'Nobody knew that health care could be so complicated'... Nobody? Or only Trump?

[Simon Dog]

Well, should we just keep people alive forever on machines no matter the cost?  Originally, you had to qualify for a dialysis machine.  Not a bad idea.  Is this country going to go broke keeping everyone alive?  Sucking our young people dry?  All the healthy immigrants and Refugees who have immune systems of steel can all come in and work and pay taxes to keep us FAT, SICK Americans Alive?  Maybe that is the Left's plan.

We should give people a choice, including self-termination in the face of horrendous terminal symptoms (think late stage ALS).   Part of the cost problem is religious leaders (for example, Papists in MA) fighting laws that would allow the terminally ill an easy out.

[nursey66]

As I have said before , the rich will get richer ,the middle class will become the lower class and the lower class poor and sick people will be dead !   It is showing up in all King Trumps policies , especially the health care ! Just wait until the new tax reform comes out !

[Rerun]

Well, should we just keep people alive forever on machines no matter the cost?  Originally, you had to qualify for a dialysis machine.  Not a bad idea.  Is this country going to go broke keeping everyone alive?  Sucking our young people dry?

Wow! Rerun.  Such coldness.  Perhaps YOU would like to volunteer to get off YOUR dialysis machine-- for starters.  Maybe they should just line up dialysis people before a shooting squad.  Easy money!

I will quit someday.  I pray every night for the Lord to take me.  I feel guilty for sucking the system dry.  Believe me. 

[Michael Murphy]

I recently faced this question.  After my recent heart attack I was in the hospital and was unable to walk the 8 feet to the toilet.  This was a depressing moment and I was terrorized thinking that this was going to be my life.  As depression settled in it suddenly occurred to me that I was a dialysis patient and I could stop going to dialysis if this situation became unbearable.  Well one more stent and a 7.5 hour operation later I am slowly getting my life back.  My ejection fraction has more then doubled from the dark days and I have started Cardiac Rehab.  But the point is that strangely enough when things looked the worst  what pulled me through I'd that I had a get out of jail free card. I could stop dialysis.  My life was mine to choose.  I am glad that it worked out but even happier that  I had a doorway out of a impossible situation.  The inability to walk was caused by ventricular tachycardia a potentially fatal problem but one it seems I could be treated for.

[Simon Dog]

Yup, the freedom to stop is indeed great peace.  It makes every day a choice.

[Rerun]

It gives me great peace.    

[Bill Peckham]

If anyone is wondering, as I was, what is the deal with 6 pages of the Trumpcare bill dealing with lottery winnings, here is a very detailed explanation of a bill from the last Congress that seems to be the basis for the lottery winner language in Trumpcare.  The language does not just cover lottery winnings, it covers all lump sum payments - legal settlements, inheritance - the lottery piece is a small part of what it would impact. I think the primary reason the lottery piece is in the Trumpcare bill is to pad the length of the legislation they were submitting.

[Rerun]

This also does NOT promote getting a JOB because holly hell you may get kicked off Medicaid if you make money. 

How do these people spend their windfall of $10,000.  Beer and cigarettes... casino here I come.  We can't control that but if they know the gravy train ends for a year or two, maybe they could save it or hey novel idea pay a health care premium.

I worked on the Pigford Vs. Glickman lawsuit https://en.wikipedia.org/wiki/Pigford_v._Glickman   where farmers who won got $50,000 cash (tax free) and car sales went thru the roof. 

Teach men to fish don't give them fish. 

When I sold my house in CA I got a windfall and then uncle sam took a fourth of it.  It was sad but I saved for it.  Grow up!

[Simon Dog]

When I sold my house in CA I got a windfall and then uncle sam took a fourth of it.  It was sad but I saved for it.  Grow up!

I assume this is only because you did not re-invest in another primary residence, or this was a non-primary residence.

It is dismaying to see how people think the govt and banks should recast underwater mortgages, but not give the govt the windfall (privatize profits and socialize losses).

The language does not just cover lottery winnings, it covers all lump sum payments - legal settlements, inheritance - the lottery piece is a small part of what it would impact. I think the primary reason the lottery piece is in the Trumpcare bill is to pad the length of the legislation they were submitting.

Everyone wants bills that hammer the "elses".  If you keep the focus in inheritances, many people will think "If I get an inheritance I don't think it should mean the govt stops paying my bills", but if you talk "lottery" most people figure  "I will never win, good idea taxing those other people and leaving me alone".

