Replacing the Affordable Care Act

Discussion in 'Political Opinions & Beliefs' started by Natty Bumpo, May 16, 2016.

  1. Organic

    Organic New Member

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    How exactly are you measuring the inclusive and far less costly health delivery mechanisms. are we comparing a Chevy to a Lexus or a Mercedes to a BMW?

    economies of scale come into play when there is a surplus of production capacity, is that the case in all the healthcare systems?

    I appreciate your concern for private business, do you think that will be a powerful lobby in favor of your proposal?

    finally, what are then contributing factors to our very high percent of GDP spent on healthcare?
     
  2. GeorgiaAmy

    GeorgiaAmy Well-Known Member

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    Haven't seen the show.
    Thanks for explaining. Usually patients who go to a doctor's office prepay unless they are insured and have met their deductible...then the office will bill them after filing the claim with the provider.
    The ER is another story though...
     
  3. Daggdag

    Daggdag Well-Known Member

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    I would like to see a few changes to Healthcare reform policy,

    1; No mandate. I do not believe any person should be required to buy private health insurance. Instead, I would like to see a program where anyone unable to afford private insurance is covered by a tax paid public insurance. Anyone who can afford insurance but chooses not to buy it would be allowed to go without, but we would end all subsidies to their medical expenses. They would be forced to cover all costs out of pocket. There would still be a mandate that parents insure children under the age of 18. Failure to do so would be treated as child neglect.

    2; A cap of 250% on all medical prices. We would no longer allow scumbag drug companies to charge $1500 a pill for pills that cost them 15 cents a pill to produce. They would be allowed to charge no more than 250% of their total cost of production. Hospitals would also have this cap on their costs. So 500% would be the total markup for patients.

    3; Cover the costs of the public health insurance with FICA taxes. The individual FICA tax cap would be raised to S1,000,000. The requirement that businesses meet their employees FICA contributions would be lifted, and instead businesses would pay their own FICA taxes with a cap of $10,000,000.

    4; Lift the ban on interstate insurance purchases. The Healthcare Marketplace would be used to allow patients to companies and policies and make purchases. All health insurance companies would be required to be on the marketplace.

    5; Birth Control would be required to be covered only if there is a medical necessity for it, such as if there is a danger to a patient if they get pregnant. There would be a tax incentive for insurance companies to cover birth control for contraceptive purposes, but not a requirements that they do so. (Not wanting to have a kid is not a health issue. It is a person choice, and health insurance companies should not be forced to cover the cost of that choice)
     
  4. Shiva_TD

    Shiva_TD Progressive Libertarian Past Donor

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    Actually the fact that 70% of pre-Medicare age workers have employer provided health insurance so that they do receive medical services has a huge impact on the fact that workers are healthier than non-workers in America. They're receiving the medical services they require to remain healthy.

    What you seemed to gloss over is the fact that my proposal addresses health insurance for all workers and non-workers so everyone receives the medical services that are necessary.
     
  5. Belch

    Belch Well-Known Member

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    And assuming your plan is great, why should I (assuming I am a health care provider) choose to go with your plan instead of offering my services to the highest bidder on ebay?
     
  6. Shiva_TD

    Shiva_TD Progressive Libertarian Past Donor

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    Here's my objection to this. The ability of the individual to fund health insurance and health care is solely dependent upon the compensation package (wages and benefits) provided for by their employer. If the employer provides adequate compensation then the individual can afford the insurance and health care services but if the employer doesn't provide adequate compensation then you're calling on the government to provide a subsidy that's fundamentally a subsidy for the employers that are under-compensating their workers.

    I oppose taxpayer subsidies to make-up for under compensation by employers.

    The employer is profiting from the labor of their employees, not the taxpayers, so let the employer fund the cost of the health insurance as opposed to placing that financial burden on the taxpayers.

