[Discussion] Health Policies and ACA Reform/Repeal

The existing health thread is for discussion on how changes to current policy will/have personally affected you or those you know. This thread is for more general discussion of the subject.

Mixolyde wrote:
Demosthenes wrote:

I mean, I got walking pneumonia because I used to work with the public. I ended up going to the hospital that night when it really hit me because my mom had literally JUST got out of the hospital (after being there for 4 days) because of a really bad case of the flu. I thought I had gotten it too.

X-ray, 2 hours of monitoring, and the equivalent of 4 tylenol was almost $9,000... plus the cost for my prescriptions. A two hour visit to the hospital because some asshole came through my checkout lane sick and got me sick cost more than I made in almost a year.

TOTALLY MY FAULT THOUGH RIGHT GOP?! TAKE RESPONSIBILITY FOR MY ACTIONS TRYING TO WORK.

*headdesk*

You totally should have a year's worth of wages saved up in case of emergencies. #bootstraps

Indeed, that's what health savings accounts are for. And obviously, you should have worn a mask and washed your hands more and you wouldn't have gotten sick in the first place. It's only right you should have to pay for your own negligence rather than leech off those who produce. God said so. #makeamericasickagain

Sidenote, the Tylenol alone, which was literally just 4 pills worth of acetaminophen, was almost $500 which was about 2 weeks worth of wages post tax. I literally could have just bought that for like a buck at work.

But, something something poor people are the problem, not massively greedy corporations that would sell $1 worth of medicine for 500 times its worth because captive market.

cheeze_pavilion wrote:

I just don't think the Individual Mandate is the hill for us to die on. If the Republicans want to get rid of it, let them take the heat of finding a new way to fund this thing.

The question is whether that's morally conscionable. While it may be satisfying to watch this blow up in the Republicans' faces, that's going to come at the cost of tens of thousands of avoidable deaths. While the Democratic party should also fight back on this plan for other reasons, eventually it could very well come down to the Individual Mandate. Even if the Democrats lose political capital for fighting so hard to protect an unpopular part of the plan, unless the Republicans come up with something legitimately close to its effectiveness I still think that the Democrats should stand up for it.

Yonder wrote:
cheeze_pavilion wrote:

I just don't think the Individual Mandate is the hill for us to die on. If the Republicans want to get rid of it, let them take the heat of finding a new way to fund this thing.

The question is whether that's morally conscionable. While it may be satisfying to watch this blow up in the Republicans' faces, that's going to come at the cost of tens of thousands of avoidable deaths. While the Democratic party should also fight back on this plan for other reasons, eventually it could very well come down to the Individual Mandate. Even if the Democrats lose political capital for fighting so hard to protect an unpopular part of the plan, unless the Republicans come up with something legitimately close to its effectiveness I still think that the Democrats should stand up for it.

I think you're confusing the Individual Mandate with the protection for those with pre-existing conditions?

I wonder if this will be the point that some people realize that there are actual, honest-to-god differences between Democrats and Republicans.

cheeze_pavilion wrote:
Yonder wrote:
cheeze_pavilion wrote:

I just don't think the Individual Mandate is the hill for us to die on. If the Republicans want to get rid of it, let them take the heat of finding a new way to fund this thing.

The question is whether that's morally conscionable. While it may be satisfying to watch this blow up in the Republicans' faces, that's going to come at the cost of tens of thousands of avoidable deaths. While the Democratic party should also fight back on this plan for other reasons, eventually it could very well come down to the Individual Mandate. Even if the Democrats lose political capital for fighting so hard to protect an unpopular part of the plan, unless the Republicans come up with something legitimately close to its effectiveness I still think that the Democrats should stand up for it.

I think you're confusing the Individual Mandate with the protection for those with pre-existing conditions?

The two are linked, the Individual Mandate is the way the ACA addressed "coverage incentive" in a way that allowed the removal of pre-existing conditions as a concern. But you could remove that linkage, you could imagine a plan that does the 30% "gap fee" and has pre-existing conditions, or a plan that does the 30% "gap fee" and doesn't have pre-existing conditions.

