Healthcare

[RDU Irish]

So half of the US workforce will be self employed by 2020 and nobody on this board is self employed and willing to explain their insurance to me?

Cool. Ha

Currently pay $1150/month plus $600/month into an HSA which fully covers our maximum medical costs for any given year. Since we normally stay under deductible - the extra HSA money has paid for braces, dental and eye care - not totally but covered a vast majority. So right at $21,000 per year right now for healthcare coverage for a family of five.

Now - this is technically an individual plan. Each person has an allocated cost such that when our last kid was born in 2012 the rate went up $100/month or something but it is all combined for deductible purposes. Oldest was rated for asthma history - other than that nothing major to report.

This is also a "grandfathered" plan, we originally started in 2009. As such, we are stuck with a maternity rider that we would otherwise drop ($200/month currently) and also cannot change our deductible. I would love to move to the $10,000 deductible now that our HSA is well funded - but (THANKS OBAMA) that is considered a "change" to the plan and would lose grandfather status. Even with maternity rider - our rates are WAY below ACA plans currently available and have risen much slower.

Looking on the website - I see the following monthly costs
2017 - $1146.82
2016 - $1084.47
2015 - $1027.95

Looking at tax data
2014 was $908.38
2013 was $807.42
2012 was $627.44 before baby and $738.40 after
2011 was $614.26
2010 was $449.75 (pretty sure we were flying without maternity rider here)

My 60 year old assistant was about $200/month before going on Medicare.

 

[RDU Irish]

$2000 Indiv/ $4000 Family before 50% coinsurance kicks in with $4000 Indiv/$7000 Family maximum out of pocket. (all in network which is pretty much everything in NC for BCBSNC.) Double that for out of network coverages.

 

[RDU Irish]

That's a good example of how hollow the term "conservative" is these days. I agree that there's no classical- or neo-liberal case for single payer, and if that's what you associate conservatism with, then you're right. But if, as Walther does, you take conservatism to mean stability and solidarity across class (and I'd add generational) boundaries, then it definitely fits the bill.

There are two options for improving upon our status quo. We can either: (1) copy Singapore, which is the only developed nation that has something akin to a high-functioning "free market" in healthcare services; or (2) we can copy Western Europe and switch to a single payer system. (1) has been on the table for a while in the form of the Cassidy-Collins Bill, but the GOP has shown zero interest in pursuing it. Given Trump's populist tendencies, and the coalition-bending realignment it would likely bring about, I think (2) is the more realistic option for improving our system right now. I don't really care how it happens, as long as we start taking better care of our own.



Poor people have the same right to pursue a vocation as mothers and fathers as rich people do. It's evil to tell the lower class that they need to put in X number of years as wage slaves before they're granted the privilege of reproducing. If the American total fertility rate continues to fall, we're going to have much more serious political and economic problems than figuring out how to bring our healthcare system in line with the rest of the developed world. Lowering the individual cost of having children through healthcare reform is a big part of that.



Americans are upset because they're aware that virtually all of our peer nations have vastly superior healthcare systems. They cover a larger % of their people, produce better health outcomes, and all for a small fraction of the cost we're currently paying. It's not about an unreasonable sense of entitlement. It's about looking around and realizing that things could be much better than they are.

Respectfully disagree. Demographically - poor tend to have more kids than the rich. Very high correlation - I would argue there is definite causation going on there. Having kids without an ability to provide for them is more morally reprehensible than expecting someone to support themselves and their family.

 

[wizards8507]

Explain to me, Leader Pelosi, how one "transfers wealth from the poor to the rich." How does that work in your deranged little mind?

 

[Legacy]

Respectfully disagree. Demographically - poor tend to have more kids than the rich. Very high correlation - I would argue there is definite causation going on there. Having kids without an ability to provide for them is more morally reprehensible than expecting someone to support themselves and their family.

You are in favor of supplying birth control to low-income women?

 

[RDU Irish]

Legacy - you responded to my call for examples of denial of care for more emotional whining about cost. Much rather be bankrupt than dead. And if I don't want to be bankrupt I can insure against that risk. And if I can't afford to insure against that risk - I have little to lose in bankruptcy anyway. So stop, please stop, crying me a freaking river over our healthcare PAYMENT system and give me examples of DENIAL OF CARE.