    While this may sound good all it really does is open up an accounting nightmare. The "cost of production" is only a component of the cost of a product or service. There are non-recurring costs, administrative costs, marketing costs, and other overhead costs that can often be many times the actual "cost of production" in providing a product or service. Let me provide an example.

    STP is an engine oil additive that's basically little more than 90 weight gear oil typically used in a the differential of the car. The STP corporation made a fortune by advertising it's use as an engine oil additive and the cost of the advertising was 90% of the wholesale cost of the product. In short the mark-up to cover the costs of the advertising campaign was 9-times greater than the cost of production for the product.

    All of the costs must be accounted for and, as noted, that creates an accounting nightmare and enforcement is virtually impossible.

    The Federal Insurance Contributions Act (FICA) tax is a two part tax that covers both Social Security and Medicare. Overall it's a 15.3% (12.4% for Social Security and 2.9% for Medicare) tax on wages split between the employer and employee (with the self-employed paying the entire 15.3%) and the "retirement/disability" (Social Security) amount has a cap while the medical (Medicare) amount does not. Basically you're addressing just the medical portion of the tax equal to 2.9% that has no cap and imposing a cap on those contributions which will reduce the overall funding for medical insurance under Medicare.

    What never made any sense was the cap on the Social Security portion of the tax at 12.4%. Why have we been giving a tax break to those with high incomes while imposing this tax on much lower income individuals? Why not lift the cap completely and impose it on all income equally throughout the United States? I've never been able to understand the principle of "tax the poor but don't tax the wealthy" that many seem to argue for.

    The use of the word "ban" is a misnomer when we address health insurance because a ban doesn't actually exist. Each state has it's own health insurance regulations and if the insurance company meets those regulatory requirements it can sell insurance in the state and if it doesn't meet those regulatory requirements then it can't sell the insurance in that state. The proposition that all health insurance be available nationwide would require the federal government to establish the health insurance regulations usurping a role traditionally held by the state government.

    Many "conservatives" object to increasing federal regulation over commerce and yet that's exactly what's required for this proposition to be implemented. A traditional role of state government would have to be subjected to federal regulation. Not saying it can't be done but historically Republicans oppose the expansion of federal powers over the traditional roles of the state governments.

    There is always danger to any woman that becomes pregnant and pregnancy is potentially life-threatening for any woman. Only a misogynistic male would believe that pregnancy is absolutely safe for the woman and they would assume that based upon ignorance.
     
  7. Shiva_TD

    Shiva_TD Progressive Libertarian Past Donor

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    Health insurance provides the payment for medical services but does not directly affect the price of those services (except by negotiation with the medical providers). If a medical provider wants to only sell it's services to the highest bidder then it will have a very limited market when it comes to selling it's services and often the "highest bidder" pays less than "market value" for the product or service on eBay. Why would anyone pay more on eBay than they could purchase the same product or service right down the street from where they live?
     
  8. reallybigjohnson

    reallybigjohnson Banned

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    Doesn't get much cheaper than $50 a month.

    http://www.bloomberg.com/news/articles/2012-11-29/is-concierge-medicine-the-future-of-health-care

    That is just one case. Other doctors I have read about charged based on income so its around $50 for low income and more for high income. Keep in mind the last time I saw a doctor was years ago and it was over $70 WITH insurance.

    If you google around you will also find that it provides superior care. If you get rid of insurance companies AND government you will find that medicine improves dramatically. Returning health insurance to its original purpose of covering large and unforeseen expenses and getting it out of doctors visits for a sore throat and birth control pills and such will go a long ways to improving a system that is increasingly finding itself short of doctors and nurses.
     
  9. Curmudgeon

    Curmudgeon New Member

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    What happens when you have a massive heart attack, and you are taken to a hospital and worked on by surgeons who you do not know? This happened to me recently (I'm recovering nicely now) but the 2 and a half weeks I was on life support, the valve replacement, the 6 weeks of acute and residential rehab would not be covered by concierge doctors, Medicare and my supplemental BS/BC did cover almost all of the costs which was hundreds of thousands of dollars.

