Please Help Me Understand Your Suffering

BrickPig said:

But if I get medical care and don't pay, the cost gets shifted to everybody else.

If you can't afford to pay, you shouldn't get the care.

BrickPig said:

But if I get medical care and don't pay, the cost gets shifted to everybody else.

If you cannot afford to pay the cost, it is shifted whether you have insurance or not.

When you have insurance and you get medical care your cost is shifted to the policyholders. The only time it is not shifted is when you don't have insurance and you can afford to pay out of your pocket.

In Obamacare, the subsidy costs are shifted to all taxpayers. Its not free money. It doesn't come out of a magic bucket.

BrickPig said:

But if I get medical care and don't pay, the cost gets shifted to everybody else.

You not paying your health insurance can only have an indirect and incremental impact to me. You not paying your car insurance can have a direct and significant impact to me, particularly where personal injury is involved.

I am a huge Obama supporter, and I voted for Clinton, wholeheartedly. That said, I believe that in this 'global economy,' there are winners and losers. There may have been a total gain for this country, but I think there are substantial numbers of people, who rightly believe they themselves have suffered economically due to global trade deals. Recognizing this, verbalizing it, and figuring out how to do what is best for the country economically while addressing the professions and individuals who are sacrificed to the greater good is all-important in order to heal the division in the nation, and move forward.

There are, of course, individuals who will not support a female president or an African American president due to deep biases. But I believe there are others who have suffered, feel abandoned, and in fact have been abandoned.

but so what? societal costs (of no health insurance) can be pretty damn dramatic when you have tens of millions of people uninsured.

ctrzaska said:

BrickPig said:

But if I get medical care and don't pay, the cost gets shifted to everybody else.

You not paying your health insurance can only have an indirect and incremental impact to me. You not paying your car insurance can have a direct and significant impact to me, particularly where personal injury is involved.

And this is exactly why we need to have universal basic income.

lisat said:

I am a huge Obama supporter, and I voted for Clinton, wholeheartedly. That said, I believe that in this 'global economy,' there are winners and losers. There may have been a total gain for this country, but I think there are substantial numbers of people, who rightly believe they themselves have suffered economically due to global trade deals. Recognizing this, verbalizing it, and figuring out how to do what is best for the country economically while addressing the professions and individuals who are sacrificed to the greater good is all-important in order to heal the division in the nation, and move forward.

There are, of course, individuals who will not support a female president or an African American president due to deep biases. But I believe there are others who have suffered, feel abandoned, and in fact have been abandoned.

I never said anything was free.

BG9 said:

BrickPig said:

But if I get medical care and don't pay, the cost gets shifted to everybody else.

If you cannot afford to pay the cost, it is shifted whether you have insurance or not.

When you have insurance and you get medical care your cost is shifted to the policyholders. The only time it is not shifted is when you don't have insurance and you can afford to pay out of your pocket.

In Obamacare, the subsidy costs are shifted to all taxpayers. Its not free money. It doesn't come out of a magic bucket.

Can someone explain under the ACA - is there a time you can be denied coverage? Do you need to have a pre-existing condition for a certain length of time before you cannot be denied insurance?

If I have no coverage - then I realize I have cancer and need insurance - can I get it? If this is the case then why buy insurance at all unless you really need it? This seems to be why we need a mandate.

I'm pretty sure there is no condition under which you can be denied coverage, and yes, that's exactly why you need the mandate.

here's Krugman on the "three legged stool" of the ACA - the 3 essential things that are needed to make the whole thing work.

====================================================

Still on a high over
the Supreme Court ruling. One especially gratifying and praiseworthy
feature of the majority opinion was that it explicitly invoked the logic
of health reform to justify the “interpretive jiggery-pokery” (can this
be made into a dance step?) that so infuriated Scalia. From the
opinion:

The
combination of no tax credits and an ineffective coverage requirement
could well push a State’s individual insurance market into a death
spiral. It is implausible that Congress meant the Act to operate in this
manner. Congress made the guaranteed issue and community rating
requirements applicable in every State in the Nation, but those
requirements only work when combined with the coverage requirement and
tax credits. It thus stands to reason that Congress meant for those
provisions to apply in every State as well.

