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Trump's Full Court Press on healthcare

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RunningMn9
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Re: Trump's Full Court Press on healthcare

Post by RunningMn9 » Fri Nov 25, 2016 12:55 pm

There are other ways to deal with high student loans and malpractice insurance than charging a half year's salary for a tonsillectomy.

Certainly the current fee-for-service model wouldn't survive of course.
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Re: Trump's Full Court Press on healthcare

Post by Jeff V » Fri Nov 25, 2016 1:21 pm

I have a little bit of experience in the Philippines healthcare system, which is similar to what you describe. The chasm between privileged health care that the wealthy can afford and what is available to the masses is staggering. Hallways are clogged with patients waiting to see a physician. Potentially fatal ailments that are routinely treated here regardless of the capacity to pay are simply not done there without cash in hand. Tests that might otherwise be ordered in a comprehensive evaluation are not done. Dengue fever, for example, is very treatable if caught early. There are early symptoms that should call for immediate treatment, but the test to confirm it is dengue and not some less-deadly flu virus is too expensive, so victims are routinely treated for flu instead. Every year, hundreds die needlessly.

Medical infrastructure will suffer too. Clinical equipment is expensive. Hospitals won't be able to maintain equipment needed for uncommon procedures so treatment will be further unattainable for all but the very wealthy. Most people don't have the ability to travel across the country just because the only hospital left with a machine that goes "ping" happens to be in Sacramento.

It's really hard to imagine in your scenario anyone not wealthy ever receiving decent healthcare.

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Trump's Full Court Press on healthcare

Post by RunningMn9 » Fri Nov 25, 2016 2:10 pm

I haven't described anything yet. :)

All I'm saying is that the cost of healthcare is dictated by market forces, and right now that is being expanded by an artificially increased capacity to pay (the same reason that college tuition has exploded in the presence of easy to obtain debt).

As most here know, I was billed in excess of $45,000 by various entities for having my gallbladder lopped out a few years ago. That is one of the most common procedures performed in the US. It took less than 45 minutes to perform.

That number isn't based on a careful analysis of the cost of performing that procedure, with a reasonable profit stacked on top. The number is invented out of thin air in an attempt to extract the most money possible from any entities capable of paying.

The actual amount collected by the billing entities was in the neighborhood of $12,000 - which still vastly exceeds the cost of performing that procedure.

The notion that this is the only way it can all work is comical, since this way doesn't work.
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Re: Trump's Full Court Press on healthcare

Post by Jeff V » Fri Nov 25, 2016 3:15 pm

RunningMn9 wrote: The notion that this is the only way it can all work is comical, since this way doesn't work.
That part I can agree with. But what if the actual price for a gall bladder removal comes out to $6000, but you have to pay it all up front. What if you don't have the capacity to do so? The safety net is expensive, but at least it catches most people with gall bladders that need removing. A system that further increases the gap between haves and have-nots to the point where the latter group is literally dying might be cheaper, but not better.

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Re: Trump's Full Court Press on healthcare

Post by RunningMn9 » Fri Nov 25, 2016 3:24 pm

Having to pay it all up front is an unreasonable restriction. It forces the situation that you believe will exist and is unnecessary.

I would start from the other side. How much does a gallbladder removal procedure actually cost?
And in banks across the world
Christians, Moslems, Hindus, Jews
And every other race, creed, colour, tint or hue
Get down on their knees and pray
The raccoon and the groundhog neatly
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Re: Trump's Full Court Press on healthcare

Post by Fitzy » Fri Nov 25, 2016 3:43 pm

RunningMn9 wrote: How much does a gallbladder removal procedure actually cost?
https://www.healthcarebluebook.com/page ... Front.aspxLet's you see a "fair price". $6900 in MD. You can pick your own state. :)

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Re: Trump's Full Court Press on healthcare

Post by RunningMn9 » Fri Nov 25, 2016 3:46 pm

That's the price. That's not what I'm looking for. What is the cost of the procedure, on the supply side?
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Make up bags of change
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Re: Trump's Full Court Press on healthcare

Post by Chaz » Fri Nov 25, 2016 3:50 pm

But according to market-driven economics, the price comes out to be whatever the market will bear, regardless of the cost.
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Re: Trump's Full Court Press on healthcare

Post by Jeff V » Fri Nov 25, 2016 4:04 pm

RunningMn9 wrote: How much does a gallbladder removal procedure actually cost?
That answer will be different for every facility performing the procedure. Different amounts of salary and overhead for starters.

