"Nobody knew that healthcare could be so complicated"
What a putz
@ 12 months ago
Chaska, MN 55318, USA
What a maroon
@ 12 months ago
Villa Park, IL, USA
@ 12 months ago
Yorkville, New York, NY
Is that the book after Habakkuk?
who said that?
@ 12 months ago
Cerritos, CA, USA
@ 12 months ago
Yellow Springs, OH 45387, USA
@Undr - http://thehill.com/policy/healthcare/321318-trump-nobody-knew-that-healthcare-could-be-so-complicated
@ 12 months ago
Yay, the plan is out.
Meet the new boss, same as the old boss
Just saying there are huge differences.
Well I hope this one works better
Like dumping a meth addict for a crack addict
Would you ACA was a success?
Lisle, IL, USA
Parts of it.
I wouldn't say it was a failure.
It wasn't a complete failure, but it did fail in to achieve key goals
Naperville, IL, USA
Some. Can't just stop the Titanic on a dime.
You were a big cheerleader years ago, I was skeptical but hopeful
maybe we can both agree that meaningful changes are necessary and that the current proposal is not the cure
Oswego Township, IL, USA
Still am. It was an incremental improvement that built on the existing health insurance infrastructure - not the radical change it was portrayed as.
hey I'm still a fan of the Chicago Bears, so I guess I can understand
I have no doubts that Trumpcare will get passed. In short time, many will regret the change and we'll start the process over again.
maybe..... the current proposal will struggle to get the votes in the Senate
So far all Republican opposition to Trump has been just bluster before falling in line. I expect no different here.
we are such a bizarre species.
why is that?
Skål, what makes you certain the new plan will fail?
Bumper stickers don't translate into good policy.
I'd be happy to address specifics if you'd like to discuss, otherwise I'll avoid the soapbox for now.
I do with sincerity, in time. This month is a little bananas for me
Don't get me wrong, I think the plan will be successful with what they really want to accomplish.
Health care, no so much.
A nice summary; http://files.kff.org/attachment/Proposals-to-Replace-the-Affordable-Care-Act-Summary-of-the-American-Health-Care-Act
Is there any concern about Congress ramming this bill down our throats? The ACA was passed after 14 months of debate and discussion. And Paul Ryan was adamant that nothing would be considered until CBO weighed in.
@ 12 months ago
Lakeland, MN 55043, USA
Seems to me that Ryan now wants to push this bill as far forward as possible before the CBO figures can be provided! Why is that?
@ 12 months ago
The strategy seems to be, pass it to find out what it will cost us.
Almost 14 until signed and passed. February '09 to March '10
I hope it does pass and takes effect as fast as possible.
The bill was introduced in September 2009. Not understanding the 14 months. Unless you think healthcare reform talk only started when Obama came into office. Which we all know is not true
it was introduced well before 2009....
just saying you might want to revisit how the law meandered through the house and senate. there was significant debate in committee for months
Hey everyone knows principles like 'don't ram the bill down our throats' , and 'don't keep it secret' fly out the window when you're in power
Northwest Harbor, NY 11937, USA
the gop gave plenty of input on ACA before it made it out of Baucus's committee. 30+ meetings. changes were made despite them having no intentions to support the bill. these were well chronicled at the time.
And eventually with the help of a bolt of lightning, Obama's monster was brought to life
If you think ACA was a monster, wait until this piece of shït passes.
what do you predict will happen
Massive rate hikes? exponentially rising deductibles? indifferent and unemployed younger workers? unfunded liabilities? increase in percentage of part time workers? less competition? I guess history does tend to repeat itself
I mean it's always possible to make things worse at an *increased* rate.
Will Dems be able to Tea Party this thing in 2018 or will the poor match ups and usual poor dem midterm turnout screw them up.
Rate hikes and exponentially rising deductables were happening preACA. How people forget...
Less competition - there have been a few documented cases of insurers completely leaving the exchanges in retaliation because mergers weren't approved
right and it was no cure
What do I predict will happen? Much, much worse. How much time you got?
give me the bullet points on your list of doom
1) Changes in subsidies/tax credit from need-based to age-based
2) Change in age-rating from 3:1 to 5:1.
Huge shift in cost to the 50-65 yo cohort, which is larger than normal b/c baby boomers.
3) Change from individual mandate to a one time penalty up to 30% of the premium for not having been insured during the preceding 12 months, but guarantee issue is kept.
Just like ACA, the penalty is not strong enough
It's a horrible policy and because there isn't even a threat of a mandate there will be even less incentive to sign up.
Death spiral on steroids.
4) Eliminate medicaid requirement to cover mental health and substance abuse . This is just bad policy IMO.
5) HSA changes: Personally, I'm going to make a killing on this one, but most people don't make enough money to take advantage of these or self-ration when they really shouldn't.
I got a kick out of this doc, who I highly respect as a policy analyst, as he documented his struggles with HDHP+HSA.
