ACA: Repeal and Delay?

[Ernie S.]

Where's the Dem "good will" and competence? And what's taking so fucking long for them to ACKNOWLEDGE it's been blowing up since it was launched? They too busy blocking appointments and stuff?

Nothing that can't be fixed

You want expanded HSAs? Do it
Full tax deductions? Do it
More interstate sales? Do it

Keep the exchanges and make them more efficient

Want to REALLY fix things?
Single payer

I think the Schumer gang spent all their time coming up with the catchy poster slogan for the big Press event today. "Make America Sick Again". Most of the creative energy seems to be slogans and strategery. (Bless GW Bush for that word)..

You should tweet them.. You're further along than they are.

I like that.......almost as good as let em die

Republicans want to scrap Obamacare....show us something better first
It can't be that hard

It's REALLY REALLY hard when you have lawyers and career poly sci students and politicians PRETENDING they can fix it. Nothing's gonna happen until they step aside and bring in some folks that UNDERSTAND medical services and underwriting.

Not even your fantasy "single payer".. Which is the coward's way out of actually UNDERSTANDING how to deliver healthcare efficiently and accurately.

Lets start with getting employers out of the insurance business, eliminating insurance companies as a middle man, ending monopolies from big Pharm, openly advertising rates and fees

While you hit on a big cause of rising health costs, eliminating employee benefit health insurance is a bit drastic. I would suggest first, billing the patient in stead of the ins. company directed. When people start getting bills for outrageous costs, they will rebel against out of control costs.
The problem as I see it is the fact that insurance companies are basically guaranteed a percentage of their gross as profit. There is absolutely no incentive to control costs as long as they can raise premiums.
Open, nation wide competition and full disclosure of care prices might be enough for insurance companies to become a competitive business rather than a broker taking your dollars and paying bills for an ever increasing cut.


Think about your common diagnostic tests. $2,000 or more for an MRI? WTF? Labs only charge that much because insurance companies will gladly pay it because their stockholders will pocket 300 on the bottom line. Hell! Insurance companies would love to pay $4,000. They'll just jack up the premiums enough to put the same 15% in the profit column. $600 is twice as much profit, so there is no incentive whatever to control costs

 

[TemplarKormac]

Show me one thing....How are Republicans going to cover pre-existing conditions without requiring mandatory coverage?

Tax breaks and subsidies. That's it. No more government intervention required beyond that. Yeah, they might be taxpayer funded subsidies, but it wouldn't require mandatory coverage.

What you and Coyote seem to missing (on purpose it looks like) is that you can amend the existing healthcare laws so that it makes it easier on insurers to insure people with pre-existing conditions without needing to force the monstrosity you call Obamacare on the American public.

Government is notorious for taking complicated approaches to simplistic things.

 

[TemplarKormac]

They do not have a plan

Despite the fact that I just showed you a plan. Your ignorance seems willful, RW.

No, you're just wrong about that.

Even Ryan stated on the record to reporters that what they have is "ideas".

And, it's widely stated that there is significant disagreement within the GOP as to what direction a plan should take.

Hate to break it to you, but...

Republicans have a plan to replace Obamacare, and its costs are unclear
https://www.washingtonpost.com/news...etterWay-HealthCare-PolicyPaper.pdf?tid=a_inl

 

[WillReadmore]

Nothing that can't be fixed

You want expanded HSAs? Do it
Full tax deductions? Do it
More interstate sales? Do it

Keep the exchanges and make them more efficient

Want to REALLY fix things?
Single payer

I think the Schumer gang spent all their time coming up with the catchy poster slogan for the big Press event today. "Make America Sick Again". Most of the creative energy seems to be slogans and strategery. (Bless GW Bush for that word)..

You should tweet them.. You're further along than they are.

I like that.......almost as good as let em die

Republicans want to scrap Obamacare....show us something better first
It can't be that hard

It's REALLY REALLY hard when you have lawyers and career poly sci students and politicians PRETENDING they can fix it. Nothing's gonna happen until they step aside and bring in some folks that UNDERSTAND medical services and underwriting.

Not even your fantasy "single payer".. Which is the coward's way out of actually UNDERSTANDING how to deliver healthcare efficiently and accurately.