There are other potential issues with having a baseline price based on ideal absolute cost. Your procedure took 45 minutes. What if the poor SOB on the table next to you had complications and it took 90 minutes? If the price is absolute, then doctors will have an incentive to work faster and possibly ignore something important. A hospital might put off purchases on new or replacement items because the overhead will make them unprofitable. If the price is not absolute, the buyer might wake from anesthesia only to die from sticker shock when the bill is several times the expected cost.

Mostly though I think what Lawbeef said earlier would prove to be true. If I didn't have to pay $1000 per month for health insurance, there is probably a small chance any of it will get banked for a potential catastrophic illness or accident. Years ago I was suffering acute back and knee pain, after an MRI, both pains were found to be connected and was successfully treated by PT. I probably would be continuing to endure the pain today if I had to do it all over again, except this time pay entirely out of pocket.

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Re: Trump's Full Court Press on healthcare

Post by Rip » Fri Nov 25, 2016 4:10 pm

Jeff V wrote:
RunningMn9 wrote: I'm saying what happens if you take that option away from everyone. The market will only bear what the market can bear.
Then you wind up with an infrastructure that can only treat popular ailments. Truly expensive things like organ transplants and most invasive surgeries will become another perk that only the wealthy enjoy. Saddled with high student loans, malpractice insurance costs and declining income, the number of people entering the medical profession will decline as well, especially those going into specialties like neurosurgery.
You could start with malpractice insurance costs. That byself is a backpack full of rocks that anyone interested in medicine is forced to drag around. Want good health care? Stop suing the pants off of anyone who makes a mistake. Otherwise live with what ails you.

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Re: Trump's Full Court Press on healthcare

Post by RunningMn9 » Fri Nov 25, 2016 5:16 pm

Chaz wrote:But according to market-driven economics, the price comes out to be whatever the market will bear, regardless of the cost.
Yes, I know that - that's the point I've been making. :)

That said, I'm still asking what the actual cost of performing the procedure is - because that information is part of the next point. ;)
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Re: Trump's Full Court Press on healthcare

Post by Kraken » Fri Nov 25, 2016 5:49 pm

RunningMn9 wrote:
Chaz wrote:But according to market-driven economics, the price comes out to be whatever the market will bear, regardless of the cost.
Yes, I know that - that's the point I've been making. :)

That said, I'm still asking what the actual cost of performing the procedure is - because that information is part of the next point. ;)
How much overhead do you include in "actual cost"? Administration? Pensions? etc? Or just the immediate facility and personnel costs?

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Re: Trump's Full Court Press on healthcare

Post by RunningMn9 » Fri Nov 25, 2016 5:56 pm

You are free to define the cost however you please. Whatever you want to pro-rate over that 45 minutes of the surgeon's time is fine with me.
And in banks across the world
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Re: Trump's Full Court Press on healthcare

Post by Fitzy » Fri Nov 25, 2016 6:57 pm

RunningMn9 wrote:That's the price. That's not what I'm looking for. What is the cost of the procedure, on the supply side?
I suspect that's as close as you're getting. There is no way to calculate it. '

The intake workers also do more than your intake, how do you calculate their contribution? The nurses who rotate around different patients. Your surgery may have been 45 minutes, but how long was the surgeon actually in there? How long did he look at images to decide on a strategy for removing it? How long where you in the surgical room? How long were you in the recovery room? How long did it take the orderly to push you between them? How hot or cold was it outside and how much did the HVAC system cost the time you were in? How many instruments did they use on you? How many techs did it take to clean them? Who drew your blood? How many tests were run?

The variables are so complex, I'd be surprised if even if the hospital knows the cost of what they did for you.

A "simple" surgery isn't a widget. It doesn't have a value and doesn't have a price you will ever find. Anything you do find will be an estimate and every estimate will vary.

Sorry, but I really don't think what you're looking for exists. I'd love to see the numbers if I'm wrong though.

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Re: Trump's Full Court Press on healthcare

Post by RunningMn9 » Fri Nov 25, 2016 7:01 pm

I understand all of that, and I don't think there's an answer, aside from this one: the cost is certainly less than $6500. Probably quite a bit less, but I can't assert that factually.