Yes! The Court (minus
the three stooges) understood that the ACA is designed to work via the
“three-legged stool” of guaranteed issue and community rating, the
individual mandate, and subsidies. All three elements are needed to make
it work, which is why it was obvious to anyone who paid any attention
that the lawsuit was nonsense.

The thing is, a lot of
people on the right have never grasped this logic, either because all
they need to know is that Obamacare is eevil big government, or because
of the Upton Sinclair principle of finding it difficult to understand
something when your salary depends on your not understanding it. But the
court majority did the basic policy analysis, which gratifies my inner
wonk as well as my outer health reformer.

jamie said:

Can someone explain under the ACA - is there a time you can be denied coverage? Do you need to have a pre-existing condition for a certain length of time before you cannot be denied insurance?

If I have no coverage - then I realize I have cancer and need insurance - can I get it? If this is the case then why buy insurance at all unless you really need it? This seems to be why we need a mandate.

jamie said:

Can someone explain under the ACA - is there a time you can be denied coverage? Do you need to have a pre-existing condition for a certain length of time before you cannot be denied insurance?

If I have no coverage - then I realize I have cancer and need insurance - can I get it? If this is the case then why buy insurance at all unless you really need it? This seems to be why we need a mandate.

You can only be 'denied' if it's not covered under your plan.

In answer to your second question: That's why there's a defined open-enrollment period. If you're diagnosed with cancer today, you can't buy a plan on the exchange until November 1, and it won't take effect until January 1. The only time you can buy or be added to a plan outside of the national open enrollment period is if you experience a 'qualifying event," such as lose your employer-sponsored coverage, get married and need to add your spouse, etc.

but doesn't every plan cover the same thing - just to different degrees? maybe not - I don't know. But I mean it's not like someone can offer a policy on the exchange that doesn't cover cancer, right?

eta: I admit I've been mostly insulated from the vagaries of the act. I've simply kept my employer's insurance since ACA was incepted. It's had no noticeable effect on me, at all.

Privilege in action....

shoshannah said:

jamie said:

Can someone explain under the ACA - is there a time you can be denied coverage? Do you need to have a pre-existing condition for a certain length of time before you cannot be denied insurance?

If I have no coverage - then I realize I have cancer and need insurance - can I get it? If this is the case then why buy insurance at all unless you really need it? This seems to be why we need a mandate.

You can only be 'denied' if it's not covered under your plan.

In answer to your second question: That's why there's a defined open-enrollment period. If you're diagnosed with cancer today, you can't buy a plan on the exchange until November 1, and it won't take effect until January 1. The only time you can buy or be added to a plan outside of the national open enrollment period is if you experience a 'qualifying event," such as lose your employer-sponsored coverage, get married and need to add your spouse, etc.

drummerboy said:

but so what? societal costs (of no health insurance) can be pretty damn dramatic when you have tens of millions of people uninsured.

ctrzaska said:

BrickPig said:

But if I get medical care and don't pay, the cost gets shifted to everybody else.

You not paying your health insurance can only have an indirect and incremental impact to me. You not paying your car insurance can have a direct and significant impact to me, particularly where personal injury is involved.

We were talking about the individual and their "choice". Whether society benefits or not is another story.

shoshannah said:

jamie said:

Can someone explain under the ACA - is there a time you can be denied coverage? Do you need to have a pre-existing condition for a certain length of time before you cannot be denied insurance?

If I have no coverage - then I realize I have cancer and need insurance - can I get it? If this is the case then why buy insurance at all unless you really need it? This seems to be why we need a mandate.

You can only be 'denied' if it's not covered under your plan.

In answer to your second question: That's why there's a defined open-enrollment period. If you're diagnosed with cancer today, you can't buy a plan on the exchange until November 1, and it won't take effect until January 1. The only time you can buy or be added to a plan outside of the national open enrollment period is if you experience a 'qualifying event," such as lose your employer-sponsored coverage, get married and need to add your spouse, etc.

So God forbid someone is diagnosed with something severe today, they're in some serious trouble.

drummerboy said:

but doesn't every plan cover the same thing - just to different degrees? maybe not - I don't know. But I mean it's not like someone can offer a policy on the exchange that doesn't cover cancer, right?

eta: I admit I've been mostly insulated from the vagaries of the act. I've simply kept my employer's insurance since ACA was incepted. It's had no noticeable effect on me, at all.