6) Change in Medicaid funding to block grant. Lots of problems here.
7) Repeals medicaid eligibility for children between 100-138% FPL.
8) Innovation and stability grants intended for high risk pools can be used for whatever the state wants - kinda like the tobacco $
That's a good start. I laughed when I saw that they kept the IPAB and the exchanges.
Also notably missing was a provision to allow for purchasing across state lines. Good IMO, but strangely absent since this has been pushed by the GOP for the last 7 years.
Yep it's the wrong way
Skal,,, Isn't the state line thing created by individual state regulations. I don't see how congress could fix it without stepping on states rights.
Most plans have discussed allowing states to join interstate compacts, which they are constitutionally prohibited from doing without congressional approval.
That said, the ruling party's desire to step all over states rights is always a case-by-case basis. We're seeing that now with the stance the fed is taking towards marijuana.
A good primer on the issue. http://www.ncsl.org/research/health/out-of-state-health-insurance-purchases.aspx
I see it as a positive only if the market were to open on a national basis. And then only if there were standard coverages provided. Otherwise you would see companies offering crap policies to draw in the bargain hunters.
I agree. There's two things to consider though - Coverage and network.
What good are low premiums from a plan I can buy from another state if all my local docs are out of network?
I'm sure Donald will negotiate a tremendous solution in short order. Now that he understands how complicated it is he may need another week or so.
That's the thing, has this proposal received his blessing?
Northlake, IL, USA
Not exactly. He said it was a wonderful plan. That gives him a lot of latitude.
he's good at that
#4 seems pretty worrisome to me... That'll be real good for crime.
Crime, opioid problem... Not good policy.
@ 11 months ago
The goal should be to increase labor participation rate, phase out profit seeking insurance providers, allow businesses and self employed individuals to negotiate/buy coverage directly with healthcare providers
@ 11 months ago
All persons not covered otherwise, either over the age of 70 or earning less than $30k annually will receive basic coverage under an updated Medicare program
The full amount of insurance purchased (not received via Medicare) will be tax deductible.
We're in the midst of a baby boomer retirement wave. How do you expect to keep them from retiring and leaving the workforce? The labor participation rate is only going to keep dropping, and that's all about demographics.
Phase out for-profit insurers - good luck with that ya commie.
Businesses to buy coverage directly with providers - they can do that already if the provider offers that type of plan. Most don't.
Convert Medicaid to medicare? I like the idea, but not politically feasible.
That tax deduction would be incredibly costly to the treasury and would eliminate the federal tax for a lot of people.
Your comment on labor participation is partially correct. There are many more factors than just boomers retiring that have contributed to the significant reduction we've seen in the last 8 years
When it comes to healthcare I consider the elimination of insurance providers as a move towards capitalism, not away.
A direct provider to consumer system
No incentives currently for providers to adopt this system, but there could be
Incredibly costly to the Treasury, not necessarily and you are simply wrong about it eliminating federal tax for lots of people, it wouldn't
Yes, my comment on labor participation was an over simplification, but retiring boomers (and retirees living longer in general) are a very large part of it.
Most people don't see the elimination of for profit insurance providers as capitalism. Do you forget the debate during the ACA writing process?
Direct provider to consumer plans are interesting, but these are limited when you need someone outside that agreement, like a hospital or specialist.
Re eliminating federal tax liability - it depends on what would happen to employee provided insurance.
Median family income is 52K. Imagine another 18k deduction for a family on top of the standard deduction + others.
Maybe I'm not must people lol
Labor participation fell too sharply and part time employment as a percentage increased. These trends have to be mitigated.
Maybe hospital groups can have a big party and agree to working together hand in hand. it will be beautiful
where did you get the $18k deduction from
btw youth unemployment is probably as big of a factor as Boomer retirement, also factor in the increase in nursing home populations (who are not part of the unemployed pool)
implement a mandatory draft that puts youth into the nursing homes. problem solved.
@ 11 months ago
that would be like so totally not cool
I like it scuba, show them the future. fùcking lazy àsses..
@ 11 months ago
Williamsburg, Brooklyn, NY
18k here: http://www.ncsl.org/research/health/health-insurance-premiums.aspx
Fully deductable premium = 18k.
Sorry, there are many more boomers than 16+ teens.
Yeah but that number is the result of obscenely inflated equipment and administrative costs. Get rid of the procedural fat + excessive testing and watch that number fall
Well aware of direct primary care. Like I said above, these agreements are useless when you need to see a specialist or visit a hospital - you are uninsured to them at get charged the cash price.
Expecting competing hospital groups to sing Kumbaya - what are you smoking?
if they are in different regional markets it wouldn't result in margin erosion, quite the opposite actually
if insurance isn't involved then patients will receive essential care at more flexible and affordable prices, no unnecessary tests, no quadruple Mark ups
Put down the pipe.
