Whatcha think Pawdawg: ACA replacement

[DawgyNWindow]

Trump says a lot of things, and you can't believe a single one of them. He's a pathological liar at worst, an imbecile at best.

WOW. I am really becoming a Trump fan. I think you are watching from another universe with alternate facts.

He is really attempting to do everything he said he would do in the election. I used to think he was a total narcissistic jerk, but now I am not so sure. He defers to others when they know more, doesn't try to micromanage things he doesn't understand, and can actually give a speech without mentioning himself fondly dozens of times like the previous WH occupant.

The left is totally unglued, and they will fail against this guy. He is no where near as fragile as I thought he might be. AND, I love the big reveal from Maddow tonight. He pays a bigger percentage in taxes than all of her heroes (Sanders, Clinton and her network).

[RhythmDawg]

Then I'm okay with keeping Obamacare as it is, because I'm ready for the government to collapse.

It is about to get ugly.

Too bad no one predicted its collapse...with nauseatingly accurate detail.

[theprofessor]

WOW. I am really becoming a Trump fan. I think you are watching from another universe with alternate facts.

He is really attempting to do everything he said he would do in the election. I used to think he was a total narcissistic jerk, but now I am not so sure. He defers to others when they know more, doesn't try to micromanage things he doesn't understand, and can actually give a speech without mentioning himself fondly dozens of times like the previous WH occupant.

The left is totally unglued, and they will fail against this guy. He is no where near as fragile as I thought he might be. AND, I love the big reveal from Maddow tonight. He pays a bigger percentage in taxes than all of her heroes (Sanders, Clinton and her network).

I'll say that I was hopeful he wouldn't follow through with his campaign promises. I don't want a total repeal of Obamacare. I think it can be done better, and I wish over the past eight years when the Republicans were griping ad nauseum about it, they would have come up with a better solution. I know there are people on here who are fundamentally opposed to bigger government. That's fine. I'd argue they would flip out if certain things we've become reliant upon the government for suddenly stopped, but that's neither here nor there. I think basic health care should be available and affordable to everyone. If we truly are the best nation in the world and such an advanced society, I don't think that's too much to ask. Our current insurance system, which is a reward tied to employment, doesn't really make much sense to me. Why should my job determine whether or not I can get health care? What's the correlation there? It doesn't add up. I think we can find a better solution.

I'm very hopeful that we don't actually have a wall built to separate us from our neighbors. We live in a global society. Trump should understand this with as much business as he conducts outside of our nation's walls. One of the most iconic speeches of my lifetime was Reagan's "tear down this wall" speech. Yet, here we are, 30 years later, talking about building another wall. Why? We are that afraid of our neighbors to the south? Are they disrupting our daily lives that much that we want to spend millions and millions and millions of dollars to build a wall that will stand for nothing that our country stands for? Our country is a nation of immigrants. We are a melting pot of so many different cultures. We have seen a rise recently in white nationalists who are more and more vocal about how America should look more like they look. There's a reason people want to be in America. It's a great nation, not one that needs to be made great again. Can we do a better job with border security, keeping illegals out and making sure the correct process is followed? Sure, we can. No doubt. Building a massive, expensive wall isn't the solution.

Those were Trump's two major campaign promises. He also campaigned on jobs. The Dow is up and jobs are being created. The Dow was up before he was elected, and Obama had the longest streak of positive job gains in the history of our country. Economically, things weren't bad before Trump took office, no matter how often the right tried to say they were. The unemployment rate was below 5 percent, and despite the president saying for years that was a fake number, all of a sudden it's real now that he takes office? C'mon. The man is a liar. He screams FAKE NEWS at every opportunity, despite the fact that he's been caught in lie after lie after lie over the past couple of months.

I'm not saying Hillary Clinton was a good option. In fact, I'd argue voters had the worst two major party candidates in my lifetime (and maybe ever) to choose from in November. Principled Republicans like myself are disgusted that this is the man that we chose, over 17 other candidates, to lead our party. We have strayed far, far away from what the Republican Party used to stand for, and frankly it saddens me at what the party I've belonged to from the day I could vote has become.

[PawDawg]

How sad.

[DawgyNWindow]

I think basic health care should be available and affordable to everyone. If we truly are the best nation in the world and such an advanced society, I don't think that's too much to ask. Our current insurance system, which is a reward tied to employment, doesn't really make much sense to me.

I agree, and Obamacare is making everything worse. As a 58 year old married male, I am forced to get a policy through the exchanges and I pay a fortune for a policy that I never use because my deductibles are so high. So I am not getting health care at all, I just get an insurance card that means very little unless I have a very expensive life-threatening event. I don't need to cover much of what I am forced to pay for, and if I did need it I would have to pay the full price for the service anyway. That horrid law needs to be repealed yesterday.

