Author Topic: Obamacare Predictions for May 2015  (Read 11510 times)

OrneryMod

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Obamacare Predictions for May 2015
« on: December 12, 2015, 12:14:05 AM »

Greg Davidson

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Re: Obamacare Predictions for May 2015
« Reply #1 on: December 12, 2015, 01:04:32 AM »
Welcome, topic, to the new forum. But I was hoping that this would get 2,000 postings - guess we have to start all over again.

Mynnion

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Re: Obamacare Predictions for May 2015
« Reply #2 on: December 13, 2015, 08:00:12 PM »
;D

Pete at Home

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Re: Obamacare Predictions for May 2015
« Reply #3 on: December 22, 2015, 02:05:58 AM »
I was just informed that the only care I qualify for is something with a monthly deductible of 3/4 of my total non hey income.   I would have been better off with Medicaid pre-Obama care. Literally would have to forgo paying rent before I would get anything back. Whew.


Greg Davidson

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Re: Obamacare Predictions for May 2015
« Reply #4 on: December 22, 2015, 10:50:36 AM »
Which state do you live in?

Pete at Home

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Re: Obamacare Predictions for May 2015
« Reply #5 on: December 22, 2015, 12:20:10 PM »
Georgia

Wayward Son

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Re: Obamacare Predictions for May 2015
« Reply #6 on: December 22, 2015, 12:41:20 PM »
Doesn't sound like it is Obamacare's fault, but the state of Georgia's.  If they had elected to expand Medicare, it appears that you would've been covered.

Pete at Home

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Re: Obamacare Predictions for May 2015
« Reply #7 on: December 22, 2015, 01:11:11 PM »
Doesn't surprise me or help me.  Under previous system states did not have the option of *censored*ing over disabled folks on ssdi. I suspect Congress had a hand in this.

Seriati

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Re: Obamacare Predictions for May 2015
« Reply #8 on: December 22, 2015, 06:32:16 PM »
Really sorry to hear that Pete, can't say it's not what I expected, but I really did hope that the system would be helpful to people who need it.

LetterRip

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Re: Obamacare Predictions for May 2015
« Reply #9 on: January 03, 2016, 02:33:28 AM »
Responding to a comment by Rafi,

he quotes an unnamed source

Quote
ObamaCare will reduce work hours equivalent to 2 million jobs in the next decade amid a host of incentives not to work or to work less, a new Congressional Budget Office (CBO) report says -- the latest blow to President Obama’s signature health insurance plan.

The report estimates the Affordable Care Act, or ACA, will make the labor supply shrink by 0.86 percent in 2025. This amounts to a shrinkage equivalent to approximately 2 million full-time workers.

If we go to the actual paper

https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/workingpaper/51065-ACA_Labor_Market_Effects_WP.pdf

We see that the completely ignore under employment, and only take into account labor that is currently employed.  Since the unemployed labor will substitute for the labor that chooses to work less, there should be basically no 'shrinkage in the labor supply'.

Indeed they state,

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The estimated reduction stems almost entirely from a net decline in the amount of labor that workers choose to supply, rather than from a net drop in businesses’ demand for labor, so it will appear almost entirely as a reduction in labor force participation and in hours worked relative to what would have occurred otherwise rather than as an increase in unemployment (that is, more workers seeking but not finding jobs) or underemployment (such as part-time workers who would prefer to work more hours per week).

http://www.cbo.gov/sites/default/files/cbofiles/attachments/45010-breakout-AppendixC.pdf

Since we will be looking at a shortfall of available jobs (which will accelerate over the next 10 years due to the extremely rapid rate of progress in quality of robotics and AI and reduction of price), any voluntary reduction in labor by those who have jobs will result in net total increase of employed individuals.

So rather than me misunderstanding economics as Rafi claimed, we can see that the CBO simply ignored a factor that is important to the conclusions can be drawn from projections and simply assumed full employment.

Also if we read their projections - they note that there will be an increase in labor demand (low income individual will have some of their income freed up from spending on medical expenses resulting in more disposable income).

Greg Davidson

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Re: Obamacare Predictions for May 2015
« Reply #10 on: June 22, 2016, 12:15:23 AM »
New study from the Urban Institute indicates that the cost of providing 20 million more people with healthcare is actually a savings of $2.6 trillion. Who predicted the opposite in 2009? And can any of them acknowledge how wildly wrong their predictions were, how the Obama Administration under-estimated the gains, and how in execution after 6+ years the ACA is performing overall better than projected?

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we find that projected national health spending for 2014 to 2019 had fallen by about $2.6 trillion since the 2010 (ACA) baseline reflecting large declines in Medicare, Medicaid, private insurance, and other health spending projections. It appears that the United States continues to be on track to spend much less on health care over the next several years than projected in late 2010.

http://www.urban.org/research/publication/widespread-slowdown-health-spending-growth-implications-future-spending-projections-and-cost-affordable-care-act-update

msquared

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Re: Obamacare Predictions for May 2015
« Reply #11 on: June 22, 2016, 09:37:38 AM »
I made no predictions but would like to report what I am seeing in the companies my wife and I work for.  The health insurer my company used ( I am on my wife's policy, so was never on my works coverage) stopped offering coverage this year. We were just notified and now have 60 days to find new coverage for the company.  Having not been on the company policy, I am not sure how good/bad the coverage was for the money, but it was not a popular program.