    I seriously doubt that concierge medicine is the way to go.
     
  10. reallybigjohnson

    reallybigjohnson Banned

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    That is what insurance is supposed to be for. Insurance should ONLY be for large and unforeseen expenditures not preventive periodic care. This constant adding to what insurance is supposed to cover is what is driving up costs so much. Pay for your own damn birth control pills. Stop forcing single men or men and women over 50 to pay for maternity insurance. There is literally no other form of insurance that operates like health insurance. Your auto insurance doesn't cover fixing a flat nor does your homeowners insurance cover paying the next door kid to cut the lawn.

    If you bothered to google and do a little research you would have seen that concierge medicine is not only cheaper in many cases but is almost always provides superior care with more face time as the doctors don't have to spend all their time with paperwork. The only person that should be deciding your care is your doctor not the government nor the insurance companies.
     
  11. Daggdag

    Daggdag Well-Known Member

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    Not ever women has those complications in their pregnancies, and the treatment for them, if they do occur, is covered by insurance already.

    By the logic you use, health insuriance should be required to cover anything that could ever cause health issues.

    Should insurance be required to cover hair implants for balding men because being bald can raise the risk of brain damage and skin cancer from sun exposure?
     
  12. Organic

    Organic New Member

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    Obamacare versus What?
    Change for the better?
    Cost reduction?
    Innovation?
    Better care?
    As I ponder an issue as important and contested as healthcare the question why comes to mind.

    Why is healthcare the only good or service we consume which price does not factor into the decision making process of the consumer?
    Answer is easy.

    What if large corporations hired their own family practitioners? Located them in the office buildings or factories where large concentrations of healthcare consumers gathered.

    What if downtown office buildings had family practices in the buildings? Smaller employers could contract with the in facility health care provider for basic medicine.

    Imagine the innovation that would take place if companies contracted directly with providers and submitted monthly payments to the doctors instead of insurance companies.

    For example; my company spends $20,000 per month with Humana. Imagine I contracted with a local doctor and paid him $5,000 per month to handle the basic requirements of my group. That won’t run an office; so he finds 20 more similar sized companies and he has $100,000 per month in fixed revenues. Companies then buy insurance for catastrophic events at much lower rates. In this scenario administrative costs are reduced significantly and the entire supply chain of health care services becomes more efficient. More importantly there is price communication between payers and providers that is non-institutional.

    Without being verbose similar delivery innovations could be seen at large employers. How would doctors align themselves to market directly to corporations and individuals? What type of patient care networks would evolve? What type of regulatory and tort reform would need to take place to make this experiment possible?

    Imagine the free market concept of letting the supplier and the consumer discuss price. Might things become more efficient and less costly?

    Maybe we should say more than repeal Obamacare and introduce free market principles to reduce cost.
     
  13. lynnlynn

    lynnlynn New Member

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    There are many people employed that are healthy and never have a need to go to the doctor so your statement that because they receive health services is why they are healthy is false.
     
  14. Belch

    Belch Well-Known Member

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    No offense, but people die every day. So the question is 'why is your life important?'

    A lot of money has been spent to make sure you're alive today, but that just raises an important quesiton as to why that money should have been spent in the first place.

    So why should that money be spent?
     
  15. Steady Pie

    Steady Pie Well-Known Member Past Donor

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    The feds should have no involvement whatsoever in the health sector: to regulation, no funding, certainly no single payer.

    There is absolutely no reason why the states cannot do this in their private capacity. You just want to use the population in populous liberal states to force the remainder into conformity.

    I consider that attitude to be fundamentally anti-federalist and wrong.
     
  16. Belch

    Belch Well-Known Member

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    Then you'd have no problems with hospitals and health care providers selling their services to the highest bidder.

