Thursday, May 4, 2017

ACHA Passes: Now What

71 comments:

John said...

Liberals fascinate me in that they seem to have absolutely ZERO faith in the citizens and politicians of the States. I mean Anonymoose wrote the following over at who should pay...

"Well, now we get to see how quickly Paul will die when Peter removes life support. Hopefully, our Senators have brains."

And Greg wrote the following at the MP piece...

"Not much to say except that under Disaster Donald,...
the Republicans now have the power to kill us all,...
and that's what they'll do.
Their richest constituents will probably be the last ones to die,...
but they'll be just as dead as the rest of us in the end,...
all the while joining Dysfunctional Donald in blaming the rest of us,...
for what they, themselves, have wrought.
Sadly, Ray Bradbury was wrong,...
I don't see any way we'll manage to colonize Mars soon enough,...
to preserve the human species before we're all dead on earth."

John said...

To which I said.

"Pendulums. Our system goes Left, Right, Left, Right, etc...

I personally am indifferent regarding ACA and ACHA, for most of us Americans they have little impact. ACA cost US citizens a lot and seemingly limited competition in many locales. ACHA keeps some of the benefits and loosens a lot of the strait jacket rules.

I am always puzzled why some people distrust the local and state politicians / citizens so much. I mean even if the Feds totally exited Healthcare, do you have so little faith in your neighbors that they will do right by the truly needy people in your State?"

John said...

The consensus seems to be among these Liberals who are crying in their beer that Local and State communities are uncaring folks who are unwilling and unable to care for their own.

They seem to think that the Feds are the only folks who care, can tax and can help people in need.

I will never understand.

John said...

From MP:

"Not so fast: "I personally am indifferent regarding ACA and ACHA, for most of us Americans they have little impact."

If it goes through as is, it may impact you more than you've realized:

From VOX (https://www.vox.com/policy-and-politics/2017/5/4/15539010/ahca-lifetime-...): "A little-noticed provision in the Republican health care bill could allow insurers to reinstate lifetime limits in health insurance. This change would affect Americans in the individual market as well as the 159 million Americans who get health insurance at work, and it would be particularly dangerous to people or families with chronic conditions that require millions of dollars in medical treatment."

and

"A single state’s decision to weaken or eliminate its essential health benefit standards could weaken or effectively eliminate the ACA’s guarantee of protection against catastrophic costs for people with coverage through large employer plans in every state,” Pat


"I am perfectly aware that the Liberal view is to try to protect almost everyone from most everything via more regulations no matter the cost.... Especially if that cost can be passed on to other tax payers who they think have too much money...

But I will stick with my original position... "for most of us Americans they have little impact"... Now I do understand that a very small group of Americans may run into problems... However I am not willing to burden the whole system and all of the members for that possibility.

The idea of unlimited benefits for a very defined and limited payment amazes me... Are you willing to increase everyone's cost accordingly? Not just the unfortunate few wealthy people who have been paying it since ACA passed?" G2A

Laurie said...

Every Republican who voted for this abomination must be held accountable

John said...

Laurie,
We get it... Liberals think that everyone is entitled to unlimited free or low cost healthcare whether they:

- work or sit on the couch...
- have only the children they can afford or if they pump them out
- whether they live a healthy lifestyle or live on the edge

And they think it should be paid for by the wealthy and others who make good life choices...

No surprise here...

John said...

The gap between Jerry and yourself on this is near infinite...

Anonymous said...

"Liberals think that everyone is entitled to unlimited free or low cost healthcare..."

And Conservatives think every baby should be born, even if they will place an undue burden on society.

So, I guess we're even.

Anonymoose

Anonymous said...

"The idea of unlimited benefits for a very defined and limited payment amazes me... Are you willing to increase everyone's cost accordingly? Not just the unfortunate few wealthy people who have been paying it since ACA passed?"

What's amazing is how oblivious Conservatives are to the health care and health systems in place in the civilized world. I don't count the U.S., because our health care system is anything but civilized.