But I do know, with absolute certainty, at $6500, no one involved is losing money.
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Re: Trump's Full Court Press on healthcare

Post by Rip » Fri Nov 25, 2016 7:04 pm

I've heard the cost of malpractice insurance is 2.5-5% of healthcare cost right off the top.

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Re: Trump's Full Court Press on healthcare

Post by RunningMn9 » Fri Nov 25, 2016 7:31 pm

Rip wrote:I've heard the cost of malpractice insurance is 2.5-5% of healthcare cost right off the top.
Exactly, that's why it's generally ignored by anyone that is seriously looking at fixing the healthcare problem. When it comes to fixing the problem, it's a red herring.
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Re: Trump's Full Court Press on healthcare

Post by stessier » Sat Nov 26, 2016 5:15 am

Fitzy wrote:
RunningMn9 wrote:That's the price. That's not what I'm looking for. What is the cost of the procedure, on the supply side?
I suspect that's as close as you're getting. There is no way to calculate it. '

The intake workers also do more than your intake, how do you calculate their contribution? The nurses who rotate around different patients. Your surgery may have been 45 minutes, but how long was the surgeon actually in there? How long did he look at images to decide on a strategy for removing it? How long where you in the surgical room? How long were you in the recovery room? How long did it take the orderly to push you between them? How hot or cold was it outside and how much did the HVAC system cost the time you were in? How many instruments did they use on you? How many techs did it take to clean them? Who drew your blood? How many tests were run?

The variables are so complex, I'd be surprised if even if the hospital knows the cost of what they did for you.

A "simple" surgery isn't a widget. It doesn't have a value and doesn't have a price you will ever find. Anything you do find will be an estimate and every estimate will vary.
The variables aren't complex at all and I would bet only the ones that go out of business don't know what it costs.

With the exception of Drs. who are independent contractors, all the things you mentioned are fixed costs. At the end of the month, they know what they spent and how long each patient was with them. It's simple to divide their fixed costs by the number of hours and figure out how much each person cost. To close the loop, you have to assign an hourly/monthly cost to each doctor and divide that by the number of patients and/or amount of time they spent with each patient.

I make complex widgets - the same rules apply. When we have few orders to fill in a month, the widgets that month look really expensive because there are fewer to spread the burden over. During the months we run 24/7 and don't lose a widget for quality, they look really cheap. It's the way of the world. :)
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Re: Trump's Full Court Press on healthcare

Post by Formix » Sat Nov 26, 2016 7:46 am

Not to bring up "death panels" again, but part of this conversation of constraining costs has to be "how much is too much?". In my family, my mother's boyfriend is a former Federal Marshall, so his healthcare costs are all free to him. He recently had an aneurysm, and the price for the procedure that fixed him was over one point four million dollars in one calendar year. He is a 72 year old man. There is no way he contributed enough in his working lifetime to pay for that cost. Is this a procedure that should have been done? Until we come up with some solution that takes into account actuarial tables on expected life span, and attach a cost/benefit number to that, we will never constrain costs. I know that's controversial, but every life is not worth an unlimited amount of money, we could probably agree on that. So where is the line that is too expensive?

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Re: Trump's Full Court Press on healthcare

Post by stessier » Sat Nov 26, 2016 9:37 am

I don't think you will get agreement on that. I know I don't agree with it. Whose ever life we are talking about certainly won't agreen with it. Life is unique. Money...we can always make more.
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Re: Trump's Full Court Press on healthcare

Post by RunningMn9 » Sat Nov 26, 2016 11:29 am

stessier wrote:The variables aren't complex at all and I would bet only the ones that go out of business don't know what it costs.
I think you have more faith than most. ;)

Whether or not a hospital knows what it costs (I suspect they do), there is no relationship between what it cost the hospital to host me and what it generates as a bill (I believe we already all knew that, right?). There is a separate line item for everything involved, and the price is set to the maximum amount that any insurance company will give them. The surgeons do the same thing. They know the "blue book" / "fair cost" for a procedure in their area. And they know that at that value, they are making money.

The in-network negotiated rate for my procedure was about $1,600 for the primary surgeon. He billed $22,500. He billed that because if my insurance company was Horizon BCBS of NJ, and had they been properly notified that it was an emergency procedure, they would have paid the full bill. As it was, my insurance company from Alabama paid him $1,600 and left the remaining $21,000 for me to take care of.