Even if there are no pre-existing conditions anymore losing the individual mandate is still going to kill people. With the Mandate you have health insurance, so theoretically you have access to preventative care (although high deductible plans do provide perverse incentives to not get cheaper preventative care). With the 30% coverage fee you have two issues: first less preventative care, so that sort of person will be more likely to miss screenings and whatnot and end up dying because their cancer was cut in Stage IV rather than Stage II. The other issue is that it's not as good of an incentive as the Mandate, so people can just wait to get cancer or need surgery and accept the 30% fee. That means that we'll have more people not paying into health insurance, so everyone's insurance will be more expensive, or will get worse if ACA requirements are dropped. That's going to kill people too.

OG_slinger wrote:

I wonder if this will be the point that some people realize that there are actual, honest-to-god differences between Democrats and Republicans.

I just had a conversation with a coworker about that. Luckily his circumstances very closely mirror mine this year.

"Fred, you and I were both registered as Republicans in January of 2016, and we're both registered as Democrats this year. That is NOT because both parties are the same. We switched because the Republicans are objectively worse."

If PA didn't have open primaries he wouldn't have registered Democrat, he'd have registered Republican, but still, that rhetoric is so ridiculously powerful and sticky that even people actively being driven away by how terrible the Republican party is STILL get trapped in thinking in false equivalencies.

Yonder wrote:
cheeze_pavilion wrote:
Yonder wrote:
cheeze_pavilion wrote:

I just don't think the Individual Mandate is the hill for us to die on. If the Republicans want to get rid of it, let them take the heat of finding a new way to fund this thing.

The question is whether that's morally conscionable. While it may be satisfying to watch this blow up in the Republicans' faces, that's going to come at the cost of tens of thousands of avoidable deaths. While the Democratic party should also fight back on this plan for other reasons, eventually it could very well come down to the Individual Mandate. Even if the Democrats lose political capital for fighting so hard to protect an unpopular part of the plan, unless the Republicans come up with something legitimately close to its effectiveness I still think that the Democrats should stand up for it.

I think you're confusing the Individual Mandate with the protection for those with pre-existing conditions?

The two are linked, the Individual Mandate is the way the ACA addressed "coverage incentive" in a way that allowed the removal of pre-existing conditions as a concern. But you could remove that linkage, you could imagine a plan that does the 30% "gap fee" and has pre-existing conditions, or a plan that does the 30% "gap fee" and doesn't have pre-existing conditions.

Right--from what I'm reading has RyanCare keeps the pre-existing conditions protection. It removes the linkage.

Even if there are no pre-existing conditions anymore losing the individual mandate is still going to kill people. With the Mandate you have health insurance, so theoretically you have access to preventative care (although high deductible plans do provide perverse incentives to not get cheaper preventative care). With the 30% coverage fee you have two issues: first less preventative care, so that sort of person will be more likely to miss screenings and whatnot and end up dying because their cancer was cut in Stage IV rather than Stage II. The other issue is that it's not as good of an incentive as the Mandate, so people can just wait to get cancer or need surgery and accept the 30% fee. That means that we'll have more people not paying into health insurance, so everyone's insurance will be more expensive, or will get worse if ACA requirements are dropped. That's going to kill people too.

That's why I said forget the Mandate (which leaves people uncovered anyway when they choose to pay the tax penalty instead of getting covered) and push for other ways to pay that means the carrot of subsidies is good enough you no longer need the stick of the Mandate.

Remember the other stick here is the open enrollment periods I talked about: you can't just wait. You have to get sick at the right time, and even then you have to have a non-emergency where you can put off treatment until you get signed up.

How can you ever provide enough carrots? Carefree people are just not going to do it if it costs anything. Unless you literally make it free for them why would such a person bother to sign up? And if they do sign up you've paid them to do it, so you haven't made the system any cheaper at all.

I don't understand how you can do it without a stick.

Edit: And I don't care about the enrollment period, you want to let people sign up any time they won't, but they can't get the mandate back for the year/quarter/whatever they've already gotten the fee for, whatever, couldn't care less (honestly I think that's better). The Enrollment Period =/= Individual Mandate.

Wow, some people really, really don't like even this watered down healthcare bill.

