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comment by jadedog
jadedog  ·  2602 days ago  ·  link  ·    ·  parent  ·  post: Why everyone hates the GOP's new healthcare plan

    The ACA was a mess, and the experiment failed. Costs went up, way up. Certainly there were more people covered, but in one of the only analyses of multiple streams of information and not just a survey, Goldman Sachs came to the conclusion that there were 17 million people insured by 2015. But, of those 17 million, 11 million were gains from the expansion of medicare. 2 more million were from aging into medicare. 3 million were the ones who actually purchased insurance that didn't have it before.

I'm trying to process your argument first. Your article talks about health care costs rising.

    Prices for medicine, doctor appointments and health insurance rose the most last month since 1984.

Correct me if I'm wrong here, but I'm pretty sure that ACA only dealt with the insurance part of it. The medicine costs and the doctor costs aren't regulated. Because of those rising costs, the insurance piece of it goes up.

In some ways, it may be because of the ACA that the costs went up. If more people have access to doctors, then more people went to the doctor and got medicine. If many of those people were sicker than anticipated, that might have driven up the costs of medicine and doctor's visits on an aggregate basis.

But then wouldn't that be a success for the ACA since those people are now going to the doctor when they wouldn't have? I'll grant you that I'm making up a scenario that neither of us can prove based on your data, but I don't think it can be shown that's not what happened either from this limited data.

    Goldman Sachs came to the conclusion that there were 17 million people insured by 2015. But, of those 17 million, 11 million were gains from the expansion of medicare. 2 more million were from aging into medicare. 3 million were the ones who actually purchased insurance that didn't have it before.

I didn't look at your data because Forbes has a script I don't want to pass. But I did look up more data sets to see if I could find other data.

Here's some from Urban Institute. as reported in CNN Money:

    Obamacare has made it easier for Americans to access health care when necessary. The share of adults who said they had to skip going to the doctor because of costs dropped by nearly 19% between 2013 and 2015, according to a new Commonwealth Fund report.

    Also, the Urban Institute issued a report Wednesday that found 4.4 million children could lose their coverage if Congress repeals but doesn't replace Obamacare. Some 88% of these children would be in families with working parents, and 54% would be white.

    The number of uninsured parents would rise by 7.6 million, with nearly 86% of them in families with at least one person working part time or full time.

    A total of nearly 30 million people would become uninsured if lawmakers repeal but don't replace Obamacare, according to Urban Institute. The repeal would do away with not only the individual exchanges, but also other provisions such as Medicaid expansion and letting children stay on their parents' health plan until age 26.

It's from an article from December 2016 in CNN Money.

According to the Urban Institue, 7.6 million parents could be uninsured, 4.4 million children and 30 million people total including the Medicaid expansion.

    So how many people who had pre-existing conditions and couldn't get insurance before actually got it as a result of ACA?

I'm not sure how your question about how many people have pre-existing conditions is relevant. Whether someone couldn't get insurance before because of cost or because of pre-existing conditions doesn't make much of a difference. They're still not covered and couldn't get insurance if the ACA is repealed.

Interestingly, the proposed plan leaves pre-existing conditions, so the estimates of people who could lose coverage are those people who can't afford it, presumably.

Edit: Just saw this . In a video by CBS News, the Brookings Institution estimates 15 million may lose coverage under Trumpcare as proposed at this point on 3/10/17.





user-inactivated  ·  2601 days ago  ·  link  ·  

The ACA was a huge attempt to control health care costs as well as increase access to care under the auspices that mass enrollment of healthy people would in turn lower the risk pool and thereby costs. It didn't happen, but that was one of the goals. Also, it helps to remember that the ACA was supposed to be straight up single-payer healthcare at the outset. This resultant thing is just a weird compromise that pays off the insurance companies.

So if it was up to me, children would be covered until 18 at least with a CHIPS-type program. It's a moral obligation to take care of those who can't take care of themselves for me. That would still leave the market to develop solutions and provide other options (which I don't think will look similarly to what we do now; it's unsustainable).

The reason I want to look at the pre-existing conditions question is that the number seems really really high when they say that 15 million people will be losing healthcare. And so when I started digging I found out that the number largely includes a huge expansion of Medicare which right off the bat included an 'increase' of 11 million people as insured. They're not really insured in the common understanding of the word, so it's misleading to say that they'll lose insurance coverage. They're just restructuring the medicare program and they'll lose access to that.