Donald Trump himself said that Australia's is better than ours. Now, DJT is not exactly a Conservative, but he does happen to be the President.

Anonymoose

jerrye92002 said...

Rather than some half-baked opinion, let me offer some substance. Frankly, I was strongly against this bill because I thought it should do more to free the American health care system from oppressive government intrusion. But then I saw
this very clear explanation, and I am inclined to agree that this is an excellent first step. "Phase two and three," where HHS Secretary Price dismantles all of the "as the Secretary shall determine" stuff-- 25,000 pages of useless red tape-- and Congress passes an actual "replacement" bill (allowing sales across state lines, etc.) will finally get us to where we should have been before the ACA was foisted upon us.

Laurie said...

The American Health Care Act's Prosperity Gospel

you seem to be a proponent of the prosperity gospel in life and healthcare

John said...

I admit... After awhile I only skimmed that silly piece... Not saying there are not Conservatives out there like that, but I think the number is few.

I think most of us just believe that it is wrong to forcefully rob the Peters so the money can be given to the Pauls. Especially if the money is given with no expectation that the Pauls improve, change, learn and become self sufficient.

Remember what one gets when you give bunnies unlimited food, water and healthcare... More bunnies looking for food, water and healthcare... Exactly how many dependent, poorly educated, hopeless, miserable bunnies do you want to breed with your free feeding and healthcare program?

I am happy to give money to help people become independent, learn, develop hope and become happily self sufficient adults / citizens. But I have no desire to be part of a co-dependent relationship that enables the dependent people of our country to stay trapped in that life. And worse yet to trap their children with them.

jerrye92002 said...

It is an interesting, piece, Laurie. Here's another "odd" take:
Krauthammer

I do not agree with either of them. Other than the immorality of Robin Hood government, I prefer to eschew the moral question in favor of the practical, and I believe that argues against your "Gospel" piece. The fact is that "raising prices for the poor and sick" and "lowering prices for the healthy" may happen-- who knows what happens when you pass 2000-page pieces of legislation like Obamacare or 1000 pages to "fix" it-- but letting the free market work will almost certainly lower prices for EVERYBODY. Why shouldn't it, since that was the case BEFORE Obamacare? Just like the topic at hand, making the "poor and sick" responsible for their own care just makes sense, especially when they can exercise some choice over it, and are offered assistance (Medicaid or something better, like the former MNCare) to help them over the low hurdles.

jerrye92002 said...

And I need to add that I view giving health CARE (not insurance) to poor people not as a moral imperative, though there is a moral component if I do it for that reason, but as a practical economic matter. Sick people cannot work, so if I or, as a second choice, government, can spend $500 to fix a fellow's broken leg and he goes back to his $500/week warehouse job, "our" economy is way ahead on that exchange.

John said...

That healthcare vs health insurance argument never makes sense to me.

John said...

Maybe you will be supporting single payer sooner than you think.

jerrye92002 said...

My point is and always has been that if I give you health insurance but that no health care provider will accept it, did you get health care? NO. If I give you the health care directly, did you have insurance? Yes, in the indirect sense. Yes, "single payer" would seem to suggest that we are giving health CARE, but in actuality it is a form of government-run insurance, and we already know how that reduces the supply of actual health CARE available. Do you really want government deciding who gets paid to care for YOU, or whether you get care at all?

Something else that ran through here a while back, the complaint that the AHCA allowed "reinstating lifetime limits" in health insurance. Do not complain, please. The lifetime limit on Medicare killed my father. It's a bit of a sore point.

John said...

Jerry,
Sorry but your dad story still seems totally unbelievable in country full of private clinics, practioners and hospitals who want our money. I have seen some old people get some very expensive care.

jerrye92002 said...

You are correct that it seems unbelievable. But it's true. There is "very expensive" care available and given, but after the Medicare cap is reached, that's it. We were NOT PERMITTED to pay for him to receive further care.

