[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.

Tom Price, Disgraced Ex-Trump Official, Admits He's Also a Huge Liar

At the World Healthcare Congress in Washington today, Price said that the Republican tax bill’s repeal of the individual health insurance mandate was foolish:

According to the Washington Times, Price said he “believes [the repeal] actually will harm the pool in the exchange market, because you’ll likely have individuals who are younger and healthier not participating in that market, and consequently, that drives up the cost for other folks within that market.”

This is a very interesting development, given that last year, when he was actually in a position to influence whether or not this happened, he supported the repeal. Appearing on national television last summer, Price said the exact f*cking opposite of what he said today (emphasis mine):

“The individual mandate is one of those things that is actually driving up the cost for the American people in terms of coverage,” Price said during an appearance on ABC’s This Week. “So, what we’re trying to do is make it so that Obamacare is no longer harming the patients of this land – no longer driving up costs, no longer making it so that they’ve got coverage but no care.”

However you feel about the inclusion of the individual mandate (which was originally a Heritage Foundation idea, supported by Republicans in the 1990s) in the Affordable Care Act, the fact remains that removing it now, without replacing it with some other means of ensuring health coverage, is likely to increase premiums and reduce the number of people with coverage—a trend we’re already seeing realized—as Price admitted today. If there’s no penalty for not buying health insurance, fewer healthy people will do so, making the overall cost of health insurance higher. (This would not be an issue under single payer!)

The most galling part of this is that Price didn’t actually admit he was wrong or own up to any sort of mistake—he just offered a disinterested policy take, as if he hadn’t played an instrumental role in this bad thing that’s happening right now. He acted as if it happened beside him, rather than partly because of him—as if what you do when you’re in power doesn’t count, because then you have obligations to politics, to your party and your president, to whatever it is you’re told to go out there and say.

But the super cool thing is there will likely be no consequences for Price, save maybe a day’s worth of news outrage about this. I expect he will quietly be snapped up by a lobbying firm as soon as he decides he needs an extra million dollars a year and they decide they need another old white dude in a suit who looks like he sells shoes; they won’t care one bit that he lied and millions of Americans lost their healthcare coverage. What he did today was prove he’s good at saying the wrong thing at the right time and the right thing at the wrong time, and that’s good enough in Washington.

Somewhere a river needs to named lusion so the gag "delusion ain't just a river in [local]" can exist.

Has the ACA Medicaid Expansion Been a Success?

Trump promised them better, cheaper health care. It’s not happening.

A key small business group says Trump’s new insurance rules are unworkable, after pushing the idea for nearly 20 years.
Trump, who’s touted the expansion of so-called association health plans as a key plank in his strategy to tear down Obamacare, even announced the rules at the 75th anniversary party of the National Federation of Independent Business last month, claiming the group’s members will save “massive amounts of money” and have better care if they join forces to offer coverage to workers.

But the NFIB, which vigorously promoted association health plans for two decades, now says it won’t set one up, describing the new Trump rules as unworkable. And the NFIB isn’t the only one: Several of the nationwide trade groups that cheered Trump’s new insurance rules told POLITICO they’re still trying to figure out how to take advantage of them and whether the effort is even worth it.

Getting health insurance through work now costs nearly $20,000

Employers and workers together are spending close to $20,000 for family health insurance coverage in 2018, according to a new Kaiser Family Foundation report.

Although premiums have increased fairly modestly in recent years, the growth has far outpaced workers' raises over time. The average family premium has increased 55% since 2008, twice as fast as workers' wages and three times as fast as inflation, Kaiser's Employer Health Benefits Survey found.

Companies pick up most of the tab, shelling out $14,100 a year, on average. Still, workers have to pay an average of $5,550, up 65% from a decade ago.

Lung Cancer Deaths are 28 Percent Lower in California
State’s long-term, aggressive tobacco control programs cited as primary reason

“It is clear that from the early days of tobacco control, young people in California became increasing less likely to become addicted smokers,” said John P. Pierce, PhD, Professor Emeritus of Cancer Prevention at UC San Diego School of Medicine and Moores Cancer Center and lead author of the study. “What we saw is that among people under 35 years old, the combination of a 39 percent lower initiation rate, 30 percent lower consumption of cigarettes among those who did smoke, and a 24 percent higher early quit rate meant that young Californians now have much less exposure to cigarette smoking than those of similar age in the rest of the country.”

They're just in the pocket of Big Air, and part of the Deep Breath State

Tanglebones wrote:

They're just in the pocket of Big Air, and part of the Deep Breath State

I'd have thought that would have been Montana - "Big Sky Country" has Big Air.

deleted. Wrong thread.

Baron Of Hell wrote:

Megyn Kelly got fired for her blackface comments. This was just the latest racist thing she said.

Wrong thread??

lunchbox12682 wrote:
Baron Of Hell wrote:

Megyn Kelly got fired for her blackface comments. This was just the latest racist thing she said.

Wrong thread??

But she makes everyone sick.

Medicare for All and Administrative Costs

Wasn't that their move?