Lets start with getting employers out of the insurance business, eliminating insurance companies as a middle man, ending monopolies from big Pharm, openly advertising rates and fees

While you hit on a big cause of rising health costs, eliminating employee benefit health insurance is a bit drastic. I would suggest first, billing the patient in stead of the ins. company directed. When people start getting bills for outrageous costs, they will rebel against out of control costs.
The problem as I see it is the fact that insurance companies are basically guaranteed a percentage of their gross as profit. There is absolutely no incentive to control costs as long as they can raise premiums.
Open, nation wide competition and full disclosure of care prices might be enough for insurance companies to become a competitive business rather than a broker taking your dollars and paying bills for an ever increasing cut.


Think about your common diagnostic tests. $2,000 or more for an MRI? WTF? Labs only charge that much because insurance companies will gladly pay it because their stockholders will pocket 300 on the bottom line. Hell! Insurance companies would love to pay $4,000. They'll just jack up the premiums enough to put the same 15% in the profit column. $600 is twice as much profit, so there is no incentive whatever to control costs

Insurance companies have applied downward pressure on prices. For example, they put pressure on providers who want to be part of their provider networks. Also, insurance companies are working toward paying for outcomes rather than paying for procedures - which is a move that is widely accepted as being more cost effective.

The catch for insurance companies is that even under the ACA they have to compete with other insurance companies and they want to sell higher end policies - neither of which they can do well if they don't keep costs under control.



Anyway, I used to share your concern about BigInsurance. But, I haven't found data that indicates they are the problem. They do spend a little more on administration than Medicare does, and of course they take a profit - but it's not enough to be the real cause of high prices.

 

[WillReadmore]

They do not have a plan

Despite the fact that I just showed you a plan. Your ignorance seems willful, RW.

No, you're just wrong about that.

Even Ryan stated on the record to reporters that what they have is "ideas".

And, it's widely stated that there is significant disagreement within the GOP as to what direction a plan should take.

Hate to break it to you, but...

Republicans have a plan to replace Obamacare, and its costs are unclear
https://www.washingtonpost.com/news...etterWay-HealthCare-PolicyPaper.pdf?tid=a_inl

That is NOT A PLAN!!!

Even Ryan states that what they have is "ideas". He stated that publicly, to the press.

And, it's well known that Ryan does NOT have agreement among House Republicans on what direction should be taken.


A plan is a PLAN!!! It is not some pie in the sky objectives we all love.

A plan can be scored by analysts - like the ACA was, even before it was a bill.

 

[TemplarKormac]

That is NOT A PLAN!!!

Then why did they reveal it then if "it's not a plan"?

Well, I can already tell this conversation is going to devolve into mincing words...

...nevermind.

 

[WillReadmore]

That is NOT A PLAN!!!

Then why did they reveal it then if "it's not a plan"?

Well, I can already tell this conversation is going to devolve into mincing words...

...nevermind.

To be a plan it has to have the basic elements of being a PLAN!

Even Ryan pitched what the GOP has as "ideas".

What you published is essentially a goals or vision document. Plus, it's totally a partisan document, as arguing that the GOP has passed a bunch of bills on health care doesn't mean there is a plan.

That's certainly an important starting point, as it creates a focus on what needs to be solved and what solution methods are seen as most desirable.

 

[TemplarKormac]

That is NOT A PLAN!!!

Then why did they reveal it then if "it's not a plan"?

Well, I can already tell this conversation is going to devolve into mincing words...

...nevermind.

To be a plan it has to have the basic elements of being a PLAN!

Even Ryan pitched what the GOP has as "ideas".

What you published is essentially a goals or vision document. Plus, it's totally a partisan document, as arguing that the GOP has passed a bunch of bills on health care doesn't mean there is a plan.

That's certainly an important starting point, as it creates a focus on what needs to be solved and what solution methods are seen as most desirable.

You and I obviously have a difference of opinion as to what the meaning of the word "plan" is.

I shall leave it be.