John said...

Do you any source to back this up?

John said...

Maybe a regulation.

jerrye92002 said...

What SOURCE??? I am telling you exactly what happened. It is what I was told while I stood there, checkbook in hand.

John said...

There must have been a rule referenced.

Doctors don't just let people die on their beds.


Certainly you researched if the admin was correct.

Or tried a different clinic, or sued them for wrongful death.

John said...

Or as you claim, everyone can get healthcare at HCMC... Something is off with your story. :-(

jerrye92002 said...

"Doctors don't just let people die on their beds.
Certainly you researched if the admin was correct.
Or tried a different clinic, or sued them for wrongful death.
Or as you claim, everyone can get healthcare at HCMC."

Get back to me when you are faced with the same situation, and I'll offer advice.

John said...

Jerry, I am sorry if I am rubbing a sore spot, however claiming the government killed Dad with no details / source does not float.

John said...

Especially when you are arguing against regulating insurance policies to protect patients from low max benefits.

jerrye92002 said...

You miss the point. Medicare is the most "regulated" insurance there is. I am arguing against allowing government to set those limits, and in favor of allowing ME (and anybody) to decide, in contracting with an insurance company, medical provider and my own pocketbook, the cost and extent of my medical care.

And you are infuriating. Here is my source:

Me: Can you just let him stay here a few more days?
Doc: I'm sorry, but he has exceeded the Medicare limit, he can't stay.
Me: I will happily pay for it.
Doc: I'm sorry, but Medicare rules will not let us accept it.

A day later he was dead.

John said...

It seems your Doctor was wrong...
AARP Medicare Hospital Stay Explanation
How Much will Medicare Pay

And this is even more disturbing... Apparently capitalism and questionable hospital ethics may be to blame for the discharge.
Hospitals discharge to maximize profit

Do you still think Medicare in the bad guy here?

John said...

Now for the big question...

Does it really matter if it is Medicare, One's scrimper policy or Poverty/No Policy that gets a person's Dad discharged pre-maturely from the hospital? Or limits the quality / quantity of care they receive?

The reality is that the pre-ACA healthcare system doomed millions of poor people every year to experience what you did...

Is that what you support?

John said...

To pick this apart a bit further.

"I am arguing against allowing government to set those limits, and in favor of allowing ME (and anybody) to decide, in contracting with an insurance company, medical provider and my own pocketbook, the cost and extent of my medical care."

Now I don't disagree totally with your statement. However the unfortunate reality for huge number of people in the USA. They can not personally afford good policies with high max payouts. And before ACA companies could sell those... This worked out great for many who stayed healthy, however it was a disaster for the others.

Remember this household income chart

jerrye92002 said...

And if it is a non-profit hospital?

And because some cannot afford cadillac care, everybody has to have used-Yugo coverage or pay a fine?

jerrye92002 said...

"The reality is that the pre-ACA healthcare system doomed millions of poor people every year to experience what you did..."

Exactly right! Medicare was pre-ACA.

John said...

"Non-Profit" does not mean they are not trying maximize revenues... Get real...

For better or not, ACA took billions each year from the wealthy and the rest of us to buy down insurance for lower income people. So they could afford good policies.

Now answer my questions...

Does it really matter if it is Medicare, One's scrimper policy or Poverty/No Policy that gets a person's Dad discharged pre-maturely from the hospital? Or limits the quality / quantity of care they receive?"

John said...

Please remember that you are in the small minority of people who are dissatisfied with Medicare... Especially on the limits side...

And people are happier with government programs than with their private programs.

jerrye92002 said...

"Does it really matter if it is Medicare..."

Absolutely, and quite simply, because it is a matter of "who decides." You don't seem to recognize that the infuriating part was not that he was discharged early, because of the "limit." It was the fact that I was not allowed to pay, out of my own pocket, for additional care that would have kept him alive.

jerrye92002 said...

