210 réponses à ce sujet

[Dr.Fumbles]

Out of curiosity, when was the last time this thread was about the Conservative Party and its effort to destroy any semblance of impartiality in the BBC?

 

No clue. I came in on page 6.

[Fast Jimmy]

There's been walls of texts in page 6 and 7. tl;dr

What have you been saying, in short?

The ACA is saving everyone money, is covering more people than anytime in American history and (while far from perfect) superior to the pre-existing system in every way.

As a side note, it is NOT socialized healthcare (the exact plan, from the mandate down to the exchanges, was originally a Republican free market proposal pushed during the Clinton administration), nor was the previous system a true free market one, since the government was the largest payer in the market.

[Inquisitor Recon]

Secondly... it's working. The system IS WORKING. More people have coverage, more insurance companies are making money, more medical providers are seeing patients and, despite what every critic said before the bill passed, the Congressional Budget Office actually LOWERED its forecast for the rise of medical costs for the first time in decades.

I'm pretty certain the captain of the Titanic also said the system was working. But more seriously all of the CBO's wasted ink is of no importance if the consumer doesn't see a positive impact on his finances.

 

I'd wager Congress and everybody else important in DC is exempt to the tax on "Cadillac" health care plans.

[Fast Jimmy]

Out of curiosity, when was the last time this thread was about the Conservative Party and its effort to destroy any semblance of impartiality in the BBC?

BBC bad. Tories good!


There we go, balance restored.

[Dr.Fumbles]

The ACA is saving everyone money, is covering more people than anytime in American history and (while far from perfect) superior to the pre-existing system in every way.

As a side note, it is NOT socialized healthcare (the exact plan, from the mandate down to the exchanges, was originally a Republican free market proposal pushed during the Clinton administration), nor was the previous system a true free market one, since the government was the largest payer in the market.

 

You seem very well versed on the subject which I will admit I am beaten on. Every coin has 2 sides though, so I doubt it is going as swimmingly as you are putting it. If you would allow me, I will do some research on my own for the subject matter to show it is not as perfect as everyone says it is.

[Aimi]

BBC bad. Tories good!


There we go, balance restored.

Ha. It'd be more like "Labour bad. Tories good!" but, well.

The sad thing is that the Conservatives tend to do it to themselves:

[Fast Jimmy]

You seem very well versed on the subject which I will admit I am beaten on. Every coin has 2 sides though, so I doubt it is going as swimmingly as you are putting it. If you would allow me, I will do some research on my own for the subject matter to show it is not as perfect as everyone says it is.

 

Please do. It is part of my job (literally) to stay very much on top of it in service to my clients and my clients are VERY pleased with how it is turning out, despite being some of the ones who fought the legislation tooth and nail in the first place.

[Dr.Fumbles]

Please do. It is part of my job (literally) to stay very much on top of it in service to my clients and my clients are VERY pleased with how it is turning out, despite being some of the ones who fought the legislation tooth and nail in the first place.

 

My curiosity is piqued on what your job is, but I'll let you keep that to yourself fore I don't like to be intrusive. I have to go bed now though after I watch some John Oliver. Good talking.

[Voxr]

My curiosity is piqued on what your job is, but I'll let you keep that to yourself fore I don't like to be intrusive. I have to go bed now though after I watch some John Oliver. Good talking.

Jimmy is a male escort/Tech-pop, synth-pop DJ on the weekend.

[Kaiser Arian XVII]

MR. BBC, LET'S TEAR DOWN THIS WALL!

[Fast Jimmy]

I'm pretty certain the captain of the Titanic also said the system was working. But more seriously all of the CBO's wasted ink is of no importance if the consumer doesn't see a positive impact on his finances.

 

I'd wager Congress and everybody else important in DC is exempt to the tax on "Cadillac" health care plans.

 

Actually, no. They aren't.

 

They ARE exempt from being forced to enter the exchanges in some circumstances, but Congressman don't have the high level of coverage that meets the level of Cadillac plans. That being said, they make MORE than enough money to cover their otherwise EXTREMELY generous federal government plans (which are some of the best in the industry and, hence, the world). And staffers make much less than their private sector counterparts, so they are in the same boat.

 

 

And I fail to see how getting coverage for nine million "Average Joes" who owned their own small businesses, people who worked as contractors or part time workers, people who felt trapped in a job because of the health coverage, people who skipped going to the doctor unless a serious flare up occured... I fail to see how that doesn't help the average person. As I said earlier, the truly poor were already covered, under Medicaid and Passport. These aren't the lowest end of the spectrum - they already are taken care of. 

 

Its middle income people who can't get coverage through their job for whatever reason that are the most at risk for going bankrupt if they get seriously sick or injured without proper medical insurance. Rich people can afford it and poor people have been covered for decades... the ACA closes the gap for the average people you work with or see every day. It gives the waitress serving you food a chance at getting her diabetes covered. It gives the plumber who comes to your house to fix your pipes a way to make sure his kid can see a doctor when they get a cold. Its a small business owner who doesn't have to decide between paying two grand in premiums every month to cover him and his pregnant wife or going without and hoping for the best with his business in the balance.

 

 

 

 

That's who the ACA has helped. And if that's not helping the consumer, then I don't know what is.

[Fast Jimmy]

Jimmy is a male escort/Tech-pop, synth-pop DJ on the weekend.

 

I told you that in confidence, Voxr. IN CONFIDENCE!

[Fast Jimmy]

My curiosity is piqued on what your job is, but I'll let you keep that to yourself fore I don't like to be intrusive. I have to go bed now though after I watch some John Oliver. Good talking.

 

Same to you. And my job is... complicated. I've been doing it for years and my wife can't even halfway explain it to her friends.

[Voxr]

I told you that in confidence, Voxr. IN CONFIDENCE!

I couldn't hear it over the music. I'm sorry!

[Inquisitor Recon]

They ARE exempt from being forced to enter the exchanges in some circumstances, but Congressman don't have the high level of coverage that meets the level of Cadillac plans. That being said, they make MORE than enough money to cover their otherwise EXTREMELY generous federal government plans (which are some of the best in the industry and, hence, the world). And staffers make much less than their private sector counterparts, so they are in the same boat.

 

 

And I fail to see how getting coverage for nine million "Average Joes" who owned their own small businesses, people who worked as contractors or part time workers, people who felt trapped in a job because of the health coverage, people who skipped going to the doctor unless a serious flare up occured... I fail to see how that doesn't help the average person. As I said earlier, the truly poor were already covered, under Medicaid and Passport. These aren't the lowest end of the spectrum - they already are taken care of. 

 

Its middle income people who can't get coverage through their job for whatever reason that are the most at risk for going bankrupt if they get seriously sick or injured without proper medical insurance. Rich people can afford it and poor people have been covered for decades... the ACA closes the gap for the average people you work with or see every day. It gives the waitress serving you food a chance at getting her diabetes covered. It gives the plumber who comes to your house to fix your pipes a way to make sure his kid can see a doctor when they get a cold. Its a small business owner who doesn't have to decide between paying two grand in premiums every month to cover him and his pregnant wife or going without and hoping for the best with his business in the balance.

 

 

 

 

That's who the ACA has helped. And if that's not helping the consumer, then I don't know what is.

So seems like the political class does get to have their cake and eat it too. Not all that surprising.

 

So far it hasn't done a thing to reduce what I pay or remove some of the bureaucratic red tape which only seems to increase with time. Where can I as an individual expect some positive result from any of this? How can this thing be success if it doesn't change the bottom line, that being the cost is of medication and treatment. They've changed how some pay for it, but it hasn't done anything to the expense itself. How many thousands of pages was that bill? All of that for so very little.

[God]

So seems like the political class does get to have their cake and eat it too. Not all that surprising.

 

So far it hasn't done a thing to reduce what I pay or remove some of the bureaucratic red tape which only seems to increase with time. Where can I as an individual expect some positive result from any of this? How can this thing be success if it doesn't change the bottom line, that being the cost is of medication and treatment. They've changed how some pay for it, but it hasn't done anything to the expense itself. How many thousands of pages was that bill? All of that for so very little.

 

I think another approach on this issue is 'why are the medical costs so high to begin with?'

 

I understand some procedures are expensive. But is it really worth a few hundred dollars to get an unplanned check-up from a physician? 

[Kaiser Arian XVII]

Same to you. And my job is... complicated. I've been doing it for years and my wife can't even halfway explain it to her friends.

 

Odd Jobs ninja style!

[Fast Jimmy]

So seems like the political class does get to have their cake and eat it too. Not all that surprising.

No, it's not surprising.

But you could view at as a form of protection and security. Do you want federal employees, with access to information, systems and personnel of some of the most powerful agencies and legislators in the world to be going bankrupt from medical expenses, making them easy targets for bribery? Do we want them to feel undervalued and willing to take payoffs to cover their bills? Do we want them to jump ship to the private sector at the earliest opportunity for better benefits, taking confidential information and expertise along with them?

Yeah, it's flimsy. But still - there's value in making sure federal employees are have strong benefits.

So far it hasn't done a thing to reduce what I pay or remove some of the bureaucratic red tape which only seems to increase with time. Where can I as an individual expect some positive result from any of this? How can this thing be success if it doesn't change the bottom line, that being the cost is of medication and treatment. They've changed how some pay for it, but it hasn't done anything to the expense itself. How many thousands of pages was that bill? All of that for so very little.

No offense, but it sounds like you get your health coverage form your employer or a Taft-Harley Union group. Which means you are getting the sweetest deal imaginable in a system that's not socialized healthcare. If that's not the case for you personally, then please realize this is below is somehwat of a rant to the countless faceless people I've seen in my years who complain about their health care costs going up at their employer.

Employer group plans get the benefits of reduced premiums by being a group (the larger the group, the more the reduction, due to reduced administration and a mroe widely spread risk pool). I. Addition, your employer pays for (on average) close to two-thirds of your premiums, meaning you are only paying a third of the bill you are supposed to. Lastly, since your insurance premiums are taken via a Section 125 payroll deduction, they are tax free, while health insurance premiums paid outside of employment, such as through the exchanges of private policies, are paid with post-tax dollars.

So you are getting the reduction of being in a group (a reduction of about 15-20%), you are getting a further reduction by having you employer cover the majority of your premium (66% off the first reduction) and then you don't have to pay taxes on your premiums (which saves you an additional 20%, varying on your tax bracket).

Before the ACA, a $1000-a-month policy would have been typical for an indiviudal policy, easy. Apply the group discount and you are down to $800 a month. Then your employer picks up the lion share, making your cost ~$275 a month (which averages to about $125 a paycheck). And you get this $125 every paycheck taken out ttoall tax free, as otherwise it would be the equivalent of $150 a paycheck, or an extra $650 a year. Would you rather pay $1000 a month post tax, or $275 a month pre tax?

Couple that with the fact that employer groups use bargaining power for better networks, lower deductibles, lower annual plan maximums and have better appeal avenues for any disputed cases and I'll say what I'm not usually able to say to people who get their coverage through their job in my line of work - shut the heck up. You are getting a golden deal with coverage and price as a form of payment for your service to your company. Complaining that your premiums are going up $20 a month one year or that your copay is being raised from $25 to $30... please, just be quiet. No one who actually understands what's going on, who actually sees the numbers of what is being paid out and sacrificed by companies to get you as close to free healthcare as you are going to get in this world.



So put it this way - if you haven't seen the ACA make healthcare more affordable to you personally, I'm sorry. But you were one of the last people in line who needed their healthcare to be any cheaper.

[Addai]

Its middle income people who can't get coverage through their job for whatever reason that are the most at risk for going bankrupt if they get seriously sick or injured without proper medical insurance. Rich people can afford it and poor people have been covered for decades... the ACA closes the gap for the average people you work with or see every day. It gives the waitress serving you food a chance at getting her diabetes covered. It gives the plumber who comes to your house to fix your pipes a way to make sure his kid can see a doctor when they get a cold. Its a small business owner who doesn't have to decide between paying two grand in premiums every month to cover him and his pregnant wife or going without and hoping for the best with his business in the balance.

That's who the ACA has helped. And if that's not helping the consumer, then I don't know what is.

LOL You're kidding me right. It's the middle income people who are now being dumped from employer coverage and forced to either go without insurance and pay more taxes, or else go into the bureaucratic and financial nightmare that is the exchange and subsidy process.

We haven't even seen the negative impact yet of the ACA- the doo really hits the fan when the employer provisions are finally enforced, if they ever are. I was told by my company's insurance broker that our current coverage, which was grandfathered in and thus not ACA compliant, is no longer available even under Cadillac plans, and to get anywhere near what we currently have, our premiums will go up 90%. I work for a small, struggling company. I can guarantee you that they aren't going to pay a 90% increase in health insurance premiums. We'll either be dumped, or else the employee contribution will skyrocket for a much inferior insurance product.

Oh, and in case you bring it up- our company doesn't qualify for SHOP because the average salary is too high for it. That's what happens in a small company made up of a few engineers and salespeople, and some clerical and warehouse workers. Guess who gets screwed the worst in this scenario. Hint, it's not the high paid engineers.

My spouse had great coverage, but he was a contractor and his company dumped benefits coverage for contractors shortly after the ACA went into effect. They saw the writing on the wall. Until I got my current job, we went without insurance for a while, for the first time in my life.

The ACA is a full-on nightmare for working people.

[Fast Jimmy]

I think another approach on this issue is 'why are the medical costs so high to begin with?'

I understand some procedures are expensive. But is it really worth a few hundred dollars to get an unplanned check-up from a physician?

Well, firstly, under the ACA, normal annual check up physicals are now covered for free as part of preventative medicine.

Secondly, imagine how much in costs to get your car looked at, even if nothing is wrong. Get its oil changed, have its fluids topped off, hooked up to a couple machines to see if anything looks funky... then imagine that the mechanics doing that mostly get on the job training that doesn't add a dime of student debt. Now compare that to a doctor who has to go to college for seven years and then work for peanuts in internships and residencies for years after that before they can go out and begin working in their own practice.

Thirdly, you have serious problems of utilization. Over-utilization, where people are going to the doctor three times a month, asking for unnecessary tests (or doctors who perform unnecessary tests to avoid any sort of malpractice suit). Then you have under-utilization, where someone ignores that fungus on their foot for three years until it is practically rotting off and requires serious procedures, medication and follow-up. And then you just has improper utilization, where people are going to the emergency room to have their ear checked out because it hurts and just have a common infection... that runs a bill of around $2,000 for the insurance and member to pay.

Encourage people to see a doctor regularly to build a relationship where major illnesses are identified, but also discourage them from stopping by every time they get wet from the rain and make sure they have a means to ask professional help to see if what they are experiencing can wait until tomorrow when they can see their doctor or if they need to go to the ER before they pass out from blood loss. The ACA does all of that - free annual wellness checks encourage people to get looked at every year, but then brings them back to a paid model of they head back repeatedly or there is a direct illness to be treated. The act also earmarked money for both a move to electronic medical records and money for insurers to build or expand nurse line services, where people can call and talk to a certified nurse 24 hours a day, 7 days a week, to help refer them to the right level of care.

But the biggest problem is the cost of pharmaceuticals. Drug costs are the number one driving factor of healthcare costs increasing. Of course, the biggest problem with drug costs is that often the most effective cutting edge drugs are the most expensive and are protected by brand name patents from introducing any competition in the market place, often lasting from two to seven years. The ACA helped combat this as well, with pathways for life saving drugs to have a shorter brand name patent status time frame.

This, of course, has a huge flaw, where biologic drugs (which are things like injectable medicines that treat cancer or Harvoni, the extremely expensive Hepatitis C drug) were given thirteen year patent protection under the ACA, due to the much larger upfront research costs drug companies have with these new types of research medicines. Fortunately (and unfortunately), these new types of therapies are often more effective and have less complications that traditional pharmaceutical treatments, but their (extremely) high costs make insurance companies hesitant to cover them, while the drug patents prevent competition in the space for over a decade. Not surprisingly, he biggest increase in drug costs over the past five years has been strongly from biologic and other "Specialty" pharmacy drugs, so it is a huge problem the ACA did not address... then again, biologic drugs were still far from being as widely applied in 2008 as they are today, so it was a problem not fully understood.



If you really want health care costs to go down? Ban smoking in any way you can and support any form of legislation that requires restaurants to post calories on their menus (or whatever way you can think of to get people to eat more healthily). Heart disease, diabetes and other smoking and obesity-related diseases represent, FAR AND AWAY, the bulk of medical expenses in the US.