My wife's company has Anthem and they are being told that they will have double digit increases for premiums this year. Also, the pharmacy formulary is being redone and certain meds, like my acid reflux med, is being taken off.  I used to get a 90 day generic for less than $10. Now I will have to buy at the store for about $22 for 6 weeks or $44 for 12 weeks.  So over 4 times the amount.

msquared

Seriati

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Re: Obamacare Predictions for May 2015
« Reply #12 on: June 22, 2016, 09:57:24 AM »
Seriously Greg?  That's a study of what the government claims its going to pay, not a study of what it actually will pay or what the actual cost will be.  I agree if you make a law that say's you're going to pay $1 for each covered person and receive $130k in benefits you can in fact gain $2.6 trillion on $20 million people.  It's however, laughable to claim a projection based on government policies that are unlikely to be held to  is proof of actual savings. 

Not to mention it's completely contrary to the observed results with respect to the actual costs being observed, including the increases on the exchanges, and the increases the STATEs have had to pick up to make the federal government policies last this long.

Greg Davidson

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Re: Obamacare Predictions for May 2015
« Reply #13 on: June 22, 2016, 10:41:04 PM »
Seriati, all the Republicans made claims that the initial estimates for Obamacare were wildly optimistic and that costs would be far higher than projected.  As we get deeper and deeper into execution, not only are the Republican fears being disproved, but the Democratic promises are being shown to be vastly more conservative than actual experience.

$2.6 trillion dollars.  That is far greater savings than any other Republican effort to reduce the budget in US history.

Greg Davidson

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Re: Obamacare Predictions for May 2015
« Reply #14 on: June 22, 2016, 10:43:58 PM »
And, Seriati, last time we went through the data, it showed that overall medial expenses were trending just like the Democrats promised they would, or they were doing even better.

Seriously, just go back through this thread to the old site - all of the claims and arguments are there, and the evidence in May 2015 was iron clad. This latest study just continues to reinforce that the Republicans were wildly wrong.  You were wildly wrong.

Pete at Home

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Re: Obamacare Predictions for May 2015
« Reply #15 on: June 23, 2016, 12:26:22 AM »
Seriati, all the Republicans made claims that the initial estimates for Obamacare were wildly optimistic and that costs would be far higher than projected.  As we get deeper and deeper into execution, not only are the Republican fears being disproved, but the Democratic promises are being shown to be vastly more conservative than actual experience.

$2.6 trillion dollars.  That is far greater savings than any other Republican effort to reduce the budget in US history.

That last sentence does not say much, Greg. :D  But 2.6 Trillion dollars, that has my attention.  Link me?


Fenring

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Re: Obamacare Predictions for May 2015
« Reply #16 on: November 01, 2016, 12:50:47 PM »
I just saw this article on CNN:

http://money.cnn.com/interactive/news/economy/obamacare-by-the-numbers/

Quote
As enrollment begins Tuesday, the impact of an average 22% rise in benchmark plan prices will vary wildly depending on where you live. While Obamacare plans on some state exchanges will have modest price increases, others will have staggering hikes.

I have very little knowledge on this subject, so I wanted to ask the members here - what does this article mean? Greg has been arguing for the success of Obamacare for some time, while Seriati, for example, has raised issues against it. Some of the arguments had to do with the cost of the whole program, others with overall levels and quality of coverage. What of the issue with premiums? Are we to gather from this article that insurance premiums are now on average higher than they used to be prior to the ACA?

D.W.

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Re: Obamacare Predictions for May 2015
« Reply #17 on: November 01, 2016, 01:10:40 PM »
You have to be careful with that one.  Rates tend to go up every year.  Sometimes a little, sometimes a lot.  A legit hike may still be within industry norms and not a failing of ACA or the exchanges.

Then you have the issue that a lot of insurers may have incorrectly estimated the pool of healthy enrollees.  This could be the natural course correction needed.  Further muddying that are those who are uninsured becoming educated that they will "A" be penalized for staying so to the extent that paying more to at least get something may seem viable, and "B" they may be eligible for a tax credit offsetting some of that cost.  This could adjust the pool of healthy enrollees upward.  Granted, that never seems to lower the prices we* pay, but it may prevent upward creep/jumps next year....

Trying to tackle a rather contentious partisan issue like this when health insurance is almost never clear cut in the first place is a hornet's nest.  :)

That ignores the possibility that it was never meant to be a solution and is a step towards universal health care anyway.  ;)

*I say "we" but for the record, I'm not participating in the exchange as I have coverage through my employer.

Greg Davidson

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Re: Obamacare Predictions for May 2015
« Reply #18 on: November 01, 2016, 11:15:26 PM »
Premiums are only part of the story - the important number is health care costs. Obamacare plans must cover more expenses than pre-Obamacare plans were able to offer, so the premiums may be a relatively larger share of overall costs.

This is a big increase in premiums - in fact, Obamacare premiums for policies offered on the exchanges had been trending below expectations (most recently 2% in 2015 and 7.5% in 2016), and this latest increase wipes out those savings. Average premium prices are almost exactly at the level that back in 2009 the Congressional Budget Office predicted for 2017. Seven years ago CBO predicted $5,538 as average premiums for 2017, and HHS is projecting average premiums for 2017 as $5,586.  http://www.cnn.com/2016/10/25/opinions/affordable-health-care-exchange-premiums-jost/

There is also a clear pattern that states where they are trying to make Obamacare work are, unsurprisingly, having lower levels of premium increases. This is particularly noteworthy as some of the statistics cite premium growth as measured on states that use the federal Obamacare exchange, but remember those are primarily the sabotage states that have fought against Obamacare to the degree possible. States like California are seeing much lower increases (13% in 2017 after 4.2% in 2015  and 4.0% in 2016).