Members of the Republican Study Committee, a larger conservative group, were already critical of key elements of the plan. “This is a Republican welfare entitlement,” reads an RSC analysis distributed late Monday, addressing the inclusion of refundable tax credits in the plan.

Giving anything to anyone equals bad. Got it.

“Keep the ‘Cadillac’ tax in place? Keep Medicaid in place until 2020?” said Rep. Jim Jordan (R-Ohio), a co-founder of the House Freedom Caucus, referring to high-priced health-care plans. “We didn’t have Medicaid expansion in the bill we sent to President Obama, but we have it in the one we send to President Trump? That makes no sense to me.”

Adding coverage! Sweet mercy, no! We should only be taking away coverage!

“If this warmed-over substitute for government-run health care remains unchanged, the Club for Growth will key vote against it,” said the group’s president, David McIntosh, referring to a process in which lawmakers are graded on their votes, the better to use them as ammunition on the campaign trail.

Offering a small tax refund so people can buy health insurance from private insurers equals government-run health care? I don't think they looked closely at the definition of what "government-run" means.

“The House Republican proposal released last night not only accepts the flawed progressive premises of Obamacare but expands upon them,” Michael Needham, the head of Heritage Action for America, said in a statement Tuesday. “Congressional Republicans should fully repeal the failed law and begin a genuine effort to deliver on longstanding campaign promises that create a free market health care system.”

How is anything in this bill expanding on progressive premises? If helping anyone get anything considered a progressive ideal now? And guess what? We already have a free market health care system. If they mean remove any and all regulations from health insurers... well, I guess we've still got a little ways to go.

A cartoonist friend of mine did this one on the plan:
IMAGE(https://scontent.xx.fbcdn.net/v/t31.0-8/s720x720/17097302_10158270089045612_8668630246966185896_o.jpg?oh=9215b549d3e1ffc8ba7fad41f35891f6&oe=596CCB16)

Is that real? The Cooke tweets.

Baron Of Hell wrote:

Is that real? The Cooke tweets.

Yes.

And Carol Bannon's twitter account should be a cautionary tale about the dangers of combining conservative religious beliefs, a steady diet of pretty much only conservative (fake) news sources, and having far too much time on your hands.

Yonder wrote:

How can you ever provide enough carrots? Carefree people are just not going to do it if it costs anything. Unless you literally make it free for them why would such a person bother to sign up?

So we're way past talking about everyone subject to the Individual Mandate. We're down to talking about a subset of that group, a subset this carefree.

And if they do sign up you've paid them to do it, so you haven't made the system any cheaper at all.

I don't understand how you can do it without a stick.

Oh, I don't want to make it cheaper. I don't think any liberal wants to make it cheaper in this way. I think we want the burden shifted off of the kind of people who might make a choice between the tax penalty and the premiums, because those people aren't the ones who should be shouldering this much of the financial burden in the first place.

Edit: And I don't care about the enrollment period, you want to let people sign up any time they won't, but they can't get the mandate back for the year/quarter/whatever they've already gotten the fee for, whatever, couldn't care less (honestly I think that's better). The Enrollment Period =/= Individual Mandate.

I can't figure out the phrasing of this part.

Kehama wrote:

How is anything in this bill expanding on progressive premises? Is helping anyone get anything considered a progressive ideal now?

Pretty much. : /

This is one of those strange situations where conservatives saying this is just Obamacare 2.0 and unacceptable are wrong when it comes to their arguments about Obamacare, but are right that this is what the criticisms of Obamacare Classic were all about.

The confusing scenario of a fight between conservatives who are more wrong but less hypocritical, or less wrong but more hypocritical, who all acted like they were on the same side until they got the power to actually do something.

(minor edits)

Jayhawker wrote:

IMAGE(https://pbs.twimg.com/media/C6VsgCgUoAA6bPQ.jpg)

p0wn3d

https://www.instagram.com/p/BRWRE4cg...

Spoiler: NSFW language

Spoiler:

A woman holding a protest sign saying "Viagra is gov't funded. If getting pregnant is God's Will, than so is limp dick."

Conservatives Pick Up ‘Mixed Messages’ From White House On Health Care

Conservatives are questioning where the White House stands on the GOP health care bill, with House Freedom Caucus members saying late Tuesday that the Trump administration isn’t wedded to the the legislation ― which they say can’t pass anyway.