Chaz wrote:

Wasn't that their move?

i think this will have to wind its way up the courts and then if the supreme Court upholds the ruling, Republicans in Congress are going to have to decide if they want to come up withor support a Democratic alternative that doesn't throw millions of people off of healthcare. It's going to be entirely on them.

Wasn't this already effectively decided by the SC?

Apparently the judge's ruling is that now that Congress reduced the penalty for the individual mandate to zero makes the mandate unconstitutional, and the mandate can't be excised from the rest of the law, therefore the entire law is unconstitutional.

I know that we're years out from this having any actual effect, but it's still depressing. Especially since the GOP isn't going to come up with anything to replace the ACA, but will swear up and down that they're trying to cover people.

The Dems will take the senate and presidency in 2020, and then we will really fix this mess. This was part of the consequences of Trump winning. 2020 was always going to be about cleaning up the Deplorable's mess.

Maybe this is how the republicans will deliver Medicare for all. They fished for the cliche death by a thousands cuts but instead got whatever doesn’t kill it makes it stronger.

Chaz wrote:

Apparently the judge's ruling is that now that Congress reduced the penalty for the individual mandate to zero makes the mandate unconstitutional, and the mandate can't be excised from the rest of the law, therefore the entire law is unconstitutional.

The irony is that the mandate being unexcisable from the rest of the law was an argument of the Obama administration. (LINK):

Both the Obama administration and the law’s opponents have one argument in common. They express concern about what might happen to health insurance markets if the mandate is severed from the statute but the requirements that insurance companies cover sick patients and don’t charge them higher rates remain. If healthy people do not have to buy insurance and insurance companies are forced to cover the sick, they warn, insurance would be far more expensive. No doubt rates would rise as a result. But the size of that increase — whether it would be 10 percent or 20 percent, as some claim — is unknown, and the Supreme Court is in no position to make that judgment on its own.

It’s not clear why the Obama administration has chosen this course. Perhaps it made a strategic choice to raise the stakes of striking down the mandate by asking the court to also invalidate the law’s more popular provisions. Or it may be concerned that, if the mandate alone is struck down, there would not be enough votes in Congress to pass new provisions to compensate the insurance industry for its loss. But as a legal matter, the court should reject the argument.

The "individual mandate" was always liberals at their worst, trying to defend something just because of the sweet, sweet conservative tears. Obama actually ran on a no individual mandate position, then decided to change in order to not run afoul of his other promise not to raise taxes on people making less than 250k(?). The whole (edit) conversation around the law was a dumpster fire.

The ACA has another provision against adverse selection--you can only sign up during certain times of the year. In fact, uh, I think this is the last day to sign up, thanks to Trump? I think you used to have until sometime in January, but that got rolled back to today as part of the Trumpublicans efforts to hurt people to achieve their political goals (of hurting even more people).

Yeah--deadline is today. Spread the word, maybe it will save someone's life in the coming year.

I've been getting emails every day for this entire month reminding me about the deadline. I'm surprised that the 45 administration didn't have those cut off too in hopes that people would forget and lose their insurance. Maybe they just don't know about the emails yet.

Buttery males death panels.

Progressives Will Get Their Debate On Medicare For All — And Questions Abound

The debate about Medicare for All is about to get more serious ― and more complicated.

The idea of creating a single national health insurance program for all Americans has been a big topic of political conversation since 2016, when Sen. Bernie Sanders (I-Vt.) touted it during his Democratic presidential campaign. But Medicare for All couldn’t be anything more than a rallying cry as long as Republicans controlled the levers of power in Washington.

Political circumstances are different now. Democrats hold the House majority and, as Speaker Nancy Pelosi’s office confirmed to The Washington Post on Thursday, at least two committees will hold hearings on Medicare for All this year. Exactly what those hearings will entail isn’t clear ― Democratic leaders aren’t saying ― but one focus will be a bill that Rep. Pramila Jayapal (D-Wash.) plans to introduce in the next few weeks.

A detailed analysis of American ER bills reveals rampant, impossible-to-avoid price-gouging

For more than a year, Vox's Sarah Kliff has been investigating hospital price-gouging in America, collecting hospital bills from her readers and comparing them, chasing up anomalies and pulling on threads, producing a stream of outstanding reports on her findings.

In her latest installment, Kliff digs deep into the famously bizarre world of ER bills and points out some of the most egregious ways in which these are rigged.

For example, if you are injured and also financially precarious, you might travel to a more distant ER just to be sure that the hospital you're visiting is in-network for your insurer, but that means nothing. "In-network" ERs often staff "out-of-network" doctors, and there is no way to find out whether the doctor treating you is covered by your insurer until you get the bill: one of Kliff's readers got bills for $8,000 from an out-of-network surgeon who treated his broken jaw at an in-network hospital.