But still more can be done. Hillary Clinton is running on a platform that includes the so-called public option, in which states would be allowed to set up a government-run option to add competition into the marketplace. No one would be forced to use the government option, but it could help drive competition over prices, particularly in areas where there was limited price competition

 


Fenring

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Re: Obamacare Predictions for May 2015
« Reply #19 on: November 02, 2016, 01:32:21 AM »
Thanks for the answers. I will confess that on this subject I'll probably always be out of my depth but I do tune in to conversations about it here and read the occasional article to learn what little I can.

Seriati

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Re: Obamacare Predictions for May 2015
« Reply #20 on: November 04, 2016, 03:18:29 PM »
Premiums are only part of the story - the important number is health care costs. Obamacare plans must cover more expenses than pre-Obamacare plans were able to offer, so the premiums may be a relatively larger share of overall costs.

Premiums should, but really don't in a government manipulated market, directly relate to costs.  Here, premiums can be defined as that portion of the true costs of providing medical care that the government chooses to let the insurance companies recover from the people they insure.  Most of why Obamacare exchanges and plans have failed relates directly to the manipulation of premiums. 

As Greg points out, the plans are required to cover more things (and to pay money out for those things), they are also barred from actually evaluating the likely medical costs of customer in deciding what to charge for their "insurance" including being required to accept payment obligations for known and costly conditions without any chance at charging the actual amount of such costs back to the customer.  The only ways they can even pretend to make this work are to set deductibles so high that the average consumer receives little actual benefit from their insurance coverage in a given year (certainly less than the premiums they pay) or by direct government payments to the insurer to make up the difference. 

Pretty much, exactly, what we said when the law was passed.  And exactly what has played out in the exchanges.

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This is a big increase in premiums - in fact, Obamacare premiums for policies offered on the exchanges had been trending below expectations (most recently 2% in 2015 and 7.5% in 2016), and this latest increase wipes out those savings. Average premium prices are almost exactly at the level that back in 2009 the Congressional Budget Office predicted for 2017. Seven years ago CBO predicted $5,538 as average premiums for 2017, and HHS is projecting average premiums for 2017 as $5,586.  http://www.cnn.com/2016/10/25/opinions/affordable-health-care-exchange-premiums-jost/

Well again, changes in premiums are useless as a determination of cost specifically because the government directly manipulates them.  They are manipulated both by price controls where an insurer has to get permission to increase them and get approval of the increase, and by direct subsidization - which because it occurs behind the scenes confuses people into not realizing its part of the cost of the product.

Government, could, if it chose literally make the premiums negative, they have absolutely nothing to do with the real costs.

Quote
There is also a clear pattern that states where they are trying to make Obamacare work are, unsurprisingly, having lower levels of premium increases. This is particularly noteworthy as some of the statistics cite premium growth as measured on states that use the federal Obamacare exchange, but remember those are primarily the sabotage states that have fought against Obamacare to the degree possible. States like California are seeing much lower increases (13% in 2017 after 4.2% in 2015  and 4.0% in 2016).

California, what an example.  They forced insurers to cancel grandfathered plans (which is not the federal rule) to force more people into their exchanges, benefitted from the maximum in subsidies and the tightest in controls and still can not maintain their level of plans or cost ratios.  Meanwhile they took full advantage of federal subsidies to increase their Medicaid roles by 5 million people, what's going to happen to their budget and healthcare costs when federal support expires?  Yes, specifically government manipulation can keep a lid on the amount the consumer realizes that they pay (premiums) but ultimately we collectively still end up with the bill (CA is already one of the states that pays the highest portion of its tax revenue towards medical expenses, so ouch when federal subsidies expire (or even get distributed even across the other states)).

Quote
But still more can be done. Hillary Clinton is running on a platform that includes the so-called public option, in which states would be allowed to set up a government-run option to add competition into the marketplace. No one would be forced to use the government option, but it could help drive competition over prices, particularly in areas where there was limited price competition

That's not competition.  State run companies don't compete at all.  They are not subject to cost pressures, or quality pressures or any legitimate market forces.  Their performance can be as horrid as it wants to be without consequence, their charges and costs bear no relationship to actual charges and costs.  And they are highly subject to political based manipulation.

So what about the fact that the plans on the exchange, if you don't receive them as a government handout - I mean on a subsidized basis - cost so much and have such high deductibles, that rather than protect someone from bankruptcy, put them into bankruptcy?  What about the fact that visits by patients with Obamacare are going down, specifically because they can't afford to go to the doctor?  What about the fact that all that is true, and at the same time the insurers themselves are largely  incapable of making a profit (absent massive grants paid for by tax payers) and forced to raise the rates dramatically while increasing deductibles even further? 
« Last Edit: November 04, 2016, 03:21:16 PM by Seriati »

Wayward Son

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Re: Obamacare Predictions for May 2015
« Reply #21 on: November 04, 2016, 03:36:23 PM »
Quote
The only ways they can even pretend to make this work are to set deductibles so high that the average consumer receives little actual benefit from their insurance coverage in a given year (certainly less than the premiums they pay)...

But isn't that how all insurance works?  ???

I mean, show me an insurance plan that provides the average customer more than the premiums they pay.  (Then I'll show you a bankrupt insurance plan. :))

TheDeamon

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Re: Obamacare Predictions for May 2015
« Reply #22 on: November 04, 2016, 06:42:31 PM »
Quote
The only ways they can even pretend to make this work are to set deductibles so high that the average consumer receives little actual benefit from their insurance coverage in a given year (certainly less than the premiums they pay)...

But isn't that how all insurance works?  ???

