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post #121 of 275 (permalink) Old 01-29-2017, 03:18 PM
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Re: If ACA is repealed

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Originally Posted by tech-novelist View Post
No, of course that isn't everything; that's exactly my point. If health care can be free for everyone, why can't everything be free for everyone?

Or at least all necessities, like water, food, clothing, shelter, education, internet access, transportation, and phone service? I'm sure there are more necessities of life that I can't think of right now, but everyone needs those too!

Are you a greedy capitalist who thinks people should pay for what they get?
I can't tell if you're being sarcastic, but if you aren't, I agree with you. Maybe not on the internet part, but everything else... Maybe, instead of suddenly making everything free, which would obliterate the economy in those sections of life, a stipend could be paid to every citizen so that they could buy food, insurance, basic housing, etc.



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post #122 of 275 (permalink) Old 01-29-2017, 03:23 PM
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Re: If ACA is repealed

John is 100% right.

And in truth this is a perfect example of where the government could make a HUGE difference. For example, the primary reasons for run away health care costs are - exactly what John said:
- Intentional opacity on outcome quality
- Refusal to provide transparent pricing

For a simple example, just look at the care surrounding child birth. Child birth is either:
1. Vaginal
2. C section

In each of those cases, there is the base cost (assuming the best possible outcome) and then there are a short list of common 'extra' procedures, meds, etc. So while it is true that a hospital can't give you a fixed cost quote before the birth, they could EASILY provide you their price list. But they make it so hard to get this info, that almost no one price shops.

And they absolutely refuse to provide outcome statistics. In this manner they have removed rational economic decision making from the process.



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Competition in health care? Good luck with that. No transparency of costs, provider quality, outcomes...

The only savings via HSA and high deductible is when people don't use services.
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post #123 of 275 (permalink) Old 01-29-2017, 03:34 PM Thread Starter
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Re: If ACA is repealed

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Originally Posted by EllaSuaveterre View Post
I can't tell if you're being sarcastic, but if you aren't, I agree with you. Maybe not on the internet part, but everything else... Maybe, instead of suddenly making everything free, which would obliterate the economy in those sections of life, a stipend could be paid to every citizen so that they could buy food, insurance, basic housing, etc.
I'm pretty sure he's being sarcastic, Ella.

I heard recently that Finland is going to try some sort of minimum income program. Should be interesting to see how it turns out.

One of the deepest feminine pleasures is when a man stands full, present, and unreactive in the midst of his woman's emotional storms. When he stays present with her, and loves her through the layers of wildness and closure, then she feels his trustability, and she can relax. -- David Deida, The Way of the Superior Man
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post #124 of 275 (permalink) Old 01-29-2017, 03:40 PM
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Re: If ACA is repealed

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We will ALL benefit from Medicare if we live to 65. And HALF of us will be in the above average cost group, meaning the subsidized group while on Medicare. The question becomes: Is that fair? And the answer is quite simple. If you believe we are here to take care of one another, then you will see this as fair.

If however, you are both healthy and of the belief that life is an 'every man for himself' proposition, than you will see it as unfair.
We are here to take care of another, it's not about, "Why me?” It's about, “How can I use this in my practice to be mindful and help others". But in the same breath I will not if at ever possible choose to pay for another's harmful path... this is not judging his path, it is ensuring I am not a willing accomplice to their unmindfulness.

My cousin's husband was a 4-pack a day smoker (yes, 4) and now his weeks are cycled around doctors and hospitals. He is not working, they have little money, his health care is fully covered by a very generous system. It troubles me to know his choices tax a system that he wants to use to it's financial limits instead of accepting his self-inflicted demise.

Once the conditions are irreversible, letting go is important for both the individual and the system. I would wager that a month of his care would provide a thousand children basic services for a year... some sacrifices must be understood.

Very hard decisions to apply without sadness, but better for all is an individual choice.
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post #125 of 275 (permalink) Old 01-29-2017, 03:45 PM
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Re: If ACA is repealed

Let's all remember that we are dealing with politics and politicians. They will make grand claims about having done even small things and they usually get away with it. As an example, while president, Bill Clinton pushed an anti-smoking bill pretty hard. The bill basically restricted cigarette advertising. Just one month after the bill was signed, Clinton declared that he had single-handedly solved the country's smoking problem. Never mind that it was now 1998 and smoking had been in sharp decline, due to social pressures, since the 1970s. Before the bill was signed, US cigarette consumption per person was already about 60% below its peak in the 60s. The slope of the curve did not change due to the bill.