 

[RDU Irish]

You are in favor of supplying birth control to low-income women?

Adoption is a noble choice that should be celebrated. And implying that there is a shortage of birth control is comical.

This country does next to nothing to remove innocent children from horrible situations. If you can't show up sober to give birth, why are we trusting you to give this innocent child a chance the next 18 years? The hurdle to lose custody is pretty sickening really.

 

[Legacy]

Legacy - you responded to my call for examples of denial of care for more emotional whining about cost. Much rather be bankrupt than dead. And if I don't want to be bankrupt I can insure against that risk. And if I can't afford to insure against that risk - I have little to lose in bankruptcy anyway. So stop, please stop, crying me a freaking river over our healthcare PAYMENT system and give me examples of DENIAL OF CARE.

I am always appreciative of comments on how my comments come across. I did not realize that I was, as you say, "crying me a freaking river", but was under the impression that I supplied a difference in current insurance coverage for these families and that condition in comparison to pre-Affordable Care Act and potential changes under proposed legislation.

Obviously, under current legislative mandates, I cannot supply you with cases that have been denied except prior to ACA and will have to wait if and when Rep health care bills pass to supply you with future examples.

 

[Emcee77]

Poor people have the same right to pursue a vocation as mothers and fathers as rich people do. It's evil to tell the lower class that they need to put in X number of years as wage slaves before they're granted the privilege of reproducing. If the American total fertility rate continues to fall, we're going to have much more serious political and economic problems than figuring out how to bring our healthcare system in line with the rest of the developed world. Lowering the individual cost of having children through healthcare reform is a big part of that.

Yes, and this hits on a key point for me. Barring some sort of revolution that I don't foresee, there will always be large swaths of the population who will spend their whole lives near the lower end of the socioeconomic spectrum, not because they aren't working hard but just because that's where they end up based on what their jobs pay. It's no solution to tell these people they should get more education and get better jobs; we will always need SOMEONE to do these jobs, and these people may well be happy working as laborers or clerks or whatever. But some people want to tell these people, to the extent that they can't afford healthcare coverage, that it is irresponsible for them to have a child? Our society is prosperous enough that we can do better than that. I just don't want to live in a society that cares about so many people so little.

 

[RDU Irish]

I am always appreciative of comments on how my comments come across. I did not realize that I was, as you say, "crying me a freaking river", but was under the impression that I supplied a difference in current insurance coverage for these families and that condition in comparison to pre-Affordable Care Act and potential changes under proposed legislation.

Obviously, under current legislative mandates, I cannot supply you with cases that have been denied except prior to ACA and will have to wait if and when Rep health care bills pass to supply you with future examples.

Examples of denial of care please. Prior to ACA would be great since that is what you and Kimmel are claiming they fixed.

 

[BleedBlueGold]

That's a good example of how hollow the term "conservative" is these days. I agree that there's no classical- or neo-liberal case for single payer, and if that's what you associate conservatism with, then you're right. But if, as Walther does, you take conservatism to mean stability and solidarity across class (and I'd add generational) boundaries, then it definitely fits the bill.

There are two options for improving upon our status quo. We can either: (1) copy Singapore, which is the only developed nation that has something akin to a high-functioning "free market" in healthcare services; or (2) we can copy Western Europe and switch to a single payer system. (1) has been on the table for a while in the form of the Cassidy-Collins Bill, but the GOP has shown zero interest in pursuing it. Given Trump's populist tendencies, and the coalition-bending realignment it would likely bring about, I think (2) is the more realistic option for improving our system right now. I don't really care how it happens, as long as we start taking better care of our own.



Poor people have the same right to pursue a vocation as mothers and fathers as rich people do. It's evil to tell the lower class that they need to put in X number of years as wage slaves before they're granted the privilege of reproducing. If the American total fertility rate continues to fall, we're going to have much more serious political and economic problems than figuring out how to bring our healthcare system in line with the rest of the developed world. Lowering the individual cost of having children through healthcare reform is a big part of that.