The point being, whether the surgeon or hospital knows the true cost of lopping my shitty organs out of my body, that has virtually no connection to what they charge. What they charge is based *entirely* on what they can get, and in these modern times, that is artificially inflated because insurance companies can pay more than individual people.
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Re: Trump's Full Court Press on healthcare

Post by stessier » Sat Nov 26, 2016 1:50 pm

Oh yeah, I agree with all that. I just disagree with the notion that we can't do better because we can't figure out the cost.
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Re: Trump's Full Court Press on healthcare

Post by Pyperkub » Sat Nov 26, 2016 3:43 pm

It's also artificially inflated because of the lack of price transparency.
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Re: Trump's Full Court Press on healthcare

Post by Grifman » Sat Nov 26, 2016 11:44 pm

Rip wrote:I've heard the cost of malpractice insurance is 2.5-5% of healthcare cost right off the top.
It's 2.5% but includes the cost of "defensive medicine". The actual insurance is a lot less.
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Re: Trump's Full Court Press on healthcare

Post by Formix » Sun Nov 27, 2016 10:43 am

I recognize that our lives are all worth unlimited sums to ourselves, but I'm talking about on the whole. Our system (or any system) does not have unlimited resources. However, we are constantly coming up with better procedures and methods for prolonging life. Eventually there must come a limit. Ignoring that fact doesn't make it go away or remove it as a factor in the ever increasing healthcare cost spiral.

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Re: Trump's Full Court Press on healthcare

Post by noxiousdog » Mon Nov 28, 2016 12:29 pm

There are a lot of parallels between the cost of health care and the costs of universities.

Both spend a lot of money on the campus and research that has little direct impact on the actual consumers.
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Re: Trump's Full Court Press on healthcare

Post by Smoove_B » Fri Dec 02, 2016 12:00 pm

Only 26% of Americans support full repeal of Obamacare:
One-fourth, or 26 percent, of Americans favor a full repeal of the health care law, while 17 percent say scale it back, according to the Kaiser poll. On the other hand, 30 percent favor expanding the law and another 19 percent want lawmakers to move forward with the law as it is.
I know it's too early for polls, but I do find the report to be interesting. Even more:
Overall, the survey finds that some key provisions of Obamacare are very popular among Democrats and Republicans. For example, 85 percent favor keeping young adults on their parents' insurance plan until age 26. Sixty-nine percent like the prohibitions on insurance companies denying coverage based on pre-existing conditions.

The most unpopular feature of Obamacare? Only 35 percent favor the individual mandate requiring all people to sign up for health insurance or pay a fine.

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Re: Trump's Full Court Press on healthcare

Post by LordMortis » Fri Dec 02, 2016 12:15 pm

Smoove_B wrote:
Overall, the survey finds that some key provisions of Obamacare are very popular among Democrats and Republicans. For example, 85 percent favor keeping young adults on their parents' insurance plan until age 26. Sixty-nine percent like the prohibitions on insurance companies denying coverage based on pre-existing conditions.

The most unpopular feature of Obamacare? Only 35 percent favor the individual mandate requiring all people to sign up for health insurance or pay a fine.

What percent of Americans have any understanding of how insurance pools work and how they relate to paying for medical care?

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Re: Trump's Full Court Press on healthcare

Post by RunningMn9 » Fri Dec 02, 2016 12:19 pm

noxiousdog wrote:There are a lot of parallels between the cost of health care and the costs of universities.

Both spend a lot of money on the campus and research that has little direct impact on the actual consumers.
And both are additionally fueled by a complete disconnect between paying for them. In the case of universities, they are fueled by student loans that most teenagers don't rightly contemplate when acquiring massive amounts of debt to fund their educations. In the case of health care, it's a toxic combination of insurance companies with massive resources and a complete and utter lack of cost transparency to the consumer.