Skål, you can destroy the ACA. Obama has foreseen this. It is your destiny. Join me, and together we can rule healthcare as Voter Mappers.
I'm going all in on the GOP plan. I hope the freedom caucus gets their way so the conservative wing gets everything they want.
Your lack of faith disturbs me
lack of faith?
i have full faith in their incompetence
in my plan
you've never watched Star Wars huh?
Is that the one with the Borg?
(you got Vader's quote wrong, btw)
how so lol
So now that the CBO has weighed in, how is this bill going to fare? Are Republicans still going to pass it? Like Skål, part of me seriously wishes to see these asshats get their way. They have whined long enough. So let's go for it!
@ 11 months ago
On the other hand, this isn't a fúcking game. We're literally talking about decisions with actual, immediate life-or-death-or-serious-suffering consequences.
Playing politics and parsing phrases to carefully omit...rushing slapdash bills around in the middle of the night, and desperately trying to discredit the CBO ahead of today...these are horrible games to play with people's lives.
My health care premium is 100% covered, and so is Mr. Evil's. We are very lucky in that respect. Together, we cost about $20,000/year for insurance premiums alone. And that doesn't include dental. So yeah, I'm not personally worried, barring the
usual catastrophes. And one of us losing our jobs does not count as one of those catastrophes, by the way. But what will happen to poor people, aside from is paying for their care anyway...in the ER?
(us paying for)
A $4000 subsidy won't make $20,000/year affordable to someone making $15/hour.
So I can predict what'll happen there! Hooray for the free market, where we will provide welfare care in our ERs for five or maybe fifty times as much as wellcare.
But the cost to taxpayers will be worth it! We'll show those slackers! And more importantly, we'll show Obama just how quickly we can pass OUR bill and totally win the race!!!
The Spicester tells us that a short bill good, long bill bad. Is fast bill good too or is it just the Dopeler effect (bad ideas seem less bad when they come at you quickly)?
Doc, I couldn't have said it better. But as usual, John Oliver did.
@ 11 months ago
@Evil - The conflict is real. Unfortunately, people will believe that the GOP has great ideas on healthcare until reality slaps them in the face. That reality check can't happen soon enough, IMO.
Ironically, we are going to have to repeal the ACA before many will understand what was actually in it.
I fear the sorta slow death spiral that seems to be occurring could actually speed up
@ 11 months ago
ACA's business model is flawed, it will always hinder growth, it will always encourage higher rates of part time employment, and it will always add debt
It was ill conceived, poorly implemented, and weak in mandate.
Any thought that the train will suddenly right itself has proven to be unlikely.
It's time to move on, question is what are we moving on to
Sorry to beat the dead horse but here is a good rundown of the legislative process that led to the passage of the ACA: http://wapo.st/2nmpYyu
Is WaPo considered authentic news these days? It's hard to keep up, frankly.
Anyway, if you believe the article (I'm looking at you, PLC), that whole "ramming Obamacare down our throats" thing is utter and complete bullhonky. What I can't figure out is why no one mentioned this when idiots on Fox and their minions like PLC
and h2o and the rest where screaming bloody murder about things being stuffed down America's snowflake-y gullet.
Thousands will die!!
The proposed bill isn't the right one though that's for sure
Another horrible idea from the GOP: https://www.statnews.com/2017/03/10/workplace-wellness-genetic-testing/
Welcome to Gattaca
nice to see skàl's, open mind finally revealed.
"another horrible idea from the gop"
only dems have righteous ideas, right skal?
Spotsylvania Courthouse, VA 22553, USA
nevermore AHA sucks as bad as ACA, both rape the middle class.
taxes and controlled care
it should be obvious these Washington fùcks are incompetent, both sides.
nevermore = never mind
Dems have plenty of horrible ideas - they aren't exclusive to any particular party.
What taxes in AHCA rape the middle class?
Where is the controlled care in AHCA?
I'd like to know the basis of those two statements, H2O, when you get a chance...
Cadillac Tax, on health insurance deemed to be better than allowed by government
Skål, I thought this article from WaPo was a good summary explanation of issues in ACA vs. AHCA (and shared problems), not just regarding those with chronic illness as the title suggests: http://wapo.st/2ma9psQ
Agreed, although not very concise.
The goal of most GOP plans are to shift costs from the current payer (whether that be govt or private insurer) to the patient - regardless if they can afford it.
That shifting would absolutely make premiums low - but there's more to health insurance than just premiums.
@H2O - Cadillac tax isn't a new tax in AHCA and they delayed it from taking effect. Probably a perpetural delay.
Where is the controlled care in AHCA?
let's answer one question
why does health insurance exist?