So, Trump says he repealed ACA. The entire text of the executive order is on the White House website (www.whitehouse.gov). It's pretty brief. Although in the first article, he claims that it is his intent to repeal ACA, nothing in the current order does so. The actual title is "Executive Order Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal"

What the EO does is:
- Grants authorities to states to seek methods of reducing the economic and regulatory burdens of the law - on not just the states, but also on citizens (referred to as "recipients of health care services"). It does not, anywhere, say that they should consider reducing expenses for health insurance companies or employers!
- Encourages the creation of an open market "with the goal of achieving and preserving maximum options for patients and consumers."

To be honest, Obama himself, when asked by the press, what was his biggest regret, answered "Obamacare". He says he was not involved in it enough and the resulting program was far too burdensome in terms of cost and regulations, and he wished he could remain in a position of influence so that he could (then came a list that is pretty much what Trump proposed).

So, I expect that the problems of ACA, as recognized by people on both sides of the aisle, will be addressed - nothing this big can be implemented this fast and be done right. And, after exactly the kinds of alterations that would have been done no matter who's in office, Trump will take credit and claim he killed Obamacare.

Exactly the same behavior every president exhibits.
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post #126 of 275 (permalink) Old 01-29-2017, 03:47 PM
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Re: If ACA is repealed

From the perspective of objective benefits, we hugely overspend on end of life treatments at the expense of overall child 'care'.




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We are here to take care of another, it's not about, "Why me?” It's about, “How can I use this in my practice to be mindful and help others". But in the same breath I will not if at ever possible choose to pay for another's harmful path... this is not judging his path, it is ensuring I am not a willing accomplice to their unmindfulness.

My cousin's husband was a 4-pack a day smoker (yes, 4) and now his weeks are cycled around doctors and hospitals. He is not working, they have little money, his health care is fully covered by a very generous system. It troubles me to know his choices tax a system that he wants to use to it's financial limits instead of accepting his self-inflicted demise.

Once the conditions are irreversible, letting go is important for both the individual and the system. I would wager that a month of his care would provide a thousand children basic services for a year... some sacrifices must be understood.

Very hard decisions to apply without sadness, but better for all is an individual choice.
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post #127 of 275 (permalink) Old 01-29-2017, 04:11 PM Thread Starter
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Re: If ACA is repealed

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Originally Posted by DustyDog View Post
So, Trump says he repealed ACA. The entire text of the executive order is on the White House website (www.whitehouse.gov). It's pretty brief. Although in the first article, he claims that it is his intent to repeal ACA, nothing in the current order does so. The actual title is "Executive Order Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal"

What the EO does is:
- Grants authorities to states to seek methods of reducing the economic and regulatory burdens of the law - on not just the states, but also on citizens (referred to as "recipients of health care services"). It does not, anywhere, say that they should consider reducing expenses for health insurance companies or employers!
- Encourages the creation of an open market "with the goal of achieving and preserving maximum options for patients and consumers."
Really?

Sure looks like it could be interpreted that way to me:

Sec. 2. To the maximum extent permitted by law, the Secretary of Health and Human Services (Secretary) and the heads of all other executive departments and agencies (agencies) with authorities and responsibilities under the Act shall exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications.

Full text: Trump's executive order on Obamacare - CNNPolitics.com

One of the deepest feminine pleasures is when a man stands full, present, and unreactive in the midst of his woman's emotional storms. When he stays present with her, and loves her through the layers of wildness and closure, then she feels his trustability, and she can relax. -- David Deida, The Way of the Superior Man
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post #128 of 275 (permalink) Old 01-29-2017, 04:11 PM
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Re: If ACA is repealed

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Originally Posted by tech-novelist View Post
We already know that you don't know anything about free market economics. You don't have to keep proving that.
Right. It's not like I taught college level decision analysis, with half the class being economics... or my wife worked 15 years in big pharma and now big insurance... or my first ever job was in health care... Or my kid starts med school next fall. Nah, I'm clueless.

There's no free market in health care. I challenged​ you to point out metrics that can be used for comparison earlier. Cricket symphony...

For the love of God, you're older than me, you're probably not as well off as me, and ideology is still your jihad? At your age - or mine - finding a generic lipitor that works should be far more important to you than ideology.

You demonstrate exactly how people vote against their interests. Like my fellow Kentuckian coal miners who, by voting away ACA, they voted away it's coverage for black lung.
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post #129 of 275 (permalink) Old 01-29-2017, 04:15 PM Thread Starter
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Re: If ACA is repealed

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Right. It's not like I taught college level decision analysis, with half the class being economics... or my wife worked 15 years in big pharma and now big insurance... or my first ever job was in health care... Or my kid starts med school next fall. Nah, I'm clueless.

