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GOP Healthcare Plan is a Liberal Conspiracy. Follow

#1 Mar 09 2017 at 6:08 PM Rating: Decent
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Thanks Trump voters, I really appreciate this gift.
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#2 Mar 09 2017 at 7:01 PM Rating: Good
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I'm curious about their methodology though. The key bit I could garner was that the Obamacare subsidy varies by geography and premium rates, while the Trump plan is a flat tax credit based on age. Given that one of the problems with Obamacare was that it resulted in significantly increased premiums, the on paper value of the subsidies will appear inflated (um... but are also one of the components of the "death spiral" that has made this program untenable in the long run). Comparing those inflated costs to more normal ones is unfair at the very least.

If, as a result of changing incentives and payment structures, premiums return to more normal numbers, than those projected cost benefits disappear. Ironically, what this map is really measuring is how much of a problem cost overruns are under Obamacare. It relies on the somewhat bizarre assumption that spending more dollars is always better. Making this a tax credit (presumably tied to actual health expenditures over a year), makes the program more efficient since it focuses dollars on where they are actually needed, and in theory creates at least some incentive to keep costs low. The subsidy program in Obamacare was more or less "we're giving you this amount to pay for your health insurance, whether you need it or not, or whether you use it or not". Which was basically a free gimme to the health industry and provided them incentives to find ways to artificially increase costs (the higher the costs, the bigger the subsidy, and thus the more money they could make for the same health care).

The negotiations on the bill are still ongoing, and I'm sure there are still many changes to make. I have no clue how good or bad the result will be, but one of the things I did find amusing was the degree of media coverage about "Divisions in the GOP" over healthcare. Um... What you're seeing right now is healthy debate about a bill. They're actually doing what they complained about the Democrats not doing. They're reading the bill. Then debating the bill. Then making changes to the bill. That's a huge contrast to Democrats who were told by their leadership to just put their heads down and support whatever came out of committee, and don't worry about bothering to read it or debate it.

This is actually how the process is supposed to work, yet somehow it's being painted as a negative. Funny.
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#3 Mar 09 2017 at 8:32 PM Rating: Good
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gbaji wrote:
The negotiations on the bill are still ongoing, and I'm sure there are still many changes to make

Er, no. They're ramming the bill through committees because the negotiations aren't ongoing and they're trying to force this bill through as soon as possible. They know that a delay and debate on it will be deadly for their chances of getting it passed. Ryan is pressing the Senate to pass it as is instead of passing their own bill.

Now, it might end up where this bill fails and they're forced to come up with something new but that's not the plan or intent.
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#4 Mar 09 2017 at 9:22 PM Rating: Good
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Jophiel wrote:
Now, it might end up where this bill fails and they're forced to come up with something new but that's not the plan or intent.
Let's Select Your Adventure this. "It won't fail because --"
corrupt liberal media is lying about it and it's actually perfect.
corrupt liberal politicians are lying about it and it's actually perfect.
corrupt liberal analysts are lying about it and it's actually perfect.
corrupt liberal doctors and insurance companies are lying about it and it's actually perfect.
corrupt people pretending to be conservatives are lying about it and it's actually perfect.

There, I just saved you five pages.
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#5 Mar 10 2017 at 11:04 AM Rating: Excellent
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Maybe I'm missing something, but I don't see how this new plan lowers health care costs. I mean, wasn't that supposed to be the point of all this legislation? Or has that gotten lost over the years? Seems like they're basically keeping the same broken program, just fiddling with some of the details a bit.
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#6 Mar 10 2017 at 11:28 AM Rating: Decent
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someproteinguy wrote:
Maybe I'm missing something, but I don't see how this new plan lowers health care costs.
You're not missing it, the price tag and all the analysis have been conveniently left out.
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#7 Mar 10 2017 at 12:59 PM Rating: Excellent
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lolgaxe wrote:
someproteinguy wrote:
Maybe I'm missing something, but I don't see how this new plan lowers health care costs.
You're not missing it, the price tag and all the analysis have been conveniently left out.
Yay for democracy! Smiley: yippee

I mean, I know it's not a "finished product" or whatever, but I'd still feel more at ease if there was some serious backlash from the industry on this one. Many of the "no comment" and otherwise neutral responses from the health care companies lead me to believe they're not really doing much to address the excess bloat in the system.

Edited, Mar 10th 2017 11:01am by someproteinguy
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#8 Mar 10 2017 at 1:03 PM Rating: Good
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someproteinguy wrote:
Seems like they're basically keeping the same broken program, just fiddling with some of the details a bit.

Right, but now instead of a "coverage mandate", we have a "conditional tax credit".

Totally different!
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#9 Mar 10 2017 at 1:08 PM Rating: Excellent
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You mean Obamacare will be 90% enshrined by Republicans who will now bear 100% of the blame for every rising premium or increased MRI bill?

The system works.
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#10 Mar 10 2017 at 1:27 PM Rating: Excellent
Smiley: thumbsup
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#11 Mar 10 2017 at 1:32 PM Rating: Decent
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I hear that the man who will do just about anything to get his named placed in gold letters on buildings, steaks and a fake university, is objecting to calling the GOP healthcare plan "Trumpcare."

Think about it.

Even the idiot in chief thinks this is a bad plan, while pushing for it's passing.
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#12 Mar 10 2017 at 2:06 PM Rating: Excellent
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"TrumpCare" is an oxymoron anyway.
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#13 Mar 10 2017 at 2:15 PM Rating: Decent
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I like what Ryan Williams is saying about it, that it's the "care" part that sounds bad to people.
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#14 Mar 11 2017 at 11:19 AM Rating: Decent
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Samira wrote:
"TrumpCare" is an oxymoron anyway.


I think it's just one of those phrases that you can only use ironically.
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#15 Mar 11 2017 at 11:19 AM Rating: Good
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Xsarus can you mod me so I can delete my own constant double posts?

I swear I won't abuse my power.

Heh, that's another one of those phrases. Good thing Xsarus can't read anything in small text.

Edited, Mar 11th 2017 12:24pm by Kavekkk
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#16 Mar 11 2017 at 12:28 PM Rating: Excellent
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Xsarus can you mod me so I can delete my own constant double posts?

I swear I won't abuse my power.

Edited, Mar 11th 2017 12:24pm by Kavekkk

I'll get right on that, since you promised!
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#17 Mar 13 2017 at 5:24 PM Rating: Good
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someproteinguy wrote:
Maybe I'm missing something, but I don't see how this new plan lowers health care costs. I mean, wasn't that supposed to be the point of all this legislation? Or has that gotten lost over the years? Seems like they're basically keeping the same broken program, just fiddling with some of the details a bit.


Isn't finalized yet, but based on the bullet points the GOP wants, here's a few:

1. Removes the mandates for coverage. Meaning, you can choose to only cover things you think you'll need instead of "everything". This, by itself, is a major point of cost savings, since the introduction of such is what caused premiums, co-pays, etc to sky rocket to unsustainable levels under Obamacare. You could literally just roll that back and do nothing else and costs to consumers will go down.

2. If they can put in changes to allow purchase of insurance across state lines, this may also reduce costs. In many states, there's may only be one or two insurers, in some just one, and now thanks to Obamacare, some states are heading in the direction of having *none*. Creating competition is always a good thing. How much this may reduce costs is unknown, but if implemented, it at least could do so.

3. Tort reform. This has been an issue for the GOP all along. Again, there's some question as to whether they can get this put in, but this can be a huge cost increase for care. Health care providers are basically faced with choosing between over covering or risking lawsuits if someone get sick because they failed to do that extra test or check for that extra thing. And the extra coverage is easier to just pass right into the insurance system and back to the consumer, so that's often what they do.

Those are just three right off the top of my head. A number of other elements are possible as well. Again, just removing many of the mandates and regulations put in place by Obamacare can reduce costs. Changing *where* the coverage gaps are can make a huge differences as well. I suspect that one of the big problems with the ACA was that it attempted to eliminate the coverage gap (point where government subsidies don't cover enough, but the person can't afford to make up the difference themselves). The problem is that all it did was push that gap upward in the economic system. Which, ironically, meant that instead of an earnings pool made up mostly of single people in their 20s with no children being in the gap, it became an earnings pool mostly made up of working class families. As you shift money to pay more in subsidies to fill the gap, that results in a cost increase to everyone who was previously above the gap, and some of them will have some combination of employers dropping their coverage and themselves being no longer able to pay out of pocket for insurance. Combine that effect with coverage mandates which *also* increase costs, and the result is a large gap in coverage at a higher economic level.

Which is "BAD". Just undoing that helps out a ton.
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#18 Mar 13 2017 at 6:46 PM Rating: Excellent
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Plus the CBO says that 24,000,000 people will lose their insurance by 2027 under the GOP plan. Think of all the money we can save by having them die!
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#19 Mar 13 2017 at 7:13 PM Rating: Good
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Jophiel wrote:
Plus the CBO says that 24,000,000 people will lose their insurance by 2027 under the GOP plan. Think of all the money we can save by having them die!


By 2027?! Um... Seriously? You'll have to forgive me for taking that figure with a massive grain of salt.

I'm also curious what they're actually measuring here (seems like a recurring theme here, like "jobs created or saved"). Are these people who will no longer be under the exact same insurance provider in 10 years as they are today? Um... Is that unusual? I have no clue. Is this just counting people who are insured today, but who wont be in 10 years? Ok. Does that include people who are, you know, going to die of old age in the next 10 years, even with health care the whole time (I would assume they aren't counted in this, but you never know). Or is it counting the total number of people in our population today who are insured and then comparing it to some hypothetical number in 10 years and then doing subtraction? Er... Again, how do they know?

The problem with CBO calculations (as I've pointed out for years and years on a number of different topics), is that they have to calculate based on the assumption that the same actions are taken after a legal change as they are before that change. They treat everything as zero sum. If the bar for assistance dollars changes by X amount, they assume that everyone who was below the bar before, but now is above it, can't afford the thing it was providing. They assume that every dollar taken away or added to some program has the same weight as the dollars currently there. But the act of changing these things changes how the results are calculated. In many cases, that's precisely the reason for making the change.

Heck. It could be as simple as the GOP saying that if we remove the mandates, we will drive down the cost to employee people, which will result in greater hiring, which will result in greater economic growth, which, over the next ten years, will result in more people being employed in higher paying jobs, and thus being able to afford health care directly. Without a single dollar of assistance. That's a calculation that the CBO can't do though. It has to assume the same exact stratification of economic conditions across the population. Again, this is why they were so wrong with the scoring for the ACA. Their numbers assumed a similar rate (or a return to rates) of GDP growth, employment, etc that we enjoyed prior to the 2008 crash. Except that we didn't get those growth numbers. Not even remotely close. And at least some of that lack of growth was directly attributable to the passage of the ACA itself.

It's the same age old issue. Democrats tend to want to treat the symptoms of problems, while Republicans want to fix the problem itself. Where the CBO scoring fails is that it can't calculate "more people making more money" into its equation. And it also can't calculate "more people making less money" either. So yeah, I'm going to assume they're just as wrong with this calculation as they were with the ACA itself.
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#20 Mar 13 2017 at 7:35 PM Rating: Decent
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If you didn't take everything with so much salt, you wouldn't be such a salty motherfucker.

Just accept that conservatives are evil subhumans and that liberals are perfect. Why do you have to be so stubborn?
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#21 Mar 13 2017 at 7:48 PM Rating: Excellent
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gbaji wrote:
Jophiel wrote:
Plus the CBO says that 24,000,000 people will lose their insurance by 2027 under the GOP plan. Think of all the money we can save by having them die!

By 2027?! Um... Seriously? You'll have to forgive me for taking that figure with a massive grain of salt.

Ignoring inconvenient stuff is kind of your forte so you're forgiven.

People who championed Ryan's "I had the Heritage Foundation score it!!" budget lose the right to comment about the CBO Smiley: laugh
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#22 Mar 13 2017 at 8:07 PM Rating: Decent
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What other rights do you want to take away from the American people, Jophiel? Will there be any rights left, after your kind are through?

I thought not.
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#23 Mar 13 2017 at 8:49 PM Rating: Good
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Jophiel wrote:
gbaji wrote:
Jophiel wrote:
Plus the CBO says that 24,000,000 people will lose their insurance by 2027 under the GOP plan. Think of all the money we can save by having them die!

By 2027?! Um... Seriously? You'll have to forgive me for taking that figure with a massive grain of salt.

Ignoring inconvenient stuff is kind of your forte so you're forgiven.


Well, let's start with the accuracy of the CBO scoring of the ACA, shall we? Or is that a bit too "inconvenient" for you.

Ironically, that score was wrong for the exact same reasons I just spoke of. And those reasons were brought up by conservatives at the time, and also ignored then. It's almost like you'd think that in a sane world, you'd start realizing just how often conservatives are right about these sorts of things, and the liberals are just plain dead wrong.

Quote:
People who championed Ryan's "I had the Heritage Foundation score it!!" budget lose the right to comment about the CBO Smiley: laugh


While you're at it, how about people who defended the birther movement for years? They lose the right to comment about it too, right!

You're not even aware when you do this, are you?
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#24 Mar 13 2017 at 10:19 PM Rating: Good
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The White House's own estimates are 26,000,000 -- so I guess you got the CBO there!

Spend more time whining about how "don't even know I'm doing this" to cover for your basic lack of facts and usual flailing to try and defend the GOP Smiley: laugh
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#25 Mar 13 2017 at 11:24 PM Rating: Good
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Kavekkk wrote:
If you didn't take everything with so much salt, you wouldn't be such a salty motherfucker.

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#26 Mar 14 2017 at 7:24 AM Rating: Decent
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Jophiel wrote:
The White House's own estimates are 26,000,000 -- so I guess you got the CBO there!
The best part is that the first 14m to lose their insurance will be by 2018 is a little detail that seems to be lost by both sides of the argument. Well, that and how in the decade of being told just how much better the GOP plan was for "the people" this is what they came out the gate with.
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#27 Mar 14 2017 at 7:55 AM Rating: Excellent
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Quote:
While you're at it, how about people who defended the birther movement for years? They lose the right to comment about it too, right!

Well, I thought the Ryan budget was more appropriate since it was directly about scoring legislation and how you insisted that it was valid scoring despite its ludicrous results. But, yeah, your Birther nonsense does help show a pattern of accepting any sort of inanity if it makes you feel better politically. So, sure, I'll accept it Smiley: thumbsup
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#28 Mar 14 2017 at 10:03 AM Rating: Excellent
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gbaji wrote:
1. Removes the mandates for coverage. Meaning, you can choose to only cover things you think you'll need instead of "everything". This, by itself, is a major point of cost savings, since the introduction of such is what caused premiums, co-pays, etc to sky rocket to unsustainable levels under Obamacare. You could literally just roll that back and do nothing else and costs to consumers will go down.
Premiums have been steadily rising for the last several years. You can't even spot on the graph where Obamacare starts: linky linky. It rightly deserves criticism for not doing anything about the rise in healthcare costs, but that's just it, Obamacare didn't really do anything. It basically just kept the status quo, doing little beyond making people sign up for the broken system. Hence the reason it was so heavily supported by industry. Hence the reason it got passed.

gbaji wrote:
2. If they can put in changes to allow purchase of insurance across state lines, this may also reduce costs. In many states, there's may only be one or two insurers, in some just one, and now thanks to Obamacare, some states are heading in the direction of having *none*. Creating competition is always a good thing. How much this may reduce costs is unknown, but if implemented, it at least could do so.
I'm generally in support of this idea. The market could use more competitiveness. I'm still probably more concerned about the rise of the health care networks, the limited selection of treatment facilities in many locations, and the diffused personal costs through insurance. Buying insurance from Wisconsin to use in Vermont isn't going to matter much if virtually every health care provider in Vermont is part of a different network. These sweetheart deals between drug manufacturers, providers, and insurance companies need to be addressed or all the "competition" in the world isn't going to help out. Right now the established industry members are in a position to easily kick out any "competition" because the barrier to entry is so high.

gbaji wrote:
3. Tort reform. This has been an issue for the GOP all along. Again, there's some question as to whether they can get this put in, but this can be a huge cost increase for care. Health care providers are basically faced with choosing between over covering or risking lawsuits if someone get sick because they failed to do that extra test or check for that extra thing. And the extra coverage is easier to just pass right into the insurance system and back to the consumer, so that's often what they do.
Again something I'm generally supportive of, but I'm not sure it'll make a big difference in many places, as many individual states have stepped into this gap already. But, I've yet to know the details yet either, so maybe there's something good in there somewhere I'm not aware of. Some more universal limits on malpractice damage caps, extent of liability for data breaches, etc would be welcome regardless. These are major policy drivers at our hospital, and even high caps on damages help with the insurance costs. Insurance providers will not hold back the charges if there's the potential for unlimited liability.

gbaji wrote:
Again, just removing many of the mandates and regulations put in place by Obamacare can reduce costs. Changing *where* the coverage gaps are can make a huge differences as well. I suspect that one of the big problems with the ACA was that it attempted to eliminate the coverage gap (point where government subsidies don't cover enough, but the person can't afford to make up the difference themselves). The problem is that all it did was push that gap upward in the economic system. Which, ironically, meant that instead of an earnings pool made up mostly of single people in their 20s with no children being in the gap, it became an earnings pool mostly made up of working class families. As you shift money to pay more in subsidies to fill the gap, that results in a cost increase to everyone who was previously above the gap, and some of them will have some combination of employers dropping their coverage and themselves being no longer able to pay out of pocket for insurance. Combine that effect with coverage mandates which *also* increase costs, and the result is a large gap in coverage at a higher economic level.
I'm all for doing something about the burden mandated insurance has on people. I'm not convinced however, that removing the mandate is really the answer. Yes, you've made it so that people don't have to sign up for the broken program, but on the other hand you're basically leaving that same program alone otherwise. You're not really fixing the problem, so much as admitting the system is broken. Making people sign up for a bad deal is bad, but plenty of other people are still forced to sign up for it, or go without insurance; which really isn't a good option either.

You'd be better off actually doing something to reform the system much more heavily. The fact that people would rather be without insurance says a lot in and of itself about American health care. The thing is, I don't hear (and maybe this is my bad for not paying attention) people talking about addressing major cost drivers. What I see in the Republican plan is more lip service to the politically convenient talking points (more free-market, less handouts, less regulations, etc). The health care companies don't care much either way if this passes, you don't see them lining up for or against it, because it's doubtful it's going to affect their profits much. That isn't surprising because Obamacare didn't change much for them either, so even a "full repeal" of Obamacare isn't going to do anything but keep the status quo a while longer. They're perfectly willing to continue lining their pockets while simply paying off a different political party.

If you want to fix the cost issue you have to address the power structure. The power to set price points needs to be in the hands of the consumer, not the provider. Right now that's not the case. Sure it's partly a competition thing, there's limited hospitals, limited drug manufacturers (with monopolies over certain drugs), limited insurance providers, etc. You can also use the government: break-up health care networks, do something about pharmacies making deals with drug providers, hospitals, insurance providers, etc. You'll need to address end-of-life care costs to fix the problem, which is trickier. Making people cover their end-of-life costs more out of pocket will never be popular, but those expensive treatment options are much easier to swallow when everyone else is paying the majority of the bill. Until things like that happen, you're just going to be fiddling around with small changes. You're maybe getting costs to increase 90% of what they would have otherwise, in exchange for kicking some poor people out of the system.

Anyway, TL;DR, it seems like more of the same. People will get up in arms about families being punished by the mandate, or poor people who might be losing coverage, but otherwise all I see is just one more party paid off by the health care industry.

Edited, Mar 14th 2017 9:35am by someproteinguy
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#29 Mar 14 2017 at 10:41 AM Rating: Excellent
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"Selling across state lines" just means buying from the state with the least amount of regulations or protections. Most of the major insurance companies are national or regional already so you already have the option of buying from them in your own state. And, as mentioned, there's little reason for a hospital or small practice in North Dakota to accept insurance from Oregon in their network -- a fact which probably won't come up when Humana Oregon is hard-selling their product for $50/mth cheaper than your current plan.
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#30 Mar 14 2017 at 1:26 PM Rating: Excellent
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Jophiel wrote:
"Selling across state lines" just means buying from the state with the least amount of regulations or protections. Most of the major insurance companies are national or regional already so you already have the option of buying from them in your own state. And, as mentioned, there's little reason for a hospital or small practice in North Dakota to accept insurance from Oregon in their network -- a fact which probably won't come up when Humana Oregon is hard-selling their product for $50/mth cheaper than your current plan.
Don't worry it'll be mentioned in the fine print somewhere. Smiley: nod

Anyway, along with that ridiculous rant above, I probably should casually mention we have the baby boomer generation starting to die off now as well. They're going to be placing a high demand on health care services over the next 20 years or so, which will probably blunt any serious attempts to keep premiums low. Politicians are going to be making a living going back and forth over this for the next couple of decades. This generation's abortion issue I guess.

Oh well, it'll likely be entertaining at least.

Smiley: popcorn

Edited, Mar 14th 2017 12:27pm by someproteinguy
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#31 Mar 14 2017 at 1:29 PM Rating: Decent
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someproteinguy wrote:
They're going to be placing a high demand on health care services over the next 20 years or so, which will probably blunt any serious attempts to keep premiums low.
Clearly they should have invested in their healthcare instead of getting old.
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#32 Mar 14 2017 at 1:48 PM Rating: Excellent
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lolgaxe wrote:
someproteinguy wrote:
They're going to be placing a high demand on health care services over the next 20 years or so, which will probably blunt any serious attempts to keep premiums low.
Clearly they should have invested in their healthcare instead of getting old.
Why not both? Get yourself on a couple different state's retirement plans, get free medical insurance coverage, get your federal retirement stuff going, then go back to work part time in a cushy part-time job consulting or whatnot.

Seriously, those retirement plans of 40 years ago... Smiley: glare

Edited, Mar 14th 2017 1:02pm by someproteinguy
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#33 Mar 14 2017 at 5:12 PM Rating: Good
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Jophiel wrote:
The White House's own estimates are 26,000,000 -- so I guess you got the CBO there!

Spend more time whining about how "don't even know I'm doing this" to cover for your basic lack of facts and usual flailing to try and defend the GOP Smiley: laugh


or maybe just "read the article you linked":

Quote:
“This is not an analysis of the bill in any way whatsoever,” White House Communications Director Michael Dubke told POLITICO. “This is OMB trying to project what CBO’s score will be using CBO’s methodology.”


Despite this, the article writer continues to label this a "White House analysis". So I guess he didn't read his own article either!
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#34 Mar 14 2017 at 6:42 PM Rating: Good
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someproteinguy wrote:
Premiums have been steadily rising for the last several years. You can't even spot on the graph where Obamacare starts: linky linky. It rightly deserves criticism for not doing anything about the rise in healthcare costs, but that's just it, Obamacare didn't really do anything. It basically just kept the status quo, doing little beyond making people sign up for the broken system. Hence the reason it was so heavily supported by industry. Hence the reason it got passed.


There's more to the cost of health care than just premiums though. Deductables and co-pays have gone up, and coverage points have gone down (the dreaded doughnut hole). I wish I'd saved the paperwork they sent me back in like 2012 or whenever that outlined the changes in my plan, but it was literally double on everything, and half the coverage limit. It was almost laughable how much worse it was.

So Obamacare not only didn't fix the basic cost of buying the health insurance in the first place, it also made the additional costs increase as well, while limiting health care choices (in some cases, dramatically). Almost no-one was actually able to "if you like your current doctor you can keep them". Tons of people had their health provider shifted around against their wills, or were tossed off their care and put on public exchanges, and those kept getting shuffled around as the states scrambled to find insurers willing to accept what the states could afford while still staying in business (and tons of them just pulled out of some regions anyway). Which left a lot of the costs passed onto state taxpayers, which you kinda wont find on the federal cost analyses.

It would have just been a bad idea if all it had done was nothing, while imposing additional restrictions and requirements on both purchasers and sellers in the health care market. That it did that *and* made the result even more expensive for most people? Horrifically bad. Hence why just returning us to what we had back in 2009 would be an improvement, even if the GOP can't manage to make any other change at all.

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I'm generally in support of this idea. The market could use more competitiveness. I'm still probably more concerned about the rise of the health care networks, the limited selection of treatment facilities in many locations, and the diffused personal costs through insurance. Buying insurance from Wisconsin to use in Vermont isn't going to matter much if virtually every health care provider in Vermont is part of a different network. These sweetheart deals between drug manufacturers, providers, and insurance companies need to be addressed or all the "competition" in the world isn't going to help out. Right now the established industry members are in a position to easily kick out any "competition" because the barrier to entry is so high.


That's part of the issue though. That they have exclusive deals is because of state regulations which protect the "local" industry. If you get rid of that then the health care providers in Vermont can't deny payment from a health insurer from Wisconsin. Heck. Imagine if we managed to break these monolithic health care organizations entirely? You really could pick your doctor and keep him/her, because you'd no longer be required to use health provider A in conjunction with health insurer A, health provider B with health insurer B, etc. That's somewhat of an unholy alliance the way they do that anyway, and something that Obamacare failed to address at all.

And yeah, that is at least partly what causes (and has been for some time, not just because of the ACA) increased premiums over time. There's just no incentive for any player in the game to keep costs low, when they know that the cost to change services is high (or in some regions, impossible).

There's a lot of area for improvement here. And I'll be perfectly honest, that's not the ACAs fault, except to the degree that it didn't address this at all (and arguably made things a bit worse given the contraction of provider options since its passage). This was a major component that the GOP argued for back in 2009, but were more or less ignored (I guess the narrative that the "GOP has no alternative ideas" was more powerful and useful to them than, maybe actually listening to the GOP ideas and perhaps even implementing them).

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Again something I'm generally supportive of, but I'm not sure it'll make a big difference in many places, as many individual states have stepped into this gap already. But, I've yet to know the details yet either, so maybe there's something good in there somewhere I'm not aware of. Some more universal limits on malpractice damage caps, extent of liability for data breaches, etc would be welcome regardless. These are major policy drivers at our hospital, and even high caps on damages help with the insurance costs. Insurance providers will not hold back the charges if there's the potential for unlimited liability.


The tort reform is more in the area of punitive IIRC (it's been a while since I did research on the subject, so you'll have to bear with me here). It's one thing to assess a cost in damages to a patient based on a mistake, misdiagnosis, etc. It's a whole different thing when a jury decides to award a massive settlement in some class action suit, where the primary beneficiaries of the suit are the lawyers, with the massive number of folks in the class action getting maybe a few dollars. I don't know if you've noticed this, but one of the more amusing aspects of watching late night cable is all of the commercials advertising for some new drug or treatment for <insert whatever here>, followed by another ad for a lawsuit for everyone who "if you or a family member used <X> and suffered <Y>, call the law officers of <Z>", where <X> is the new drug or treatment they were advertising 6-12 months ago on the same channel.

It's like a never ending cycle. And again, none of the players have any real interest to stop it because they're all making money anyway, since they can pass the costs on to the consumers. And frankly, this has gotten worse under Obamacare, since the mandates effectively guarantee a market for any crappy drug or medical device that comes down the pipe. Oh. Because the third commercial you'll see is how you can qualify for a free <insert something here> under the Affordable Care Act. And that's a form of the red-green game in action. Everyone knows it's hurting them, but each player does it anyway. I have a friend who rails about the ACA all the time (for many of the same reasons I do). But guess what? When he got something in the mail telling him he was qualified for a free back brace or whatever, he filled out the form and got it. His thinking? He's already paying the higher premiums and other costs for his health insurance now, so he may as well "get his money's worth".

Which is dumb, right? But that's how people play the game when you set up the rules like that. And that drives costs up. If people have to pay out of their pockets for those sorts of things, they will (usually) make good choices. But if it's "free", with them knowing that it's free because they've really already paid for it with their insurance costs, then they'll buy stuff they'd never buy otherwise. How much does this affect things? No way to know. But it is an increase, and every bit matters.

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I'm all for doing something about the burden mandated insurance has on people. I'm not convinced however, that removing the mandate is really the answer. Yes, you've made it so that people don't have to sign up for the broken program, but on the other hand you're basically leaving that same program alone otherwise. You're not really fixing the problem, so much as admitting the system is broken. Making people sign up for a bad deal is bad, but plenty of other people are still forced to sign up for it, or go without insurance; which really isn't a good option either.


Sure. Which can be addressed with the idea of opening up competition mentioned earlier. The point is that as long as people have few or no real choices, they have to accept what is offered. The mandate just makes this worse. At least before there existed some market reason to try to draw in health care consumers by offering a good deal to them. With a mandate, that isn't even a consideration. I agree that fixing the things that are broken in the first place is a good direction to go, but I honestly do believe that a heck of a lot of that is how the current insurance based system is set up.

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You'd be better off actually doing something to reform the system much more heavily. The fact that people would rather be without insurance says a lot in and of itself about American health care. The thing is, I don't hear (and maybe this is my bad for not paying attention) people talking about addressing major cost drivers. What I see in the Republican plan is more lip service to the politically convenient talking points (more free-market, less handouts, less regulations, etc). The health care companies don't care much either way if this passes, you don't see them lining up for or against it, because it's doubtful it's going to affect their profits much. That isn't surprising because Obamacare didn't change much for them either, so even a "full repeal" of Obamacare isn't going to do anything but keep the status quo a while longer. They're perfectly willing to continue lining their pockets while simply paying off a different political party.


I think one of my main points here is that "health insurance" is not the same as "health care". We ought to have a system where you can obtain the latter without having the former at all. Just do the math on those premiums linked earlier. What's it up to? $18k/year for a family plan on average? Can you imagine if you could just take that money, every year you've paid into your health insurance, and just put it into an interest bearing account? Most families aren't actually spending anywhere near $18k/year on health care. And that's the average of all people in those plans, whether they use them or not. That's a heck of a lot of money that isn't actually going to directly provide health care.

As a conservative, I'm going to talk about market forces and whatnot, but I really do believe that if you put that money back into the hands of those who earned it and let them make purchasing decisions with it, then they'll apply pressure to the health care market to keep costs down. And that'll benefit the entire market, not just themselves. Even the person who didn't save up enough money, or put enough into their health account benefits, because the costs of everything he may want or need is lower as a result. And yes, you'd need to have some mechanism to try to balance the issue of people who wont make any effort to save money, but I think a great start is companies moving to health savings accounts instead of existing insurance plans (not just in addition to them, which is what many are doing now, which basically just means that you're setting aside money to pay the deductables and co-pays ahead of time, which is maybe a step in the wrong direction).

Is that a complete solution? No. But we'd literally be better off if instead of forcing everyone to purchase insurance, which they lose if they don't use each year, we mandated that they put money (some percentage of their income perhaps?) into a health account which they get to keep, can earn interest, and they can use to pay directly for health care. Not that I'm a fan of mandating anything, but if you were going to do a mandate, this would have been a 100 times smarter method.

I'd also completely revamp the insurance model itself, favoring covering only catastrophic health care with insurance. The very concept of comprehensive health insurance is absurd on its face, and the steady rise in costs over time tells us why. Right now though, employers with more than 50 (75?) employees are forced to provide a comprehensive coverage option for their employees if they provide any health insurance at all (yes, this goes all the way back to the mid 70s). Obamacare just takes that mistake and makes it worse with the mandates, but that's more or less at the heart of the problem.

Insurance is only a good method to pay for things if those things are both rare and prohibitively expensive. If the cost is a regular recurring cost, using insurance to pay for it can only increase the cost across the board (and creates incentives for "padding" those services). You'd never buy shoe insurance, right? Because you have to buy shoes fairly regularly and it's not a bankrupting cost when you do. You don't buy clothes insurance, or gas insurance, food insurance, or insurance for anything that is just a regular cost of living expense. You just pay it. What you need insurance for is if you crash your car and it's going to cost you tens of thousands of dollars to replace (or replace the other guy's car). You probably don't have that kind of money lying about, while you do probably have enough to buy some cold medicine, or get a routine checkup, or a flu shot. Those things just don't cost that much, if you were actually paying for them right out of your own pocket. And in fact, if more people paid out of their pockets, they'd cost far less than they do today.

Leave the insurance to pay for serious injuries, or if you happen to contract cancer, or get a brain tumor or something. It should pay for expensive hospital stays and care. What it should not pay for is your monthly supply of medications, and yes, that includes your birth control pills. Same deal. Those would all be much less expensive if they were paid for out of pocket. Most people spend far far less on actual health care each year than they spend on food, and even less than they spend on housing. Why are we paying for this with insurance? It's just dumb.

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If you want to fix the cost issue you have to address the power structure. The power to set price points needs to be in the hands of the consumer, not the provider. Right now that's not the case. Sure it's partly a competition thing, there's limited hospitals, limited drug manufacturers (with monopolies over certain drugs), limited insurance providers, etc. You can also use the government: break-up health care networks, do something about pharmacies making deals with drug providers, hospitals, insurance providers, etc. You'll need to address end-of-life care costs to fix the problem, which is trickier. Making people cover their end-of-life costs more out of pocket will never be popular, but those expensive treatment options are much easier to swallow when everyone else is paying the majority of the bill. Until things like that happen, you're just going to be fiddling around with small changes. You're maybe getting costs to increase 90% of what they would have otherwise, in exchange for kicking some poor people out of the system.