And much of the care you receive at an ER is subject to bizarre price gouging: one of Kliff's readers was charged $238 for two drops of the generic eyedrop ofloxacin which retails for $15/vial; the routine pregnancy test that ERs administer to women of childbearing years can cost up to $465, enough to buy 84 pregnancy kits at the pharmacy; and one Seattle hospital charged $76 for a squirt of generic neosporin. Not all hospitals gouge on all drugs, and many of these drugs are not being administered for urgent health problems -- a halfway honest hospital could advise a patient, "We charge $238 for this eyedrop, why don't you pick up a bottle for $15 next door and administer it yourself?"

Finally, Kliff uncovers wild variability in the "ER facility fee," which is a cover-charge you're assessed just for walking in the door at an ER. One of Kliff's readers paid $5,751 for sitting in a hospital waiting room with an ice-pack and a bandage while waiting to see a doctor, but who left because she was feeling better and didn't need care after all. Kliff's work reveals that these "facility fees" are rising at twice the rate of other health charges, with no rhyme or reason.

All of this refers to people who come into the ER under their own power, out of an abundance of caution -- for example, my daughter recently broke her collarbone, but we didn't know that until we went to the ER for an X-ray, and if we'd less prudent, we could have iced it and made a regular doctor's appointment for the next day, leaving her untreated and undiagnosed. But of course, ERs treat large numbers of people who are unconscious or in agony when they arrive, either on their own or on an ambulance gurney. These patients can't possibly be expected to shop around, to demand to know whether their medicines are medically necessary (I once had a small eye injury that I went to get checked out on a Sunday just in case and had to stop the nurses from pumping me full of IV dramamine just in case it turned out I would need neurosurgery!), to evaluate whether the doctors are in- or out-of-network, and so on.

(We ended up paying $2,400 out of pocket for our daughter's ER visit, including $2.50 for a generic tylenol, despite having gold-plated insurance from Cigna)

Kliff's work reveals the whole story of "market based medicine" to be a fiction. Markets are regulated zones where consumers compare the offerings of producers and make purchase choices based on their information. To call being wheeled unconscious into an ER and raced into an operating theater and then presented with a bill months later a "market transaction" is to make a terribly, grisly joke.

It's as good an argument for Medicare for All and single-payer health care as you could ask for.

That makes me real nervous to see what we wind up getting billed for the stomach flu my wife had two weeks ago. She spent 16 hours unable to keep anything down. We assumed stomach flu, so called our insurance's nurse line. They asked about dehydration and abdominal pain, both of which she had. We were guessing related to all the throwing up, so we figured she probably needed fluids and nausea meds. The nurse line said the same, and said we should call our doctor's office, but would probably need to go to urgent care.

Called the doc's office, they agreed we should go to urgent care because their office couldn't do IV fluids. Packed up the kids, went to urgent care. An hour in there, they said they couldn't be sure about the abdominal pain, so we needed to go to the ER to get an abdominal workup. They gave her some oral nausea meds, and off we went to the ER.

In the ER, they spent an hour triaging, taking some blood, doing an EKG, and doing an abdominal x-ray and ultrasound. Eventually they put her on a liter of IV fluids and some more nausea meds. Another hour and a half later, they decided nothing seriously wrong, so it was probably food poisoning or a stomach bug. We got a prescription for nausea pills, and sent us home.

I have no idea what was actually done, and we certainly weren't asked. I'm assuming the ER was in-network, but with an exhausted, dehydrated wife, also-sick toddler, and a 4-month-old, and running on two hours sleep myself, I sure wasn't in a position to go research in- vs out-of-network ERs in the area. I'm sure we'll be able to cover whatever the bill winds up being, but it sucks that it's even a consideration when we have insurance coverage. If you're in a position to need to go to the ER, the last thing you should be expected to do is try and figure out insurance coverage. That's a rat's nest that's almost impossible to decipher at the best of times. For both our kids, we and our midwife's biller called the insurance company to find out what their coverage was for home birth, and we got a different answer each time, and the rep basically said "well, we won't really know until they file the claim, then we'll see what happens." So even if you as a consumer do your due diligence, there's really no way to actually know what the cost will be. That's a sh*tty way to do things. Shocker.

Half of my career has involved reviewing medical records and bills. I can fully endorse the "there is no rhyme or reason" argument. I can tell you the ballpark average of what various procedures SHOULD cost but what you get on the bill is all going to depend on where you went and who you saw. Heck, just the cost of being transported TO the hospital would break most low income families if they are expected to pay it all out of pocket. When I see what hospitals charge and that they're actually paid by insurers after all the massive cuts, I'm still shocked that so many hospitals seem to be struggling to keep their doors open.

Chaz wrote:

I have no idea what was actually done, and we certainly weren't asked. I'm assuming the ER was in-network, but with an exhausted, dehydrated wife, also-sick toddler, and a 4-month-old, and running on two hours sleep myself, I sure wasn't in a position to go research in- vs out-of-network ERs in the area. I'm sure we'll be able to cover whatever the bill winds up being, but it sucks that it's even a consideration when we have insurance coverage.

I was going to make some snarky comment about how you need to be responsible and that is the glory of the free market with will keep us all free/safe/happy/slaves but I couldn't find the correct balance of sarcasm, bleakness, and humor.

I hope it doesn't cost you an arm and leg.