There's no free market in health care. I challenged​ you to point out metrics that can be used for comparison earlier. Cricket symphony...

For the love of God, you're older than me, you're probably not as well off as me, and ideology is still your jihad? At your age - or mine - finding a generic lipitor that works should be far more important to you than ideology.

You demonstrate exactly how people vote against their interests.
Like my fellow Kentuckian coal miners who, by voting away ACA, they voted away it's coverage for black lung.
Hear, hear.

You don't need lipitor, though, do you, john?

One of the deepest feminine pleasures is when a man stands full, present, and unreactive in the midst of his woman's emotional storms. When he stays present with her, and loves her through the layers of wildness and closure, then she feels his trustability, and she can relax. -- David Deida, The Way of the Superior Man
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post #130 of 275 (permalink) Old 01-29-2017, 04:16 PM
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Re: If ACA is repealed

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We will ALL benefit from Medicare if we live to 65. And HALF of us will be in the above average cost group, meaning the subsidized group while on Medicare. The question becomes: Is that fair? And the answer is quite simple. If you believe we are here to take care of one another, then you will see this as fair.

If however, you are both healthy and of the belief that life is an 'every man for himself' proposition, than you will see it as unfair.
We could use this as an example...

Where do I stand... I want to know how much this 30 yr old man earned for a living that decided to forgo the $300 a month health care?

Most of us have at least that much coming out of our pay check every month even with Employer health care, don't we? .... I wouldn't have cheered in any way with that crowd.. but yet I do feel it's rather irresponsible if you CAN easily afford coverage and choose NOT TO GET IT...especially under our current system...knowing full well how one will be raped in medical bills...where you would have to work non stop for the rest of your life to pay the da** debt.

All I am advocating is.. if one is cut off of Medicaid assistance (which I sure hope remains for the poorest among us) making "too much" just over the threshold.. I feel the income scale for help should not fall off the steep cliff into "thousands" & "thousands" more territory.. but be factored in these family situations..on a scale that is "AFFORDABLE". .. some of these examples I gave earlier - I do not feel are affordable given the income of the individual / family.

Someone like myself is very big on NOT taking on frivolous debt.. I know people who have lived high on the hog buying new toys, new cars, think nothing of blowing money in expensive restaurants, then end up bankrupt still paying rent every month... I tend to look at them & would stamp "Irresponsible with money" on their forehead...yeah...I can be judgmental like that..

If anyone was to compare THEIR INCOME and OURS at any given time... we'd be thousands ahead in assets -even if they made thousands more...

MY point is.. I am the QUEEN of being responsible ..but we're still a lower income family -given our family size...

What is a reasonable figure for ANY OF US to spend solely on health care in a month, a year ?? so a Family can still live a life feeling they can prosper and enjoy the fruits of their labor..

What say YOU ??? But also .. all the corruption -with those in high places filling their pockets raping the tax payer.. this also needs re-hauled.. love to see Trump take that on! he'd be my Hero ..

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post #131 of 275 (permalink) Old 01-29-2017, 04:19 PM Thread Starter
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Re: If ACA is repealed

Good luck thinking Trump would ever do that, SA.

One of the deepest feminine pleasures is when a man stands full, present, and unreactive in the midst of his woman's emotional storms. When he stays present with her, and loves her through the layers of wildness and closure, then she feels his trustability, and she can relax. -- David Deida, The Way of the Superior Man
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post #132 of 275 (permalink) Old 01-29-2017, 04:49 PM
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Re: If ACA is repealed

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Perhaps it is time for a primer on 'insurance'.

The sole purpose of insurance is to spread financial risk across a pool of participants. At one extreme, you would treat everyone the exact same regardless of their choices. At the other extreme you create very fine grained risk buckets based on statistics.

For car insurance, we have chosen to bucket risk in a fairly fine grained manner, because we believe that safe driving is almost entirely a matter of choice. For health care, our primary 'risk bucketing' is connected to age. Without Medicare, 90% of the populace couldn't afford health care because health care for the 65+ crowd is staggeringly expensive.

As to fairness:
During ANY defined time frame under which you are insured, you are either below average or above average from a 'cost' perspective. If your costs are 'below' average you are subsidizing the folks with above average costs. If your costs are 'above' average you are being subsidized by the lower cost half of the pool.

