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

[Michael Murphy]

The argument using cable tv is bogus because if you won't or can't pay for cable you don't get cable if you don't have health insurance you get crappy care paid for by the taxpayer.  You want to force them off the rolls and then pay more money to still pay for their treatment. The only difference is more money ends up in the hospital or doctors pocket. 

[Rerun]

I still say the problem is "TRUTH in BILLING"  The hospitals and Doctors and Surgeons all LIE about what things cost.  They need a Come To Jesus monent and settle the billing gaps  so people know what something will cost.  Start there.

[Bill Peckham]

Tomorrow is a big vote ... or not. It is still not clear if there are the votes to pass Trumpcare, if the votes aren't there I'd expect Ryan to pull the vote, but there is a lot of horse trading going on. The proposed changes to the bill means if Trumpcare becomes law people in the first 33 months of using dialysis will be paying a lot more for insurance.

The latest reporting is that in order to get the Freedom Caucus on board the legislation will strip the essential benefits provision from current insurance rules. This would mean, for instance, that one could choose an insurance policy that does not cover maternity care. Obviously men will be safe saving a few bucks by opting for the plan without maternity care. It'll mean women will pay more if they choose coverage that includes pregnancy, maternity and newborn care but that is the point they are free to choose. I am not convinced that is an actual conservative position but that is the logic - everyone can choose inexpensive coverage if they are willing to forgo some essential benefits.

What are the other essential benefits? There is some variation state to state but they all must include:

• Ambulatory patient services (outpatient care you get without being admitted to a hospital)
• Emergency services
• Hospitalization (like surgery and overnight stays)
• Pregnancy, maternity, and newborn care (both before and after birth)
• Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
• Prescription drugs
• Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

Plans must also include the following benefits:

• Birth control coverage
• Breastfeeding coverage

So if you can imagine yourself being twentysomething and healthy which essential benefits would you do without if it could mean saving $100s of dollars a month? Everyone will make different choices but the point is that #1: Ambulatory patient services, would be a prime option to cut. If you are young and healthy why would you need that? You could just self pay if you sprain an ankle or if needed use #2: Emergency Services. The problem is that leaves people who have to get policies that include outpatient coverage, for instance people who need dialysis,  in insurance pools with other people who have to use outpatient medical care and few people who are young and healthy. That will be a much more expensive policy. Even if you get insurance through your employer it could smack you, because your employer will be free to offer options with low or high deductibles / more or less copays with the difference being the insurance policies will cover different things. Again this will cluster people who need certain coverage - whether mental health or dialysis, or god forbid, someone who needs both (but I am sure that never happens) - into insurance with much higher costs.

At least if it gets too bad you could qualify for Medicaid ... oh, wait    never mind, you'll be screwed if Trumpcare becomes law.

[KarenInWA]

We in the USA already have a lower life expectancy for those on dialysis, and for the general population overall. Looks like with this new "healthcare" proposal, we as a nation can look forward to even lower life expectancy - and I suspect lower quality of life as well. MAGA baby, MAGA!!!!! 

What I really love is MAGA is against abortion, but also is against maternity/pre-natal care. Because THAT makes sense,!!!       

I'm seriously beginning to think that saving for retirement is nothing but a big waste of $$ for me, and I should just spend freely and enjoy my $$ and life while I still can. It's all going down the toilet soon anyway, with this band of clowns in charge.

KarenInWA

[MooseMom]

Bill, have you seen any proposed legislation that would address the question of how one would/could add an "essential benefit" to one's plan?

Yes, a man might choose to save some bucks by not buying coverage for pregnancy/maternity, but that same man might get married one day and choose to start a family.  So, at what point can he add this coverage, and will there be a big penalty for adding coverage only when you come to find you need it?  (This assumes the mother stays home to look after the baby and thus has no income of her own.)

Or maybe he opts out of paying for mental health coverage but is later diagnosed with a mental illness.  What chances would he have for then purchasing coverage for that?

[MooseMom]

Oh my God.  The Freedom Caucus won't vote for TryanCare because it still includes the pre-existing condition provision in it.  The Freedom Caucus wants that cut.

Who ARE these people?

[Bill Peckham]

Bill, have you seen any proposed legislation that would address the question of how one would/could add an "essential benefit" to one's plan?

No they'll need to pass the bill for us (and the CBO) to know the details of how it is suppose to work. Their idea for motivating people to keep coverage (as the bill was first written) is to allow insurers to charge a 30% premium on coverage for a year if sign back up after a coverage gap. I think we can all see the problem with this ... to come out ahead financially you'd just need to go four months without coverage, there are so many other problems with Trumpcare that this fundamental flaw does get a lot of attention but anyway, who knows. At this point everything is in play. It's madness.


Oh and one of the tactics I've seen discussed is to give the Senate instructions to fix the bill. I assume the idea is to get something to a House/Senate committee that would hammer out a final bill. Madness.

[Bill Peckham]

To be fair the preexisting condition provision is the reason it is impossible for the Republicans to devise a plan (that could even theoretically work) that can get 216 republican votes in the house. But for that path to make sense you'd have to also eliminate the requirement that hospitals must treat people who show up needing medical care.


The Freedom Caucus knows that they have the White House by the short hairs so they have every incentive to get all they can out of the legislation.

