Health Care Options

[KeithE]

[Shawn Koester]

[KeithE]

[Dave Roberts]

One interesting fact about Medicare is that it focuses on health, not disease. For example, my Supplement offers Silver Sneakers benefits that includes gym memberships (such as with the local YMCA). They have discovered this is one of the best investments to keep expenses down for the company's payouts on those they insure. It would seem that most American healthcare models focus on treating diseases rather than preserving health because the only way doctors get paid is for treating diseases.

In looking at what I have been able to see of the GOP alternative rammed through a committee without more than cursory discussion is that it repeats the mistakes of not working for healthy outcomes. It's as though we also think poor people are a dispensable commodity or that we can go back to forcing medical providers to cost-shift their care onto private patients with insurance coverage or who pay their own bills rather than spreading it to the whole pool. It will force group and individual policies through the roof in five years to cover these shifted costs.

[KeithE]

[Sandy]

I agree, from what I've read and seen, that the alternative Republican plan is just a tax break scheme for the wealthy, and not really much of a health care plan at all. Fortunately, it seems there are enough Republicans to keep it from happening. I guess the size, scope and tone of crowds at town halls, and a combination of polling data, have convinced many of them that they will not be re-elected, even in deep red states, if they don't at least cover as much as Obamacare, and lower the cost. Well, that's what the orange haired buffoon said they'd do. So I guess there are some Republicans who realize that their political career is tied to the perception of the public related to how their health care plan comes off.

I think many of the Europeans look at incentives for prevention as part of what they offer as well. I know they do in Switzerland. For a long time, when I had a policy with Aetna, there were some rate discounts and benefits provided for things like membership in the ymca, or weight watchers.

[Dave Roberts]

The question for the GOP should lie in the promotion of Health Savings Accounts as a replacement for subsidies. How many poor people can afford to put money into health savings accounts? The answer should be obvious.

[Mrs Haruo]

The answers SHOULD be obvious, but there are way too many in today's GOP who seem to live in a world of gold plated faucets and mink toilet seat covers and if they have any idea of the struggles of average Jane and Joe Doe, they forgot them years ago in the mindless rush for the almighty dollar.

[Mrs Haruo]

The answers SHOULD be obvious, but there are way too many in today's GOP who seem to live in a world of gold plated faucets and mink toilet seat covers and if they have any idea of the struggles of average Jane and Joe Doe, they forgot them years ago in the mindless rush for the almighty dollar.

[JE Pettibone]

[William Thornton]

While I share many of the conclusions of my mod lib friends on healthcare, nothing about solutions is obvious,or simple.

[Dave Roberts]

[Tim Bonney]

[Sandy]

Is it really all that complicated?

What's the priority, the needs of people, or the use of pain, and access to medical treatment that saves lives as economic commodities to generate profits? It can't be both. Once the priorities are in place, then developing a workable, and relatively simple plan shouldn't be a problem. The Canadians have one. So do most of the European countries.

The current Republican administration doesn't have a realistic perspective of the ACA, all they seem to want to do is make false statements that pander to their base, and that's probably why they are finding this so complicated. What they promised was to deliver a program that would provide a higher level of health care to everyone, at a much lower cost. And they're going to have to conclude that people aren't as stupid as they think they are, and that most people will be able to tell whether they got better health care, better benefits, and paid less than they do now. If that doesn't happen, and soon, then the Democrats will have another shot at health care reform after the 2018 elections.

Personally, I'm an advocate for a nationalized health care system. The improvements in access to quality care, and from research and development that would result from the increased investment of resources directly into health care would be worth the trouble of making the shift. And I'd certainly be OK accessing the same quality health care that Canadians get, and keeping the 50% more that we currently pay which goes to "administrative costs" and "dividends and profits."

[Rvaughn]

[Tim Bonney]

[KeithE]

Well the CBO analysis is out. Better than anything I can do, analytics-wise. is the 28 page full text from the CBO (minus the Tables, which I cannot find).