In both cases, what CAN be charged is no longer dependent on what people can actually pay. And so what IS charged is no longer dependent on what people can actually pay. And the perceived value of education and healthcare are such that demand is always incredibly high, regardless of ability to pay (since it no longer matters) - and thus the cost of both has skyrocketed.
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Re: Trump's Full Court Press on healthcare

Post by Malificent » Fri Dec 02, 2016 5:03 pm

Smoove_B wrote:Only 26% of Americans support full repeal of Obamacare:
One-fourth, or 26 percent, of Americans favor a full repeal of the health care law, while 17 percent say scale it back, according to the Kaiser poll. On the other hand, 30 percent favor expanding the law and another 19 percent want lawmakers to move forward with the law as it is.
I know it's too early for polls, but I do find the report to be interesting. Even more:
Overall, the survey finds that some key provisions of Obamacare are very popular among Democrats and Republicans. For example, 85 percent favor keeping young adults on their parents' insurance plan until age 26. Sixty-nine percent like the prohibitions on insurance companies denying coverage based on pre-existing conditions.

The most unpopular feature of Obamacare? Only 35 percent favor the individual mandate requiring all people to sign up for health insurance or pay a fine.
People want something nice but don't want to have to pay for it? I'm shocked, I tell you, shocked...

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Re: Trump's Full Court Press on healthcare

Post by geezer » Fri Dec 02, 2016 6:41 pm

LordMortis wrote:
Smoove_B wrote:
Overall, the survey finds that some key provisions of Obamacare are very popular among Democrats and Republicans. For example, 85 percent favor keeping young adults on their parents' insurance plan until age 26. Sixty-nine percent like the prohibitions on insurance companies denying coverage based on pre-existing conditions.

The most unpopular feature of Obamacare? Only 35 percent favor the individual mandate requiring all people to sign up for health insurance or pay a fine.

What percent of Americans have any understanding of how insurance pools work and how they relate to paying for medical care?
About 35% I would say ;)

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Re: Trump's Full Court Press on healthcare

Post by Smoove_B » Tue Dec 06, 2016 8:13 pm

So what's the pressing matter in January?
Repealing Obamacare will be the first order of business in the U.S. Senate in January, Senate Majority Leader Mitch McConnell, a Republican, said on Tuesday.

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Re: Trump's Full Court Press on healthcare

Post by malchior » Tue Dec 06, 2016 8:31 pm

Smoove_B wrote:So what's the pressing matter in January?
Repealing Obamacare will be the first order of business in the U.S. Senate in January, Senate Majority Leader Mitch McConnell, a Republican, said on Tuesday.
Part of me wants to see Congress do this to put Trump on the spot. Either he is going to protect people or he is not. But the consequences are dire so I don't think they should be experimenting at all. And it ;ooks like hospitals are gearing up to fight and I have to imagine the big insurers are going ape shit right now. Still this is absolutely crazy - there is absolutely no logical reason for this fervor. The disconnect and tunnel vision on this one is pretty frightening. So many problems coming our way and taking health insurance from their populace is their number one priority? They are disgusting human beings to say the least. Seriously - I don't know how I could ever vote for a Republican again.

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Re: Trump's Full Court Press on healthcare

Post by Smoove_B » Tue Dec 06, 2016 10:08 pm

They've collectively been carrying such a raging hard-on for over 8 years with this issue - I wouldn't expect them to stop now. I'm of the same mind - let's see what happens when they actually try and take healthcare away from people. I want to believe the blow-back will be so severe they'll finally drop it...but I'm also afraid like you are that they'll just hammer down the accelerator and drive straight into the wall.

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Re: Trump's Full Court Press on healthcare

Post by Kraken » Tue Dec 06, 2016 11:38 pm

Smoove_B wrote:They've collectively been carrying such a raging hard-on for over 8 years with this issue - I wouldn't expect them to stop now. I'm of the same mind - let's see what happens when they actually try and take healthcare away from people. I want to believe the blow-back will be so severe they'll finally drop it...but I'm also afraid like you are that they'll just hammer down the accelerator and drive straight into the wall.
Those who are covered through the ACA exchanges and Medicaid are likely to be Democratic voters, right? Sure would be a shame if they died. Republicans won't get blowback from their own tribe unless they go after Medicare, too, and I doubt that they'll go that far. They may be evil, but they aren't stupid.

