I hope this hasn’t been posted as I’ve tried to read most posts in this thread. It was determined that “Aetna tried to leverage its participation in the exchanges for favorable treatment from DOJ regarding the proposed merger”. This makes me sick!
http://www.latimes.com/business/hiltzik/la-fi-hiltzik-aetna-obamacare-20170123-story.html
Ugh, that’s truly disheartening.
In my state there is a “traditional” medicaid plan and some alternative options. I tried to read the website to understand the different plans and their coverage but could not make heads nor tails of it. And I know that if a person selects the traditional plan, it has no mental health benefits for someone over 21. I don’t know how anyone negotiates their way through this system.
"Trump’s budget director, Mick Mulvaney, also defended the Ryan plan on the Sunday show circuit by trying to draw a distinction between “care” and “coverage.” He suggested that the new law would lead to better, more affordable health care for most Americans even if fewer of them carry insurance.
“That’s what we’re trying to fix,” Mulvaney said. “Not coverage for people, not coverage they can afford, but care they can afford. When they get sick, they can go to the doctor. That’s what the Donald Trump plan is working on, and that’s where we think it is going to be wildly successful.”
See? It’s going to be great - the greatest in the world healthcare plan, in fact. So great you won’t even need insurance at all.
Did anyone see this from the WSJ? I don’t have a subscription, so I couldn’t read the whole article, but this quote is definitely trending on Twitter:
Call me crazy, but that’s not “care they can afford.”
^ The argument is - if you can’t figure out a way to pay for your insurance on your own - you are “choosing” not to purchase health insurance. It’s called “freedom.”
These people just need to stop buying IPads and their problem will be solved. At least that’s what I’ve heard.
This plan is based basically on the idea that somehow by cutting the subsidies for insurance (which it will, the age based subsidies are well below ACA) that doctors and health providers will suddenly be like WalMart and dollar stores and offer ‘lowest prices, guaranteed’ for health care, they think that their ideas are going to promote market competition that will bring the prices of health care down like TV’s have become so cheap. I think (and it is only my opinion) that they think that if people really feel the pain of health care, they won’t “overuse it”, which has been a common claim, that because it is ‘cheap’ all these people are doing all kinds of expensive care because, hey, doesn’t cost them anything (I wonder if anyone believing that has actually had to deal with health insurance plans, with all the copays and deductibles and insurance companies deciding ‘that isn’t appropriate care’ and refusing to pay…).
The idea of acess that is being floated around, from trying to read between the lines, is that the subsidies will allow people to buy insurance that basically pays for routine medical costs (which at the level they are talking about, is likely all it will cover), so they will go to the doctor for preventative care and won’t need expensive treatments. While there is some truth that with uninsured people, that conditions tend to get much, much worse before the people get care, but basing a health care plan on this is statistically unsupported, a lot of the people who end up with expensive medical care have health insurance and still get sick. The supporters also claim that facing huge medical bills with major illness would be a ‘deterrent’ to bad lifestyles so people would have incentive to be healthy…It is one thing to try and come up with a plan to try and make people more mindful of the causes of sickness, especially with nutritiion and lifestyle things, and another to basically say “hey, you get really sick, it is your fault, you are on your own”.
One of the most glaring things is this plan will cut the cost to the government of health care in the sense of subsidies and medicaid, but it does nothing to try and work on the other side, making people healthier. One of the reasons that poor people have such bad health is not just access to health care, it is that being poor their choices in food are limited, and the cheapest food out there is some of the worst for you. Cheap processed food, thanks to things like the corn subsidies (cheap HFC that is in everything), cheap meat raised on corn and antibiotics, cheap bread loaded with sugar and other crap, the relatively high price for fresh fruit and vegetables leaves those who are poor with unhealthy choices in food, canned food, processed food, etc (take a look sometime at the good choices in a dollar store), and you get an idea of why poor areas tend to have much more sickness IMO. Among other things, I doubt very much you will see the subsidies for corn farming go away, I doubt very much there will be attempts to finally ban tobacco, or to ban the practice of pumping beef full of hormones and antibiotics to make them grow faster, or to regulate processed food to stop them from loading it with sugar and salt to make cheaply produced food palatable.
i also wonder about the impact of this on people with traditional plans, I suspect you will see price inflation returning to pre ACA levels, but that remains to be seen (and despite the myth, increases in health insurance were much, much larger across the board before ACA then after).