I mean, show me an insurance plan that provides the average customer more than the premiums they pay.  (Then I'll show you a bankrupt insurance plan. :))

Tri-Care, and probably a number of other "employer subsidized" insurance plans. Not that Tri-Care fully qualifies as health insurance in the normal sense.... But you were talking about a healthcare program where the person enrolled pays less in than they get out.  8)

Seriati

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Re: Obamacare Predictions for May 2015
« Reply #23 on: November 07, 2016, 06:06:49 PM »
Quote
The only ways they can even pretend to make this work are to set deductibles so high that the average consumer receives little actual benefit from their insurance coverage in a given year (certainly less than the premiums they pay)...

But isn't that how all insurance works?  ???

No actually it's not.  Are you joking?  Or are you unclear on how insurance was actually intended to work?  The rest of the quote (which you dropped) was important for context.

Real insurance that is designed to insure against risk (which is not what we have, what we call insurance is actually a subsidized health care plan), lives and dies by the insurers ability to identify and price risk based on the specifics of the individual covered.  Smokers pay more than non-smokers, elderly customers pay more than the young, those who are sick - if they can be covered at all - pay the cost of treating that illness plus the expected costs of developing new illnesses.  But if you look over time, an individual doesn't actually have to pay the full amount of their expected cost of care, because the insurance company can, and does, invest the premiums received.  Real insurance doesn't pay for routine medical care, unless the impact of that care makes a material difference to the long term expected costs greater than the cost of that care.

In any event, what we have is not real insurance, it's literally subsidized mutual health care.  As such, it covers routine costs regardless, to a large extent, of their benefit to cost reduction.  It "insures" for known conditions as well as risks, which it does solely by cost sharing.  All those benefits have to be paid for between premiums, deductibles and subsidies, and since it bars any tuning of costs based on actual expected medical needs the inevitable consequence is to charge those who are healthy far more than they could ever benefit from the "insurance".  The impact of this change means that a healthy person overpays every year when they are young based on what their own expected usage would be by a far greater amount than they would if the insurance company was allowed to offer them coverage based on their own expected health costs.

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I mean, show me an insurance plan that provides the average customer more than the premiums they pay.  (Then I'll show you a bankrupt insurance plan. :))

Have you ever actually looked at how insurance company pricing worked?  With investment income and the time value of money it really wasn't that difficult for insurance companies to pay out more dollars than the premiums generated and still make profits.  At least until the relatively modern manipulation of the insurance market that required unilateral changes to the agreed deal in favor of the customers broke the actual statistical models on which premiums collected over 40 years or more rested.

Not to mention, there are plenty of kinds of insurance that provide real measurable benefits and that you don't expect to collect more than you pay for them.  I mean honestly, term life insurance is a complete waste for the majority of people that purchase it.  The trade off is that it is far more affordable than an equivalent whole life plan and a big benefit for the family of those that did collect.

The equivalent to that kind of benefit in health care, would be the old ultra high deductible plans.  Pay for your own preventative care and be protected from bankruptcy events.  Minimal cost, no expectation that you'd collect more than the premiums.  Of course this model also broke as a result of insurance manipulation, which changed how medical services are priced (ie maximizing costs to try and impact the medicare reimbursement rates, which systematically underpay for services), which lead to those trying to pay for routine services getting exorbitant bills.

Greg Davidson

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Re: Obamacare Predictions for May 2015
« Reply #24 on: November 08, 2016, 01:51:32 AM »
Quote
what we have is not real insurance, it's literally subsidized mutual health care

This is correct - our American approach to health care is not simply about amortizing financial risk (and this was the case both before and after Obamacare). Originally, companies started providing health insurance benefits during wartime when there was a cap on salaries but companies wanted to compete by offering something beyond salary. So health insurance in the US has come to mean primarily employer-provided health coverage - it's not just financial insurance. Companies (and individuals) can go bankrupt, but as a society we are squeamish about letting sick people die.  In 1986, hospitals were forbidden by law from throwing people out because they did have the money for medical care. President Obama has said that if he could have started from scratch, he would never have designed something like Obamacare, but we currently have a trillion dollar industry built around the way we have done things for 70 years.

All other developed countries do things differently, they generally spend less than half as much per patient, they have better outcomes than in the US, and people in those countries on average report a higher level of satisfaction with their health care coverage than do people in the US>

Seriati

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Re: Obamacare Predictions for May 2015
« Reply #25 on: November 08, 2016, 10:05:53 AM »
Quote
what we have is not real insurance, it's literally subsidized mutual health care

This is correct - our American approach to health care is not simply about amortizing financial risk (and this was the case both before and after Obamacare).  Originally, companies started providing health insurance benefits during wartime when there was a cap on salaries but companies wanted to compete by offering something beyond salary. So health insurance in the US has come to mean primarily employer-provided health coverage - it's not just financial insurance. Companies (and individuals) can go bankrupt, but as a society we are squeamish about letting sick people die.  In 1986, hospitals were forbidden by law from throwing people out because they did have the money for medical care.

That's all true, none of this started with Obamacare.    Obamacare massively exacerbated it.

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President Obama has said that if he could have started from scratch, he would never have designed something like Obamacare, but we currently have a trillion dollar industry built around the way we have done things for 70 years.

That's an overstatement.  We haven't done things the same way for 70 years.  At every step, people with good intentions have added more bricks on the pathway to where our healthcare system ended up.

