donald Trump — providing Trump with a pelt, polishing a credential for Trump...

Quote

Third, the bill was crafted by people who were insular and nearsighted, who could see only a Washington logic and couldn’t see any national or real-life logic...


I'll note that David Brooks isn't much of a realist himself.  Later on, he says he's for health care savings accounts, something practical only for the rich.

Logged

Robert Holmén

Hear me as I Play My Horn


Get your Popper, Dotzauer, or Kummer play-alongs!
Piano man
*
Offline Offline

Location:
Joined: Feb 10, 2006
Posts: 9537

View Profile
« Reply #133 on: Mar 24, 2017, 01:56PM »

As I see it, Obamacare could get passed because it was mostly about making the health care insurance business to act sensibly.

You're right, Obamacare passed due to its lack of ambition. The premise was to keep everything in place that was already there (workplace-based insurance, Medicare, etc.) and fill in the cracks with something else. This gave rise to the great lie--If you like your insurance, you can keep it--which may have been the intention but wasn't something Obama could deliver.

It passed because it held AMA and pharma harmless, then demonized insurance companies while rounding them up millions of new customers.

Obama was roundly excoriated for his lie about Obamacare, but Trump's mendacity is greater by an order of magnitude. He simply pretended to have a plan when he didn't. He took everything that people groused about under the current regime--high premiums, high deductibles, mandates, etc.--and claimed to have a plan that would fix them, and give everyone insurance, for less money. He bragged about being a tough negotiator who would stand up to big pharma and wangle great prices for the American people.

He had one meeting with the pharma CEOs and the big boys walked all over him and he abandoned the project, and the promise.

He then let the GOP Reps. create a random plan that effectively addressed none of thoe promises he made, and endorsed it. Now, after stumping hard for the plan, his minions are already blaming Ryan for not coming up with a better plan. If he's unhappy with Ryan's plan, why doesn't he use his own?

Because he doesn't have one, and never did. Trump could have surprised us and done something good. It's time to recognize that he's not going to do that, and that he's **** as president. We're spending millions on his constant golf vacations, and in my opinion it's money well spent.

Logged

"What gets us into trouble is not what we don't know, it's what we know for sure that just ain't so." --Mark Twain
Graham Martin
Purveyor of 'HOT' Jazz

*
Offline Offline

Location: Redland Bay, Queensland, AUSTRALIA
Joined: Nov 5, 2000
Posts: 11239
"Dixieland/Mainstream/Big Band"


View Profile
« Reply #134 on: Mar 24, 2017, 04:16PM »

I am rather hoping that the fact the Republican bill to dismantle Obamacare has been pulled by US House Republican leadership will mean the beginning of the end for Trump. Oh, please!
Logged

Grah

"May God bless and keep you always
May your wishes all come true
May you always do for others
And let others do for you
May you build a ladder to the stars
And climb on every rung
May you stay......forever young."
robcat2075

*
Offline Offline

Location: Dallas, Texas
Joined: Apr 19, 2009
Posts: 5111

View Profile
« Reply #135 on: Mar 24, 2017, 05:22PM »

This gave rise to the great lie--If you like your insurance, you can keep it--which may have been the intention but wasn't something Obama could deliver.

I think what Obama didn't realize is that a lot of people "liked" really bad (cheap) insurance, people unaware of how inadequate it would be when they had a health crisis and needed it to be there.

A commentary I heard yesterday noted that there were policies being sold that covered five doctor visits and nothing else.  Someone who had never been through a substantial illness might think that was all they'd need.

A lot of insurance appeared, on paper, to give real coverage but back then it was so easy for an insurance co. to drop someone for "pre-existing conditions" that the insurance was still worthless.

The people who had insurance policies that no longer qualified to be called insurance were the ones that "lost" their insurance. Real insurance policies that do real coverage cost money. Surprise. Obama failed to convey that reality.

Obama wasn't intentionally lying; he didn't grasp what Elizabeth Warren had been warning about for years: people had been fooled into buying cheap insurance that wasn't really there for you you when you got sick.