Americans are upset because they're aware that virtually all of our peer nations have vastly superior healthcare systems. They cover a larger % of their people, produce better health outcomes, and all for a small fraction of the cost we're currently paying. It's not about an unreasonable sense of entitlement. It's about looking around and realizing that things could be much better than they are.

I wish I had the time to sit down and study the Singapore model (https://www.brookings.edu/wp-content/uploads/2016/07/AffordableExcellencePDF.pdf), as it does sound intriguing. I agree with you, though, that single-payer is probably much more likely in our future.

I don't want to pretend to be an expert on any plan. I just want to see America do better. I agree 100% with the bolded.

 

[Whiskeyjack]

False.

From Humanae Vitae, Pope Paul VI, July 25, 1968

Under "Responsible Parenthood," emphasis mine.

This only supports your point when taken out of the context of the Church's longstanding teaching on what a just political economy looks like (spoiler: nothing like ours). There are only two vocations: marriage or celibate religious life. Both involve parenthood of a sort. Yes, there is certainly a place for prudential considerations about how many children a couple should have. But when a large % of the population is being told that number is effectively zero, that's strong prima facie evidence of economic injustice. You're basically telling the poor that they have no vocation, and are only fit to toil away for minimum wage.

Bullshit, you're smarter than that. Our "peer nations" only have the health outcomes they have because they ride on the back of what we do here. It's like saying "such-and-such Western democracy only spends $X on their military." Well yeah, they can get away with spending so little because we have a big ass military.

That's not a very apt comparison. Western Europe doesn't free ride primarily on our military innovation (which has been stagnating for decades, but that's another argument). They free ride on our actual real-world military capabilities.

I don't buy the argument that our lightly-regulated (not remotely true) and "free market" (also not remotely true) healthcare system drives global innovation in pharmacology and medical technology. There are lots of drugs and treatments available in the EU (and elsewhere) that are demonstrably superior to what we have here in the States. But because our Congress sits comfortably in the pocket of Big Pharma, our own citizens have been denied the most effective treatments for many conditions simply because the FDA can be lobbied to protect wealthy patent holders over the Common Good.

And even if that argument were true, and we were driving global medical innovation, why should the American poor suffer so that wealthy consumers in other parts of the world can benefit from slick designer drugs?

Respectfully disagree. Demographically - poor tend to have more kids than the rich. Very high correlation - I would argue there is definite causation going on there. Having kids without an ability to provide for them is more morally reprehensible than expecting someone to support themselves and their family.

Unless you're taking a vow of celibacy, everyone should get married and have kids. The poor welfare queen with 6 illegitimate kids v. the wealthy stay-at-home mom with only two is a totally false dichotomy. The argument isn't that the former is somehow morally superior to the latter; the argument is that the cost of medical care shouldn't stop any married couple from having children they're otherwise prepared to care for. That's not the case in our country currently, which is a major indictment of our system.

 

[RDU Irish]

Yes, and this hits on a key point for me. Barring some sort of revolution that I don't foresee, there will always be large swaths of the population who will spend their whole lives near the lower end of the socioeconomic spectrum, not because they aren't working hard but just because that's where they end up based on what their jobs pay. It's no solution to tell these people they should get more education and get better jobs; we will always need SOMEONE to do these jobs, and these people may well be happy working as laborers or clerks or whatever. But some people want to tell these people, to the extent that they can't afford healthcare coverage, that it is irresponsible for them to have a child? Our society is prosperous enough that we can do better than that. I just don't want to live in a society that cares about so many people so little.

I call it reality. If you cannot afford healthcare, how will you afford a child exactly? They ain't cheap - I can tell you from experience. Wax nostalgic all you want, it is my responsibility to pay for my kids. Not yours.

 

[wizards8507]

And even if that argument were true, and we were driving global medical innovation, why should the American poor suffer so that wealthy consumers in other parts of the world can benefit from slick designer drugs?

Because, eventually, those "slick designer drugs" become "holy shit we eradicated smallpox. As in, 'smallpox no longer exists, period.' Polio is next. Then on to cancer."