 

[rightwinger]

Nothing that can't be fixed

You want expanded HSAs? Do it
Full tax deductions? Do it
More interstate sales? Do it

Keep the exchanges and make them more efficient

Want to REALLY fix things?
Single payer

I think the Schumer gang spent all their time coming up with the catchy poster slogan for the big Press event today. "Make America Sick Again". Most of the creative energy seems to be slogans and strategery. (Bless GW Bush for that word)..

You should tweet them.. You're further along than they are.

I like that.......almost as good as let em die

Republicans want to scrap Obamacare....show us something better first
It can't be that hard

It's REALLY REALLY hard when you have lawyers and career poly sci students and politicians PRETENDING they can fix it. Nothing's gonna happen until they step aside and bring in some folks that UNDERSTAND medical services and underwriting.

Not even your fantasy "single payer".. Which is the coward's way out of actually UNDERSTANDING how to deliver healthcare efficiently and accurately.

Lets start with getting employers out of the insurance business, eliminating insurance companies as a middle man, ending monopolies from big Pharm, openly advertising rates and fees

While you hit on a big cause of rising health costs, eliminating employee benefit health insurance is a bit drastic. I would suggest first, billing the patient in stead of the ins. company directed. When people start getting bills for outrageous costs, they will rebel against out of control costs.
The problem as I see it is the fact that insurance companies are basically guaranteed a percentage of their gross as profit. There is absolutely no incentive to control costs as long as they can raise premiums.
Open, nation wide competition and full disclosure of care prices might be enough for insurance companies to become a competitive business rather than a broker taking your dollars and paying bills for an ever increasing cut.


Think about your common diagnostic tests. $2,000 or more for an MRI? WTF? Labs only charge that much because insurance companies will gladly pay it because their stockholders will pocket 300 on the bottom line. Hell! Insurance companies would love to pay $4,000. They'll just jack up the premiums enough to put the same 15% in the profit column. $600 is twice as much profit, so there is no incentive whatever to control costs

I have seen the same thing

The medical provider talks directly to the insurance company and does not include the patient in seeing if the charges are accurate

I would like to see competitive advertising. Especially on drugs. Why I can't go online and find who will sell me a prescription cheapest is beyond me. I would like to see the same on medical procedures and hospital costs

 

[rightwinger]

They do not have a plan

Despite the fact that I just showed you a plan. Your ignorance seems willful, RW.

No, you're just wrong about that.

Even Ryan stated on the record to reporters that what they have is "ideas".

And, it's widely stated that there is significant disagreement within the GOP as to what direction a plan should take.

Hate to break it to you, but...

Republicans have a plan to replace Obamacare, and its costs are unclear
https://www.washingtonpost.com/news...etterWay-HealthCare-PolicyPaper.pdf?tid=a_inl

That is NOT A PLAN!!!

Even Ryan states that what they have is "ideas". He stated that publicly, to the press.

And, it's well known that Ryan does NOT have agreement among House Republicans on what direction should be taken.


A plan is a PLAN!!! It is not some pie in the sky objectives we all love.

A plan can be scored by analysts - like the ACA was, even before it was a bill.

Republican "plans" have concentrated on tort reform, removing "lines around states" and tax incentives

None of which provide comprehensive healthcare for tens of millions

 

[WillReadmore]

That is NOT A PLAN!!!

Then why did they reveal it then if "it's not a plan"?

Well, I can already tell this conversation is going to devolve into mincing words...

...nevermind.

To be a plan it has to have the basic elements of being a PLAN!

Even Ryan pitched what the GOP has as "ideas".

What you published is essentially a goals or vision document. Plus, it's totally a partisan document, as arguing that the GOP has passed a bunch of bills on health care doesn't mean there is a plan.

That's certainly an important starting point, as it creates a focus on what needs to be solved and what solution methods are seen as most desirable.

You and I obviously have a difference of opinion as to what the meaning of the word "plan" is.

I shall leave it be.

This is easier than that. We CAN agree here.

Plus, it's good that we have the same view on where we are in this process.

Here's a quote from the first of the two cites posted above:

"A senior House GOP leadership aide who briefed reporters on the proposal Tuesday compared the document to the “white paper” issued by then-Sen. Max Baucus (D-Mont.) days after Obama won the 2008 election that formed the blueprint for what became the Affordable Care Act — calling it a “framework” to be filled out later by congressional committees."

Also, there is the Ryan TV hit where he and Mike Pence were at the podium and Ryan pitched the GOP as having "ideas" - NOT a plan.

I know the MSM has allowed the "white paper" to be called a plan. And, in some respects I excuse them for that, as the real point is where the GOP is headed, not where we are in the process.

But, that aide pointed to there being committees formed to create the plan, and we don't know anything committees at this point.

For example, how many Dems will be part of these committees?

 

[WillReadmore]

I think the Schumer gang spent all their time coming up with the catchy poster slogan for the big Press event today. "Make America Sick Again". Most of the creative energy seems to be slogans and strategery. (Bless GW Bush for that word)..

You should tweet them.. You're further along than they are.

I like that.......almost as good as let em die

Republicans want to scrap Obamacare....show us something better first
It can't be that hard

It's REALLY REALLY hard when you have lawyers and career poly sci students and politicians PRETENDING they can fix it. Nothing's gonna happen until they step aside and bring in some folks that UNDERSTAND medical services and underwriting.

Not even your fantasy "single payer".. Which is the coward's way out of actually UNDERSTANDING how to deliver healthcare efficiently and accurately.

Lets start with getting employers out of the insurance business, eliminating insurance companies as a middle man, ending monopolies from big Pharm, openly advertising rates and fees

While you hit on a big cause of rising health costs, eliminating employee benefit health insurance is a bit drastic. I would suggest first, billing the patient in stead of the ins. company directed. When people start getting bills for outrageous costs, they will rebel against out of control costs.
The problem as I see it is the fact that insurance companies are basically guaranteed a percentage of their gross as profit. There is absolutely no incentive to control costs as long as they can raise premiums.
Open, nation wide competition and full disclosure of care prices might be enough for insurance companies to become a competitive business rather than a broker taking your dollars and paying bills for an ever increasing cut.


Think about your common diagnostic tests. $2,000 or more for an MRI? WTF? Labs only charge that much because insurance companies will gladly pay it because their stockholders will pocket 300 on the bottom line. Hell! Insurance companies would love to pay $4,000. They'll just jack up the premiums enough to put the same 15% in the profit column. $600 is twice as much profit, so there is no incentive whatever to control costs

I have seen the same thing

The medical provider talks directly to the insurance company and does not include the patient in seeing if the charges are accurate

I would like to see competitive advertising. Especially on drugs. Why I can't go online and find who will sell me a prescription cheapest is beyond me. I would like to see the same on medical procedures and hospital costs

Amen on the drugs. The legislation blocking drug price competition has to be eliminated - no matter how much big pharma hoses down congress with $$$


I don't know how you price medical procedures as the outcome can be anything from outpatient to long health care ending in death due to factors of age, previous condition, complications, previously unknown factors, etc.

Advertising about what some provider will charge seems impossible to be believed. All they would do (or could do) is give some minimum - which again hits me as almost sure to be nonsense.

Unfortunately enough, insurance companies are in a better position to push prices down by limiting who is in their provider network, etc.

 

[flacaltenn]

It's REALLY REALLY hard when you have lawyers and career poly sci students and politicians PRETENDING they can fix it. Nothing's gonna happen until they step aside and bring in some folks that UNDERSTAND medical services and underwriting.

Not even your fantasy "single payer".. Which is the coward's way out of actually UNDERSTANDING how to deliver healthcare efficiently and accurately.

Lets start with getting employers out of the insurance business, eliminating insurance companies as a middle man, ending monopolies from big Pharm, openly advertising rates and fees

Why don't you and I and the other 5 rational people start an interest group and discuss this away from all the venom and hijinks and slogans. Seriously -- It's time to ditch the bovine manure.

One thing I've NEVER HEARD and don't understand is why we would EVER be "subsidizing insurance" if the problem is truly working poor and the chronically ill. The idea of pushing folks into high deductible policies as a "fix" for all that is brainless and inhumane.

Seems to ME -- you should be subsidizing DEDUCTIBLES and total OutOfPocket costs when services are DELIVERED instead.

Under THAT paradigm, you allow folks to cover what they can -- even if it's just CATASTROPHIC coverage.. And help them if shit happens. You could even MANDATE minimum coverage if you wanted to (based on income or paycheck to keep them from sandbagging. Make the minimum plan an automatic FICA deduction if you wanted to.

No more govt designed plans that cover EVERYTHING, including stuff you don't need. But provide no help when you NEED medical services with their high deductibles.

Subsidizing insurance premiums that get nibbled and inflated by Insurance carriers is stone stupid. The goal is to CUT the power of the Insurers and their enslavement of medical providers.

Have you ever even HEARD this paradigm discussed? No. I haven't..

I think your idea requires that government administer the program, examining care, doing means verification, and cutting subsidy checks that would arrive ... sometime, leaving providers and pharmacies in the lurch until money comes in, (or failing to provide needed care and meds until the government forwards the money first??).

Insurance companies are set manage health care.

Medicare is also set up to do that.

I think you have to base your proposal off of one of those two models.

Time for the model to change. Patients are NOT the only victims. Doctors and service providers are being tortured with uncertainty on reimbursements. That's why the "rack rate" on drugs and services is a price that hardly ANYONE pays -- except the truly needy.

If you define a LEVEL of OOPocket subsidy that can be SPENT by a consumer with some type of catastrophic policy it can include approx the same "negotiated discounts" that insurance company "management" provides. Those negotiated prices are the REAL prices anyways. Otherwise medical services would be going bankrupt. Having the insurance companies CAPTURE and STRONGARM providers really does not add value.

Let consumers take their dollars right to Walgreens and CVS. Free them from the insurers. I assure you, there would SPECIAL Walmart stores created to handle the long lines. They'd get the message. WITHOUT all the layers of "management"..

You haven't explained what agency would be administering this idea of yours, or how a patient would get the money they need for their meds before walking into the pharmacy - or getting wheeled in for heart surgery.

I'm not in favor of another federal administration branch. We already have two, plus we have insurance companies.

My preference remains Medicare for all, with the VA being more of a specialty service available more broadly, as I don't know why segregating vets makes care any better.

Belgium and others have insurance companies that offer coverage for stuff the state solution doesn't cover. That's fine with me, as it means the state solution doesn't have to pay for everything you could ever want.

If every American had Medicare, we would improve it.

There is no other admin required. How does the insurance company get the Fed subsidy right now? (hell if I know, but they obviously do) .. Think of it this way. Instead of MediCare where the GOVT holds the "main policy" and manages and admins the plan (actually they contract out), and the individual HIRES an outside insurance company to MediGap themselves for the deductibles and OOPocket and drugs. Reverse that. .

Insurance company runs and administers the MAIN plan. Determines when and how and where anyone gets "rolled into surgery". But the Govt subsidy is a supplemental stop loss on the huge deductible. Write it like a a set of MediGap policies based on "need" and primary coverage. PAY IT directly to the prime insurer based on THEIR calculated discounts. Discounts have to be equal or BETTER than "non-subsidized" policies.

All those Medicare Supplementals are actually simple ass policies. There's no magic there. No large contention between "what the govt allows" and what their portion of the bill is. Insurance companies only downside is that they are marginalized from the being the Big Kahunas. All they DO is manage networks and negotiate pricing and process billing. They got money coming in from the insured and the govt. And they STILL GOT the 80% of America who will be free of mandatory minimum coverages and can POOL --- any damn way they want to.

I'll probably drop all this into the CDZone as a debate so that I can get help figuring out WHY this ain't far superior to current nonsense on Capitol Hill. In fact, in terms of MedCaid, it's even MORE attractive. Because the govt ends up paying most actual costs everything ANYWAY. But with a high deductible commercial insurance policy underwriting the MAJOR LOSSES, the States and Feds can concentrate on money for SERVICES without huge admin and mgt costs.

 

[basquebromance]

No preexisting conditions.
Anyone can join a group pool.
HSA reinstated.
Breakdown state border interference.
Make Medicaid easier.
Done.

 

[BlueGin]

Lets start with getting employers out of the insurance business, eliminating insurance companies as a middle man, ending monopolies from big Pharm, openly advertising rates and fees

Why don't you and I and the other 5 rational people start an interest group and discuss this away from all the venom and hijinks and slogans. Seriously -- It's time to ditch the bovine manure.

One thing I've NEVER HEARD and don't understand is why we would EVER be "subsidizing insurance" if the problem is truly working poor and the chronically ill. The idea of pushing folks into high deductible policies as a "fix" for all that is brainless and inhumane.

Seems to ME -- you should be subsidizing DEDUCTIBLES and total OutOfPocket costs when services are DELIVERED instead.

Under THAT paradigm, you allow folks to cover what they can -- even if it's just CATASTROPHIC coverage.. And help them if shit happens. You could even MANDATE minimum coverage if you wanted to (based on income or paycheck to keep them from sandbagging. Make the minimum plan an automatic FICA deduction if you wanted to.

No more govt designed plans that cover EVERYTHING, including stuff you don't need. But provide no help when you NEED medical services with their high deductibles.

Subsidizing insurance premiums that get nibbled and inflated by Insurance carriers is stone stupid. The goal is to CUT the power of the Insurers and their enslavement of medical providers.

Have you ever even HEARD this paradigm discussed? No. I haven't..

I think your idea requires that government administer the program, examining care, doing means verification, and cutting subsidy checks that would arrive ... sometime, leaving providers and pharmacies in the lurch until money comes in, (or failing to provide needed care and meds until the government forwards the money first??).

Insurance companies are set manage health care.

Medicare is also set up to do that.

I think you have to base your proposal off of one of those two models.

Time for the model to change. Patients are NOT the only victims. Doctors and service providers are being tortured with uncertainty on reimbursements. That's why the "rack rate" on drugs and services is a price that hardly ANYONE pays -- except the truly needy.

If you define a LEVEL of OOPocket subsidy that can be SPENT by a consumer with some type of catastrophic policy it can include approx the same "negotiated discounts" that insurance company "management" provides. Those negotiated prices are the REAL prices anyways. Otherwise medical services would be going bankrupt. Having the insurance companies CAPTURE and STRONGARM providers really does not add value.

Let consumers take their dollars right to Walgreens and CVS. Free them from the insurers. I assure you, there would SPECIAL Walmart stores created to handle the long lines. They'd get the message. WITHOUT all the layers of "management"..

You haven't explained what agency would be administering this idea of yours, or how a patient would get the money they need for their meds before walking into the pharmacy - or getting wheeled in for heart surgery.

I'm not in favor of another federal administration branch. We already have two, plus we have insurance companies.

My preference remains Medicare for all, with the VA being more of a specialty service available more broadly, as I don't know why segregating vets makes care any better.

Belgium and others have insurance companies that offer coverage for stuff the state solution doesn't cover. That's fine with me, as it means the state solution doesn't have to pay for everything you could ever want.

If every American had Medicare, we would improve it.

There is no other admin required. How does the insurance company get the Fed subsidy right now? (hell if I know, but they obviously do) .. Think of it this way. Instead of MediCare where the GOVT holds the "main policy" and manages and admins the plan (actually they contract out), and the individual HIRES an outside insurance company to MediGap themselves for the deductibles and OOPocket and drugs. Reverse that. .

Insurance company runs and administers the MAIN plan. Determines when and how and where anyone gets "rolled into surgery". But the Govt subsidy is a supplemental stop loss on the huge deductible. Write it like a a set of MediGap policies based on "need" and primary coverage. PAY IT directly to the prime insurer based on THEIR calculated discounts. Discounts have to be equal or BETTER than "non-subsidized" policies.

All those Medicare Supplementals are actually simple ass policies. There's no magic there. No large contention between "what the govt allows" and what their portion of the bill is. Insurance companies only downside is that they are marginalized from the being the Big Kahunas. All they DO is manage networks and negotiate pricing and process billing. They got money coming in from the insured and the govt. And they STILL GOT the 80% of America who will be free of mandatory minimum coverages and can POOL --- any damn way they want to.

I'll probably drop all this into the CDZone as a debate so that I can get help figuring out WHY this ain't far superior to current nonsense on Capitol Hill. In fact, in terms of MedCaid, it's even MORE attractive. Because the govt ends up paying most actual costs everything ANYWAY. But with a high deductible commercial insurance policy underwriting the MAJOR LOSSES, the States and Feds can concentrate on money for SERVICES without huge admin and mgt costs.