Forget the cure for cancer. You really want insurance to be cheaper? Find a cure for Marlboro Reds and Hoho's.

[Fast Jimmy]

LOL You're kidding me right. It's the middle income people who are now being dumped from employer coverage and forced to either go without insurance and pay more taxes, or else go into the bureaucratic and financial nightmare that is the exchange and subsidy process.

We haven't even seen the negative impact yet of the ACA- the doo really hits the fan when the employer provisions are finally enforced, if they ever are. I was told by my company's insurance broker that our current coverage, which was grandfathered in and thus not ACA compliant, is no longer available even under Cadillac plans, and to get anywhere near what we currently have, our premiums will go up 90%. I work for a small, struggling company. I can guarantee you that they aren't going to pay a 90% increase in health insurance premiums. We'll either be dumped, or else the employee contribution will skyrocket for a much inferior insurance product.

Oh, and in case you bring it up- our company doesn't qualify for SHOP because the average salary is too high for it. That's what happens in a small company made up of a few engineers and salespeople, and some clerical and warehouse workers. Guess who gets screwed the worst in this scenario. Hint, it's not the high paid engineers.

My spouse had great coverage, but he was a contractor and his company dumped benefits coverage for contractors shortly after the ACA went into effect. They saw the writing on the wall. Until I got my current job, we went without insurance for a while, for the first time in my life.

The ACA is a full-on nightmare for working people.

I highly disagree that the applying for the subsidies is anywhere near a "bureaucratic nightmare," but that may be because my state was rated as having one of the better models of their exchange site. It's was easy as clicking a few boxes, typing in some numbers and getting a form to submit with taxes for my sister and mother when I did it for them. This might vary from state to state, but since they are federal subsidies through the IRS, I can't imagine the process being that much more tedious.

I am sorry you lost your Cadillac plan coverage. That being said, with a more affordable plan with a higher deductible and some planning/saving through a Health Savings Account, I have no doubt that your family will not only have enough to meet your medical costs, but also save for retirement with the BEST retirement saving vehicle on the market. Honestly, I look at health plans that don't have deductibles high enough to allow for an HSA as huge rip-offs. Your higher premiums are wastes when they could be put into your own pocket tax free.

As brutal as this is to say, you are the most minority of minorities. Your employer was willing to throw a garish amount of money into your health plan in proportion to your actual salary. That's nice... but it is a small casualty for you to get health insurance plans more in line with the rest of the country so millions of people who can't afford or are unable to receive even basic insurance through their work can have reasonable coverage that is affordable.

[Addai]

I highly disagree that the applying for the subsidies is anywhere near a "bureaucratic nightmare," but that may be because my state was rated as having one of the better models of their exchange site. It's was easy as clicking a few boxes, typing in some numbers and getting a form to submit with taxes for my sister and mother when I did it for them. This might vary from state to state, but since they are federal subsidies through the IRS, I can't imagine the process being that much more tedious.

And those who didn't estimate their income correctly? Allowing the IRS to calculate your health insurance premium for you is as close to the definition of insanity I can think of.
 

I am sorry you lost your Cadillac plan coverage.

It is by no means Cadillac- that's just what it's called now. It was normal coverage for everyone in employer insurance a few years ago, even small businesses. In other words, it's fairly affordable even for working people. Now that's considered high falutin.
 

That being said, with a more affordable plan with a higher deductible and some planning/saving through a Health Savings Account,

HSAs are all but eliminated now. And please, do not patronize me. I've shopped for insurance plans for several years now for my employers, and I tried to get individual insurance as well, so I know what that market is like. I'm not an idiot.
 

As brutal as this is to say, you are the most minority of minorities. Your employer was willing to throw a garish amount of money into your health plan in proportion to your actual salary. That's nice... but it is a small casualty for you to get health insurance plans more in line with the rest of the country so millions of people who can't afford or are unable to receive even basic insurance through their work can have reasonable coverage that is affordable.

More in line with the new reality, which is worse for everyone but the most minority of minorities.

[Fast Jimmy]

And those who didn't estimate their income correctly? Allowing the IRS to calculate your health insurance premium for you is as close to the definition of insanity I can think of.