I'm very hopeful that we don't actually have a wall built to separate us from our neighbors. We live in a global society. Trump should understand this with as much business as he conducts outside of our nation's walls. One of the most iconic speeches of my lifetime was Reagan's "tear down this wall" speech. Yet, here we are, 30 years later, talking about building another wall. Why? We are that afraid of our neighbors to the south? Are they disrupting our daily lives that much that we want to spend millions and millions and millions of dollars to build a wall that will stand for nothing that our country stands for? Our country is a nation of immigrants. We are a melting pot of so many different cultures. We have seen a rise recently in white nationalists who are more and more vocal about how America should look more like they look. There's a reason people want to be in America. It's a great nation, not one that needs to be made great again. Can we do a better job with border security, keeping illegals out and making sure the correct process is followed? Sure, we can. No doubt. Building a massive, expensive wall isn't the solution.

I am 100% for as much legal immigration as we can absorb. But a country without borders is not a country at all. The wall Reagan referred to was one separating one country, and I too am against putting up a border wall on the California/Nevada border (for now). Many of the illegals coming in from the south are not Mexican nationals, but instead are folks using Mexico as an entry point into our country--and some are Mexicans who use our open borders to move illegal drugs into our country. Those drugs destroy the future of our country. And don't forget to mention the brown nationalists who keep telling us the country is going to be much browner, as if that's a goal. Personally, I don't want to identify with anyone that defines themselves by race first.

Those were Trump's two major campaign promises. He also campaigned on jobs. The Dow is up and jobs are being created. The Dow was up before he was elected, and Obama had the longest streak of positive job gains in the history of our country. Economically, things weren't bad before Trump took office, no matter how often the right tried to say they were. The unemployment rate was below 5 percent, and despite the president saying for years that was a fake number, all of a sudden it's real now that he takes office? C'mon. The man is a liar. He screams FAKE NEWS at every opportunity, despite the fact that he's been caught in lie after lie after lie over the past couple of months.

Yet the labor participation rate went up a tad this last report. The unemployment rate is a fake number because it only counts people looking for work. In a complete welfare state, the unemployment rate would be 0% right before everything collapsed.

I'm not saying Hillary Clinton was a good option. In fact, I'd argue voters had the worst two major party candidates in my lifetime (and maybe ever) to choose from in November. Principled Republicans like myself are disgusted that this is the man that we chose, over 17 other candidates, to lead our party. We have strayed far, far away from what the Republican Party used to stand for, and frankly it saddens me at what the party I've belonged to from the day I could vote has become.

I can't stand either party. I blame the repubs as much for the disastrous Obamacare legislation as I do the dems because they continued to fund it while whining about it and passing repeal legislation that they knew would be vetoed. So far, Trump has been bucking both sides of the isle, and that is what I want him to do. Time for government to work for the country instead of the political parties.

[RhythmDawg]

I think basic health care should be available and affordable to everyone.

Here's the thing...basic healthcare services, from the standpoint of actual costs, ARE affordable to everyone. The insurance reimbursement model is what is causing the problem. I could explain it, but I'd have to use graphs and spreadsheets and stuff.


But here is an example...

Labcorp, the largest clinical reference lab and pathology provider in the US, will bill your insurance $45+ for a CBC. They will get paid, depending on the payer, between $3.50 (UHC) to upwards of $25 (BCBS). For the same test, your physician might prefer to do what is called "pass through billing," which is gradually being outlawed for various modalities. Your physician might bill your insurance that $45+, but Labcorp actually receives the specimen and runs the test. So, your physician will get paid from your insurance carrier. But Labcorp will charge your physician a fee for that CBC of $2.50. That $2.50 fee is how reference labs compete against each other for business...but that's another story. Your physician makes a profit on the difference of the reimbursement and the Labcorp fee. The thing is...Labcorp still made a profit on the $2.50 CBC.

The cost to run a CBC is based on the volume of tests per set of reagents. The more tests you can run through them, the lower the cost per test. Labcorp's cost on a CBC is about $.75.

If you are a cash pay patient without insurance, you will be charged the $45+ and may get a self-pay discount...normally around 20%-30%.

Without the insurance reimbursement model, the cost to the patient of that CBC would likely be less than $5.

[johnnylightnin]

Here's the thing...basic healthcare services, from the standpoint of actual costs, ARE affordable to everyone. The insurance reimbursement model is what is causing the problem. I could explain it, but I'd have to use graphs and spreadsheets and stuff.


But here is an example...

Labcorp, the largest clinical reference lab and pathology provider in the US, will bill your insurance $45+ for a CBC. They will get paid, depending on the payer, between $3.50 (UHC) to upwards of $25 (BCBS). For the same test, your physician might prefer to do what is called "pass through billing," which is gradually being outlawed for various modalities. Your physician might bill your insurance that $45+, but Labcorp actually receives the specimen and runs the test. So, your physician will get paid from your insurance carrier. But Labcorp will charge your physician a fee for that CBC of $2.50. That $2.50 fee is how reference labs compete against each other for business...but that's another story. Your physician makes a profit on the difference of the reimbursement and the Labcorp fee. The thing is...Labcorp still made a profit on the $2.50 CBC.