Federal subsidies are doled out to the state and the state gives the healthcare providers and hospitals their portion.

 

[flacaltenn]

L

They do not have a plan

Despite the fact that I just showed you a plan. Your ignorance seems willful, RW.

No, you're just wrong about that.

Even Ryan stated on the record to reporters that what they have is "ideas".

And, it's widely stated that there is significant disagreement within the GOP as to what direction a plan should take.

Hate to break it to you, but...

Republicans have a plan to replace Obamacare, and its costs are unclear
https://www.washingtonpost.com/news...etterWay-HealthCare-PolicyPaper.pdf?tid=a_inl

That is NOT A PLAN!!!

Even Ryan states that what they have is "ideas". He stated that publicly, to the press.

And, it's well known that Ryan does NOT have agreement among House Republicans on what direction should be taken.


A plan is a PLAN!!! It is not some pie in the sky objectives we all love.

A plan can be scored by analysts - like the ACA was, even before it was a bill.

You sound reasonable, except for arguing how the ACA could be "scored" before implemented. The bill STILL is not completely written or implemented. It was a fill in the blank as you go along exercise. Because the Dem Congress failed to actually WRITE an ACA. Pelosi wasn't lying when she said "we'd have to pass the bill to see what's in it".. That SHOULD have been an AIR RAID siren alarm that they had NO FUCKING idea how it was gonna "score"...

 

[Ernie S.]

They do not have a plan

Despite the fact that I just showed you a plan. Your ignorance seems willful, RW.

No, you're just wrong about that.

Even Ryan stated on the record to reporters that what they have is "ideas".

And, it's widely stated that there is significant disagreement within the GOP as to what direction a plan should take.

Hate to break it to you, but...

Republicans have a plan to replace Obamacare, and its costs are unclear
https://www.washingtonpost.com/news...etterWay-HealthCare-PolicyPaper.pdf?tid=a_inl

That is NOT A PLAN!!!

Even Ryan states that what they have is "ideas". He stated that publicly, to the press.

And, it's well known that Ryan does NOT have agreement among House Republicans on what direction should be taken.


A plan is a PLAN!!! It is not some pie in the sky objectives we all love.

A plan can be scored by analysts - like the ACA was, even before it was a bill.

We all wish obama had a plan before he pushed through the crap he's left us with.

 

[Timmy]

They do not have a plan

Despite the fact that I just showed you a plan. Your ignorance seems willful, RW.

No, you're just wrong about that.

Even Ryan stated on the record to reporters that what they have is "ideas".

And, it's widely stated that there is significant disagreement within the GOP as to what direction a plan should take.

Hate to break it to you, but...

Republicans have a plan to replace Obamacare, and its costs are unclear
https://www.washingtonpost.com/news...etterWay-HealthCare-PolicyPaper.pdf?tid=a_inl

That is NOT A PLAN!!!

Even Ryan states that what they have is "ideas". He stated that publicly, to the press.

And, it's well known that Ryan does NOT have agreement among House Republicans on what direction should be taken.


A plan is a PLAN!!! It is not some pie in the sky objectives we all love.

A plan can be scored by analysts - like the ACA was, even before it was a bill.

We all wish obama had a plan before he pushed through the crap he's left us with.

Maybe the GOP should've worked with him when they have a chance. Instead of being babies about it and refusing to participate whatsoever.

 

[Ernie S.]

They sat in long enough to know that further participation was only for appearance.

 

[WillReadmore]

Lets start with getting employers out of the insurance business, eliminating insurance companies as a middle man, ending monopolies from big Pharm, openly advertising rates and fees

Why don't you and I and the other 5 rational people start an interest group and discuss this away from all the venom and hijinks and slogans. Seriously -- It's time to ditch the bovine manure.

One thing I've NEVER HEARD and don't understand is why we would EVER be "subsidizing insurance" if the problem is truly working poor and the chronically ill. The idea of pushing folks into high deductible policies as a "fix" for all that is brainless and inhumane.

Seems to ME -- you should be subsidizing DEDUCTIBLES and total OutOfPocket costs when services are DELIVERED instead.