We could have fixed it, and bolstered the free market at the same if we choose.  Heck one simple fix would go a long way to realigning the cost sensitivities with the consumers, get rid of the deductibility of insurance by employers and make it a personal exemption, let people know the real costs of what they're paying for.  A more radical idea would be to take serious illness off the insurance table, and have the government take over fatal and expensive medical care (of course the downside is that while the government is all in favor of forcing third parties to take on these expensive costs, when they get stuck with the bill they invariably turn to rationing and dictating treatment options).

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All other developed countries do things differently, they generally spend less than half as much per patient, they have better outcomes than in the US, and people in those countries on average report a higher level of satisfaction with their health care coverage than do people in the US>

Shrug, I think its way more complicated than you like to believe.  It's certainly not true that "all" have better outcomes on half costs, you can cherry pick examples that show the opposite just as easily depending on the metrics you use.  And those other countries always have the safety valve of medical tourism to deal with unsatisfying results.  The simple truth of health care is that the vast majority of people are NOT SICK, and satisfying them is an incredibly simple task of not forcing them to bear ridiculous costs, the US market has been deliberately manipulated to do the opposite, to force people to bear ridiculous costs both before and as a result of Obamacare.

It's certainly also the case that the US market pushes the lion's share of the worlds' medical innovation, which you'd have to find a way to replace if we adopted the same system other countries use (unless you prefer a depressed rate of medical growth rather than the excessive one we have now).

Fenring

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Re: Obamacare Predictions for May 2015
« Reply #26 on: November 08, 2016, 10:10:10 AM »
A more radical idea would be to take serious illness off the insurance table, and have the government take over fatal and expensive medical care

Not to derail your discussion, but can you explain your thoughts on this in particular?

Greg Davidson

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Re: Obamacare Predictions for May 2015
« Reply #27 on: November 08, 2016, 10:24:18 AM »
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The simple truth of health care is that the vast majority of people are NOT SICK, and satisfying them is an incredibly simple task of not forcing them to bear ridiculous costs, the US market has been deliberately manipulated to do the opposite, to force people to bear ridiculous costs both before and as a result of Obamacare.

On any given day, the vast majority of people are not sick. Over their lifetimes, not only is virtually everyone sick, but a very high percentage of people die while receiving medical care.

Back before Republicans made it toxic to talk rationally about health care, Democrats were talking about real data on real problems, and one of them was that on average Americans consume 40% of their lifetime medical expenditures in their last 60 days of life. 

Seriati

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Re: Obamacare Predictions for May 2015
« Reply #28 on: November 08, 2016, 11:50:44 AM »
Quote
The simple truth of health care is that the vast majority of people are NOT SICK, and satisfying them is an incredibly simple task of not forcing them to bear ridiculous costs, the US market has been deliberately manipulated to do the opposite, to force people to bear ridiculous costs both before and as a result of Obamacare.

On any given day, the vast majority of people are not sick. Over their lifetimes, not only is virtually everyone sick, but a very high percentage of people die while receiving medical care.

Back before Republicans made it toxic to talk rationally about health care, Democrats were talking about real data on real problems, and one of them was that on average Americans consume 40% of their lifetime medical expenditures in their last 60 days of life.

Which is exactly why its not difficult to satisfy the average health care consumer for their entire life, minus 60 days.  And in fact, when Obamacare came in to "fix" the problem Americans were overwhelming satisfied with their coverage (you're the one who brought this point up).

Again, it's absolutely the case that people are generally only sick for a little bit of time, and that's generally concentrated in few brief instances and especially in old age.  There are outliers of course.  All of that is easily accountable with effective actuarial evaluation and the ability to charge based on expectations based on those charts.  Don't get health "insurance" till you're sixty five, you'll pay a fortune.  About the only constraint you really needed was to prevent insurance companies from kicking people out or attempting to jack their rates based on sickness (both of which make actuarial sense, but responsible companies should have planned for that and charged the higher premiums at the start of the relationship that they need to). 

Healthcare costs rising excessively tipped the scale, and that is pretty directly tied to government manipulation of health pricing that has been going on for the entire period of runaway costs.

Your absolutely wrong about Democrats.  They don't talk about this remotely sensibly, they talk about it with passion and emotion and do a disconnect on consequences with respect to policies that feel right.  Heck you did it yourself several times on the prior thread with your off comments about Republicans wanting to kill old people, or am I misremembering?

Fenring, its my one piece of socialism.  I don't really think there is any reasonable way to "cost share" a million dollar illness through a private party like an insurance company.  Make them all pay a fee to the federal government (like how worker's comp works) and have the feds take over all care on fatal and/or excessively expensive diseases.  That's a 100% percent cost sharing over all tax payers.  It gets out of the way a whole range of diseases that the left will rail about where they don't believe the market can be fair price (what price wouldn't someone pay to survive a fatal disease, after all).  Only downside I see, is that - just like every other socialized medicine country - the government will ration such care, either by not making it available in sufficient quantities, forcing less successful but cheaper options on patients or just nationalizing it and refusing to pay the actual cost.  Of course there's always the risk that the left will try to expand and creep the mission and coverages to expand their control over our lives.

Fenring

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Re: Obamacare Predictions for May 2015
« Reply #29 on: November 08, 2016, 11:55:57 AM »
The good thing about budgeting serious ailment on the Federal level is that when drawing up the budget monies can be allocated there from other areas that could be cut, meaning there is somewhere for the money to come from. Just considering that buying one less destroyer could mean thousands of people receiving highly-prices care, one could at least weight this in the balance and decide what is best. Right now there is no leeway or even a mechanism through which to make such a decision.