Addison, IL, USA
Because people in the 1920s wanted to socialize rising medical costs
does that article explain our current insurance situation or does it explain why larger employers are expected to subsidize cost
No, you asked why health insurance exists. I gave the answer :D
Sure, I never said you didn't
The "The Modern System Is Born" section start to hit on those two topics - but that wasn't the purpose of the article.
it was a fine article, thanks for posting
You brought up those two topics - what were you hoping to discuss?
i sincerely did enjoy the article and history it detailed
I guess I'm seeking the in-between from how we went from there to where insurance companies became such an influential driver in healthcare
Another good one:
But anyways, it became so influential when it became tied to employment - trapping people in jobs and hindering innovation/business formation.
Agreed Skål, and the AHCA's removing the requirements for minimum plan value is not something that's been widely discussed but will have a direct impact on every individual's bottom line.
The impact of the AHCA on people like h2o, with a chronic heart condition, is going to be (and I quote) HUUUUUGE.
I hope the folks that end up paying for worthless coverage under the new law, then develop a major health issue, are happy with this choice. I hope they are happy with their champion of the little people and their complicit Congress.
Maybe not - Medicare is largely untouched.
We voted for this and now, we're gonna get it. In abundance!
Medicare, tricare, AND coverage under Etna prime ( wife's plan).... I'm okay with insurance, thanks for your concern doc.
@Evil - you've probably seen this already. These type of stories crack me up. What did they expect?
@H2O - She said "people like h2o", not necessarily you specifically.
And she's right. Chronic conditions are expensive and this plan hits them hard.
Crunch time. Are the conservatives really going to vote against repeal and replace?
but what do the Russians think??
This bill has everything they want except it isn't tough enough on the poor. A vote no is a vote to keep Obamacare.
They'll come around.
isn't tough enough on the poor lol
Probably just tough enough to pass and make Rand Paul have a major hissy.
One can only hope.
Skål I've been reading worse...people totally clueless about what's about to go down, but sure happy that the Obamacare nightmare is about to end.
You just don't know whether to laugh or cry at the gobsmacking these poor bastards are about to get.
Hop aboard the schadenfreude train! Chooo choo!!
Oh yeah, there've been much worse...that one was just local. Not uncommon over here in Paulsenland.
I didn't know ACA, was so damn perfect.
Did you know that ACA mandates a 300% increase in insurance cost on military retirees at age 65?
yea, I know great law
No one said it was perfect, but AHCA is a complete piece of ####.
Re military retirees - so their costs get subsidized less by everyone else.
You should be happy...or is socialism only ok if it benefits you?
They had seven years to come up with a coherent plan to repeal and replace.
Instead, we got this steaming pile.
Let's pass this POS.
Absolutely Skål, especially now that POTUS has seriously thrown his reputation and clout behind it. It couldn't be more appropriate.
More Uber graduated from there then any other University
Does anyone in Congress hold a degree from that fine institution, I wonder?
If it fails to pass today, I hope Trump stands at his podium and reads the names of the dissenting Repubs to publicly shame them.
"Representative Massey from Kentucky voted to keep Obamacare."
"Representative Meadows from NC voted to keep Obamacare."
If there is one thing he is good at, it's being a vindictive SOB.
Heroes? Most of the freedom caucus claims to be voting no because it doesn't go far enough.
If Obamacare never passed in the first place, would Republicans even be in power today.. I wonder.
Midtown, New York, NY
it doesn't go far enough, that's precisely the issue
In what way, AMI?
To encourage free market competition to provide a wider range of options for business owners and employed individuals
And to provide defined parameters on healthcare provisions for the uninsured and impoverished
So, where does this not go far enough on either of those points?
Great job guys! Strip out those essential benefits! Cheaper premiums with nothing covered - it's so freedom-y you can almost taste it!
liberals, see skàl, would prefer to limit middle & upper class Healthcare in order to provide extensive Healthcare to criminals, unmotivated, uneducated, non taxpayers.... vs limiting Healthcare to that group. it's easier to limit middle income.
Spotsylvania, VA 22553, USA
Healthcare for gang members and drug dealers..... 45 semi automatic and bus ticket to Chicago
What is this extensive healthcare provided to criminals, unmotivated, uneducated, nontaxpayers of which you speak?
Medicaid? hahahahahahahahahhaha shut up.
I'm also curious where I can find a free market...any clues?
thanks for confirming, Skàl
h2o, you seem to be pretty ignorant regarding any actual facts related to this topic.
To summarize: quit before you embarrass yourself further.
I mean we all know listening to wing nut pundits tell you what's what is a mistake. It's just embarrassing to see someone puke it up unmodified like that...proof that you can't think for yourself.
Confirming what? That's the first I've heard Medicaid described as extensive healthcare.
You work in a hospital. You know better than that.
I just heard Tucker Carlson say this on Fox and Friends: "The public wants universal health care." This was to differentiate what the public wants, from what the politicians want. Sad!
h2o, aren't you on public assistance, er um Medicaid? You're old enough aren't you?
So which do you think is worse (politically) for the GOP... Pass or not pass? Seems like lose-lose but maybe there's such thing as 'less of a loss'?
@H2O - That comment equating Medicaid to extensive healthcare is truly baffling.