Let's call the degree to which you are subsidizing or being subsidized an 'imbalance'.

There are objective factors which can be used to contour pricing in an attempt to PARTLY reduce the size of these imbalances. For health and life insurance these can be smoking and weight.

That said, if you FULLY address the imbalance, then you no longer have insurance, since the WHOLE concept of insurance is to spread risk across a pool. And if everyone is paying their true costs, there is no spreading.

We will ALL benefit from Medicare if we live to 65. And HALF of us will be in the above average cost group, meaning the subsidized group while on Medicare. The question becomes: Is that fair? And the answer is quite simple. If you believe we are here to take care of one another, then you will see this as fair.

If however, you are both healthy and of the belief that life is an 'every man for himself' proposition, than you will see it as unfair.
If you think I don't know what insurance is, or how it works, then you are terribly mistaken.

I don't know what you're carrying on about fairness for. Was that aimed at someone else? You'll note I said nothing about fairness. Life isn't fair. Hopefully, though, our social constructs, such as laws are JUST though. Don't confuse the 2. They aren't even remotely related.

What you're missing, in your comparison on car insurance, is what if I don't own a car? Do I have to pay it anyways? No. To demand someone pay for something do not have, and could never conceivably use isn't unfair, it is unjust. Regardless of this, you too have completely missed my point in this thread. You are interested in governments telling you how to live your life (well, telling others, they'd never do that to you /sarcasm) and have no interest in things like freedom.

It's about more than money MEM. I don't have some illusion that I'm entitled to any service. If that's something you can't conceive, I don't know what to tell you. Perhaps you should read some Thomas Paine, Montesquieu, Jefferson, and other Enlightenment thinkers?

We aren't all "in this together". You don't believe that. Not for a second. It's a platitude that you spout because it sounds intellectual--and if you take the time to think on it, you'll see that the sound is hollow.
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post #133 of 275 (permalink) Old 01-29-2017, 04:53 PM
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Re: If ACA is repealed

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Right. It's not like I taught college level decision analysis, with half the class being economics... or my wife worked 15 years in big pharma and now big insurance... or my first ever job was in health care... Or my kid starts med school next fall. Nah, I'm clueless.

There's no free market in health care. I challenged​ you to point out metrics that can be used for comparison earlier. Cricket symphony...

For the love of God, you're older than me, you're probably not as well off as me, and ideology is still your jihad? At your age - or mine - finding a generic lipitor that works should be far more important to you than ideology.

You demonstrate exactly how people vote against their interests. Like my fellow Kentuckian coal miners who, by voting away ACA, they voted away it's coverage for black lung.
The point you miss John, is that there is more to life than money. That some things are worth more to some of us... that our financial interests aren't our only interests. This is something I see regularly in this thread.
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post #134 of 275 (permalink) Old 01-29-2017, 04:55 PM
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Re: If ACA is repealed

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Good luck thinking Trump would ever do that, SA.
I would have far more trust in someone who at least showed empathy towards other human beings, his mocking of that reporter was the Lowest of the Low and what he said about War Veteran John McCain..

Nor can he ever identify with a lower working class person....many can not... I found this write up not long ago ...Political scientist Charles Murray put together a short quiz testing the thickness of people’s social bubble: "There exists a new upper class that’s completely disconnected from the average white American and American culture at large...Take this 25-question quiz to find out just how thick your bubble is"...

Do you live in a bubble? A quiz | PBS NewsHour

Though....I must confess I loved it when he told Being to take their plane back..."I think Boeing is doing a little bit of a number. We want Boeing to make a lot of money but not that much money"...

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post #135 of 275 (permalink) Old 01-29-2017, 04:58 PM
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Re: If ACA is repealed

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John is 100% right.
Of course he is 😁.

Quote:
example, the primary reasons for run away health care costs are - exactly what John said:
- Intentional opacity on outcome quality
- Refusal to provide transparent pricing
Back in the early 2000's, there was a startup called Lumenos that offered fairly accurate estimates of costs plus a novel - at the time - spending account. It worked too well. A competitor bought them and assimilated them.

From the early 90's to early 2000's we had a regional HMO that was stellar. These guys paid for a ton of stuff. No referrals, $5 office visits.. they shut down because employers did not like it. It was great in controlling costs...

Today there's hundreds of reviews of plumbers and 3 - 4 for a doctor.

If you think competition lowers price, visit a dentist or veterinarian. You may save a bit by going to a ho hum dentist but generally the good ones all charge the same. Ditto for veterinarians.
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