Under THAT paradigm, you allow folks to cover what they can -- even if it's just CATASTROPHIC coverage.. And help them if shit happens. You could even MANDATE minimum coverage if you wanted to (based on income or paycheck to keep them from sandbagging. Make the minimum plan an automatic FICA deduction if you wanted to.

No more govt designed plans that cover EVERYTHING, including stuff you don't need. But provide no help when you NEED medical services with their high deductibles.

Subsidizing insurance premiums that get nibbled and inflated by Insurance carriers is stone stupid. The goal is to CUT the power of the Insurers and their enslavement of medical providers.

Have you ever even HEARD this paradigm discussed? No. I haven't..

I think your idea requires that government administer the program, examining care, doing means verification, and cutting subsidy checks that would arrive ... sometime, leaving providers and pharmacies in the lurch until money comes in, (or failing to provide needed care and meds until the government forwards the money first??).

Insurance companies are set manage health care.

Medicare is also set up to do that.

I think you have to base your proposal off of one of those two models.

Time for the model to change. Patients are NOT the only victims. Doctors and service providers are being tortured with uncertainty on reimbursements. That's why the "rack rate" on drugs and services is a price that hardly ANYONE pays -- except the truly needy.

If you define a LEVEL of OOPocket subsidy that can be SPENT by a consumer with some type of catastrophic policy it can include approx the same "negotiated discounts" that insurance company "management" provides. Those negotiated prices are the REAL prices anyways. Otherwise medical services would be going bankrupt. Having the insurance companies CAPTURE and STRONGARM providers really does not add value.

Let consumers take their dollars right to Walgreens and CVS. Free them from the insurers. I assure you, there would SPECIAL Walmart stores created to handle the long lines. They'd get the message. WITHOUT all the layers of "management"..

You haven't explained what agency would be administering this idea of yours, or how a patient would get the money they need for their meds before walking into the pharmacy - or getting wheeled in for heart surgery.

I'm not in favor of another federal administration branch. We already have two, plus we have insurance companies.

My preference remains Medicare for all, with the VA being more of a specialty service available more broadly, as I don't know why segregating vets makes care any better.

Belgium and others have insurance companies that offer coverage for stuff the state solution doesn't cover. That's fine with me, as it means the state solution doesn't have to pay for everything you could ever want.

If every American had Medicare, we would improve it.

There is no other admin required. How does the insurance company get the Fed subsidy right now? (hell if I know, but they obviously do) .. Think of it this way. Instead of MediCare where the GOVT holds the "main policy" and manages and admins the plan (actually they contract out), and the individual HIRES an outside insurance company to MediGap themselves for the deductibles and OOPocket and drugs. Reverse that. .

Insurance company runs and administers the MAIN plan. Determines when and how and where anyone gets "rolled into surgery". But the Govt subsidy is a supplemental stop loss on the huge deductible. Write it like a a set of MediGap policies based on "need" and primary coverage. PAY IT directly to the prime insurer based on THEIR calculated discounts. Discounts have to be equal or BETTER than "non-subsidized" policies.

All those Medicare Supplementals are actually simple ass policies. There's no magic there. No large contention between "what the govt allows" and what their portion of the bill is. Insurance companies only downside is that they are marginalized from the being the Big Kahunas. All they DO is manage networks and negotiate pricing and process billing. They got money coming in from the insured and the govt. And they STILL GOT the 80% of America who will be free of mandatory minimum coverages and can POOL --- any damn way they want to.

I'll probably drop all this into the CDZone as a debate so that I can get help figuring out WHY this ain't far superior to current nonsense on Capitol Hill. In fact, in terms of MedCaid, it's even MORE attractive. Because the govt ends up paying most actual costs everything ANYWAY. But with a high deductible commercial insurance policy underwriting the MAJOR LOSSES, the States and Feds can concentrate on money for SERVICES without huge admin and mgt costs.

I think you could say that in fewer words and make it clearer what you are thinking by saying who is on each side of the transactions you propose.

It sounds like what you are saying is that the insurance company would bill the government. But, there still has to be an agency on the government side of that transaction. We're not just going to let corporations make withdrawals from the "the government" without keeping track of exactly what is going on.