The cost to run a CBC is based on the volume of tests per set of reagents. The more tests you can run through them, the lower the cost per test. Labcorp's cost on a CBC is about $.75.

If you are a cash pay patient without insurance, you will be charged the $45+ and may get a self-pay discount...normally around 20%-30%.

Without the insurance reimbursement model, the cost to the patient of that CBC would likely be less than $5.

How much of the reimbursement craziness do you lay at the feet of medicare and medicaid?

[dawg80]

Saw a good proposal.... one "problem" is getting healthy, young people (ahem) to buy health insurance with the theory being they will pay premiums but not use the system (much). That will offset older people, and others, who do use the system a lot. The proposal was to allow you, anyone, to lock in lower premiums much like you can with term life insurance. That should encourage/motivate young people to go ahead and buy HI now, even if they rarely use it. That could work if properly marketed.

However, these recent generations are not really as "healthy" as they should be. Young people today are much fatter, lazier, and more unhealthy than previous generations.

Still, that is a good idea about the lower premiums.

[PawDawg]

Removing the mandates will allow young and healhty people to buy indemnity plans. Underwriting for "not so healthy" participants would follow.

Big Pharma is the problem. They have billions tied to having control over cost of for the unhealthy like cancer or diabetic patients. They are guaranteed payment when the government is in control.

If the government wants to provide for the pre-ex conditions let them. They always have.

[Soonerdawg]

How much of the reimbursement craziness do you lay at the feet of medicare and medicaid?

i don't know this, but I have a feeling you will find that the cost of medicine has gone up proportionately to the advent and then escalation of Medicare and Medicaid. I have no desire to verify if that feeling is reality. But, I would expect it to be so.

[RhythmDawg]

How much of the reimbursement craziness do you lay at the feet of medicare and medicaid?

Just as much as BCBS, United Healthcare, et al. But if you are looking to blame the one who goes first...most commercial payers conform to whatever medicare does in terms of claims processing procedure and payment methodology. Medicaid is sort of its own thing...even when "privatized".


By the way...the GOP's whole "across state lines" thing won't work.

[PawDawg]

By the way...the GOP's whole "across state lines" thing won't work.

Sounds good though.

[RhythmDawg]

Sounds good though.

the concept and how it would create competition, driving prices down, is legit. But it isn't feasible the way insurance networks and provider enrollment and credentialing currently work. It would be impossible for providers to get credentialed with potentially every carrier in the country without it being standardized and centralized. That would require all insurance companies to work together, and to simplify the process. It could be regulated that way, but it's unlikely. Especially considering that the process is one of the strategies they use to keep from paying out claims. They purposely have made it complex.

[PawDawg]

the concept and how it would create competition, driving prices down, is legit. But it isn't feasible the way insurance networks and provider enrollment and credentialing currently work. It would be impossible for providers to get credentialed with potentially every carrier in the country without it being standardized and centralized. That would require all insurance companies to work together. It could be regulated that way, but it's unlikely.

Yes, the only region I could think of that it might apply would be on the east coat and northeast where networks actually overlap across state lines.

As you know, we have networks here that are not accessable unless a patient leaves Monroe or NE Louisiana. Can't even buy across parish lines.

[dawg80]

I don't accept that "buying across state lines" won't work. HI is like any other insurance. The insurer is betting on how much their customers are likely to claim. Premiums are set based on risk factors and stats. That is no different than any other insurance. People who live along the Gulf Coast pay more for the "hurricane factor" on their home owner's insurance. It's not an exact science. Some people who live in that high-risk region have NEVER filed a claim as a result of a hurricane, while others, who live in a low-risk area, have. Best example of that was 2008 when Gustav and Ike wreaked havoc further inland, including in central and northwest Louisiana. Yet, because of stats, people in those parts of the state still pay less than someone who lives a little above Slidell who has NEVER filed a claim due to hurricane damage.

Louisiana residents pay higher for auto insurance simply because we live in Louisiana. Never mind that my wife and I have an absolutely clean record for 40+ years each! Some punk in Texas, who actually has a speeding ticket, or two, and maybe even was involved in an accident, pays less just because statistically, there is lower risk. (after a while, he does). (uninsured motorists contributes a lot to high premiums in LA.)

Point is, ALL other insurance types make risk assessments on regions and price their products accordingly. I would fully expect to pay a little more for HI because I live in Louisiana, which has the lowest life-expectancy in the nation (save for Mississippi), the highest cancer rates, etc...

We need:

1. tort reform
2. real competition
3. real choices for consumers

Numbers 2 and 3 depend on "buying across state lines."