Or, honestly, start by eliminating the existing government regulations that more or less force our health care system into those models. We should not just be looking at repealing the ACA. We ought to also look at repealing (or at least seriously modifying) the HMO act. That's the law that gently but firmly forces our health care system into an insurance only model. Which in turn makes creating health care plans (HMO stands for "health maintenance organization", right? Guess what thing it's goal is to create and enforce?), all about groups of health care providers and insurers working as large monolithic players in the market rather than a zillion different players all competing with each other. The requirements of that act nearly force them into as large a scale as possible, meaning that over time, competition has all but disappeared in our health care system.

And yeah, once again, is that a complete solution? Nope. Does is solve everyone's problems? No again. But if you're waiting for "perfect", you'll be waiting for a very long time. I'm happy to settle for a system that is "better", or even just "doesn't create even more problems". That's at least a good starting point, right?

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Anyway, TL;DR, it seems like more of the same. People will get up in arms about families being punished by the mandate, or poor people who might be losing coverage, but otherwise all I see is just one more party paid off by the health care industry.


There's no way to be sure what exactly will happen. And yes, I'm cynical as well about politicians and their choices (regardless of party). But at least the GOP is being pressured by people who are by ideology opposed to the "big" nature of our health care and want to go back to a more competitive model. They may not always meet our expectations, but at least there's a chance they will. On the other side there is no pressure to do anything other than feed the money pump at taxpayer and consumer expense.

Edited, Mar 14th 2017 5:56pm by gbaji
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#35 Mar 14 2017 at 7:03 PM Rating: Excellent
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gbaji wrote:
Despite this, the article writer continues to label this a "White House analysis". So I guess he didn't read his own article either!

"We, uh, totally didn't do an analysis of the bill... we just blindly guessed at what someone else's analysis would be! I mean, by running the numbers and all but that doesn't make it an analysis!"

God, you're such a useful idiot Smiley: laugh
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#36 Mar 14 2017 at 7:09 PM Rating: Good
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Jophiel wrote:
"Selling across state lines" just means buying from the state with the least amount of regulations or protections. Most of the major insurance companies are national or regional already so you already have the option of buying from them in your own state. And, as mentioned, there's little reason for a hospital or small practice in North Dakota to accept insurance from Oregon in their network -- a fact which probably won't come up when Humana Oregon is hard-selling their product for $50/mth cheaper than your current plan.


Get rid of the concept of insurance/care "networks". Cause there's the problem right there.

I'm allowed to shop around repairs for my car and my insurance company has to pay it. There's zero connection or collusion between those who provide the actual repairs and the insurance company. In fact, if you look in most industries where insurance is involved, you'll find that it's unheard of (if not outright illegal) for the insurance company to have any sort of connection with or cooperation with the companies that actually provide the product/service they're paying for via insurance.

Except for health care. Gee. I wonder why it's so expensive?
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#37 Mar 14 2017 at 7:43 PM Rating: Excellent
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Get rid of it how? Outlaw it? Add more regulations to the insurance industry? There's also a definite benefit for the health care provider to broker deals -- they have three or five plans to keep track of rather than two hundred. How do you insist that they now need to track rates for every insurance company in America?

Health insurance isn't much like auto insurance* and the process of ten years of chemotherapy and rehabilitative care isn't much like replacing your bumper.

*"We determined that your co-worker is at fault for sneezing Ebola virus on your salad and you should contact his health insurance provider about getting you a doctor's appointment or we could do it but you'll have to pay your doctor's bills upfront until we negotiate payment with his provider. Actually, you know what? We'll just consider you totaled and here's a check for $7000 -- good luck, don't call back."
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#38 Mar 14 2017 at 8:11 PM Rating: Good
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Jophiel wrote:
Get rid of it how? Outlaw it? Add more regulations to the insurance industry?


No. Remove them. I already explained this. Remove the requirement for employers to offer HMO plans. Allow them to only offer catastrophic care if they wish. Then see what happens.

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There's also a definite benefit for the health care provider to broker deals -- they have three or five plans to keep track of rather than two hundred. How do you insist that they now need to track rates for every insurance company in America?


Wow. If only there were some simple way to check to see if someone can afford to pay for something. You know, kinda like a solution that banks and credit card companies solved decades ago. Heck. Most retail outlets can manage this somehow. The health care provider should not be looking at what the insurance company will pay for and then deciding what to charge (cause I can't see how that might be abused at all). They should be looking at emergency care first and providing it, then sorting out costs after the fact (which is what they currently do anyway). For anything else, they do the same thing any other service provider does. They tell you your options and then you look to see what you can afford (in this case what your insurance will cover). Then the consumer makes the decision.

Let's also not forget that I'm also proposing that we eliminate (or at least seriously curtail) comprehensive insurance. So the volume of insurance covered events would be significantly lower and most of what's covered would be pretty standardized. The plans and coverages are complex today specifically because there's a bewildering array of what may or may not be covered. Simplify it, and much of that problem goes away.

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Health insurance isn't much like auto insurance* and the process of ten years of chemotherapy and rehabilitative care isn't much like replacing your bumper.


Catastrophic care is a lot like auto insurance though. That's the point. We've expanded the concept of "health insurance" to cover things that make no sense to pay for via insurance. Which leads you today to view them as totally different animals (and also massively increases the total cost).

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*"We determined that your co-worker is at fault for sneezing Ebola virus on your salad and you should contact his health insurance provider about getting you a doctor's appointment or we could do it but you'll have to pay your doctor's bills upfront until we negotiate payment with his provider. Actually, you know what? We'll just consider you totaled and here's a check for $7000 -- good luck, don't call back."