You see, conservatives live in this fantasyland where they think #### like that is true.
@Drew - Politically their hosed either way. Had they spent some of that 7 years coming up with a plan so they could be *for* something rather than *against* ACA, they'd be in a better spot.
But they didn't, so now they get to reap what they've been sowing.
Just gonna kick my legs up, grab some popcorn, and enjoy the ####show.
Voting is scheduled to start in half an hour kiddies. Do you think Trump will live-tweet threats against those voting no? Because that would be delicious.
The absolute worst aspect of all this is that two branches of government collectively and unabashedly told us that this is ALL about the politics of the thing, the content is secondary. But...But they are messing with fúcking health care!!!
One can only hope. I'm so glad twitter will let you get notifications when specific users tweet.
Too bad most of the good ones will come tonight during tonight's 3AM poop.
This isn't a damn game of chess you idiots! This stuff actually (bigly, even) impacts people's lives on a day to day basis.
For many poor people this is literally a matter of life or death. And yet these Congresspeople who have nothing to worry about when it comes to them and their families, see nothing wrong with using this purely as a political football.
When did this ever happen? And how are people ok with this? It's not even Trump, per se, because I expect it from him. But Paul effin Ryan? Come on get serious. The guy is giving away all the gravitas he's built up over the years...for this.
OTOH, people will still vote for them regardless of what they do when in office - so why would the Congresscritters worry?
And these teat-sucking mamas boys in Congress just buckle and cave, and are so busy averting their eyes you'd think their eyeballs are gonna fall out of their big, stupid heads.
Evil - what do you mean? This is a variation of the plan that Ryan has been pushing for years. (Doesn't block grant Medicare like Ryan has always wanted, just medicaid)
And all you Conservatards out there know this is ALL true.
Hey here's a great photo, taken just yesterday!
Did he get to stop for ice cream afterwards?
Right? It's like when I took my kids to open house at the Bayport Fire Station and they loved getting to take a turn sitting in the driver's seat of a real fire truck!!! Maybe this wasn't as fun as a fire truck, but he got to blow the horn!!!
Anyway Skål yes this may have been Ryan's vision, but when held up against the ACA in any objective analysis it fails miserably. Plus, he never tried to craft his vision into something workable or take input from the various factions of
the Republican Party until, well, just now really.
Plus plus, this bill is reportedly a completely slapdash effort...though apparently NO ONE IN CONGRESS HAS READ IT other than its purveyors (no irony there!).
How is it that seven years of pushing the same fúcking thing as so great, could result in something that fails so completely on so many levels?
Bring out your dead!
Wood Dale, IL, USA
I believe we are witnessing the political suicide of Paul Ryan, in real time, faster and more spectacularly by far than any politician I can remember.
Ryan kinda did...Remember "Path to Prosperity I" and "Path to Prosperity II: Electric boogaloo" a few years back?
"NO ONE IN CONGRESS HAS READ IT"
They'll just parrot the Pelosi line, because that's all they remember about what she said - definitely nothing about the context of the bull#### peddling that she was referring to.
Hmm...yes, you're right, health care was just part of that overall deal I believe. Very prone to the Dopeler Effect in that regard: "repeal ACA" was all that anyone took from that and of course, that sounds great!!!
No complaints there right? Details schmetails! All Republicans agree!
Once you have to actually pay attention to those pesky details, the truth is, as POTUS so wisely noted, it's really hard.
I know all about the unfortunate extra-contextual Pelosi quote...The true irony here is that the Republicans are now actually doing what they falsely accused Pelosi of doing.
I remember two politicians that actually sank faster than Ryan, but both were only candidates for POTUS: Gary Hart (affair) and Howard Dean (the scream).
Saw this on Drudge just now:
"Trump asks Ryan to pull at last minute..."
Pull and pray. Works every time!
Neither of those guys willingly walked to the slaughterhouse though. I'll be amazed if Ryan doesn't go down over this. POTUS must have a scapegoat and it's gonna be little Eddie Munster.
He'll have more time for biceps curls then.
Yep, Ryan pulled out. What a fúcking great use of taxpayer dollars, everyone cheer for the Republican Party!!!
Told you it would fail
The Democrats are equally adept at wasting taxpayer dollars Doc
It's amazing how thorough and FAST the Republicans have been in fúcking themselves over, in the face of the majority they've howled and slathered after for so many, many years. What a bunch of asshats.
So here is an interesting question, first blush: what on earth is the Republican narrative about ACA now?
They will continue to work to instigate that death spiral they've been drumbeating about.
The last big move was Rubio finding a way to get rid of the risk corridors.
ami, this sort of silliness is really beyond the pale. Was this result not predictable given how they (ahem) tried to ram it down our throats (once again actually doing what they FALSELY accused Democrats of doing with the ACA)?
If that result was predictable, I'll submit that this was not a legitimate legislative process but a stupid time sucking sideshow for which you and I paid dearly.