    That's cool with me, and with all other free market capitalists. So really, there's no need for obamacare or the AMA or anything stopping me from selling my services to whoever I want to, and for whatever price I can get.

    Yes?
     
  17. Belch

    Belch Well-Known Member

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    Let me explain why this idea of a life being important is unimportant.

    My wife is fairly important to the medical field. I am much less so, but still, the interest is there. I want people to live!

    Unfortunately, we have bills. We have put money into our children's education funds every month (now graduates and earning their own keep), we paid for our gas bills, our mortgage, our credit cards....

    All that stuff that people pay to just to keep the lights on, and off the streets. Just normal moes.

    So why is a single life important to those of us who help save lives? Nobody else cares about us! The car salesman I recently bought my car from didn't give us any deal because of our involvement with health care. When I go to the gas station to fill up, I don't get any special "you saved my life, so this tank of gas is free" deals.

    We get bills just like you do! So why should your life be important at all? So yeah, you managed to survive a heart attack. This is great news, but it is of zero relevance when I come home and dig out the pile of bills that the mail dude delivered. Cell phone bills, car payments, mortgage, municipal and state taxes...

    I'm getting no love, here!!!! So why should you guys on the other end of that intravenous tube be given any love? Just hopefully paying customers, is all, and why shouldn't we soak you guys the same way my wife and I are being soaked by the electric company?

    As far as I know, you work for the electric company!
     
  18. Mircea

    Mircea Well-Known Member

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    And what about the $Billions spent on Research & Development for the medication? How do they recoup that cost?

    Germany's sickness funds tax is 9.225% for employees and 8.325% for employers for a total of 17.55%

    Given that payroll for 2015 was $6.4 TRILLION, you're only looking at tax revenues of $1,123 TRILLION you think you can fund healthcare in the US?

    Guess again.
     
  19. Natty Bumpo

    Natty Bumpo Well-Known Member

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    Your ideological dogma comports with neither the actuarial sensibility of maximizing the risk pool, nor to the extant paradigm of multiple advanced nations that achieve universal coverage at far lower cost.

    There is no reality-based example of your faith-based notion.
     
  20. Steady Pie

    Steady Pie Well-Known Member Past Donor

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    I am not interested in minimizing cost, I am interested in minimizing compulsory state action against my wallet. Give me an opt out option and I'm happy.

    It's the force I have a problem with.

    Your condescension is noted. Nice work bro.
     
  21. Natty Bumpo

    Natty Bumpo Well-Known Member

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    Thank you for confirming that your concern is the nation's compliance with your ideological dogma rather than a pragmatic adoptiion of a reality-based approach that works best for Americans.
     
  22. Marcotic

    Marcotic Well-Known Member

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    Sounds like Trump.
     
  23. jrr777

    jrr777 Well-Known Member

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    An indoctrination to the lost sheep. Got to have the government do everything for us, can't figure out ourselves. Soon, we will need the government to hold our hand, when walking across the street.

    The day of regret. When you look down and notice you need to renew your drivers license. Stand in line for what feels like two days. I guess this is one of the processes people choose to have when dealing with their health.

    They say if one sheep walks off a cliff, the entire herd follows. Seems to be the same with humans.
     
  24. Shiva_TD

    Shiva_TD Progressive Libertarian Past Donor

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    Ignorance of economics is obvious. As prices increase the market share goes down and eventually the customer base disappears and the enterprise that tries to gouge the consumers with excessive charges goes bankrupt because once their customers leave for lower prices they won't come back, ever.
     
  25. Shiva_TD

    Shiva_TD Progressive Libertarian Past Donor

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    I believe the Kaiser Foundation is doing exactly what you propose. It offers the "insurance" while also providing the medical services. There are other HMO's that also provide both the "insurance" and the medical services for their customers.

    Of course this only works for very large hospitals and not for small private health care providers that can't afford the risk because they don't treat enough patients to mitigate the risk factors.
     

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