Exiting a meeting with former Freedom Caucus member Mick Mulvaney, the Office of Management and Budget director, conservatives suggested the White House isn’t completely sold on the Republican House bill advancing through committees on Wednesday.

“If you look at all the comments from the White House, you will find there is a mixed message,” Rep. Mo Brooks (R-Ala.) said Tuesday night.

Alexandra Erin in the middle of a twitter run on this subject, farley:
https://twitter.com/alexandraerin/st...

AARP publicly comes out against the GOP's replacement plan

farley3k wrote:

Conservatives Pick Up ‘Mixed Messages’ From White House On Health Care

Conservatives are questioning where the White House stands on the GOP health care bill, with House Freedom Caucus members saying late Tuesday that the Trump administration isn’t wedded to the the legislation ― which they say can’t pass anyway.

Exiting a meeting with former Freedom Caucus member Mick Mulvaney, the Office of Management and Budget director, conservatives suggested the White House isn’t completely sold on the Republican House bill advancing through committees on Wednesday.

“If you look at all the comments from the White House, you will find there is a mixed message,” Rep. Mo Brooks (R-Ala.) said Tuesday night.

Possibly because it sounds like, yet again, infighting. Bannon/Breitbart is coming down hard on the bill, even relating it, somehow to Soros (because how could they not). Looks like at least Bannon is interested in f*cking over Ryan, not that that was going to be hard anyway. Ryan apparently still is under the impression people who are not rich are super excited about being super poor to pay for the rich to get richer... rather than the party's actual platform of exceptionalism and bigotry. AARP pointing out that seniors are about to double their insurance costs thanks to this isn't going to help him much (not entirely sure why Bannon's bothering, AARP alone is probably going to end up sinking it).

cheeze_pavilion wrote:
Yonder wrote:

How can you ever provide enough carrots? Carefree people are just not going to do it if it costs anything. Unless you literally make it free for them why would such a person bother to sign up?

So we're way past talking about everyone subject to the Individual Mandate. We're down to talking about a subset of that group, a subset this carefree.

That's not a subset of a subset, that's the entire Individual Mandate group. "I am young and/or healthy. I am part of the segment of the population that pays more into health insurance than they get out. By definition that's true, that's why they want me, because buying health insurance is a financially losing proposition for me."

For this segment of the population choosing health insurance is entirely, 100% based on how risk averse you are. The whole reason the individual mandate is a thing is because a huge number, honestly a majority from enrollment numbers of people in this group, are "carefree" not in a skipping through life across busy streets without looking both ways sort of way, but in a "I am willing to risk a very unlikely medical disaster if it means I save a couple thousand dollars a year" sort of way.

And if they do sign up you've paid them to do it, so you haven't made the system any cheaper at all.

I don't understand how you can do it without a stick.

Oh, I don't want to make it cheaper. I don't think any liberal wants to make it cheaper in this way. I think we want the burden shifted off of the kind of people who might make a choice between the tax penalty and the premiums, because those people aren't the ones who should be shouldering this much of the financial burden in the first place.

I think what you're saying is that you think that young healthy people enrolling is a red herring, and instead of worrying about those people we should just be getting more money from the rich to pay for healthcare? I disagree that that's not important, I think that incentivizing (honestly I would prefer forcing, a public plan in marketplace that everyone is signed up for by default unless they switch to another valid plan, but that's another topic) all people to have healthcare is an important part of lowering average costs. I also think it's important to remove financial incentives for even young/healthy people not getting checkups and preventative care to keep them healthy.

Additionally, I am really not swayed by the argument that personal liberties requires letting people make the conscious choice to avoid healthcare. (I'm not saying that you are making this argument, it's just another argument against the mandate I hear because I work with conservatives, and I wanted to be thorough).

Edit: And I don't care about the enrollment period, you want to let people sign up any time they won't, but they can't get the mandate back for the year/quarter/whatever they've already gotten the fee for, whatever, couldn't care less (honestly I think that's better). The Enrollment Period =/= Individual Mandate.

I can't figure out the phrasing of this part.