DJQuag

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Re: Obamacare Predictions for May 2015
« Reply #30 on: November 08, 2016, 01:26:47 PM »
Lived in the UK for a few years now, and what I tell people here is that the US is the best country in the world, *if you have money.*

I suffer from a chronic illness, and the healthcare that I get here is exemplary. And I don't have to decide between paying the electric bill and going to see the doctor/getting medication.

Seriati

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Re: Obamacare Predictions for May 2015
« Reply #31 on: November 08, 2016, 03:22:17 PM »
Lived in the UK for a few years now, and what I tell people here is that the US is the best country in the world, *if you have money.*

I suffer from a chronic illness, and the healthcare that I get here is exemplary. And I don't have to decide between paying the electric bill and going to see the doctor/getting medication.

Or more likely now, between paying your premiums and not seeing a doctor, or facing a tax fine and no coverage, or your electric bill.

DJQuag

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Re: Obamacare Predictions for May 2015
« Reply #32 on: November 08, 2016, 04:31:02 PM »
Lived in the UK for a few years now, and what I tell people here is that the US is the best country in the world, *if you have money.*

I suffer from a chronic illness, and the healthcare that I get here is exemplary. And I don't have to decide between paying the electric bill and going to see the doctor/getting medication.

Or more likely now, between paying your premiums and not seeing a doctor, or facing a tax fine and no coverage, or your electric bill.

I agree. The US needs socialized health care. ;)

Greg Davidson

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Re: Obamacare Predictions for May 2015
« Reply #33 on: November 19, 2016, 05:00:13 PM »
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And in fact, when Obamacare came in to "fix" the problem Americans were overwhelming satisfied with their coverage (you're the one who brought this point up).

This is factually wrong - the remarkable thing is that Americans pay twice as much as any other country per capita for health insurance, and in polling on satisfaction with health care the Americans tend to have a lower level of satisfaction with their health care than about 60% of people from other developed countries.

And I never said that Republicans wanted to kill tens of thousands of people - I said that they took actions that were responsible for the deaths of tens of thousands of people. I am sure they sincerely believed in right wing media that suggests that people having less access to medical care poses zero risks to their health.

cherrypoptart

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Re: Obamacare Predictions for May 2015
« Reply #34 on: November 19, 2016, 05:44:56 PM »
Not a single Republican voted for Obamacare.

What that means is that if the Democrats under Obama had wanted to pass single payer they could have. No Republican could have stopped them.

Instead they chose to pass this disaster.


Greg Davidson

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Re: Obamacare Predictions for May 2015
« Reply #35 on: November 19, 2016, 09:14:15 PM »
cherry,

Obamacare was the compromise approach taken in order to get 60 votes from the 58 Democrats and 2 independents. 

And with respect to your charge that Obamacare has been a disaster, can you explain how the status quo was better? We had almost 50 million people without health insurance, health care costs had gone up by double digits per year for decades, many insurance companies competed by shedding customers as soon as they got seriously ill (they had whole departments dedicated to finding some excuse to drop coverage if people would cost them a lot), insurance companies were allowed to spend less than 85 cents on the dollar of premiums on actually providing health care, there was no transparency on radically different prices for medical procedures (in some cases here in California the same operation could could six times more at some hospitals than others - and no, the outcomes were not better at the more expensive hospitals as you could tell because Obamacare required hospitals to publish their outcomes).

Right now the Republicans have control, and as they have been promising for 7 years, they are going to repeal and replace. Except they have never said how they can change Obamacare and not make things worse.

So if this is a disaster, cherry, tell us why you preferred the previous status quo where total costs were higher and tens of millions of fewer people had health insurance?

cherrypoptart

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Re: Obamacare Predictions for May 2015
« Reply #36 on: November 19, 2016, 10:03:47 PM »
Whatever the problems were the one thing that is clear right now is that Obamacare wasn't the solution. Why couldn't the Democrats and the two independents have seen this coming?

I think you're right that it was a rigged system before with the policy caps and the insurance companies able to kick you after you got sick along with many policies having a long list of exclusions for everything you could think of that you were likely to experience and need the insurance for, such as hernia surgery. But it's not any better now for the people who have to pay for it just because the government says they can afford it whether they can actually afford it or not, and with limited choices as far as keeping your doctor with the plans available.

And the mandate? Why did Obama say this about Obama opposing a mandate that Hillary supported:

“Both of us want to provide health care to all Americans. There’s a slight difference, and her plan is a good one. But, she mandates that everybody buy health care. She’d have the government force every individual to buy insurance and I don’t have such a mandate because I don’t think the problem is that people don’t want health insurance, it’s that they can’t afford it,” Obama said in a Feb. 28, 2008 appearance on Ellen DeGeneres' television show. “So, I focus more on lowering costs. This is a modest difference. But, it’s one that she’s tried to elevate, arguing that because I don’t force people to buy health care that I’m not insuring everybody. Well, if things were that easy, I could mandate everybody to buy a house, and that would solve the problem of homelessness. It doesn’t."

Maybe the next idea should take input from all sources instead of just having one side ram it through.  And it should be a plan that we don't have to lie about to get it passed. That might help to prevent some of the obvious problems like we have now.

I'm thinking of catastrophic insurance with private health savings accounts for most people. For the really sick people that are the reason why none of the ideas really work, this may be blasphemy for conservatives but perhaps we just have to have the taxpayers pay for them through the government. Hopefully they will be able to save up enough in their personal health savings accounts before they get sick but for the difference somebody is going to have to cover it or they'll die so instead of the government paying the insurance companies who take their slice of the money the government just pays the hospitals directly, and if it's expensive medication we try to get it cheaper somewhere. Maybe we even set it up for some expensive procedures that can be done safely and less expensively in Mexico or Canada or India since the taxpayers are footing the bill anyway if it's possible we fly them where they need to go to get it done, at a U.S. inspected facility, just as a voluntary option for the patients. As I said before we could train more health care professionals by using the military template where the government puts you through school and then you serve a term of service. After that, you can go into the private sector with the knowledge you've gained.