There are pros and cons between the AHCA (aka RyanCare) and the continuation of the ACA (aka ObamaCare). I will be reading the 28 page and noting pros and cons of the AHCA below:

Pros:
1) AHCA will reduce the deficit by $337B by 2026. Outlays reduced by $1.2T but tax revenues would be reduced by 0.9T (partly ending taxes to rich people/big companies in ObamaCare and partly due to less insured and less preventive care covered).

2) Premiums (averaged over all ages) will be 10% down by 2026 under the AHCA (but note #2 Con).

Neutral:
1) Budget differences between AHCA and ACA are minor (<$5B/year) for years 2027 and beyond.

2) Premiums will be down for the young and up for older folks (50 to 65 Medicare)

3) 30% surcharge on enrollees that have been uninsured for 63 days within the previous year.

4) The stability of the health insurance market is unchanged (though neither AHCA and ACA will lead to a stable market year after year). (i.e. Republican claims that additional choices will result is not real).


Cons:
1) 14M more people would be uninsured next year (2018) with AHCA vs ACA (20M more in 2020, and 24M in 2026). The total uninsured by 2026 with AHCA is 54M (that is 1/6 of Americans) vs 24M with ACA (1/13the of America).

2) Premiums of the “nongroup” people (these w/o group insurance through employer) will go up by 15-20% through 2020.

3) Requirements on the insurance provided correctly must meet 60% of the fully compatible insurance provisions.That requirement will end by 2020. Thus theinsrance coverage will be less (for instance not im=ncluding out preventive medicine requirements). Note this is the reason the premiums will begin to become less expensive vs the ACA after 2010.

4) $100B less allotments to the states from 2018-2026 for Medicaid.

5) Estimate increased load on Medicare due to increased numbers of uninsured receiving treatment at hospitals of $43B over the 2017-2026

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Ok there is much more smaller stuff. Overall, more Cons than Pros in voting for RyanCare. Thus Price is already out swinging (Trump was swinging before it came out).

The big winner is the young/rich and big losers are old/poor and the states. As an example, a tax credit for someone under 30 is $2000/year (regardless of income) while that for someone over 60 is $4000/year. A 2:1 ratio. Meanwhile the difference is allowable premiums is 5:1. A 60-65 making $50K/year would likely pay $15,000/year for health insurance just when they need it most.

Also note that those who make over $500,000 year had a Medicare payroll deduction increase by 0.9% (from 1.45% to 2.35%) under the ACA (ObamaCare). That has been eliminated with the AHCA costly a reduction of revenues of $123B over 10 years .

I also continue to note that the AHCA or the ACA do little reduce health care cost themselves - they continue the motivation to overtreat since pay is received by how much service is done. Medicare and most other countries put more stringent limitations on treatment to that medically recommended.

I’d loved to see a CBO analysis of the Medicare-for-All (H.R. 876). That was never allowed to be scored.

[Tim Bonney]

Thanks for the detailed analysis Keith!

As you say, neither Obamacare or Ryan/Trump/GOPcare address the real problem. As long as we still with a system with a patch work of for profit insurance companies the US will continue to pay more for healthcare than any other nation and, as a result, be able to provide less actual care to its citizens.

I think the only good solution is a universal healthcare system. I'm not holding my breath for it any time soon. My theory is that the middle class is going to have to have a very high percentage of loss of reasonable coverage before this can be turned around. When the pain is enough the system will change.

[KeithE]

[Tim Bonney]

I can understand why the GOP leadership likes this. It helps them give their rich buddies tax cuts. But I may never understand why working class Americans would vote for a billionaire playboy who has never done without a day in his life and think that he would understand their needs or even care about them.

Already I'm seeing posts from Trump supporters who are disappointed that he isn't doing anything positive for them. What did they expect from President Daddy Warbucks?

[William Thornton]

[KeithE]

[KeithE]

[Sandy]

[William Thornton]