The best form of inheritance is telling junior "Clean the gold out of my safe once I'm dead and don't tell anyone about it".  No paperwork; no medicaid spend down issue; no estate taxes; unattachable by creditors; etc.

[Michael Murphy]

The law was changed you can exempt the first 250 thousand and that exemption is good again in two years.
Edited to make goog good.

[Bill Peckham]

The Congressional Budget Office has released their report on the American Health Care Act

https://www.cbo.gov/publication/52486

"CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. Most of that increase would stem from repealing the penalties associated with the individual mandate. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.

Later, following additional changes to subsidies for insurance purchased in the nongroup market and to the Medicaid program, the increase in the number of uninsured people relative to the number under current law would rise to 21 million in 2020 and then to 24 million in 2026."


On average premiums are expected to go down overall, but averages are made of extremes:

"Under the legislation, insurers would be allowed to generally charge five times more for older enrollees than younger ones rather than three times more as under current law, substantially reducing premiums for young adults and substantially raising premiums for older people."


"Because of the magnitude of its budgetary effects, this legislation is “major legislation,” as defined in the rules of the House of Representatives. Hence, it triggers the requirement that the cost estimate, to the greatest extent practicable, include the budgetary impact of its macroeconomic effects. However, because of the very short time available to prepare this cost estimate, quantifying and incorporating those macroeconomic effects have not been practicable."

So we still don't have an official expectation of what this will do to health spending overall. Controlling total health spending is a one of the Affordable Care Act's goal, something it has achieved to an extent beyond expectations. Trumpcare reduces Federal healthcare spending but that is certainly at the expense of overall spending, but because of the speed with which this is being pushed through we won't have an idea of what the expectation should be.

[Simon Dog]

I'm impressed that the CBO has not been politicized to the point that it always produces an opinion favorable to the current administration.

The current re-write is DOA if the administration cannot even pretend it does not create a huge pool of loosers.

[Bill Peckham]

From TPM:

Donald Trump: "We’re going to have insurance for everybody. There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” Washington Post 1/15/17

Donald Trump: "Obamacare has to go. We can't afford it. It's no good. You're going to end up with great healthcare for a fraction of the price. And that's going to take place immediately after we go in. Okay? Immediately. Fast Quick." (CSPAN, Timestamp 34:23) 2/19/16

Donald Trump: "Everybody's got to be covered. This is an un-Republican thing for me to say because a lot of times they say, "No, no, the lower 25 percent that can't afford private. But-- ... I am going to take care of everybody. I don't care if it costs me votes or not. Everybody's going to be taken care of much better than they're taken care of now." - 60 Minutes, 9/27/15

Donald Trump: "We're gonna come up with a new plan that's going to be better health care for more people at a lesser cost." ABC News, 1/25/17

Donald Trump: "There are people who say everybody should have a great, wonderful, private plan, and if you can't afford that, and there is a percentage, a fairly large percentage that can't afford it, then those people don't get taken care of. That's wrong. We're going to take care of that through the Medicaid system. We’re going to take care of those people. We have no choice." Dr. Oz, 9/15/16

Donald Trump: "The new plan is good. It's going to be inexpensive. It's going to be much better for the people at the bottom, people that don't have any money. We're going to take care of them through maybe concepts of Medicare. Now, some people would say, "that's not a very Republican thing to say." That's not single payer, by the way. That's called heart. We gotta take care of people that can't take care of themselves." CNN GOP Townhall, 2/17-18/16

Donald Trump: "I’m not going to cut Medicare or Medicaid." 5/21/15. The Daily Signal.

[Shaks24]

Looks like Paul Ryan is thrilled with pushing 24 million off of health insurance to save some 330 billion over 10 years in spending. Trump and his staff are bad mouthing the CBO estimates yet their own OMB projections predicted 26 million would become uninsured. Its funny how they accept the CBO projections they like though. I have no idea if this bill can pass but I sure hope it does not as it is written. The example CBO gives of what would happen to premiums of those aged 50 - 64 is down right scary. Thank you dear Lord for Medicare.

[Rerun]

They are just not forcing people to have health care insurance anymore...  No mandates and no fines.  FREEDOM. 

Why would you be pro FORCE anything.  What if you were FORCED to get cable TV.  So you get it for a few years because otherwise you would get fined.  THen Trump gets into office and you are no longer FORCED to get Cable TV.  You can buy it if you want to and we will help you but you are no longer will be FORCED to buy Cable TV. 