 
Logged

Robert Holmén

Hear me as I Play My Horn


Get your Popper, Dotzauer, or Kummer play-alongs!
Piano man
*
Offline Offline

Location:
Joined: Feb 10, 2006
Posts: 9537

View Profile
« Reply #136 on: Mar 24, 2017, 05:31PM »

I think what Obama didn't realize is that a lot of people "liked" really bad (cheap) insurance, people unaware of how inadequate it would be when they had a health crisis and needed it to be there.

A commentary I heard yesterday noted that there were policies being sold that covered five doctor visits and nothing else.  Someone who had never been through a substantial illness might think that was all they'd need.

A lot of insurance appeared, on paper, to give real coverage but back then it was so easy for an insurance co. to drop someone for "pre-existing conditions" that the insurance was still worthless.

The people who had insurance policies that no longer qualified to be called insurance were the ones that "lost" their insurance. Real insurance policies that do real coverage cost money. Surprise. Obama failed to convey that reality.

Obama wasn't intentionally lying; he didn't grasp what Elizabeth Warren had been warning about for years: people had been fooled into buying cheap insurance that wasn't really there for you you when you got sick.

You're largely correct--the companies selling worthless, or nearly worthless, insurance used the ACA as an excuse for dropping people they didn't really want to insure in a meaningful way. A policy with high out-of-pocket costs and low lifetime caps is effective neither as comprehensive nor catastrophic insurance--you've basically bought nothing, because you're hoping to hit a vanishing sweet spot where you're doing better than getting your own money back.

If you incur no expenses, you've paid for nothing. If you incur minor expenses, you pay for them out of pocket, so you've paid for nothing. If you incur significant expenses, you pay for them out of pocket, then receive part or all of your premiums back, so you've paid for nothing. If you have massive losses, you exceed the caps, and you no longer have insurance, and you're bankrupt, so you paid for nothing.

That's why the majority of medical bankruptcies were sought by people who had medical insurance.

The people being ripped off by these schemes 'liked' their insurance because they weren't smart enough to know that it wasn't a good deal. Obama should have anticipated that and avoided making the claim.
Logged

"What gets us into trouble is not what we don't know, it's what we know for sure that just ain't so." --Mark Twain
Russ White

*
Offline Offline

Location: Orange City, Fl
Joined: Feb 27, 2007
Posts: 4974

View Profile
« Reply #137 on: Mar 24, 2017, 06:58PM »

The "great Obama LIE" could have been avoided with the simple addition of the phrase, "if it complies with ACA requirements" to his "If you like....".
Logged

Better than yesterday, better yet tomorrow.
robcat2075

*
Offline Offline

Location: Dallas, Texas
Joined: Apr 19, 2009
Posts: 5111

View Profile
« Reply #138 on: Mar 24, 2017, 07:13PM »

Shocked headline on RedState.com...  :D


GOP Lawmaker: Previous ObamaCare Repeal Votes Were a Fraud

Quote
...quote from Rep. Joe Barton...
Quote
    Reporters asked why, after Republicans held dozens of nearly-unanimous votes to repeal ObamaCare under President Obama, they were getting cold feet now that they control the levers of power.

    “Sometimes you’re playing Fantasy Football and sometimes you’re in the real game,” he admitted. “We knew the President [Obama], if we could get a repeal bill to his desk, it would almost certainly be vetoed. This time we knew if it got to the President’s [Trump's] desk [Trump]it would be signed.”

That’s about as blatant an admission of political fraud as you are ever likely to see.

That's a more damning assessment than the left-leaning sites have given it, but then, the left-leaning sites knew it was play-acting all along.
 
Logged

Robert Holmén

Hear me as I Play My Horn


Get your Popper, Dotzauer, or Kummer play-alongs!
robcat2075

*
Offline Offline

Location: Dallas, Texas
Joined: Apr 19, 2009
Posts: 5111

View Profile
« Reply #139 on: Mar 24, 2017, 09:49PM »

Logged

Robert Holmén

Hear me as I Play My Horn


Get your Popper, Dotzauer, or Kummer play-alongs!
Pages: 1 2 3 4 5 6 [7] 8  All   Go Up
Print
Jump to: