Replacing the Affordable Care Act

Yes, and we provide food, money for food, minimum wage, etc. There are differences in the nature of food expenses and health care expenses that I'm sure you recognize - making the solutions not identical.

Health care is not like a free market commodity. When you need entertainment you can buy a book, go on vacation, subscribe to Netflix, buy a bigger TV, go to the movies, walk around some arboretum/park, etc.

When you need health care, you need health care. Period. In fact, it is often (or even usually) an event serious enough that it impacts employment or threatens life. The result is that poor health care systems impact national productivity, bankruptcy rate, etc. And, of course there is a moral issue with denying health care to those who don't happen to have a lot of money - a moral issue that is not at all like the morality of denying a TV to someone who can not afford it.

Beyond that, we provide health care to those who can make it to an ER, whether they can pay or not. (That's not like what happens when you can make it to a TV store!) So, we have a bottom line that recognizes that health care is not just a commodity and includes a degree of socialization of health care.

 

Which is why when you walk into a hospital, you're required to do it with your hands on your knees and underwear by your ankles.

As Trump says, you have to be willing to walk away from a bad deal. That's something you absolutely refuse to do, which is why you get such a bad deal. You're the American tourist at the last souvenir shop before going back home, and the locals see you coming from so far away, they know they can just triple their already high tourist prices and you'll pay it.

It's not just a coffee mug that says "I Mexico". It's a matter of life or death for you.

 

Your first sentence is just plain perverse.

From there, you seem to have just given up being rational. But, yes, health care is a serious issue.

 

It is for you, just as that coffee mug at the souvenir shop is to a tourist. You'll pay whatever they're asking, and everybody knows it.

 

??
Get a grip!

 

You couldn't be more wrong.

Because of Wage Inflation ---- rapidly rising wages induce Inflation --- FDR created a Wage & Price Control Board and levied a Wage & Price Freeze on all wages and prices.

It was thus illegal for your employer to give you a pay raise, unless it was first approved by the National War Labor Board.

As a result, employers started to pay for your health plan coverage.

It worked like this: You choose the plan, and your employer paid part or all of the plan as part of your benefits in lieu of a pay raise.

The IRS cried, "Foul!", and so a decision was issued by the National War Labor Board in favor of employers:

The 1949 In Re: Inland Steel Supreme Court decision was the final nail in the coffin, creating the current employer-based health plan coverage you have now.

 

The statement I responded to had nothing to do with risk pooling. It had to do with funding through additional taxation that low income households can't afford. Of course many politicians are logical enough to understand that the poor can't afford taxation and would fight that taxation while others oppose taxing those that can afford to pay more in taxation so we end up with the same question I asked that wasn't responded to.

Would you rather have highly paid insurance executives that are required by the market to provide "value for the dollar" for their customers or penny-pinching politicians that will "reduce benefits" to save money?

 

Several issues are addressed and I'll try to be brief in my response (not something I'm noted for).

Private health insurance worked for over 70% of those that weren't on Medicare/Medicaid prior to 2013 when the PPACA was implemented and it provided far superior benefits at a lower cost when compared to Medicare/Medicaid. Throwing out the baby with the bathwater doesn't make sense.

The issue is about those that can't afford the cost of medical services which includes not only the "cost of insurance" but also the costs of copays that the individual household must make. This is one of the greatest failures of the PPACA because the "poor" can only afford the lowest cost government subsidized (private) health insurance that has the highest copays that they can't afford after paying for the insurance. We've also seen that as the costs go up but the subsidies don't cover the increased costs while the individual/household income did not go up to cover the increased costs.

The costs of the actual medical services does not change based upon the method of payment. If insurance is involved then it doesn't matter if it's private or publically funded insurance. The difference is whether the insurance covers the costs because if it doesn't then the individual/household must make up the difference. We know that the two primary government insurance programs, Medicare and Medicaid, don't cover the costs of the services provided and that places a financial burden on the individual/household that if not met results in no medical services being provided. Over 95% of private clinics (that don't receive huge government subsidies) will NOT accept new Medicare/Medicaid patients because Medicare/Medicaid don't pay the costs of the medical services provided. If the individual/household is denied services then the "insurance" is fundamentally worthless.

Yes, other "developed countries" have generally adopted "single-payer systems" and it's been stated that the US could have done this in the 1950's but not today. The negative financial impact of making private insurance obsolete with a single-payer system is estimated to run into trillions of dollars adversely affecting tens of millions of Americans that are invested in "for profit" insurance corporations. The retirement incomes for millions of Americans that have mutual funds that include private insurance corporation stocks would be dramatically reduced. Just try to imagine how many millions jobs would be lost because private insurance companies were replaced with a single-payer system.