A. Your poll is 2 years old and I would not bet it would be the same today.
B. It is an opinion poll, and most often these reflect personal experience, with no consideration of how someone else may be doing.
C. I don't care. I may be a "minority" of only 23% but why is that favorability not 100% for these "perfect" government programs? Take away the taxpayer contribution, make the beneficiaries pay full cost and THEN ask the question. Hey, would you like free health care? Heck yeah, love it!
D. What were the alternatives each respondent could consider? Did they have a choice between Medicare, employer, or private insurance? You tend to like the only thing you can get.

Hopefully the AHCA will start giving us real choices rather than government controls.

John said...

Jerry,
On the upside, no one will accuse you of being open minded or wishy washy...

"I was not allowed to pay" This was apparently between you and your Doctor. As noted above, I found no rule that prevented them from keeping your Father there and accepting your money. And you sure have not provided one.

Now if one are low income and can not afford the premiums for good comprehensive healthcare / health insurance... Do they get to choose in any system?

John said...

Here is a more recent version.

John said...

People on Medicare are most satisfied with the US Healthcare system.

"65% of Americans satisfied with healthcare system, down from 67% in 2014

Americans with government health plans most satisfied

Republicans much less satisfied than Democrats"

John said...

And another source.

"As valuable as Medicare is, it's by no means comprehensive, said Floyd.

Take Part A, which pays for hospitals and skilled nursing care. It comes with a $1,316 deductible, the amount you must pay before Medicare will pick up the tab. While there is no charge for hospital stays up to 60 days, for stays between 61 and 90 days, you must pay $329. For stays beyond 90 days, the charge is $658 a day.

For Part B, in addition to a deductible of $183, there is also a 20 percent co-insurance.

A supplemental plan can help pay for the gaps."

jerrye92002 said...

"AHCA passes now what"

Our national health care system gets better for almost everybody. Of course, Republicans in the Senate could still screw this up. Maybe after they fix Obamacare and Medicaid, they can keep Medicare from bankrupting the country. That may be even more difficult, since a lot of people like the idea of somebody else footing their medical bills.

John said...

We all hope you are correct.

But with $100 Billion less available to help fund the American healthcare system, I think that could be challenging.

jerrye92002 said...

First of all, I think getting government out of the "loop" will EASILY save $100 billion. And second, I think there will be additional savings by having the spending controlled by the consumer rather than third-party government (actually fourth-party, since they're taking it from taxpayers, giving it to insurance companies who then pay the doctors. NOT a good free-market system.

John said...

"Our national health care system gets better for almost everybody."

Since 50% of America's households make under ~$50,000, I think your assessment is incorrect, without subsidies many of those folks will struggle.

Just curious... How do you keep these 2 very different things in your head without it exploding?

- Based on your personal experience, dooming people to rely on ER rooms, the charity of Doctors / Hospitals and gov't healthcare to save their parent / child is terrible. (ie some people will die)

- Providing significant health insurance subsidies so that people can afford good private health insurance is terrible. (ie takes money from hard working citizens, lazy people may benefit, promote continued generation poverty)

Now personally I can see that there is a trade off to be made here, and that neither extreme is GREAT and neither is TERRIBLE. Where as both the far right and the far left certainly seem polarized.

jerrye92002 said...

Who said "without subsidies"? We now spend ~14% of GDP on health care. If a $50,000 household spends the same, that's about $7000/year or %510/month. Somebody making half that would, theoretically, spend half that on health care and, I point out, that is about what I was paying for my "cadillac" plan from my employer. If we got government out of the health care business, it is estimated (Mayo clinic) that we could cut those costs in half.

Granted, that people are going to die under the "personal responsibility and charity" scenario. But what makes you think just having government making our health care decisions prevents people from dying?

John said...

First, I don't believe in miracles so I have huge doubts regarding if the plan you had was a Cadillac plan. Secondly that was ~8 years ago, and given the medical inflation rate that means your premium would be ~2 times what it was then.