And spare me the "suffering of the American poor" nonsense. It doesn't exist. On a global historical scale, there is no such class of people as the "American poor" that is "suffering" unless you dramatically twist the definition of "suffering" to fit a narrative. Yes, there is a small amount of real suffering in this country, but it's not an entire class of people.

 

[RDU Irish]

This only supports your point when taken out of the context of the Church's longstanding teaching on what a just political economy looks like (spoiler: nothing like ours). There are only two vocations: marriage or celibate religious life. Both involve parenthood of a sort. Yes, there is certainly a place for prudential considerations about how many children a couple should have. But when a large % of the population is being told that number is effectively zero, that's strong prima facie evidence of economic injustice. You're basically telling the poor that they have no vocation, and are only fit to toil away for minimum wage.



That's not a very apt comparison. Western Europe doesn't free ride primarily on our military innovation (which has been stagnating for decades, but that's another argument). They free ride on our actual real-world military capabilities.

I don't buy the argument that our lightly-regulated (not remotely true) and "free market" (also not remotely true) healthcare system drives global innovation in pharmacology and medical technology. There are lots of drugs and treatments available in the EU (and elsewhere) that are demonstrably superior to what we have here in the States. But because our Congress sits comfortably in the pocket of Big Pharma, our own citizens have been denied the most effective treatments for many conditions simply because the FDA can be lobbied to protect wealthy patent holders.

And even if argument were true, and we were driving global medical innovation, why should the American poor suffer so that wealthy consumers in other parts of the world can benefit?



Unless you're taking a vow of celibacy, everyone should get married and have kids. The poor welfare queen with 6 illegitimate kids v. the wealthy stay-at-home mom with only two is a totally false dichotomy. The argument isn't that the former is somehow morally superior to the latter; the argument is that the cost of medical care shouldn't stop any married couple from having children they're otherwise prepared to care for. That's not the case in our country currently, which is a major indictment of our system.

Healthcare just scratches the surface. Daycare cost, book fees, program fees, food, clothing, bigger house, bigger car - those are hard dollar costs. Opportunity costs impacting your career - inability to stay late, work weekends, sick days pulling you away... lots of factors impact your earning potential.

Many wealthier folks wait until later in life to have kids - initial working years are important to building your career and impacting your earnings trajectory. And they have fewer kids because they prioritize being able to pay for college or private school or whatever. Not to mention time value of money from investing before you breed.

Working in some vacuum as if your financial picture is identical (or should be) whether you have no kids or eight is some real Pollyanna utopian Quaalude worthy stuff.

 

[NDgradstudent]

<blockquote class="twitter-tweet" data-lang="en"><p lang="en" dir="ltr">All left-wing arguments against GOP bills now boil down to:<br>1. It will kill children<br>OR<br>2. It will make it too difficult to kill children</p>— John Hayward (@Doc_0) <a href="https://twitter.com/Doc_0/status/860175304991571969">May 4, 2017</a></blockquote>
<script async src="//platform.twitter.com/widgets.js" charset="utf-8"></script>

 

[RDU Irish]

Because, eventually, those "slick designer drugs" become "holy shit we eradicated smallpox. As in, 'smallpox no longer exists, period.' Polio is next. Then on to cancer."

And spare me the "suffering of the American poor" nonsense. It doesn't exist. On a global historical scale, there is no such class of people as the "American poor" that is "suffering" unless you dramatically twist the definition of "suffering" to fit a narrative. Yes, there is a small amount of real suffering in this country, but it's not an entire class of people.

80% of the world population would kill to be "poor" in America.

Talk to me about innovating healthcare like the rest of the economy where innovation means better CHEAPER outcomes. Price is never an object in healthcare. Perfect example is being REQUIRED to go to the pediatrician to get a $5 antibiotic. Doc gets $200 and the thing that actually fixes the problem gets $5 - but drug companies are the evil "dealers" not the guy that actually writes the script. Let Watson diagnose and send in the script (anyone think the MDs will ever allow that).

 

[wizards8507]

80% of the world population would kill to be "poor" in America.