If you think the mortgage crisis that lead to the 2008 Recession was bad then you might be able to understand that replacing private insurance, that provides the best medical benefits at the lowest cost, with a single-payer system would cause a recession that is far worse. Only some of the mortgage lenders went belly-up while almost all of the 1,400 private insurance companies would go belly-up.

We really don't know what the economic landscape will be 75 years and arguably there could be virtually no employment at all because Artificial Intelligence and Technology is rapidly replacing human labor that our economy relies upon. There's obviously going to have to be a dramatic change in how our economy functions that's far more reaching than just health services that people require. Capitalism is failing because it relies on human labor which is becoming obsolete. What we should do about that is a much bigger question than what we should do about the tens of millions of households that can't afford medical services today.

Here's what we don't need a PhD to understand. "For Profit" health insurance companies are currently competing with "Not For Profit" health insurance companies. The compete by providing "value for the dollar" which is why they have the best benefits at the lowest costs.

A "single-payer" system doesn't compete with anyone and it's subject to the whim of Congressional authorizations which is why our government insurance programs, Medicare and Medicaid, provide far fewer benefits and a much higher cost for the benefits provided.

Think about this. We literally have "socialized medicine" being provided for by the VA for veterans but because of a penny-pinching Congress it's grossly under-funded and doesn't have the staff or facilities necessary to provide quality medical services to our veterans. If Congress doesn't care enough about the veterans in America to provide quality health care in a timely manner do you think it really gives a damn about the average American? You can literally bet your bottom dollar that if we went to a single-payer system it would be underfunded and provide relatively crappy health care benefits to Americans because it's Congress isn't willing to tax and spend the money necessary to provide "value for the dollar" that private insurance companies must be primarily concerned with.

I do believe there's a better way to address this issue but it's not a single-payer system that we know will provide fewer health care benefits at a higher cost than what a combination of private and public insurance would provide.

 

I would just expand Medicaid, nationalize medical licensing of all medical professionals, and ban them from working under license unless they participate in Medicaid and to encourage States to participate do two things cover all the costs added if they provide funds of the current amount adjusted for inflation and favor those States and parties within them who participate to discretionary Federal funds over ones that don't this includes parts of a business. If a military contract has one factory in a non-participating State they get a reduced chance of a renewal or government contract over one that is all in participating States. That should get everyone on board. To add revenue to Medicaid so you can raise rates of pay tax junk food, tobacco, e-cigarettes and payroll (split with the employer taking the bigger hit).

Medical providers would gain Federal protections for the care for Medicaid patients this to be applied as an adjustment to malpractice insurance up to 40% and if they only treat Medicaid patients the Federal government would cover Malpractice and make it hard to sue the medical provider over "acceptable risks" of care as in if a complication is "an expected risk" you couldn't sue for that it would need to meet a high bar. But tracking performance and complaints would be openly done. I would also allow MD's from other nations who hold "proper credentials" to practice medicine as a Nurse Practitioner and I would allow them to be with licensed NP's here to be primary care providers (gatekeepers).

 

In short, what you are saying in one sentence is, our medical industry is like a runaway train, no matter what we decide for the future. And you could very well be right, because we do not know what the landscape would look like 75 years from now.

But here's the thing, you said private insurance worked for over 70% who had private insurance. And the other 30%? We had roughly 40 to 50 million without insurance before ACA. That's a staggering figure. Actually, it's embarrassing to say the least, seeing that we prioritize a military budget that is so inflated, that it surpasses all developed countries combined. You say single payer is not sustainable. Maybe? But neither is our inflated military budget, for something we could cut dramatically. Are you getting this picture yet? A strong military is useless, if your overall population is sick. And if we are going to inflate a budget, let's do it for the right cause. Setting up a base defense for one's health, has to be a priority over an inflated military budget. For what good is a bloated military defense, when you have no medical defense?

Now, as to your predictions, that some mortgage lenders would go belly up, and almost 1400 ins. companies would do the same while running trillions of dollars into debt. That could be a real possibility, seeing that we already did that with the military. But here's the question I pose to you as I have others; given the choice, do you protect the private insurance companies and the mortgage lenders at the expense of human health, or do we throw the 40 to 50 million people back into the uninsured pool again, by throwing them back to the wolves? All because we as a country made the wrong choices in the beginning by not having single payer? According to what I have read from your post, that seems to be the only alternative you are suggesting? You did say "I believe there is a better way". Yea! I've heard that from a bunch of Republicans many times, and they haven't come up with a plan yet.