That move singlehandedly led to the closing a many state co-ops, giving the appearance of widespread failure all happening concurrently.
In that sense, ami, this has been different from anything that went before it, imo. At least in the past the effort was serious, even if you hated what they were pushing.
Skål, we're taking past each other, too bad we're not at the bar together. Which move was that now...?
That's why I hate this app - no threading!
Rubio slipped a provision into one of the omnibus bills that said that the risk corridors had to remain budget neutral.
I think there is a calculated strategy to all this. They know the chances of a replacement bill passing with the necessary Republican support is unlikely. So rush a bill to a vote as quickly as possible they know will not pass.
Lombard, IL, USA
Now that it's dead they can say they tried and move on to focusing on legislation much easier to move through. In the meantime they wait to see how ACA actually plays out and try to leverage that plotline
They have already taken the steps that will insure the demise of ACA. The question is, who will own the political ramifications.
both parties should
So that's what happened to the exchanges Skål, I couldn't figure it out...it was so sudden and no one said anything about why the sudden exodus from the marketplace.
Then of course the skyrocketing premiums followed in due course, didn't they. Is this what happened in MN?
this whole thing just proves that ALL politicians are idiots
President Not Sure
@ 11 months ago
Wright City, MO, USA
@Evil - That was part of the exodus. Another reason was retribution after the DOJ blocked a few mergers.
@Evil - re MN: No. We didn't have a co-op and Rubio's shenanigans only affected those.
One of MN's strengths in the group market was a curse for the individual market.
Only 5% of people in MN purchase ind. plans, and of those, only about 1 in 5 bought a plan on the exchange last year. (the rest were off exchange)
In other words, that's a very small risk pool.
Guess where the 26,000 people from the high risk pool went?
On top of that, PreferredOne wanted to capture a large share the first few years and sold plans that were way too cheap
Others adjusted their premiums accordingly and jacked their rates after PO pulled out to recoup
does.that mean, I get to keep paying more? yippeeee
I don't know what I'd do without purple heart insurance increases
You certainly wouldn't have been paying less with the piece of garbage that just flopped.
Well Skål you predicted it'd pass
I thought the freedom caucus would come to their senses and realize they would never get *everything* they wanted and still get a bill that would make it though the Senate
I was wrong. They'll never come to their senses
One thing to 'fall in line' with Trump during campaign time, it's quite another once that's over. Looks like that's not gonna happen.
It doesn't take a genius to see that our healthcare system is about half as effective in delivering value to the public per GDP than comparable systems
that's BIG money
It was never designed to deliver value. Action is valued over thought, so you get more action.
Obviously it wasn't designed to deliver value
Increasing value means increasing cost when insurance is purchased as a private product. Single payer, universal health care systems reduce that cost more efficiently to provide better a better value overall.
Skål, thank you for the explanation above. Mr. Evil self-insures (gets reimbursed by his company) and I couldn't understand the sudden horror show that developed over the past year or so.
His personal experience with the exchange was positive, but the 2017 plan he was offered to replace the one he bought last year was much more expensive with worse coverage. So now he's on my plan. Costs as much but good coverage.
Why wouldn't he have been on your plan to start with
I guess the message to us was: don't fúcking retire...ever. You're going to be too much at the mercy of these fúckwads in Congress creating mass uncertainty on a day to day basis.
Thanks Republicans for being a bunch of witless blowhards that can't even pass legislation with both houses of Congress and the Executive
don't forget to thank the dems for passing such a fine example of legislation when they had it all.
@Evil and AMI: Value = quality/cost. There two ways to increase value - improve quality or lower cost.
Right, so which variable would you choose?
As you know, I like single payer too, but frankly I don't trust the farkwads in Congress not to sabotage it out of spite.
@PNS - healthcare is complicated. The ACA reflects that. The ACHA is what happens when you try to turn a bunch of bumper sticker protest slogans into policy.
@AMI - personally, I'd choose quality (but i have quite a bit of bias towards that one).
The tough thing though is that quality is very tough to define. If you can't define it well, it's tough to measure and track.
why not have a measured balance of both?
Sorry Skål I'm not an expert on this stuff but in the parlance I meant "quality".
PNS, the ACA was the product of over a year of debate and compromise and amendment before going to a vote. Might have something to do with why it did not fail.
@AMI - ideally, yes. But that's where the details of how to measure quality starts to make things more difficult.
Maybe this all actually ends with Donald working with Dems to fix some O'care problems? I mean everyone's been so wrong with all their predictions so who knows.
Possible Drew...I kinda doubt it though. If the tables were turned (as they were not long ago) would you say it could happen?
I am really getting tired of all this winning.