And? What's funny is that you're still not able to step away from the idea that the "health insurance provider" would get you a doctors appointment. You get a freaking doctors appointment. One would assume in the case of ebola exposure, without taking a lot of time to worry about cost, but in most cases, *you* the consumer have to deal with cost and you the consumer decide when and how to go visit a doctor and take that cost into account.

And while you're trying to imply that the system I'm proposing is flawed because there's a limit on coverage, that's the way it is now already. That's an inherent to the system. There is a point at which your insurance stops paying more money, no matter how much that fails to meet the costs. Sucks and all, but that's not a feature of anything I'm proposing here. So yeah, at that point, your insurance company does consider you "totaled", and you're stuck with any additional health care costs incurred in that coverage cycle. That's not some evil thing. It's just the way the world works. OMG! What's the worst case here? Your life is saved and you go bankrupt. Or, you die and don't need to worry about that health care debt you incurred. Or, and this is just crazy liberty speak here, you get to make decisions about how much to spend, and whether attempting to save/extend your life is worth demolishing your life savings and any estate you may hand to your children.

Tough choices. But life gives you tough choices. And those choices exist right now even under the glorious Obamacare. Saying that an alternative doesn't solves these problems and should be rejected somewhat misses the point. No solution fixes these problems. Nope. Not even a fully socialized health care system does. There's a point in those systems where they stop trying to treat you and just move into pain management as well. Anyone who's dealt with a loved one dying of cancer knows this story. It's not new. And it's not going to disappear no matter what changes we make to our health care system.

But if we can make the other stuff less expensive? The stuff that most of us have to deal with most of our lives and which can affect us and our fortunes dramatically? I think that's worth doing.
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#39 Mar 14 2017 at 9:08 PM Rating: Good
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gbaji wrote:
Heck. Imagine if we managed to break these monolithic health care organizations entirely?


We can. It's called "single payer".
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#40 Mar 14 2017 at 10:42 PM Rating: Excellent
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gbaji wrote:
Wow. If only there were some simple way to check to see if someone can afford to pay for something.

If you don't know how insurance actually works mechanically, you can just say so.
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Catastrophic care is a lot like auto insurance though

No, not really. Repairing a person grievously wounded after a car accident is, in fact, very little like replacing the car after a car accident. Likewise, the insurance is completely different. If my car is hit by another car, it's a fairly simple question of "Who is at fault/pays?" but my auto insurance company doesn't quibble over whether or not my headlights are included or they'll cover the body work but not the electrical system. On the other hand, there's a million different questions and levels of coverage behind will my medical cover skin grafts? Reconstructive surgery? Various medications? Prosthetics? What kind or level? Rehab? How much and how long? How long will they pay for me to stay in a hospital charging a thousand dollars a day?

Edited, Mar 14th 2017 11:52pm by Jophiel
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#41 Mar 15 2017 at 6:11 AM Rating: Excellent
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Well, if the insurance company can just stamp "TOTALED" on your medical chart, unplug you and pay your widow a flat blue-book value, won't that be more efficient than wasting all that money on you when you'll never really be the same again?
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#42 Mar 15 2017 at 8:24 AM Rating: Decent
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TIL: Conservatives think people are the same as cars.
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#43 Mar 15 2017 at 8:56 AM Rating: Decent
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I just can't understand why you Americans hate each other so much that you argue over whether or not you should pay to keep each other alive and healthy. It's disgusting.
#44 Mar 15 2017 at 8:58 AM Rating: Excellent
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#45 Mar 15 2017 at 9:04 AM Rating: Decent
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You'd hate paying to keep people alive too if you had Florida.
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#46 Mar 15 2017 at 9:34 AM Rating: Good
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Professor stupidmonkey wrote:
Have you met us?


Not really, you're kind of like the neighbour who never mows his lawn. Nobody really knows what you do for a living but every once in a while we see you smoking a cigarette on the porch in a wife beater.
#47 Mar 15 2017 at 10:01 AM Rating: Excellent
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Yodabunny wrote:
Professor stupidmonkey wrote:
Have you met us?


Not really, you're kind of like the neighbour who never mows his lawn. Nobody really knows what you do for a living but every once in a while we see you smoking a cigarette on the porch in a wife beater.
Well yeah, keeps the kids off it. Gotta do what you gotta do.

Seriously though, our health care costs way more and often accomplishes less than in other countries. Plus we're too busy competing with each other anyway. If you die that means a better shot at a promotion for me.
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#48 Mar 15 2017 at 10:35 AM Rating: Excellent
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Yodabunny wrote:
I just can't understand why you Americans hate each other so much that you argue over whether or not you should pay to keep each other alive and healthy. It's disgusting.

Not true. It's just the wealthier ones hating the poorer ones and being resentful of the pennies from their pocket that go to give an undeserving child in poverty vaccinations or milk.

Me, I don't resent those pennies at all. But then I'm not the one promoting a bill to knock millions off their insurance and giving a big tax break to the wealthy in the process.
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#49 Mar 15 2017 at 5:12 PM Rating: Good
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Yea yea, we all already know how un-American you are.
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#50 Mar 15 2017 at 7:30 PM Rating: Excellent
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Samira wrote:
"TrumpCare" is an oxymoron anyway.
I believe the proper title is Donald T Care or DonTCare for short.
#51 Mar 16 2017 at 7:29 AM Rating: Good
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So I have a staff member off today and tomorrow because he has to fly to Florida to send off his Uncle.

His Uncle is on Obamacare.

He died of the flu.

They didn't admit him because they were worried that they'd be stuck with the bill they couldn't pay when Obamacare was killed and Trumpcare took over and he just wasn't dying enough for emergency care.

People are literally dying rather than going to the hospital because of Trumpcare fear and it hasn't even happened yet.
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