And 99.9% of the population of human history would kill to be "poor" in 2017.

 

[Whiskeyjack]

Because, eventually, those "slick designer drugs" become "holy shit we eradicated smallpox. As in, 'smallpox no longer exists, period.' Polio is next. Then on to cancer."

The first polio vaccine was discovered long before our current 3rd party payer system came into being. And what sort of economic incentives does Big Pharma currently have to improve the plight of global poor? They're busy pouring billions of research dollars into hypertension treatments, a few of which coincidentally worked as boner pills as well.

And spare me the "suffering of the American poor" nonsense. It doesn't exist. On a global historical scale, there is no such class of people as the "American poor" that is "suffering" unless you dramatically twist the definition of "suffering" to fit a narrative. Yes, there is a small amount of real suffering in this country, but it's not an entire class of people.

US life expectancy just declined for the 1st time in a quarter century:

For the first time in more than two decades, life expectancy for Americans declined last year — a troubling development linked to a panoply of worsening health problems in the United States.

Rising fatalities from heart disease and stroke, diabetes, drug overdoses, accidents and other conditions caused the lower life expectancy revealed in a report released Thursday by the National Center for Health Statistics. In all, death rates rose for eight of the top 10 leading causes of death.

A year ago, research by Case and Angus Deaton, also an economist at Princeton, brought worldwide attention to the unexpected jump in mortality rates among white middle-aged Americans. That trend was blamed on what are sometimes called diseases of despair: overdoses, alcoholism and suicide. The new report raises the possibility that major illnesses may be eroding prospects for an even wider group of Americans.

But you're probably right. The American poor don't really understand how good they have it.

Healthcare just scratches the surface. Daycare cost, book fees, program fees, food, clothing, bigger house, bigger car - those are hard dollar costs. Opportunity costs impacting your career - inability to stay late, work weekends, sick days pulling you away... lots of factors impact your earning potential.

Many wealthier folks wait until later in life to have kids - initial working years are important to building your career and impacting your earnings trajectory. And they have fewer kids because they prioritize being able to pay for college or private school or whatever. Not to mention time value of money from investing before you breed.

Working in some vacuum as if your financial picture is identical (or should be) whether you have no kids or eight is some real Pollyanna utopian Quaalude worthy stuff.

You're inadvertently making my point for me. The above is quite an endorsement of capitalism! That's the sort of society everyone should want to live in, right?

80% of the world population would kill to be "poor" in America.

Talk to me about innovating healthcare like the rest of the economy where innovation means better CHEAPER outcomes. Price is never an object in healthcare. Perfect example is being REQUIRED to go to the pediatrician to get a $5 antibiotic. Doc gets $200 and the thing that actually fixes the problem gets $5 - but drug companies are the evil "dealers" not the guy that actually writes the script. Let Watson diagnose and send in the script (anyone think the MDs will ever allow that).

Note that I didn't say that Big Gubmint is the only way forward. If we really wanted to improve things, we could copy Singapore's system too. But here you and wizards are going to mat to defend our status quo, which isn't lightly regulated or remotely free-market! You guys were the first ones arguing against the insurance mandate, pointing out all the market distortions that would arise from forcing everyone to buy "grocery insurance" and then only shopping with that. But when someone suggests the current system could be improved, you're suddenly Grover Norquist:

 

[wizards8507]

But here you and wizards are going to mat to defend our status quo, which isn't lightly regulated or remotely free-market!

 

[ND NYC]

house just passed bill to replace ACA...

 

[Emcee77]

I call it reality. If you cannot afford healthcare, how will you afford a child exactly? They ain't cheap - I can tell you from experience. Wax nostalgic all you want, it is my responsibility to pay for my kids. Not yours.

I'm not sure I totally disagree with you, with respect to how a person should analyze his or her options at this particular moment, but this might be beside the point I was trying to make, which was about the question of whether that state of affairs is good or not.