Has Obama or any Democrats proposed one idea for increasing the number of health care professionals? If so, I haven't seen it.

AI Wessex

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Re: Obamacare Predictions for May 2015
« Reply #37 on: November 20, 2016, 10:15:10 AM »
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Whatever the problems were the one thing that is clear right now is that Obamacare wasn't the solution. Why couldn't the Democrats and the two independents have seen this coming?
I admire your steady discussion technique of giving an inch and trying to take a mile.  Perhaps all anyone really needs is privatization of Medicaid and Medicare and a gift card to Walgreen's.  Add to that a saw, knife, scissors and thread so we can do the doctoring ourselves.

Greg Davidson

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Re: Obamacare Predictions for May 2015
« Reply #38 on: November 20, 2016, 11:08:54 AM »
cheryy,

First, thanks for the lengthy reply.

Second, your argument does not substantiate your claim that Obamacare was a disaster.  You dismiss the advantages by asserting that the disadvantages (and there are some) offset the advantages:
Quote
But it's not any better now for the people who have to pay for it just because the government says they can afford it whether they can actually afford it or not, and with limited choices as far as keeping your doctor with the plans available.

It is at least debatable that those disadvantages truly offset the list of advantages I described (we didn't have unlimited choices for keeping our doctors in the old world either), but even if I stipulate your assertion, "not any better" does not imply that Obamacare is a disaster.  I don't understand your argument that since Obamacare was not better than the status quo, it is a disaster.

You also go on to say
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Maybe the next idea should take input from all sources instead of just having one side ram it through
  The Democrats spent over a year discussing this; Obama on multiple occasions explicitly asked the Republicans for inputs (in a way that we will never see Trump doing).  The origins of Obamacare were from the right-wing Heritage Foundation and Mitt Romney had touted a similar system.

cherry, you are smart - can you not recognize that your arguments may be puzzling to someone with coming from the other side?

AI Wessex

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Re: Obamacare Predictions for May 2015
« Reply #39 on: November 20, 2016, 11:55:33 AM »
Not a single Republican voted for Obamacare.

What that means is that if the Democrats under Obama had wanted to pass single payer they could have. No Republican could have stopped them.

Instead they chose to pass this disaster.
They tried to find a bi-partisan basis and failed.  The law as passed reflects the compromises they made, but from the first days of Obama's administration the Republicans were committed to thwarting him in every way possible.  I can imagine that they were ultimately willing to let the maimed law pass because they realized its vulnerabilities.  That gave them room to refuse to correct them and the opportunity to insist that it was a failure.  You have bought into that narrative completely.

Fenring

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Re: Obamacare Predictions for May 2015
« Reply #40 on: November 20, 2016, 08:59:57 PM »
Obama on multiple occasions explicitly asked the Republicans for inputs (in a way that we will never see Trump doing).

I'm not quite so sure of this as you are. Time will tell.

TheDeamon

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Re: Obamacare Predictions for May 2015
« Reply #41 on: November 20, 2016, 09:28:24 PM »
Obama on multiple occasions explicitly asked the Republicans for inputs (in a way that we will never see Trump doing).

I'm not quite so sure of this as you are. Time will tell.

I distinctly remember the Republicans turning up to a high profile conference with binders filled with suggestions and counter-proposals. They spent most of their time getting lectured with talking points. Usually starting up as soon as they made it about three sentences into their statements.

cherrypoptart

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Re: Obamacare Predictions for May 2015
« Reply #42 on: November 20, 2016, 09:37:20 PM »
It would have been nice for the Democrats to listen to some of the Republican criticisms and try to incorporate them into the law but in the final analysis, as I pointed out earlier, no Republican voted for it and it passed into law the way it was.

The question then is, why didn't the Democrats do a better job of foreseeing the problems with their own law?

They could have passed anything they wanted, and yet they passed this.

Sure you can blame the other Democrats with whom they had to compromise. You could even blame the two Independents.
If the Republicans had some good ideas, Republican votes weren't even necessary to build those ideas into the law, so I still fail to see how anyone can blame ANY of the Republicans. Surely the Republicans weren't keeping their ideas and objections a secret. Any besides, without Republican input the Democrats (and the two Independents) couldn't see for themselves the problems that would arise?

TheDeamon

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Re: Obamacare Predictions for May 2015
« Reply #43 on: November 20, 2016, 09:46:03 PM »
The other thing in all this, chance to negotiate on what?

The ACA is the bill that, after all, Pelosi proudly proclaimed "We're going to have to pass the bill to find out what's in it." It was proposed and rammed through congress before anyone had a chance to process what was in there.

AI Wessex

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Re: Obamacare Predictions for May 2015
« Reply #44 on: November 20, 2016, 11:20:01 PM »
The other thing in all this, chance to negotiate on what?

The ACA is the bill that, after all, Pelosi proudly proclaimed "We're going to have to pass the bill to find out what's in it." It was proposed and rammed through congress before anyone had a chance to process what was in there.
Which do you find more convincing, the soundbite you regurgitated or her statement in context?
Quote
Speaker Nancy Pelosi said Tuesday that people won’t appreciate how great the Democrat’s health plan is until after it passes.