I'm happy that everyone thinks ACA is great
It has its problems, but just think about it- the Freedom Caucus would've rather left the ACA in place than vote for this pile of shït. now they're stuck with it, pretending they'll revisit it later
sure they will
The fingerpointing blame game has been hilarious. party of personal responsibility my ass.
like I said before, it was a strategic loss
Weaken the power of the POTUS, Speaker, and HHS secretary while emboldening the Freedom Caucus?
It's a bold strategy, Cotton. Let's see if it pays off for em
It didn't weaken the power of the POTUS
Once again, they knew that trial repeal and replace was a no win situation for them. So they made a good show of it, allowed the "conservative"side of the party to defeat it, and now they can focus on
legislation that is less polarizing and more achievable.
Doesn't weaken the power of the POTUS? I heard Illinois was considering legalizing it, but did you start early?
Trump's entire character is built on being a dealmaker. He failed to close the deal on this one big time.
Not just that, but Republican staffers involved in the negotiations during the last week are making team Trump's negotiating skills look very, very bad.
ONLY if you believe it was ever meant to succeed
Of course they intended it to succeed - this group doesn't seem like 4D chess strategists.
do you know someone who is aside from Lieutenant Commander Data?
Point being that these guys don't seem like master strategists and I don't buy that this was all done on purpose.
Probably less of a loss than actually passing the piece of crap and then getting all the hell
Greenwich Village, New York, NY
I think things got to the point where to get a "win" would mean to be much more seriously fcked in the future even considering big a political loss it'd be going forward.
Wouldn't it be a Pyrrhic victory?
Not 4d chess, just major last minute damage avoidance. And yeah that speaks to Trump's being #### (at least this round) at *political* negotiation and issuing a very dopey ultimatum.
Maybe, but that wouldn't really explain Trump implying that Ryan should step down through a surrogate.
If they really didn't want this to pass, that wouldn't fit.
Well you know what happens when it doesn't fit
what happens if ACA now implodes? higher rates, less choices, less services, higher deductibles,,, AND now no mandate to purchase anything
Why would it implode now h2o? Before this vote no one was claiming that would happen.
And the mandate remains in place h2o. The new law would have removed it. You may recall that the new law didn't pass.
@Evil - not quite on both. Conservatives have been predicting a death spiral before O's ink was dry - and they've done their damnedest to make it happen. One of those things recently was an EO to essentially get rid of
Individual mandate to purchase insurance and other enforcement measures.
The Dems have done a horrible job at publicizing the sabotage, but now that ACA is becoming more popular it would be a lot easier politically to call out those shenanigans.
If it does implode, it would be completely accurate to say that the GOP was responsible for quite a bit of it, followed by a list of actions taken to undermine the law.
Gotcha. Sorry h2o, my bad, I didn't realize the moles have been so busily sabotaging from that end. Yes, with that shít going on for sure the ACA will fail. That is the purpose isn't it? It's just going to be hard to blame Democrats for that.
Stillwater, MN 55082, USA
Especially now that the Republicans own the ACA. You'd think they would do the opposite so they could crow about how they saved health care. I mean, since they failed so hard at coming up with anything else whatsoever.
When do we get to that Art of the Deal stuff? All the mad negotiation skills, all the winning. When does that start?
although correct on the mandate being removed by Trump EO, the vast majority of the ACA remains intact from 2010. R's couldn't get shìt changed in ACA (remember veto power).
so selling the possible failure to either side should be entertaining
I have to admit dems are much better at pointing the finger.
I'd personally leave it alone for a couple more years, there's nothing wrong with it in original format.
it did have wide public support when it passed, right?
It didn't because the conservative bull#### throwers were doing their thing - lying about what was actually in the law.
That's actually the context for Pelosi's famous line.
There was so much misinformation being peddled that few actually knew what was in the law.
Then there's the whole "support the ACA, but hate Obamacare" crowd. SMH
I think Trump's failure here is a big deal but I also think some of the articles on how disasterous this is gonna be for Trump going forward are more Dem's hope.
Maybe - it all depends on whether he caters to the Freedom Caucus or not. If they insist on getting everything they want, they may have a tough time getting stuff through the Senate (if it can get past the House, first).
Or maybe this is the impetus for super duper executive action Trump... That wouldn't be so good
h2o, POTUS is king of finger pointing, come on now! He started out blaming Dems (really?) then moved to everyone else in turn add that one was just too implausible. Anyone, everyone is to blame except him...opposite of "the buck stops here."
he may be current King, but Schumer has longevity hands down,
think about it, Republicans get blamed for sequestration, a Democrat plan.
All that procedural posturing junk belongs to both parties, h2o. Who's in power dictates what they think about it.
POTUS has done more finger pointing since taking office than Schumer does in 10 years. Who fúcking blames and insults the judiciary for a decision they don't like??
And by "who" I mean any representative of the people of the United States. Not the general public.
Really it's not even a close contest h2o. Narcissists hate being wrong but dictators refuse to be wrong. Someone must be to blame that isn't them. POTUS seems to completely refuse all accountability and lashes out at anyone within reach.
see what I mean..
proof democrats/liberals can pass blame better than Repubs and accept no responsibility for any failure.