[Shaks24]

There is a 30% premium penalty mandate if you have a 63 day or more lapse in coverage so to say no fines is not true. Here is some of Trumps publicly made promises and the CBO response to them:



TRUMP: "We're going to have insurance for everybody. There was a
philosophy in some circles that if you can't pay for it, you don't get
it. That's not going to happen with us." — to The Washington Post, Jan.
15.
CBO: It estimates the bill would leave 14 million fewer people insured in the first year, 24 million fewer by 2026.

TRUMP: People covered under the law "can expect to have great health
care. It will be in a much simplified form. Much less expensive and much
better... lower numbers, much lower deductibles."
CBO: It says
cost-sharing payments in the individual market, including deductibles,
"would tend to be higher than those anticipated under current law."
Cost-sharing subsidies would be repealed in 2020, "significantly
increasing out-of-pocket costs for nongroup (private) insurance for many
lower-income enrollees."

TRUMP, at a Cabinet meeting Monday: "Obamacare, all of a sudden, the
last couple of weeks, is getting a false rep that maybe it's OK. It's
not OK, it's a disaster and people understand that it's failed and it's
imploding. And if we let it go for another year, it'll totally implode."
CBO:
Not in the view of the budget experts. They described the market for
individual policies under Barack Obama's health care law as "stable."
They said it is likely to remain stable under the proposed GOP
replacement legislation, too.
 

[Rerun]

Well, if you have insurance but have to pay the first $5,000 before you can use it... do you have health coverage?

[kickingandscreaming]

Rerun- you are SO brainwashed! It's SAD.

[MooseMom]

Well, if you have insurance but have to pay the first $5,000 before you can use it... do you have health coverage?

Yes.

[Rerun]

Rerun- you are SO brainwashed! It's SAD.

Answer my question:  If you have health care but have to pay the first $5,000 ...??  Do you really have health care coverage?

I feel sad for/about you too.  That is why I keep coming back to get your nasty, demeaning, rude, remarks about me. 

[Rerun]

Well, if you have insurance but have to pay the first $5,000 before you can use it... do you have health coverage?

Yes.

OK, but you won't use it because maybe you don't have the $5,000.  Because you lost it at the Casino.  This is all pushing for 1 payer system like Medicare where the Middle Class pays for the poor who mismanage their money. 

I think everyone needs basic care.  Especially kids up to 18 (IMO) .  How come we don't have Trump Dental and Trump Vision??  I just heard that 50% of Americans are "missing" Teeth. 

[Simon Dog]

Why would you be pro FORCE anything.

Are you in favor of FORCING hospitals to provide emergency care to people who cannot prove ability to pay prior to treatment?

What about FORCING an MD not to refuse follow-up care for a patient who is not paying his bills?   (ie, patient dismissal)

If the answer is yes, you are in favor of force and the only question is when, and to whom, that force is applied.

It's like the guy at a fancy party who offered a woman to sleep with him.  Sure, she said.  He said "well, I don't have $1M, how about $50?" and she replied "what kind of woman do you think I am?" to which he responded "we've already established that, we're just negotiating price".

[Rerun]

   LOL You are correct but I just could not turn away a baby or a puppy who can't pay.  Should we have a volunteer hospital where only the really nice people who really Care (Doctors without borders) so people could go there who could not pay? 

I know the Union Gospel Mission here has a few doctors who volunteer a couple of times a month to see the homeless.

It makes me mad the people who could have health care but squander their money and expect help.  It is the babies and the puppies.

[Michael Murphy]

The answer is if a 5000 dollar deductible makes sense is is the insurance with that deductible 400 a month cheaper than the insurance with no deductible. 
The problem is the basic cost structure and payment levels with decreased subsidies drive most people on the ininsured rolls.  Last year if I wasn't on Medicare with a great advantage package I would have generated over 900000  in bills. Now since I am on Medicare every thing must be billed under Medicare rates.  The other thing they are pushing is to allow patients to be billed for additional money that doctors and hospitals want the patient to pay.

[Simon Dog]

Should we have a volunteer hospital where only the really nice people who really Care (Doctors without borders) so people could go there who could not pay? 

If the docs worked for free, who would pay for the MRI machines, CAT scanners, supplies, drugs (cancer drugs commonly cost thousands per dose), auxillary staff (down to the janitor that cleans the OR), parts (hips, etc.)?   My hip job ran something like $40K (insurance negotiated), of which less than $2000 was the surgeon's fee.

The other thing they are pushing is to allow patients to be billed for additional money that doctors and hospitals want the patient to pay.

That would turn it into college style pricing.  Examine the finances of every patient and charge the absolute maximum that patient has available for payment.