I would submit that it is not good. We should look for policy solutions to what I view as a serious public policy problem: that people have to take into account whether they can afford healthcare for a child before they decide to have a child. In my opinion, our society would be healthier (not physically, but in terms of the strength of the fabric of society) if people didn't have to face potentially wrenching decisions in that vein, and people in other prosperous societies all over the world are relieved of those wrenching decisions to a greater extent, so it only seems natural to do what we can to achieve what they have achieved, even if we do it in a different way.

 

[phgreek]

Man...so Republicans were goaded into taking the death spiral cluster off Democrat hands with something that won't help much.

20 million people were uninsured by choice and that number was heading north, not south. Many places were down to NO choice even if people could pay...The entire ACA was sold on lies and deception...yet the impending mess will be hung on Republicans...

I guess if you are gonna be dumb, you better be tough.

 

[woolybug25]

house just passed bill to replace ACA...

It's kinda annoying to me that everyone is calling this a "repeal and replace", it's not. They made a few changes to an existing infrastructure and renamed it.

The whole thing is dumb as shit too. They found a way to not only make the system worse, but also take the blame for it. Remember when anti-Trump conservatives were saying that he would do long term damage to the party? This is what that looks like.

The Republicans now have the hot potato to own.

 

[wizards8507]

It's kinda annoying to me that everyone is calling this a "repeal and replace", it's not. They made a few changes to an existing infrastructure and renamed it.

The whole thing is dumb as shit too. They found a way to not only make the system worse, but also take the blame for it. Remember when anti-Trump conservatives were saying that he would do long term damage to the party? This is what that looks like.

The Republicans now have the hot potato to own.

This.

Hopefully the big brains in the Senate do something half intelligent with this.

 

[Whiskeyjack]

It's kinda annoying to me that everyone is calling this a "repeal and replace", it's not. They made a few changes to an existing infrastructure and renamed it.

The whole thing is dumb as shit too. They found a way to not only make the system worse, but also take the blame for it. Remember when anti-Trump conservatives were saying that he would do long term damage to the party? This is what that looks like.

The Republicans now have the hot potato to own.

DNC: "Man, ramming through the ACA really killed us in the 2010 midterms. There's no way you guys could do something stupider than that, right?"

GOP: "Hold my beer."

 

[NorthDakota]

My very well placed source says zero percent chance the Senate let's it through without "major big time changes. "

 

[Legacy]

Trumpcare

Trumpcare

Off the top of my head (please clarify if you wish), Trumpcare

- is a cost-shifting mechanism which has no value-based purchasing that rewards efficient care management at the various levels of health care

- as such, states with some assistance in federal funding as well as hospitals and health care providers will bear the responsibility for managing their health care dollars. Uncompensated medical care at the most expensive part of the HC system (ERs) will increase

- there are no mandates for coverage by employers and states can set their own exclusions and critieria for preexisting conditions as well as Medicare qualifications. Many states are now struggling to balance their budgets

- States can define their high-risk pools to which individuals belong with health insurance companies can choose to offer coverage, which would be expected to be expensive. It's logical to expect that, if those companies are pulling out of individual plans which now share costs with low risk people, few will provide insurance options to these pools

- Low risk people could see lowering of their premiums and more affordable health plans, especially if HC insurance companies choose not to enter high-risk pools.

- providers who are for-profit such as physicians, skilled nursing facilities, and other intermediate care facilities could refuse uninsured or Medicaid patients, which may result in longer, unnecessary in-patient hospital stays. Insurance companies could refuse to pay for those stays for patients who are judged not to meet standards for inpatient

- those who are responsible for the costs of extended stays that are denied for patients who cannot be placed in lower levels of care will be individuals or their family members

- with states' budgetary struggles and, effectively, caps on increase any bureaucracy to monitor health expenditures, more states will be pushed to lower Medicaid qualifications effecting the working poor.

That's what the Reps in the House would replace existing programs with.

 

[woolybug25]

My very well placed source says zero percent chance the Senate let's it through without "major big time changes. "

Does it matter? Regardless of what they put together, there will still be an army of MAGA folks like you sprinkling powdered sugar on every turd Trump lays.

 

[Rack Em]

Does it matter? Regardless of what they put together, there will still be an army of MAGA folks like you sprinkling powdered sugar on every turd Trump lays.

Sounds like your dinner