Both my mom and sister, who I did the subsidy work for, are contractors in their own small business. I understand the challenge of predicting income, but there is literally no other way to determine subsidy amount. You face the same issues trying to pay the correct tax rate based on income. It is already becoming a standard service for tax accountants or for tax service software to handle, which I would always suggest contractors use for the purposes of handling their taxes correctly for many reason that do not include the ACA.

It is by no means Cadillac- that's just what it's called now. It was normal coverage for everyone in employer insurance a few years ago, even small businesses. In other words, it's fairly affordable even for working people. Now that's considered high falutin.

Let me guess... bi-weekly premiums in the double digits, deductible less than $500, copay for doctor's office of $15, specialist for $25, ER for $100, $5000 annual maximum?

Yeah... trust me... your company could have BOUGHT YOU A CADILLAC for less than the amount they were paying each month for your coverage. Easily.

HSAs are all but eliminated now. And please, do not patronize me. I've shopped for insurance plans for several years now for my employers, and I tried to get individual insurance as well, so I know what that market is like. I'm not an idiot.

I'll try not to treat you like an idiot, but you are patently, irredeemably, unequivocally wrong on this front. I'm d@mn near close to one of the top 1,000 most knowledgeable people in the world on HSAs. That may even be an understatement. Believe me when I say - HSAs are, in no way, shape or fashion, in any danger of being removed and were, in fact, stated by the IRS to be increasing maximum deductions for 2016 up to $6,750 a year for family coverage (assuming you are under the age of 55).

More in line with the new reality, which is worse for everyone but the most minority of minorities.

The reality is that medical costs have increased rapidly, far outpacing inflation, for over five decades, back in the 60's. It's really nice that some small companies were able to keep the prices for their employees the same as they were set back in mid-90's, but that simply resulted in your company eating the costs as time went on, and then passing those costs right back to the American tax payers in the form of tax breaks on all money applied to health insurance benefits, regardless of how much that amount was per employee.

Meanwhile, these expensive plans had no better health results for its members and some of the worst proper utilization rates. And a bigger and bigger tax burden each year as health costs grew. Because spending more money wasn't yielding better results and since bankruptcy is most often avoided beyond a certain level of coverage, the U.S. government made a law that draws the line on how they will give tax breaks (and, in turn, will actually change penalties for) for such health insurance policies. You can't really blame them for that.

[Addai]

Let me guess... bi-weekly premiums in the double digits, deductible less than $500, copay for doctor's office of $15, specialist for $25, ER for $100, $5000 annual maximum?

Yeah... trust me... your company could have BOUGHT YOU A CADILLAC for less than the amount they were paying each month for your coverage. Easily.

No, you're off on every count, and I know exactly what my company pays for me every month since I cut the check. I also saw what they'll be paying for me when we're finally forced to go ACA compliant- which I'm fighting tooth and nail for the sake of all our employees, especially those with families who have no choice but to stay covered. I can also see what the other employees are going to do- the young ones who are supposed to be the cash cows for ACA. They're never going to pay those exorbitant premiums. Hence why the ACA enrollment figures look like they do.
 

I'll try not to treat you like an idiot, but you are patently, irredeemably, unequivocally wrong on this front. I'm d@mn near close to one of the top 1,000 most knowledgeable people in the world on HSAs. That may even be an understatement. Believe me when I say - HSAs are, in no way, shape or fashion, in any danger of being removed and were, in fact, stated by the IRS to be increasing maximum deductions for 2016 up to $6,750 a year for family coverage (assuming you are under the age of 55).

They still exist no thanks to the efforts of ACA supporters, who wanted to get rid of them.
 

Meanwhile, these expensive plans had no better health results for its members and some of the worst proper utilization rates. And a bigger and bigger tax burden each year as health costs grew. Because spending more money wasn't yielding better results and since bankruptcy is most often avoided beyond a certain level of coverage, the U.S. government made a law that draws the line on how they will give tax breaks (and, in turn, will actually change penalties for) for such health insurance policies. You can't really blame them for that.

I most certainly can. This was an ideological bill, pure and simple- not driven by any practical realities. Even those who favor universal health care agree.

[mousestalker]

Out of curiosity, how many exchanges are out of money now?