Affordable Care Act

[Timsup2nothin]

Why does everyone but you understand how the distinction you're making is irrelevant to the discussion? We all understand your point. You just don't understand why it is irrelevant.

He doesn't have the advantage most of us have. For me, just the fact that it is his point puts me looking for the high probability that it is at least irrelevant and more likely an intentional attempt at deception.

 

[Cutlass]

Here's a fun political fact. After Republicans refused to have anything to do with the creation of the ACA, and tried to derail, and later repeal, it at every opportunity, Trump blames the Democrats for not helping with their plan. But Paul Ryan is saying that he does not want Democrats to have any part of his plan. He wants it to be an exclusively Republican plan.

 

[Sommerswerd]

Here's a fun political fact. After Republicans refused to have anything to do with the creation of the ACA, and tried to derail, and later repeal, it at every opportunity, Trump blames the Democrats for not helping with their plan. But Paul Ryan is saying that he does not want Democrats to have any part of his plan. He wants it to be an exclusively Republican plan.

That's because by "helping" he meant "surveillance"... Gah, haven't you caught on yet?

 

[onejayhawk]

We all understand your point. You just don't understand why it is irrelevant.

Sanders wants to eleminate private insurers. Any change in ACA will increase the involvement of private insurers, not eliminate them. How is that distinction not relevant?

J

 

[Lexicus]

Any change in ACA will increase the involvement of private insurers, not eliminate them.

Well I suppose if you ignore all the potential changes to the ACA that would do the opposite, like, uh, adding that public option thing that the Republicans killed way back when.

 

[Sommerswerd]

Well I suppose if you ignore all the potential changes to the ACA that would do the opposite, like, uh, adding that public option thing that the Republicans killed way back when.

As tempting as it is to blame the Republicans for that... let's put the blame where it so richly belongs, squarely on the narrow shoulders of Joe Sleazeberman

 

[Lexicus]

As tempting as it is to blame the Republicans for that... let's put the blame where it so richly belongs, squarely on the narrow shoulders of Joe Sleazeberman

Yeah I wanted to say that the Democrats killed but it's generally best to keep the rails as narrow as possible with J.

 

[Sommerswerd]

Nope, not "the Democrats"... just jiltin' Joe...

 

[Azem.Ocram]

The best system for health in a large, diverse nation is tax-payer funded universal health insurance for emergency, routine preventative, and basic health appointments and procedures with copays ranging from a token $1 for cheap unavoidable visits and up to $50 for expensive treatments but charge completely out of pocket for cosmetic and elective procedures.

The Democrats behind the ACA wanted to enact a public option but Republicans destroyed it. Trump's replacement would have given more power to private insurers, increased the budget deficit, and destroyed patient rights.

 

[Zkribbler]

The Republican-controlled Assembly and Senate in Kansas just voted for the Medicaid extension in their state. The Republican Governor vetoed it.

 

[Broken_Erika]

Of course the Governor vetoed it, Medicaid expansion is the first step towards COMMUNISM! This way taxpayer money won't be wasted on such unnecessary luxuries like health care.

 

[El_Machinae]

The best system for health in a large, diverse nation is tax-payer funded universal health insurance for emergency, routine preventative, and basic health appointments and procedures with copays ranging from a token $1 for cheap unavoidable visits and up to $50 for expensive treatments but charge completely out of pocket for cosmetic and elective procedures.

The Democrats behind the ACA wanted to enact a public option but Republicans destroyed it. Trump's replacement would have given more power to private insurers, increased the budget deficit, and destroyed patient rights.

I walk back and forth on copay. Copay is a really great way of reducing consumption. The idea of paying $5 for a $300 service will cause us to hesitate in ways that a 'free' visit doesn't. OTOH, since a lot of medical conditions aggravate over time, a copay can cause an unnecessary delay in seeking and implementing a medical intervention. It's a heck of a balancing act.

That said, public insurance tends to be mostly abused by a small percentage of people. Usually the numbers are ridiculous, where 5% of the patients cause 33% of the costs, just by abusing the ability to have visits whenever they want. I'm sure that even private insurers have such issues. A copay on people like them would probably really help to keep costs down. That said, the Dr. might not have the incentive to apply a copay structure to a serial abuser, if they're getting paid for visits anyway. I'll liken it to a liquor store not really having an incentive to cut back the number of visits from their local alcoholics.

 

[metalhead]

Can't you slap a limit on visits, but allow exemptions to the limit if a doctor signs off on it?

I think small co-pays, like $10 a visit, $5 a prescription, waived for low income people is fine. Also waived if you have a condition like cancer or end-stage renal disease that requires a lot of office visits.

 

[MRM]

That said, public insurance tends to be mostly abused by a small percentage of people. Usually the numbers are ridiculous, where 5% of the patients cause 33% of the costs, just by abusing the ability to have visits whenever they want. .

Those numbers are not necessarily a sign of abuse. Older people and people with chronic diseases causes higher costs. Sure, hypochondria exists - the question is how much do they really costs.

Can't you slap a limit on visits, but allow exemptions to the limit if a doctor signs off on it?

I think small co-pays, like $10 a visit, $5 a prescription, waived for low income people is fine. Also waived if you have a condition like cancer or end-stage renal disease that requires a lot of office visits.

In Germany we have up to 10€ per prescription. We also had 10€ per visit ( but only once in a quarter ) until 2013, but the so called "Praxisgebühr" was removed because it caused more costs then it had prevented. The argument was mainly bureaucracy. However I would also add that sometimes if you hesitate to visit your doctor ( maybe because of those co payments ) a sickness may become worse and drive the costs of the treatment up.

 

[Sommerswerd]

Can't you slap a limit on visits, but allow exemptions to the limit if a doctor signs off on it?

That runs into the same problem El-Mac already mentioned in the last two sentences, though right? Why would a doctor refuse to sign off on your exemption? I can see whole cottage industries developing where doctors just sign off on exemptions all day for fees.

 

[Broken_Erika]

That runs into the same problem El-Mac already mentioned in the last two sentences, though right? Why would a doctor refuse to sign off on your exemption? I can see whole cottage industries developing where doctors just sign off on exemptions all day for fees.

That's the glory of capitalism.

 

[metalhead]

That runs into the same problem El-Mac already mentioned in the last two sentences, though right? Why would a doctor refuse to sign off on your exemption? I can see whole cottage industries developing where doctors just sign off on exemptions all day for fees.

Heavy fines and long jail sentences if you get caught approving visits that turn out to be BS. Proactive enforcement including random chart audits. It generally works OK for the IRS.

I mean, there are always going to be people who try to commit fraud. There will always be people who get away with it; the people who get caught are the people who get greedy, and the people who get greedy are the ones you want to catch because they cost the most. Circle of life.

All you can do is deter it as best you can without stepping on the toes of the legitimate practice of medicine. Requiring an affirmation from a doctor that a given visit is necessary provides a much higher deterrent value on that kind of fraud than if you simply paid out every visit no matter what.

 

[El_Machinae]

How do you audit a waiver without breaching confidentiality? You almost need sting operations

 

[metalhead]

It's fairly straightforward to scrub identifying information from patient records.

 

[onejayhawk]

It appears the Republican bill is not dead yet.
http://www.realclearpolitics.com/ar...ts_freedom_caucus_hopes_for_truce_133489.html

As I understand it, the Freedom Caucus is asking that two more mandates be removed. The two that were already out is business mandate (all businesses had to offer coverage) and the personal mandate (everyone must join or be fined, excuse me, taxed). The FC also wants to remove the list of mandatory coverages and the community ratings. Both existing mandates tend to force a one-size-fits-all approach to policy design.

J