What an appropriate defense of your leader, h2o. The "yeah, but that other thing" deflection is very fashionable these days.
It does not present any actual argument or attempt to deny an assertion. If that's all you got then I'm thinking my assertions are correct.
thanks, I'm trying to be converted to a liberal
water brother, you already are!
Gardena, CA, USA
Latest plan sucks too.
@ 10 months ago
More favors for big insurance?
@ 10 months ago
Not quite. Mostly pandering to republican voters that like their cake and want to eat it to.
Good example in middle right row of infographic.
You feel that Kaiser is an unbiased source?
Anyways, I'm struggling to determine the data driving the the increase in positive opinions of ACA. Can you identify what it is?
I think it's because when something is threatened to be "taken away" people start getting defensive about and worried what they could possibly lose.
@ 10 months ago
Unbiased: doesn't exist.
Accurate: no reason to suspect otherwise. KFF is one of the most reliable health policy orgs out there.
@Drew - there's been so much bullshït about what was in the law that people are finally learning about what will be taken away.
Pelosi misspoke: you'll have to repeal it to find out what was in it.
I'm guessing if they did polling on opinions of the system pre-ACA they'd find negative... and then a similar positive swing right when ACA threatened upheaval in the system
Is that really it though
But now the ACA *is* that status quo.
Why is it necessary for someone to have insurance who can't contribute anything to the pool?
I don't think it's so much of a ringing endorsement of the ACA so much as fear of upheaval.
@ami - yes. You can thank St Reagan for that.
I'll take your word for it
@drew - as you know, most of the ACA's components have been popular since inception. They lose popularity when the same ideas have Obama's name became attached. That's pure partisanship.
Yeah but the law is a lot larger than a few popular components.
I think at this point dismantling it would cause a lot more trouble than it's worth, it's way past the point of no return, it's completely baked into the system
So has to be worked with
What exactly is baked in, Drew?
I meant more generally, that the law has already wormed its way in too far, it's not like when it was just passed.
That's a cop out.
It's difficult to debate Skal on Healthcare. He has read a LOT more on the subject than all of us put together. He hasn't always been right, but he knows exactly how to counter any criticism that
Does not two or three legit rebuttals with supporting evidence
Does not have
Let's be fair: It's tough to debate anyone in their subject domain
Sure like who is going to debate Drew on Jew stuff, or me on understatement
I suppose the law has wormed it's way into the lives of those who presently are covered and might not be...or more accurately, will lose any reasonable ability to cover themselves.
@ 10 months ago
ami, why cover those who can't contribute to the pool? Because it's cheaper for the rest of us to pay for that than for ER-only care, which is what we'll pay for otherwise.
Social Darwinism may be all the rage, but putting those ideas in motion has actual, damaging human and financial consequences.
Lol you're right it's a cop out, but I guess I meant something like what Doc said. Generally (I think) it's harder to repeal any kind of law the longer it's been since it got passed and the industry, consumers etc have adjusted.
Unless people hate it and want it gone.
One of the biggest challenges has been growing resentment towards people on Medicaid, especially as premiums rise.
You mean like former coal miners
They're probably on Medicaid because they're out of a job.
Right because their job was dumped on
Zombie industries gotta zombie
...until those workers die off for reals...which shouldn't take too long. They were coal miners, after all.
Zombie industries gotta evolve
@ 8 months ago
They got nothing. Just like POTUS, they had no idea it would be so hard! The poor snowflakes.
@ 8 months ago
I wish it was just that they didn't know it would be so hard.
They don't seem to know what they are trying to do other than sticking to buzzwords.
Buzzwords make horrible policy.
Well it's hard for them to agree. But I'm feeling your name when I think about the effort that went into the passage of the ACA, and how when it finally looked like the bill had legs the R faction started the whole narrative about Ds "shoving this
bill down our throats!!!". Now they are actually trying their hardest to shove anything they can down our throats just so they can claim some sort of political victory. And guess what...it's not working.
And it all comes down to the hard work of gaining consensus in as organization with conflicting interests. That's what I'm talking about when I say, the poor darlings had no idea it would be so hard. They had folks convinced that they'd put
Obamacare to a quick death...now that they're in the driver's seat we'd all see some real action to address the health care woes visited on us by the horrible ACA boogeyman.
lol not so much!
Seeing this situation gives me a whole new respect for the process of the ACA passage. It's easy to talk, but building that consensus is really hard, slow, boring, wonky work. Not sexy, flashy, newsworthy stuff.
I also find it interesting that they cry about market instability due top uncertainty. Ok, you made the uncertainty, asshats, and now you blame the underlying laws? Those laws are not the source of the uncertainty.
Ikr... Feeling the schadenfreude too!
The feeling at the AMA meeting was that the Senate bill will be passed and the House will just adopt that rather than seek reconciliation.