I just finished reading “Hillbilly Elegy”. Like his mother and her drug addiction, really bad choices like starting to use drugs and becoming addicted were all on her. His aunt did not make these bad choices and had a much better life. His mother went to drug treatment therapy, which his grandmother paid for, but it did not good at all. She went right back on heroin. Lost multiple jobs, multiple husbands. Basically a life out of control.
So what is a government healthcare policy supposed to do about this? Bad choices like drug or alcohol or tobacco addiction do cause many healthcare and other problems. Stemming the flow of drugs over the border could help. Raising taxes on alcohol and tobacco even more than they are now could help. Finding some sort of magic pill to rewire the brain to no longer want drugs, alcohol or tobacco could help. But is any such thing even on the horizon of medical breakthroughs?
33% of Californians are currently on Medi-Cal, California’s version of Medicaid. Due to this huge number, the state has cut reimbursements to doctors and pharmacists and hospitals and has some of the lowest compensation levels to providers in the nation. So providers limit how many Medi-Cal patients they can afford to take. Without providers, those on Medi-Cal have to use the ER. And the cycle of rising expenses continues. How much of the medical problems of this 33% are due to the bad choices they made on drugs, alcohol and tobacco?
Part of my point about whether “the mentally frail elders” would get hospitalization was that this is yet another issue that just doesn’t affect the wealthy in ways it affects others. Mr and Mrs Money Bags can pay for care for that relative. It may not be preference, but they can move in some direction, pay for insurance/co-pays, home care, AL, etc. They have options. The assumption seems to be the poor (or even not-so-poor) will just bundle on top of each other, like in olden days. Maybe these decision makers envision “poor houses,” like in Victorian times.
I worry about good people, squeezed and squished by the realities. Of course there are slackers. But you don’t tool people out of medical attention because you can point to some who don’t mind their health, don’t work by choice, abuse drugs, cigarettes, etc.
This was being discussed a few pages back, but I wanted to note another reason businesses (especially smaller organizations) offer health insurance to employees: the proprietor/boss also needs to get health insurance somewhere, and it makes more sense for him to get an employer-provided plan than to buy an individual plan.
Here’s one article about what will happen to the many folks with pre-existing conditions who may wish to purchase medical insurance on the individual market–no insurance to purchase!
via npr: How Will People Who Are Already Sick Be Treated Under A New Health Law? http://n.pr/2n72XyS
No, but according to the GOP spin, this is about freedom, it’s their choice. They choose to live so long to be age 62… They choose to earn so little. And they will have plenty of choices for cheaper coverage - they can also choose to earn more income and they can choose to move to cheaper parts of the country. And most importantly, they can choose to be uninsured.
As in any good problem-solving, you want to focus on solutions to the core problems, themselves, not simply the symptoms. If MediCal or Medicaid costs too much, don’t just cut the budget, get to the heart of the reasons, in the first place.
I don’t think we’ll learn how much is “due to the bad choices they made on drugs, alcohol and tobacco.” But to assume it’s a major chunk is to close your eyes to some of the very real economic hardships out there- working people not earning enough, people facing life situations beyond their control. It’s too easy to point to the fat and stupid and pretend that’s all it is. And suggest that everyone should be penalized because you’re certain the FaS are the ‘all and only’ of the problems. Look around you.