“You’ve heard about the controversies, the process about the bill…but I don’t know if you’ve heard that it is legislation for the future – not just about health care for America, but about a healthier America,” she told the National Association of Counties annual legislative conference, which has drawn about 2,000 local officials to Washington. “But we have to pass the bill so that you can find out what is in it – away from the fog of the controversy.”

During a 20-minute speech, she touted benefits she thinks will be tangible to the audience’s employers. She said there’s support for public health infrastructure and investments in community health centers that will reduce uncompensated care that hospitals now need to deliver.

“You know as well as anyone that our current system is unsustainable,” said Pelosi (D-Calif.). “The final health care legislation, which will soon be passed by the Congress, will deliver successful reforms at the local level.”
Note the highlighted portions, which tells you when she made the remarks and who her audience was.  Without context it's been made to seem like nobody even in Congress had read it or knew what was in it when they passed it.
« Last Edit: November 20, 2016, 11:24:32 PM by AI Wessex »

TheDeamon

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Re: Obamacare Predictions for May 2015
« Reply #45 on: November 21, 2016, 12:24:19 AM »
The other thing in all this, chance to negotiate on what?

The ACA is the bill that, after all, Pelosi proudly proclaimed "We're going to have to pass the bill to find out what's in it." It was proposed and rammed through congress before anyone had a chance to process what was in there.
Which do you find more convincing, the soundbite you regurgitated or her statement in context?
Quote
“You’ve heard about the controversies, the process about the bill…but I don’t know if you’ve heard that it is legislation for the future – not just about health care for America, but about a healthier America,” she told the National Association of Counties annual legislative conference, which has drawn about 2,000 local officials to Washington. “But we have to pass the bill so that you can find out what is in it – away from the fog of the controversy.”
Note the highlighted portions, which tells you when she made the remarks and who her audience was.  Without context it's been made to seem like nobody even in Congress had read it or knew what was in it when they passed it.

Nobody in Congress did read the bill, or if they did, they had advance copies they weren't sharing with anyone else. The ACA is freaking huge, and they passed it within days of it being finalized/released to congress at large. Parsing and processing 1200+ pages of statutory regulations in the span of just a couple days just doesn't happen, even with a decently sized legal (and medical!) consulting team on the payroll.

Pete at Home

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Re: Obamacare Predictions for May 2015
« Reply #46 on: November 21, 2016, 12:34:41 AM »
I agree that how it was passed sounds problematic.

Nevertheless over 1200 days have passed since passage and problematic sections should have been discussed by now.

AI Wessex

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Re: Obamacare Predictions for May 2015
« Reply #47 on: November 21, 2016, 01:26:57 AM »
Quote
Nobody in Congress did read the bill, or if they did, they had advance copies they weren't sharing with anyone else. The ACA is freaking huge, and they passed it within days of it being finalized/released to congress at large. Parsing and processing 1200+ pages of statutory regulations in the span of just a couple days just doesn't happen, even with a decently sized legal (and medical!) consulting team on the payroll.
You can't have it both ways, either they read the bill they were debating and fighting over for month and after month, or shame on them if they didn't. Nobody outside of the Congress would have had access to the working copy of the bill while it was still under debate and consideration.  OTOH, how many bills do you think Congressmen/women actually read before they vote on them?

Quote
Nevertheless over 1200 days have passed since passage and problematic sections should have been discussed by now.
The sad truth is that the actual content of the ACA is secondary to its mission and opposing mission.  It's a token and a symbol more than a law.

cherrypoptart

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Re: Obamacare Predictions for May 2015
« Reply #48 on: November 21, 2016, 03:13:36 AM »
Many times we hear liberals tell us about how great the healthcare systems in so many other countries are compared to our own. So my question is why didn't the Democrats and Obama model the new healthcare system they passed into law on one of those other successful systems? Does any country with a successful healthcare system have one that looks anything at all like Obamacare? Does any country with any type of healthcare system have one that looks anything like Obamacare? If Obamacare was going to be so great, then why hadn't other countries already developed something like it in the past? Now usually I don't much care for international opinion but in this case it might have been instructive to ask experts in other countries with successful healthcare system if they thought Obamacare could work. It's too late now since we already found out the hard way that it doesn't, but that might have been useful information to have about eight years ago. The Democrats of course wouldn't, and didn't, believe the Republicans who said it won't work because it doesn't even make any sense but maybe, just maybe, the Democrats would have believed experts who run the successful healthcare systems of socialist countries. Unfortunately they didn't bother to ask. Either that or they didn't like the answers they were given and so simply ignored them.

One good thing for Democrats though is that whatever happens next, since Republicans own the Presidency along with both houses of Congress, it won't be the fault of Democrats anymore. But they still should own up to what they did when they had the power.

AI Wessex

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Re: Obamacare Predictions for May 2015
« Reply #49 on: November 21, 2016, 07:23:08 AM »
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Many times we hear liberals tell us about how great the healthcare systems in so many other countries are compared to our own. So my question is why didn't the Democrats and Obama model the new healthcare system they passed into law on one of those other successful systems? Does any country with a successful healthcare system have one that looks anything at all like Obamacare? Does any country with any type of healthcare system have one that looks anything like Obamacare?
I'm a bit flummoxed by your seeming naivete.  Our country is the only major industrialized country in the world that relies on private health and medical services.  All other countries use socialized government-run universal health care with lower overall health care costs and better overall medical outcomes.  If I didn't know you better I'd think you were asking an honest question instead of finding another opportunity to bash Obama.  Or perhaps I'm wrong and you just didn't understand what Obamacare is while you were attacking it.