[RD] Let's Repeal The Affordable Care Act

[Angst]

Now, don't comment too hastily. I live in Denmark and is an avid supporter of publicly paid universal healthcare. I also see the ACA as a reasonable albeit flawed solution to the mess that is US healthcare, so out of pragmatism, I'm a supporter for that too.

But this isn't the thread for that.

See, US Republicans constantly berate the ACA and claim they have a bunch of solutions - none of which are really viable, as they will all result in a large drop of coverage, and are bluntly not very well thought out to cover those that can afford it either. This is just my opinion of course.

But for this thread, let's try to do a thought experiment. Let's give the private option the benefit of a doubt and try to figure out how the Republicans - or we - can solve this. Let's say we repeal the ACA and following suit, procure a solution that emphasizes choice and is affordable while being privately paid. You know, what Republicans like to preach. I'm not particularly interested in the "solutions" the Republicans have provided so far. I think it'll be more interesting for us to think about how to solve the problem.

I'll start. What if rather than costing a set amount of money, we force the insurance companies to set their prices as percentages of patient income? Basically you can "choose your own tax rate" based on competing companies. These companies will not be allowed to discriminate based on income in any other way than increasing the cost of premiums for richer customers, so if you get above a certain income, they're allowed to increase your premiums based on a progressive tax system. All insurance coverage must be full coverage and the state is allowed to subsidize the corporations at both federal and state level.

This is not a well thought out idea. I thought of it literally ten minutes ago. Problems with it:
- May simply not be feasible.
- May still cost way more than it should compared to treatment in Europe.
- Figuring out premiums for unemployed people is honestly horribly difficult.
- If the rate ends up being at like 30% of income, the policy is honestly useless.
- It looks too much like a tax, many of the Republicans' voters may not like that.

Any thoughts?

Any other ideas?

 

[Timsup2nothin]

To repeal the ACA and replace it with anything would require legislation as carefully crafted as the ACA was in the first place...and probably more. There is absolutely no way the Republicans are up to the task. They haven't crafted legislation more complex than "we hate dat Obamacare thingus, and anything else his name is on...signed, da congress" in close to a decade.

Your solution, while elegant and simple, relies on "force the insurance companies." This leads to the immediate questions. What happens if they fold? Do we take responsibility for forcing them to take operational losses? Do we subsidize them to maintain their profitability? How much profitability? Do we allow them to give raises to their employees even if we are subsidizing them to keep them from failing outright?

 

[warpus]

Did the Republicans ever even have a replacement for ObACAcare in mind, or did they just want to get rid of it without any ideas what it might be replaced with? I though they wanted to get rid of it and not replace it with anything, isn't that the case or have I been misinformed?

 

[Timsup2nothin]

Did the Republicans ever even have a replacement for ObACAcare in mind, or did they just want to get rid of it without any ideas what it might be replaced with? I though they wanted to get rid of it and not replace it with anything, isn't that the case or have I been misinformed?

They chanted "repeal and replace" as a campaign slogan into the environment created by their false narrative "it isn't working/it's unconstitutional/it's unamerican" but there's never been any indication they had an answer to "with what?" Trump in the white house and control of both houses of congress caught them completely by surprise, and it's pretty clear they never expected to actually have to come up with any replacement.

As to "just get rid of it and not replace it with anything," there's really no way to do that. Healthcare is a system with a gigantic number of moving parts that interacts with government at thousands of contact points. The ACA addresses how all those points of contact work. Repealing it won't change the fact that the biggest buyer of health care services in the US is the US government, so those points of contact aren't going away...and the government can't just throw its hands in the air and say "we don't know what we want you to do."

 

[Farm Boy]

All the awkwardness happening now is that you're watching Republicans finally needing to actually start informing themselves in a meaningful way on the topic of health insurance. It's going to continue being awkward, and they're going to continue being Republicans, but their softening on the stances is a predictable outcome to them actually winding up in charge and needing to figure out how to start dealing with that. People showing up to town halls has been doing a world of good. It's moving the bar of baseline opposition, this is what it looks like when the so-called "center" shifts.