And yes people will die no matter what we do... (the nature of being human) However walking into the clinic / hospital with an active health insurance policy (private or public) will definitely get a person better and more consistent care than showing up there broke and begging for help to save one's Father.

John said...

As for your very strange math up above... What?

Why would personal income relate to healthcare cost incurred? (ie premiums to be paid)

NPR Cost per Person

Now that is higher than at my diverse aged company. Here it is $5,000 per person based on total premiums and out of pocket. But we don't care for a lot of 65+ aged people and I assume they are expensive.

John said...

I am sorry for the using the Father reference above. However I am in some way trying to trigger some empathy /sympathy from you. It could be someone's Father, Mother, Brother, Sister, Child, Friend, etc who simply can not afford the care, and may not have insurance.

jerrye92002 said...

I have all kinds of sympathy, but whoever thought that Medicare would "take care of" a dear relative would be mistaken, and whoever thought that government would PROHIBIT you from helping out in time of need ought to be more careful what you ask for.

If I had been poor, I would have had the same choice, and that would be unfortunate-- it always is. But at least the choice would have been mine.

John said...

Still waiting for that proof... Regulation... Web stories of people with similar problem... etc...

"government would PROHIBIT you from helping out"

And now it seems you are saying that all poor people choose to be poor...

This string sure is going no where fast.

jerrye92002 said...

Not only am I not expressing myself well, you are again appearing obtuse.

How about "I'm sorry, but Medicare prohibits us from accepting any money from you." Is not MY story enough? If it happened to me, isn't that one person too many? Can you find a Medicare rule that would prohibit what happened to me? I doubt it. Try paying your Medicare doctor more for better care sometime.

As for being poor, I simply point out that people face "end of life decisions" about their loved ones all the time. The rich may have more options and the poor fewer, but the point is it is still THEIR decision to make. It should never be in the hands of "death panels," any other bureaucrat, or a government rule. If AHCA restores some health care freedoms, it's a good bill.

John said...

Jerry,
Your Doctor / hospital was wrong or lied to you to get more money from Medicare. I have provided you with plenty of proof. Why you resist that proof is unknown to me.

John said...

So it is better if blue cross turns down a procedure than if Medicare does? Get real.

jerrye92002 said...

"Your Doctor / hospital was wrong or lied to you to get more money from Medicare."

Now you're being... well, words fail me. If they wanted more money from Medicare, they would have kept him there. If they wanted more money from me, they would have taken it. What "proof" have you offered? I've given eye-witness testimony. What have you got?

Yes, it is better if BC turns down the procedure. Within the terms of whatever contract you signed /voluntarily/ you may be able to appeal. Or follow the terms of the agreement you signed /voluntarily/. Not to mention that neither should be denying specific "procedures" so long as the doctor believes they are medically necessary. It is the Medicare model that creates the problem.

John said...

For your convenience...

It seems your Doctor was wrong...
AARP Medicare Hospital Stay Explanation
How Much will Medicare Pay

And this is even more disturbing... Apparently capitalism and questionable hospital ethics may be to blame for the discharge.
Hospitals discharge to maximize profit

Do you still think Medicare in the bad guy here?

John said...

Now I am not sure why you are in denial... But it is clear that Medicare allows extra payments and care...

And I am pretty sure that you can buy all kinds of products that supplement the Medicare program. But that means one must make the correct choice to buy those before the problem occurs... (ie not scrimp on paying the premiums)

jerrye92002 said...

Look at what happens when those "extra payments and care" RUN OUT.

As for Medigap or "supplemental" policies, not everybody can afford them, even though these days they are almost a necessity if you want any decent level of care. And they are tightly regulated by Medicare. It's just silly. I do not know why you keep defending this obviously failed government program? Don't you think, if it was working correctly, it could be made one of several choices rather than mandatory?

John said...

No... Medicare is the base level offering that everyone gets...

Then the wealthier people can choose more options if they wish.

Just like the whole American healthcare system works today...