It all goes back to the 75 year question I asked before. Do we prepare now, for the inevitable? Or do we just keep putting the band aid on a problem that will continue to get worse, while we all pretend private insurance fixes everything, when it doesn't even come close?

We've all seen this Elephant getting bigger and bigger as the decades pass, at the detriment of millions going without getting the proper care to stay healthy, while we spend trillions on a military industrial complex, that we could dramatically cut. Just saying!

 

You don't have a regular cardiologist?
You aren't taking preventative steps to maintain your health?

 

are there no accidents, in your perfect world?

 

In the free market, the consumer compares prices, services, and quality of service. This drives prices down and quality up.

Why doesn't this happen now? 3rd party payers insulate the consumer from the cost of goods and services, which reduced, if not deletes the competition necessary for the free market.

Want to drive costs down and quality up? Want to remove insurance companies and their profits from the loop?
Remove all 3rd party payments.

 

I didn't say they were.
They are, however, both a necessity -- and so, arguing that health care cannot be part of the free market because of its status as a "necessity" doesn't fly -- you need to find a better excuse.

Health care consists of goods and services. Goods and services are free market commodities, with consumer costs determined by supply and demand.

Period? As in all situations are the same?
Because it might cost $50k to remove a tumor, the costs of a regular office visits cannot be considered a goods/services commodity?

.. on one side, with the moral issue of forcing people to provide goods and services to others, without compensation, placing them in a condition of involuntary servitude, on the other
How does not version of morality justify placing others in a condition of involuntary servitude?
In fact, how does you version of morality justify forcing anyone to do anything?

 

I never said only. In fact, I said support, which can mean giving more to one party over the other, among other things.

Actually, yes it was. The individual mandate was the central theme in 1995 with insurance exchanges as a means for that mandate. What the GOP did not do, however, was define that an insurance contract must include reproductive benefits as a requirement. But if you look at the 1995 measure, it is very similar with many of the issues with ACA.

 

Like food, health care IS part of the free market community.

Our system is totally based on insurance companies and the costs are TOTALLY set by supply and demand.

Somehow you've totally missed how our health care coverage system works.

And, yes, we have extensive programs of support for human needs, and they are paid for by taxes.

So, once again, I'm just going to have to say that you need to back up and do some thinking, because your basic understanding of our support mechanisms (and health care in particular) seems to have giant holes in it.

 

Oh, no no no...
The free market is consumer based; the health care system is insurance based.
Insurance insulates the consumer from the cost of goods and services. That's not free market.

And, since you didn't answer the question - almost like you avoided it on purpose - I'll ask again:

. on one side, with the moral issue of forcing people to provide goods and services to others, without compensation, placing them in a condition of involuntary servitude, on the other
How does your version of morality justify placing others in a condition of involuntary servitude?
In fact, how does you version of morality justify forcing anyone to do anything?

 

Hilarious!!

Insurance is bought by consumers. It is a free market product.

Much of the time, the products and services covered by insurance are also a free market products and services - health care, services in fixing or replacing stuff, etc. You can buy these products and services whether or not you have insurance. It is ALL free market enterprise.

One exception is when the insurance coverage covers things that aren't free market products or services - you may insure your leg, your life, or whatever. Your leg isn't a free market product.



Then, you come with the absolutely absurd nonsense about taxes and support. I'm sorry but I just have nothing to say to people who think taxes means servitude. Taxes are an ABSOLUTE REQUIREMENT of civilization, and until that is recognized it impossible to even start to discuss any particular tax.

 

Which in no way changes the fact that it insulates the consumer from the costs of the products and services.
When the consumer does not pay for the goods and services, and therefore does not apply he pressure that creates competition, there is no free market.

And, since you didn't answer the question about YOUR argument regarding morality - almost like you avoided it on purpose - I'll ask again:

. on one side, with the moral issue of forcing people to provide goods and services to others, without compensation, placing them in a condition of involuntary servitude, on the other
How does your version of morality justify placing others in a condition of involuntary servitude?
In fact, how does you version of morality justify forcing anyone to do anything?

Or... you can tuck tail and run. Your choice.

 

This is an area the Feds should never have entered so it remains free market.