Privilege in action....

shoshannah said:

jamie said:

Can someone explain under the ACA - is there a time you can be denied coverage? Do you need to have a pre-existing condition for a certain length of time before you cannot be denied insurance?

If I have no coverage - then I realize I have cancer and need insurance - can I get it? If this is the case then why buy insurance at all unless you really need it? This seems to be why we need a mandate.

You can only be 'denied' if it's not covered under your plan.

In answer to your second question: That's why there's a defined open-enrollment period. If you're diagnosed with cancer today, you can't buy a plan on the exchange until November 1, and it won't take effect until January 1. The only time you can buy or be added to a plan outside of the national open enrollment period is if you experience a 'qualifying event," such as lose your employer-sponsored coverage, get married and need to add your spouse, etc.

Where you get treated and by whom can have a direct impact on survival rates. And many plans simply don't cover the centers or hospitals one would initially look to go to. So yes you'll get coverage, though wait ones, treatments/drugs, doctors may be quite different. And that can make a world of difference.

ctrzaska said:

drummerboy said:

but so what? societal costs (of no health insurance) can be pretty damn dramatic when you have tens of millions of people uninsured.

ctrzaska said:

BrickPig said:

But if I get medical care and don't pay, the cost gets shifted to everybody else.

You not paying your health insurance can only have an indirect and incremental impact to me. You not paying your car insurance can have a direct and significant impact to me, particularly where personal injury is involved.

We were talking about the individual and their "choice". Whether society benefits or not is another story.

Yes. And that 'indirect and incremental impact' is apparently significant enough to large numbers of people in this country that they are horrified at the notion of paying it out of their taxes under a single payer plan.

well, it sounded to me like you were minimizing or ignoring societal costs by comparing the "costs" of health and auto insurance on the non-policy holder, which are not comparable at all.

ctrzaska said:

drummerboy said:

but so what? societal costs (of no health insurance) can be pretty damn dramatic when you have tens of millions of people uninsured.

ctrzaska said:

BrickPig said:

But if I get medical care and don't pay, the cost gets shifted to everybody else.

You not paying your health insurance can only have an indirect and incremental impact to me. You not paying your car insurance can have a direct and significant impact to me, particularly where personal injury is involved.

We were talking about the individual and their "choice". Whether society benefits or not is another story.

I didn't bring up the narrow comparison.

drummerboy said:

but doesn't every plan cover the same thing - just to different degrees? maybe not - I don't know. But I mean it's not like someone can offer a policy on the exchange that doesn't cover cancer, right?

Yes, that's correct. That's one of the features of the ACA that most offends the right. They believe that it's wasteful and unreasonable to require standardized coverage -- Men don't need maternity benefits! My family will never need mental health care! -- so they claim costs can be reduced by allowing consumers to buy "patient-centered" policies that exclude various benefits.

Thank you for acknowledging that you don't have first-hand experience with the ACA. So many people have strong opinions about the ACA without having needed to buy their own insurance before and after it was implemented. It was the bad old days.

It's disappointing that when healthcare is discussed in the context of government and politics, it's almost always about insurance. Almost all of us benefit from significant advances in medicine that weren't available to our ancestors, and the federal government is behind much of it. The National Institutes of Health is the largest funder of medical research in the world,

After all, what's the point of insurance if your care is at 1950's levels? Irony about folks who say they want small government, less government, is that when they get sick, they want the best treatment advances, largely funded by the government.

ridski said:

If you can't afford to pay, you shouldn't get the care.

I disagree.

I get American made medications free in Hong Kong.

I pay $5 per doctor visit. $10 per day for hospital stays. No deductibles. No premiums.

I can opt for a private hospital or doctor for about 10x as much, but the care is not any better, only the food.

What do you get in America in addition to high costs? Mostly people lecturing you about how you can't have what I have and how China is bad. It's all backwards.

@dave, any idea what the tax cost to you for that is? A lot than Americans fear, I bet.

dave said:

I get American made medications free in Hong Kong.

I pay $5 per doctor visit. $10 per day for hospital stays. No deductibles. No premiums.

I can opt for a private hospital or doctor for about 10x as much, but the care is not any better, only the food.

What do you get in America in addition to high costs? Mostly people lecturing you about how you can't have what I have and how China is bad. It's all backwards.

Well...