The poor have little choice
The wealthy have unlimited choice

I don't know why you continue to support the pre-ACA years... Given that usually you want to help low income people...

Anonymous said...

"Medicare is the base level offering that everyone gets...

The poor have little choice
The wealthy have unlimited choice"

Isn't that the crux of the matter? Liberals want to raise the base level so that EVERYONE either has more choice or real access to a certain (higher) standard of care. The poor cannot afford to do that on their own.

Moose

jerrye92002 said...

Why is the only way to "help poor people" for government to jack up the price of any kind of medical care, take those extra costs from somebody else and "give" care to people "for free"? And why must it be done in the most inefficent manner possible? There are probably a dozen better ways than the ACA.

John said...

Moose,
The Liberals want to give unsuccessful citizens lots of free stuff at the expense of the learners, workers, savers, investors, fiscally conservative, etc citizens of our country. And the Liberals refuse to demand that the unsuccessful people stand up, learn, improve, change and become more productive in exchange.

I have no problem giving people a hand up... But the idea of feeding them in their self created cage by stealing from others rubs me the wrong way.

Jerry,
The reality is that ACA did little wrong, other than opening the "pre-existing condition fraud door", and paying for the subsidies mostly on the backs of the 1% folks.

Maybe you should contact the GOP with your dozen better ways... They seem to be stumped.

John said...

Moose,
The challenge is that the Liberals only seem to have one trick in their bag... G2A Other Peoples Money

If you truly want improve the situation for these folks... We need to:
- hold Parent(s) accountable
- hold Schools accountable
- pressure / help people to make good choices
- pressure / help people prioritize being self sufficient
- deport all illegal workers
- encourage Americans to buy American

I truly hope that some day the Liberals start getting serious about eliminating the achievement gap and poverty...


Anonymous said...

John, the challenge is for you to learn what liberals actually think rather than what you think they think. All of us liberals who post here have tried to teach you, but you refuse to learn.

Moose

jerrye92002 said...

Actually, Moose, all I ever see from liberals is denouncements of what conservatives propose. For example, do you really want to object to erasing the achievement gap in schools (MN highest in the country)? Do you really want to object to people becoming economically self-sufficient? Do you really think we should allow anybody who wants to enter our country to do so, despite laws against it?

jerrye92002 said...

The "ACA did little wrong"??? How about millions of people losing their health insurance (presumably they all died)? How about average premiums going UP $2500/year when we were told they would go DOWN $2500/year? I suppose if you're a "glass half full" kind of guy, you might say ACA got little wrong. But to do that you'd have to say it was a mighty small glass to begin with, because there was little right about it.

John said...

Moose,
As soon as I see liberals strive for the following, I will be happy to change my perception of reality. Unfortunately they keep voting for folks who promise to fight these things...

- hold Parent(s) accountable
- hold Schools accountable
- pressure / help people to make good choices
- pressure / help people prioritize being self sufficient
- deport all illegal workers
- encourage Americans to buy American

The common themes are we need more funding/ bureaucracy/ protection for the needy / public employees and we should allow more needy into the USA. Which of course has to come from the workers and investors of America...

Please tell me a Liberal position that supports the above. WP Dem Platform

John said...

Jerry,
You are correct... They lost their policies, they got something that provided more complete coverage, and the low income folks got subsidies to cover part of the cost. And some folks even got free care through the medicare expansion.

Seems there were a lot of benefits to offset the few detriments.

jerrye92002 said...

Whoa up. People got "free care"?? Where does one get free care, from the magical, mystical money machine in Washington? TANSTAAFL.

John said...

Please note that I said "some folks got free care"... And they did... It costs them little or nothing.

I did not say that other tax payers were not being charged to provide it...

jerrye92002 said...

Precisely my point. The ACA did NOTHING to lower the cost of health care, it just shuffled the payer and added a huge cost increase to the whole thing. That is not a "benefit," it is another broken promise. And there are still "28 million" people uninsured. Not exactly "health care for all."