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Re: Trump's Full Court Press on healthcare

Post by Smoove_B » Wed Dec 07, 2016 12:08 am

Kraken wrote:Republicans won't get blowback from their own tribe unless they go after Medicare, too, and I doubt that they'll go that far. They may be evil, but they aren't stupid.
Right, but as part of the ACA Medicare now covers preventative care, cancer screenings and general wellness checks. The best is that the ACA is helping to bridge the gap of the proverbial "donut hole" in the Medicare Part D coverage, offsetting out of pocket costs for medication once Medicare benefits run out. If the Republicans are somehow going to laser out elements of the ACA so that only the poors will end up without care but somehow manage to keep ACA benefits rolling to seniors on Medicare, I'd like to see how it will work.

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Re: Trump's Full Court Press on healthcare

Post by Chaz » Wed Dec 07, 2016 6:20 am

Wasn't the deal that a lot of people would fall into the gap where they made too much to be on medicaid, but not enough to afford to buy through the exchanges, and those people were supposed to be covered by the medicaid expansion? The expansion that a lot of primarily Republican governors refused? Meaning that a bunch of likely-R voters that would be affected by the repeal of the ACA were already affected because their governor decided to refuse it? If so, and I could totally be misremembering what happened, it's possible that the Rs may not get as much of a backlash as they should, since their voters are already partially screwed over.
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Re: Trump's Full Court Press on healthcare

Post by Paingod » Wed Dec 07, 2016 8:25 am

RunningMn9 wrote:utter lack of cost transparency to the consumer.
Somewhat off-topic, but this is the part that's really frying my bacon anytime we see a medical bill. They just send us this big "$523" bill with absolutely no idea what it's for. When we ask for an itemized list of charges, they sputter and stammer and have a real hard time doing it. We don't pay unchallenged lump sum bills, sorry.
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Re: Trump's Full Court Press on healthcare

Post by malchior » Wed Dec 07, 2016 9:39 am

Kraken wrote:Those who are covered through the ACA exchanges and Medicaid are likely to be Democratic voters, right? Sure would be a shame if they died. Republicans won't get blowback from their own tribe unless they go after Medicare, too, and I doubt that they'll go that far. They may be evil, but they aren't stupid.
Not at all - several southern states expanded Medicaid coverage under the ACA and others became eligible for the subsidy and/or had pre-existing conditions. In other words, the ACA provided coverage all over the country - they'll be hurting a lot of their tribe. There isn't a clear R/D divide on this one. It is like welfare back when it was really "bad". The typical recipient was a poor, rural white person but you would have thought it was all black people by the way people talked about it. Still when they reformed welfare that turned out sorta ok...eventually. This however is a much bigger impact potentially by far.
Chaz wrote:Wasn't the deal that a lot of people would fall into the gap where they made too much to be on medicaid, but not enough to afford to buy through the exchanges, and those people were supposed to be covered by the medicaid expansion? The expansion that a lot of primarily Republican governors refused? Meaning that a bunch of likely-R voters that would be affected by the repeal of the ACA were already affected because their governor decided to refuse it? If so, and I could totally be misremembering what happened, it's possible that the Rs may not get as much of a backlash as they should, since their voters are already partially screwed over.
I think you are largely right here and agree - it limits the blow back. The lack of expansion was part of the anger too. People were angry that it didn't help them - when it was a conscious choice by their elected leaders. Obstruction has paid off handsomely for the Republicans. Why govern when you can just block efforts to help and then lie about them?

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Re: Trump's Full Court Press on healthcare

Post by El Guapo » Wed Dec 07, 2016 9:48 am

Chaz wrote:Wasn't the deal that a lot of people would fall into the gap where they made too much to be on medicaid, but not enough to afford to buy through the exchanges, and those people were supposed to be covered by the medicaid expansion? The expansion that a lot of primarily Republican governors refused? Meaning that a bunch of likely-R voters that would be affected by the repeal of the ACA were already affected because their governor decided to refuse it? If so, and I could totally be misremembering what happened, it's possible that the Rs may not get as much of a backlash as they should, since their voters are already partially screwed over.
Yes, that's right. Though the only reason that the Medicaid expansion was optional at all was because Chief Justice Roberts decided to make it optional because of vaguely constitution related reasons, even though that wasn't how the law was supposed to work. So a Republican judge on specious reasons blew a small hole in the law which created a problem which the Republican congressional majorities refused to fix which allowed Republican governors to deny benefits and interfere with the law and the local level, which of course lead people to elect Republicans to undo the law, because democracy.

Though I can't complain too much about Roberts, as he declined to blow up the law entirely, which he could have.

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