Sorry, I almost made a second edit because I thought that was a bit of a word salad. Earlier in our conversation I felt that you were conflating two parts of the ACA: the Individual Mandate, and the annual enrollment periods. You were saying that in some ways this new plan had less of a coverage gap than the ACA because under the ACA if someone without a plan needed treatment right after the enrollment period closed they would have to wait a whole year to get a plan.

While that does have some merit (only some because enrollment periods aren't unique to the ACA, my employer has annual enrollment periods too, so even without the ACA most people would be in the same boat) I felt like that was a really a distraction from the real issue of the pros and cons of the Individual Mandate versus... I'll call it a Gap Surcharge. The reason is that that enrollment period thing is an implementation detail that could be changed pretty simply (although I imagine that the more enrollment periods you have the more complicated bookkeeping and whatnot is). You could easily have a plan with an Individual Mandate and without fixed enrollment periods, or a plan with a Gap Surcharge and also fixed enrollment periods.

Demosthenes wrote:

AARP publicly comes out against the GOP's replacement plan

farley3k wrote:

Conservatives Pick Up ‘Mixed Messages’ From White House On Health Care

Conservatives are questioning where the White House stands on the GOP health care bill, with House Freedom Caucus members saying late Tuesday that the Trump administration isn’t wedded to the the legislation ― which they say can’t pass anyway.

Exiting a meeting with former Freedom Caucus member Mick Mulvaney, the Office of Management and Budget director, conservatives suggested the White House isn’t completely sold on the Republican House bill advancing through committees on Wednesday.

“If you look at all the comments from the White House, you will find there is a mixed message,” Rep. Mo Brooks (R-Ala.) said Tuesday night.

Possibly because it sounds like, yet again, infighting. Bannon/Breitbart is coming down hard on the bill, even relating it, somehow to Soros (because how could they not). Looks like at least Bannon is interested in f*cking over Ryan, not that that was going to be hard anyway. Ryan apparently still is under the impression people who are not rich are super excited about being super poor to pay for the rich to get richer... rather than the party's actual platform of exceptionalism and bigotry. AARP pointing out that seniors are about to double their insurance costs thanks to this isn't going to help him much (not entirely sure why Bannon's bothering, AARP alone is probably going to end up sinking it).

Hell. The "freedom" caucus will be enough to sink it and they want to blow it up because it gives pennies to poor people.

The question is what does Bannon gain from humiliating Ryan? My guess is a lot.

Paleocon wrote:

The question is what does Bannon gain from humiliating Ryan? My guess is a lot.

There is every indication that Trump judges people almost solely based on their perceived strength. Ryan being humiliated will severely lower Trump's esteem of him (or maintain its already low state) and make Trump unlikely to listen to Ryan and that helps Bannon in the future on any and every issue where Ryan would give the President different advice or ideas.

Yonder wrote:
Paleocon wrote:

The question is what does Bannon gain from humiliating Ryan? My guess is a lot.

There is every indication that Trump judges people almost solely based on their perceived strength. Ryan being humiliated will severely lower Trump's esteem of him (or maintain its already low state) and make Trump unlikely to listen to Ryan and that helps Bannon in the future on any and every issue where Ryan would give the President different advice or ideas.

Wow. It's like there is a Europa Universalis prestige engine involved or something.

Yonder wrote:
Paleocon wrote:

The question is what does Bannon gain from humiliating Ryan? My guess is a lot.

There is every indication that Trump judges people almost solely based on their perceived strength. Ryan being humiliated will severely lower Trump's esteem of him (or maintain its already low state) and make Trump unlikely to listen to Ryan and that helps Bannon in the future on any and every issue where Ryan would give the President different advice or ideas.

Bankrupted a handful of businesses, still views others through the lens of their success.

Yonder wrote:
cheeze_pavilion wrote:
Yonder wrote:

How can you ever provide enough carrots? Carefree people are just not going to do it if it costs anything. Unless you literally make it free for them why would such a person bother to sign up?

So we're way past talking about everyone subject to the Individual Mandate. We're down to talking about a subset of that group, a subset this carefree.