 

[Angst]

I agree that the Republicans probably used the ACA to spin political points without really expecting themselves to get into a position where it would backfire. They have however made some preparations for repealing the ACA so there is a possibility they'll go through on it. As is of course they understand that they wil probably lose a lot of votes if they repealed the service by being thrown in front of thousands of angry healthcare recipients. I think they are going to consider how to both cater to the voters that want it gone and the voters that want healthcare but couldn't have the service without the ACA. This means that they are going to consider alternatives to the policy, regardless of how bad the options are. As such I do think it's reasonable to think about what they can actually do so they don't do something as horrendous as block grants (or was it grant blocks? I don't recall)

To repeal the ACA and replace it with anything would require legislation as carefully crafted as the ACA was in the first place...and probably more. There is absolutely no way the Republicans are up to the task. They haven't crafted legislation more complex than "we hate dat Obamacare thingus, and anything else his name is on...signed, da congress" in close to a decade.

Your solution, while elegant and simple, relies on "force the insurance companies." This leads to the immediate questions. What happens if they fold? Do we take responsibility for forcing them to take operational losses? Do we subsidize them to maintain their profitability? How much profitability? Do we allow them to give raises to their employees even if we are subsidizing them to keep them from failing outright?

I'm very delighted you tink my solution is elegant and simple, even if it has the listed problems. I think that some form of subsidies may be a fair policy, but in return, there should be a system that prevents corrupt behavior such as directly channeling the subsidies into wage raises. The thing is, the insurance companies are part of a toxic system. If you don't want to hurt the healthcare recipients you probably have to do something that may cause trouble within the healthcare insurance business. As always, the whole idea was lifted from the Republican idea that increased competition drives prices down. I have to say I agree with them there. Youtube's vlogbrothers made an example as to how competition was actually internalized within British healthcare in a way that the corporations producing the health products, in their example fake hips, had to compete with each other to provide the cheapest and best fake hips, and then the hospital could choose between the hips to maximize efficiency and minimize costs; all due to implementation of increased competition. The problem is however that the specific way the Republicans believe competition will drive prices down probably won't work. But in my example, I tried to figure out a way for competition to be a factor (which the Republicans like, probably more than the ACA) while it maybe could work? I have no idea. But some form of subsidies + control could be produced, perhaps as a safety valve until the companies adapt.

Of course I can't expand on the details as to how these laws and controls will look. This is because I'm on the level of expertise at the subject that I rely on an entertainment vlog channel for my facts - meaning I'm not even a little bit of an expert.

 

[Perfection]

How the heck is an insurance company supposed to set a percentage for a plan if they have no idea how much money they'll get per enrollee?

 

[galdre]

Repeal the ACA, get rid of all private insurance, and give us a national health insurance.

 

[Timsup2nothin]

I saw Trump this morning responding to the "have you got your magical replacement for the ACA yet?" question with "who knew that it would be so complicated?" I wanted someone to scream "everyone but you and the f'ing Republicans!" but no one did.

 

[Perfection]

My worry is that they'll figure out a way to reduce insurance costs for enough of their base they'll get reelected despite really screwing over a large number of people.

 

[Angst]

How the heck is an insurance company supposed to set a percentage for a plan if they have no idea how much money they'll get per enrollee?

The same can be asked about tax-funded government plans, can't it? I mean, I have no idea how governments are (mostly) accurate in this matter, but there has to be some method to the madness? Of course, governmetns are guaranteed income due to tax monopoly, but there are so many incredibly complicated speculations that corporations do to begin with, I don't understand how this particular solution isn't viable.

... Again, I don't really support my own suggestion, I'm just trying to figure out a way that the Republicans' plan can be viable. People much, much smarter than me have failed finding a solution. I honestly think that you are probably right in your assessment that setting costs to a percentage of income is a very bad idea, but the point of this thread is to go full devil's advocate, so I'm sticking with it for a bit.

 

[Perfection]

The same can be asked about tax-funded government plans, can't it? I mean, I have no idea how governments are (mostly) accurate in this matter, but there has to be some method to the madness? Of course, governmetns are guaranteed income due to tax monopoly, but there are so many incredibly complicated speculations that corporations do to begin with, I don't understand how this particular solution isn't viable.