As to health care, the Feds supply mine and also the state kicks in.

 

Insurance IS a free market product. And, health care IS a broad collection of free market products and services from which the public and insurance companies may choose.

The fact that you can buy health care insurance does NOT change that. Providers are still free to set their product definitions and their prices. Insurance companies are free to do the same.

There is NOTHING about that relationship that isn't free market.

The important part here is that the government does not set the price for health care OR for insurance.

I'm not going to go back and discuss with you your absurd ideas about tax in a thread about our health care system.

You're just trying to jack this thread.

 

The mortgage lenders were an analogy but yes, a single-payer system would endanger up to about 1400 private health insurance providers throwing many people out of work and also destroying the investment accounts of millions of Americans that own stock in the private insurance corporations. But as noted the private insurance does work, and works very well, for those that have it but also as noted it didn't cover about 30-40 million Americans before 2013 when the PPACA was implemented.

Yes, I did say I could suggest a better way but I don't offer the same nonsense "Republican" proposals. Here's what I would suggest as a starting point.

1. Mandate that all employers provide an 80/20 group health policy to all full time employees and/or provide a annually adjusted "per hour" amount for all employees to a pool that the employee could draw from to fund their private 80/20 health insurance (that covers medical, prescription, vison and dental insurance). This solves one of the problems with the PPACA where part time workers, many of which worked multiple jobs, weren't able to obtain health insurance under the Employer Mandate and for those workers in smaller companies with less than 50 employees. Note: the "self-employed" is an "owner-employee" of the enterprise and would be required to have a group health insurance policy and those policies are available.

Republicans are going to flip-out over this but we know a couple of things. Employer provided group health insurance provides the best "value for the dollar" in benefits and it's also been shown to be financially beneficial to the enterprise because the workers receiving these benefits are healthier overall because they received the medical services they require and miss less time from work. That's why so many enterprises already provide group health insurance as a component of their employee compensation plan. Because it would apply across the board for all enterprises there's no competitive advantage or disadvantage to any enterprise. This proposal, with a few tweaks, fundamentally ensures that every worker in American has health insurance and that accounts for most of the 30-40 million that were uninsured prior to 2013.

2. The federal government needs to fully fund the PPACA expansion of Medicaid without any future financial obligation by the states.

This removes the Supreme Court decision that allowed states to "opt out" of the expansion of Medicaid because of the future financial costs that would be imposed upon them (even though it was basically only a token payment).

The basic proposal, in a nutshell, is that employers provide group health insurance for the workers of American and Medicaid covers the non-workers of America. Yes, it could require a few tweaks but in principle of all of the workers are covered by employer group health insurance (or private insurance funded by the employers) and all non-workers are covered by Medicaid then the problem of the "uninsured" goes away. And while Republicans are going to object this proposal is in line with the prior "Conservative" proposals from the late 1990's that the uninsured in America need to be addressed by a combination of private and public insurance.

As noted the obsolescence of "labor" because of the advances in artificial intelligence and technology (automation) looms large in the future and it certainly does need to be addressed and the sooner the better. This is such a huge problem that simply worrying about health care services is only a very small part of it because without income from labor people won't even have income to eat or to buy anything. Yes, it must be addressed and we're going to be forced to address it because it's going to slowly increase poverty to the point that it would result in a violent revolution if it's not addressed. How we change our economic system as human labor becomes obsolete is a problem that not even I have any idea on how to fix but it must be addressed.

 

Health Insurance, cost and how the population is divided into pool groups.

Most people believe that private insurance has the largest pool of the population who has coverage. Most people believe that the government has the population of people who have Medicaid, Medicare, and Veterans insurance.

Most people believe that government either negotiates or dictates the real cost of healthcare that is paid to providers of healthcare. Most people believe that providers of care negotiate with private insurance on reimbursement.

All of these mentioned are false

 

The media is deliberately lying to the public by saying you can shop around for the best price if you have private insurance. The contract between you and your private coverage contains a fee schedule and that fee schedule determines what they will pay for every code that is billed by a provider of care. Providers of care really don't have the power to negotiate a higher price on their services because they fear if they do this, they run the risk of losing that population who has that insurance of being denied by the insurance carrier to be included in their network.

 

Statistics of the employed population is considered the healthiest of the population as a whole. Having insurance for the healthiest of the population means these people seldom require healthcare therefore it is extremely profitable for insurance companies and employers who self-insure their employee pool. People that have private coverage through an employer has nothing to do with their excellent health status.