That's not a subset of a subset, that's the entire Individual Mandate group. "I am young and/or healthy. I am part of the segment of the population that pays more into health insurance than they get out. By definition that's true, that's why they want me, because buying health insurance is a financially losing proposition for me."

For this segment of the population choosing health insurance is entirely, 100% based on how risk averse you are. The whole reason the individual mandate is a thing is because a huge number, honestly a majority from enrollment numbers of people in this group, are "carefree" not in a skipping through life across busy streets without looking both ways sort of way, but in a "I am willing to risk a very unlikely medical disaster if it means I save a couple thousand dollars a year" sort of way.

I disagree, but granting that for the sake of argument ("Carefree people are just not going to do it if it costs anything" + "that's the entire Individual Mandate group"), then you're not talking about the Individual Mandate as it is, you're talking about a new, super charged Individual Mandate with a tax penalty as high as the cost of purchasing health insurance for everyone in that group.

Basically, you're not talking about an Individual Mandate and the incentive to spend more because you're losing enough money on the tax penalty anyway. You're talking about making people buy a health insurance plan. Which I think you say later on: "honestly I would prefer forcing, a public plan in marketplace that everyone is signed up for by default unless they switch to another valid plan, but that's another topic."

Oh, I don't want to make it cheaper. I don't think any liberal wants to make it cheaper in this way. I think we want the burden shifted off of the kind of people who might make a choice between the tax penalty and the premiums, because those people aren't the ones who should be shouldering this much of the financial burden in the first place.

I think what you're saying is that you think that young healthy people enrolling is a red herring, and instead of worrying about those people we should just be getting more money from the rich to pay for healthcare?

No. I'm saying that enrolling young healthy people is as important as you are saying, but only for purposes of getting them better health care through checkups and preventative care. Not for purposes of paying for the system. Anyone with few enough assets that they don't fear a medical bankruptcy should have their health care subsidized to the extent that they don't need the stick of Individual Mandate tax penalties to sign up. I'm saying we should provide enough carrots.

I disagree that that's not important, I think that incentivizing (honestly I would prefer forcing, a public plan in marketplace that everyone is signed up for by default unless they switch to another valid plan, but that's another topic) all people to have healthcare is an important part of lowering average costs. I also think it's important to remove financial incentives for even young/healthy people not getting checkups and preventative care to keep them healthy.

I don't think young, healthy people paying more should be how we lower average costs. I think taxes is how you lower the average costs. Whether young or old, healthy or not, taxes on those with more fund the subsidies for those with less.

Additionally, I am really not swayed by the argument that personal liberties requires letting people make the conscious choice to avoid healthcare. (I'm not saying that you are making this argument, it's just another argument against the mandate I hear because I work with conservatives, and I wanted to be thorough).

I think the liberal argument here is that if the government wants to do something like take away that liberty, it should do it in a liberal fashion. Asking people to pay just on the basis of being young and healthy is not a liberal value. Liberal values are about asking people to pay on the basis of their ability to pay. In large part these are the people who should be getting more out of the system than they are putting in, if we're talking about liberal values.

The Individual Mandate is a betrayal of our liberal values even if some of the goals are not. We should accomplish goals like preventative care using liberal means like progressive taxation.

While that does have some merit (only some because enrollment periods aren't unique to the ACA, my employer has annual enrollment periods too, so even without the ACA most people would be in the same boat) I felt like that was a really a distraction from the real issue of the pros and cons of the Individual Mandate versus... I'll call it a Gap Surcharge.

It's not a distraction. It's an answer to the criticism "without the Individual Mandate, people will just wait to get sick to sign up." If you look back, a lot of people were making that criticism.

AMA Joins Increasingly Loud Chorus Of Health Groups Opposing GOP Repeal Bill

The American Medical Association just announced that it “cannot support” the Republican bill to repeal the Affordable Care Act.

The AMA announced its opposition in a letter Wednesday morning, hours before two House committees were set to mark up repeal legislation. It comes one day after a slew of patient advocacy and health industry groups including the American Hospital Association announced they were against the House GOP bill ― and it’s one more sign of political trouble for the Republican repeal effort.

Trump will just do what he has done with all the other agencies he doesn't like. He will somehow figure out how to get a prayer or faith healer to head the AMA.

AMA isn't a government agency.