With single payer plans government doesn't have a choice whether or not to provide coverage. It will do what is mandated to do. Insurance companies can choose not to participate in the individual plan market which they will do if they view it to be too risky or not profitable.

The reason it's so risky is because it's a marketplace, that means whatever company courts the richest people will get a lot of money but whoever attracts the poorest will get screwed. You'd probably just see companies offering low percentage cost high deductible plans that are good for wealthy people but bad for poor people (who will have to accrue massive medical debt to get treatment). Single payer (Government) plans that cover everyone doesn't have that problem because everyone would be enrolled. There's no risk of having all the rich people move to a different provider.

 

[Angst]

I totally understand, but the idea is that insurance companies would only be allowed to operate if they offered a flat percentage for full coverage, while they were able to scale the percentage up for wealthier people. So there would be no incomplete coverage. No deductible plans. Just choose your own agency and tax rate.

Of course, there could be omissions on the legislative side, allowing for some flexibility in coverage, but that's not the onset I'm suggesting; that's something that can be worked with in detail after everyone is guaranteed coverage if they pay a "higher tax", so to speak. Am I making sense?

 

[Timsup2nothin]

I totally understand, but the idea is that insurance companies would only be allowed to operate if they offered a flat percentage for full coverage, while they were able to scale the percentage up for wealthier people. So there would be no incomplete coverage. No deductible plans. Just choose your own agency and tax rate.

Of course, there could be omissions on the legislative side, allowing for some flexibility in coverage, but that's not the onset I'm suggesting; that's something that can be worked with in detail after everyone is guaranteed coverage if they pay a "higher tax", so to speak. Am I making sense?

You are, but mandating that every provider provide the same coverage for the same price makes having multiple agencies in the market pointless. You wind up with them competing via their advertising budgets, which is expense without return.

 

[Angst]

That's true. Hrm. And you could allow them to offer different quality of treatment (IE you get a new set of hips whether you pay a 4% or 8% tax, but the 4% hips are of worse quality) but that's just, in the end, discrimination and worse treatment all over again.

 

[AlpsStranger]

This is all based on the, quite honestly, juvenile premise that healthcare in 2017 should be a free market.

Very few think the Fire Department or Highway Department should be private, I think it's fairly obvious healthcare shouldn't be either.

Just like with schools. You should be able to pay more and go to a fancy private doctor, but there's absolutely no reason we can't have good, solid, baseline healthcare as a basic part of our infrastructure. I don't even think it's a left-right thing, more of a silly vs non-silly thing.

New tits for the wife? Porcelain veneers? Hair plugs? Nose job? Those can all stay as they are. But necessary care should be part of basic life in America.

 

[Timsup2nothin]

This is all based on the, quite honestly, juvenile premise that healthcare in 2017 should be a free market.

Very few think the Fire Department or Highway Department should be private, I think it's fairly obvious healthcare shouldn't be either.

Just like with schools. You should be able to pay more and go to a fancy private doctor, but there's absolutely no reason we can't have good, solid, baseline healthcare as a basic part of our infrastructure. I don't even think it's a left-right thing, more of a silly vs non-silly thing.

New tits for the wife? Porcelain veneers? Hair plugs? Nose job? Those can all stay as they are. But necessary care should be part of basic life in America.

Bingo

 

[innonimatu]

Repeal the ACA, get rid of all private insurance, and give us a national health insurance.

Question: If Trump came out with that proposal, and willing to try to pass it, how would each of you stand about it? I'm not even talking about "Medicare for all", I mean a National Health Service supported from general taxation. And I'm not wanting to argue whether Trump could do this, or pigs can fly. I'm just asking: if he proposed that, how would you stand, for or against?

 

[Timsup2nothin]

Question: If Trump came out with that proposal, and willing to try to pass it, how would each of you stand about it? I'm not even talking about "Medicare for all", I mean a National Health Service supported from general taxation. And I'm not wanting to argue whether Trump could do this, or pigs can fly. I'm just asking: if he proposed that, how would you stand, for or against?

If Trump said something that wasn't stupid I would not claim it was stupid just because he said it, if that's what you are driving at.

 

[innonimatu]

You're giving the answer I anticipated. Thanks, I was wondering just how far partisanship had dislodged rational political considerations in the US, I'm getting the idea that very much.