[Michael Murphy]

The billing problem of wacky 3 tier pricing is caused by people's lack of insurance.  Medicare generally reflects the actual cost of the procedure.  The private bill reflects greater profits for the provider and partially pays for the uninsured.  The uninsured rate is set generally 3 times the insured rate. Why so high the providers don't expect to see a dime of the money from the uninsured patient but with the tax code the provider gets a lovely tax deduction so generally they make as much money as they do from private insurers.   The problem is uninsured people the hospital can not turn away a emergency and needs to make up the money somehow.

[Bill Peckham]

Bad debt results in losses for for-profit hospitals, you can't just claim a procedure is worth a million dollars and wipe out your tax liability, not to mention nonprofits use the same three tier pricing. Avoiding taxes can't be their motivation. In dialysis you can see the dynamic clearly - the rate you pay is based on your size in the market.

Medicare is the largest payor (they pay for the dialysis of about 75% of everyone using dialysis), they get the best price and they get to set the terms of care. There is more compulsion than negotiation to get to that price and those terms, but that's saving Medicare a lot of money. If every dialysis treatment had to be billed and paid the same amount, what do you think that price would need to be (what price would keep the same total amount of money funding the provision of dialysis)?

[MooseMom]

To be fair the preexisting condition provision is the reason it is impossible for the Republicans to devise a plan (that could even theoretically work) that can get 216 republican votes in the house. But for that path to make sense you'd have to also eliminate the requirement that hospitals must treat people who show up needing medical care.

Exactly.  My point is that what the Freedom Caucus wants is even worse than what the current bill would provide, and it boggles the mind that there are people in our government more ruthless than Paul Ryan.

The Freedom Caucus knows that they have the White House by the short hairs so they have every incentive to get all they can out of the legislation.

Again, exactly.  The Freedom Caucus having them by the short and curlies is the price Ryan and Trump are paying to get this passed specifically on the 7th anniversary of the ACA.

[MooseMom]

http://www.cnbc.com/2017/03/23/americans-strongly-oppose-republican-plan-to-replace-obamacare.html

[nursey66]

I would rather we spend $ on health care for all , than billions on "the wall " . They are coming in on planes ✈️ now anyway. I saw a cartoon where a doctor with Trump head, was pulling a sheet up over a patients head in a hospital bed , he said "   Coverage for all !"   And he was laughing 😂

[kickingandscreaming]

If Trump/RyanCare fails to pass, it's because it isn't cruel enough to satisfy the Republican blood lust.

[Shaks24]

Praying that this horrible bill fails in the house today.

[Bill Peckham]

Obama 2009: Vote for the bill because it’s worth losing your seat.


Trump 2017: Vote for the bill or you’ll lose your seat.

[Bill Peckham]

Never mind.

[MooseMom]

Never mind.

Buh bye, Paul Ryan.  Trump will find you a place under the bus.

[Shaks24]

Scary to think that what kept this junk bill from passing the house was extremists that wanted to take it further to the right. I sure hope Dems vote in mass during the 2018 midterms.

[MooseMom]

Nope, I was wrong.  All seems to be good between Trump and Ryan. 

Now maybe we can get some bi-partisan effort to craft improvements to the ACA where needed. 

[Shaks24]

Thats the only way to get something good done that will be sustainable. In the mean time the ACA lives!

[Warborg]

I personally think we need to totally do away with Obamacare and turn it back to the private sector. Once that's done, install a rule or regulation that insurances have to accept someone with pre-existing condition.

[Michael Murphy]

The fun part to watch this is as the republican leadership gives in to t Freedom Fanatics to gain a vote they loose a moderate.  Trump blames the Democrats, I think he should blame his grammar school teachers since he cant seem to count votes.  Even if the republican leadership could get past the house a even beggar hurdle lies ahead in the Senate.  Watching this is more fun then I could imagine. It like "The Keystone Kops Run the Government ".

[Simon Dog]

I personally think we need to totally do away with Obamacare and turn it back to the private sector. Once that's done, install a rule or regulation that insurances have to accept someone with pre-existing condition.

Obamacare is private sector.   One has to be careful when using guns to make person A to pay for person B, since it is easy to have unintended consequences if not fully thought through.  (All taxes and govt mandated payments are ultimately collected at the point of a gun)

If you allow pre-existing conditions, without other regulations, people will "self select" and only buy insurance once they get a condition or perceive themselves at risk.  A big problem with the current system is the cost of selling people like us policies at below the free market rate was spread over a small subset of the population (persons buying policies on the exchange) rather than the population at large

But then, taxes get passed by  convincing 51% of the people someone else will pay.

[Michael Murphy]

The real problem is the idea you don't need insurance till you are sick.  The people who don't get insurance because they ain't sick are not taking too much of a risk, they know that the hospitals have to take them anyway.  In some places fire service is a self funding private affair. If you want the local fire service to cover you if your house catches fire you have to be a paid member.  When people are reluctant to pay the fee these departments show up at fires of the uncovered make sure every one is safe then watch the house burn to the ground.  Unfair no the owner chose to save money and expected the same service as the members who pay every year.  If you don't have health insurance when you need it what should be done is since you could have afforded insurance but choose to put the risk on other citizens is the hospital bill you can't pay should not be removable by bankruptcy.  But your wages should be garnished till you pay back with interest the cost you have placed on society.  Let that happen a few times then see how many try to game the system.