All in all, measuring insurance coverage is a ridiculous starting point. I don't want people to be insured. I want them to get the healthcare they need. In a perfect world for me that comes from the free market, but health care is a strange economy because as kleinbl00 pointed out, there is a disinterested, always paid third party in the room that just keeps raising prices without regard to what it does to the customers on either side. I think that has a lot to do with how hard it is to become a health insurer due to regulation (i.e. I can't start a health insurance company to compete due to huge and multiple barriers to entry even on a small town-level scale).

You see a simliar, thought not exactly the same by any means, argument in the internet side of things. People bitch about internet costs, and Comcast says you can go fuck yourself because they know you can't buy it from anywhere else due to regulation. Then you say fine, I'll start my own ISP with blackjack and hookers. And you can't, because Comcast has regulated monopolistic access to the wiring needed. And you can't, because Comcast lobbies to keep it that way. So you end up in a high-cost no competition situation where it would make sense for your city to start up an ISP and run it as a state-owned entity, giving the same people who fucked you over by cozying up to Comcast control over your internet access.

I don't think the government is my friend. I think they are in the pockets of a lot of people. I think that if I can remove them from my life as much as possible it increases my liability and risk personally, but that is a cost I am willing to pay. So I don't want them in healthcare.

jadedog  ·  2601 days ago  ·  link  ·  

    So if it was up to me, children would be covered until 18 at least with a CHIPS-type program. It's a moral obligation to take care of those who can't take care of themselves for me. That would still leave the market to develop solutions and provide other options (which I don't think will look similarly to what we do now; it's unsustainable).

If the ACA was not sustainable, then Trumpcare as drafted so far will also be unsustainable. They're basically the same system. The only difference is in the amount of tax credit and how much the insurance companies can charge.

In this video , rep. Tim Ryan says that in Ohio, the head of the Ohio hospital association says that 1 million people may lose their coverage under the new Trumpcare as drafted at this point and 25% of hospitals will close.

If it's unsustainable to have insurers pull out of the market, it will be less sustainable not to have hospitals to give care at all.

Looking at a study the GAO did that was released in 2013, the factors of the growth of health care costs are the aging population, more people seeking health care under the new insurance programs and technological advancements in health care.

    Federal health care spending is expected to continue growing faster than the economy. In the near term, this is driven by increasing enrollment in federal health care programs due to the aging of the population and expanded eligibility. Over the longer term, excess cost growth (the extent to which growth of health care spending per capita exceeds growth of income per capita) is a key driver. Slowing the rate of health care cost growth would help put the budget on a more sustainable path. There is general agreement that technological advancement has been the key factor in health care cost growth in the past, along with the effects of expanding health insurance coverage and increasing income, but there is considerable uncertainty about the magnitude of the impact that the different factors will have on future health care cost growth.

Neither the ACA nor the proposed Trumpcare plan touches on these issues.

Hoping the market would develop solutions on its own when the healthcare industry is a monopoly is unrealistic. There's no incentive for the market forces to work.

The similarity of health care to Comcast is that they're both monopolies. The difference is that people can walk away from their internet service. People cannot walk away from health care. Their lives literally depend on it.

    I don't think the government is my friend. I think they are in the pockets of a lot of people. I think that if I can remove them from my life as much as possible it increases my liability and risk personally, but that is a cost I am willing to pay. So I don't want them in healthcare.

I'm curious how far you go with this philosophy. In this video , Obama talks with Bill Maher (could Bill Maher be any more in love with Obama?) about all the ways that government has socialized a number of institutions. Schools, prisons, retirement (social security) and elder health care (medicare) are some examples. Are you willing to allow the privatization of schools and prison? As Obama notes, if prisons are privatized, there will be a bigger incentive to incarcerate people. If schools are privatized, the rich will become the only people who can afford going to school, creating an elite class and an uneducated one.

Are you in favor of privatizing schools and prisons?

You mentioned single payer health care which is basically government sponsored health care. Are you in favor of single payer health care? If so, wouldn't this be more government intervention, not less?