The US overpaying for healthcare is what allows R&D to happen. If we weren't going to pay through the nose you'd have plenty of free amoxicillin that doesn't work but the next class of antibiotics (which is coming, albeit slowly) would never arrive.

Well, imo, part of the overpayment goes to R&D, but a good deal goes into admin, insurance company profits, and fancy fancy facilities. It's the complications: every doctor's office has to have extra billing staff to deal with insurance(s), whole companies spring up to administer pharmacy benefits and FSAs, not to mention employers spending time and/or money researching health benefits instead of focusing on business, on and on and on.

Serious question: why doesn't "business," and esp. small business, stand up and ask for genuine reform so they can get away from dealing with this stuff?

RobB said:

dave said:

I get American made medications free in Hong Kong.

I pay $5 per doctor visit. $10 per day for hospital stays. No deductibles. No premiums.

I can opt for a private hospital or doctor for about 10x as much, but the care is not any better, only the food.

What do you get in America in addition to high costs? Mostly people lecturing you about how you can't have what I have and how China is bad. It's all backwards.

Well...

The US overpaying for healthcare is what allows R&D to happen. If we weren't going to pay through the nose you'd have plenty of free amoxicillin that doesn't work but the next class of antibiotics (which is coming, albeit slowly) would never arrive.

http://fortune.com/2014/11/17/top-10-research-development/

https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-pharmaceutical-companies-are-spending-far-more-on-marketing-than-research/

Does it?

For example, big pharma spends more on marketing than on R&D.

The two largest pharma R&D spenders, Roche and Novartis are Swiss. I bet the ridiculous prices charged are are not charged in Switzerland or anywhere else in the EU.

Tom_Reingold said:

ridski said:

If you can't afford to pay, you shouldn't get the care.

I disagree.

I don't walk into other places and demand things I can't afford.

Another Dem messaging failure -

They should

1. Be pounding away at the incredibly high cost of healthcare with average outcomes, at best.

2. Be pounding away on the "hidden medical tax", which we all pay as part of our inflated medical and pharma costs

(2 needs some work, but that's the idea. Has to be translated into numbers.)

Approximately no one in the U.S. knows that #1 is true.

Consequently, they have no clue about how costly #2 is.

Consequently "OMG SOCIALIZED MEDSIN!!!! OBAMA EVIL MAN!!!"

Every Dem should hang their head in shame at how they've failed the national health care debate. (Not you Bernie)

For Ridski:

Emergency Medical Treatment & Labor Act (EMTALA)

"In 1986, Congress enacted the Emergency
Medical Treatment & Labor Act (EMTALA) to ensure public access to
emergency services regardless of ability to pay."

https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html

BG9 said:
http://fortune.com/2014/11/17/top-10-research-development/

https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-pharmaceutical-companies-are-spending-far-more-on-marketing-than-research/


Does it?


For example, big pharma spends more on marketing than on R&D.

The two largest pharma R&D spenders, Roche and Novartis are Swiss. I bet the ridiculous prices charged are are not charged in Switzerland or anywhere else in the EU.

The headquarters of the company doesn't matter. Novartis happily sells Gleevec in the US for twice what they do in Switzerland (and 5x what they do in Canada).

The R&D/marketing thing is misleading at best. Big pharma companies "buy" research by gobbling up small, promising competition.

jersey_boy said:

For Ridski:


Emergency Medical Treatment & Labor Act (EMTALA)

"In 1986, Congress enacted the Emergency
Medical Treatment & Labor Act (EMTALA) to ensure public access to
emergency services regardless of ability to pay."

https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html

I know this exists, but all it does is **** up the system. Is medical care a commodity or not? If it is, people who use the service have to pay for it. If it isn't, then we can pool together and all services are paid for by the pool. No healthcare system is perfect, but what we have in the US is a system of ****-tastic magnitude. No one has good medical coverage. No one can truly choose their doctor. The system under the ACA hasn't changed at all. I lived with the risk of not having coverage because I couldn't affo d it, and now I'm probably going to be fined for not having coverage for the second half of last year. If that's what happens, I really don't know.

So my point is that as long you patch this ****** system with things like EMTALA or ACA or whatever shittier thing the Republicans come up with, you'll never get a good system until people have to pay directly for the services they use. Until people start dying because they're too poor to afford doctors, nothing will change.