@lookingforward:
Thank you, you wrote in a couple of paragraphs what I struggled to write on my own. Besides the obvious factor, that ‘shaming people’ or dropping them from health insurance because they are too fat/lazy/smoke/drink etc is the old victorian Benthalmite crap, the other problem like most health care solutions is it focuses on the people and blame them for forces larger than themselves. It is a lot easier to blame drug use on individual weakness or alcoholism, rather than looking at the reality of these people’s lives, one of the things that has happened to rural America is that economically and socially they are resembling what many used to point to in the inner city among minorities as evidence that ‘they’ are to blame for ‘their problems’, suddenly in the farm belt opiate addiction is at crisis levels, people are facing economic dark times, feeling helpless, and issues like obesity are being seen there because of the same issues we see in the inner city, that the cheapest food is basically garbage.
The real problem is instead of looking at what is causing these health care issues, we have ‘it is their fault’. Employers whine about the cost of health insurance, yet they are at least in part to blame with what has happened, workers in the US are working harder and longer each week than they did a generation ago, and that trend is upwards, which leads to people not having time to exercise, grabbing food on the run and so forth, yet employers see this kind of overload as "increasing productivity’, then whining when they pay the cost. We may not subsidize tobacco farming (supposedly, I would bet there is a lot of back door financing through state transfer of block grants), but as a country the federal government has done little to try and suppress smoking, the way states have, and we still have legal advertising of tobacco products, sports sponsorships, etc. Nutritionally, junk food is cheap primarily because of government subsidies for things like corn and meat, that cheap corn leads to HFC being used as filler in many packaged goods,and cheap meat raised on corn and raised on hormones and anbtibiotics gets fat fast, but nutritionally is horrible, not to mention the crap that the FDA and other regulatory agencies allow in food.
The biggest problem I have with such ideas is forgetting 'there but for the grace of god go I", many of those now facing the scourge of economic dislocation we are talking about, drugs, alchoholism, breakdown of the family, poor eating habits, a generation or two ago said the same thing about the problems of the inner city poor.
If we really want to reign in health care costs it won’t happen from denying people coverage, it will be about the efficient delivery of health care that focuses on not just preventive care, but a whole society dedicated towards making sure people have the right foods to eat at a price they can afford (our current system is in fixing disease and problems after they happen), it is in making sure we don’t leave 10’s of millions behind in the name of economic progress, it is in how we provide medical care as well, where doctors and other providers make more keeping us health than in treating us when we are sick, so we don’t need expensive medicines, hospitals, MRI clinics, medical labs, etc, making sure that people have access to basic medical care and not have to worry about paying for it…unfortunately that is a star trek world, it is a lot easier to blame people then to try and fix the real problems.
Of course, bad choices aren’t the only things to blame. But it’s also patronizing to say "'you are not to blame (for being a drug addict or alcoholic) or “you can’t help yourself”.
"Of course, bad choices aren’t the only things to blame. But it’s also patronizing to say "'you are not to blame (for being a drug addict or alcoholic) or “you can’t help yourself”.
Wait what?
You just said the out of work coal miners are not to be blamed for their bad choices that now have them on the brink of losing not only their health insurance, but their retirement health benefits and their pensions. They had an alternative.
“Not coverage they can afford, but care they can afford?” What does that even mean? My surgery is suddenly cheap? Can someone explain?
Yes, if care is the $35 PA in a box at pharmacies where you can get your cut bandaged but no care for chronic conditions. No coverage for conditions and surgeries that can bankrupt the patient and hospital.
So “care you can afford” means you get ONLY the care you can afford to pay for?
There is a special corner of hell waiting for these people.
LA Times a few weeks ago talking about how the doctor you see in the ER can impact your chances of becoming an opioid addict:
I’m sure there are plenty of people whose oxycotin addiction is the result of their own poor choices. Just like there are others whose addiction is due to bad luck. I’m totally in favor of reducing the factors that contribute to either cause of addiction. In the meantime, there are still folks who are addicted.