The PPACA Thread Part III - Let's have a healthy debate!

[Rover]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Two things:

1) I see no good reason to ditch employer based insurance. That's where most adults get their coverage. Not a perfect system but what is?

2) Regarding implementation of single payer you can do a couple of things fairly easily. Expanded Medicaid for starters to the remaining hold out states is an easy one. Next you could have a buy in for both people approaching Medicare age (say the 55 and older crowd) as well as Medicaid for people just over the poverty line, or as an option for people not happy with their ACA exchange options. However, what doesn't change is everybody must have insurance or pay a penalty. Also insurance for only catastrophic events is stupid. Putting off routine care means higher expenses down the road.

 

[unofan]

Maybe the best solution is not a federal solution??

Because poor people in red states don't deserve to be cared for by virtue of being born in a bad place?

 

[St. Clown]

Re: The PPACA Thread Part III - Let's have a healthy debate!

It's systemic. Look at epi-pen for example then. Costs usually go down over time. The cost of that is going up. Value based pricing for Health Care is ethically and morally wrong.

The epi-pen situation is entirely separate, in no way analogous. The Hep-C pill (Daklinza) can't follow the same pricing model as the Epi-pen at all as the Hep-C pill price has eith. The Hep-C pill is a limited course, a 12-week treatment of taking one pill per day to eradicate the illness from your body, effective in 89% of patients in one test study and up to 100% in another (limited to certain genotypes). That makes for an $84,000 total treatment cost. The Epi-pen is to treat a reoccurring chronic issue that will only treat the symptom as there is no cure. The Epi-pen makers have a market for life and are digging their own corporate graves for when the patent expires or someone releases a similar medication delivery system and undercuts the Epi-pen.

FYI, the old Hep-C treatments that were replaced by Daklinza were six-figures in total cost. The pill is cheaper.

 

[SJHovey]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Two things:

1) I see no good reason to ditch employer based insurance. That's where most adults get their coverage. Not a perfect system but what is?

2) Regarding implementation of single payer you can do a couple of things fairly easily. Expanded Medicaid for starters to the remaining hold out states is an easy one. Next you could have a buy in for both people approaching Medicare age (say the 55 and older crowd) as well as Medicaid for people just over the poverty line, or as an option for people not happy with their ACA exchange options. However, what doesn't change is everybody must have insurance or pay a penalty. Also insurance for only catastrophic events is stupid. Putting off routine care means higher expenses down the road.

No. What is stupid is the system you endorse.

A needs to buy services from B.

A works for C, who in partial exchange pays money to D, who then pays money to E to help manage the A/B relationship, while at the same time A and C pay money to Government Agency (GA), and then some combination of D/E/GA pay B for A's services.

 

[ScoobyDoo]

Re: The PPACA Thread Part III - Let's have a healthy debate!

The epi-pen situation is entirely separate, in no way analogous. The Hep-C pill (Daklinza) can't follow the same pricing model as the Epi-pen at all as the Hep-C pill price has eith. The Hep-C pill is a limited course, a 12-week treatment of taking one pill per day to eradicate the illness from your body, effective in 89% of patients in one test study and up to 100% in another (limited to certain genotypes). That makes for an $84,000 total treatment cost. The Epi-pen is to treat a reoccurring chronic issue that will only treat the symptom as there is no cure. The Epi-pen makers have a market for life and are digging their own corporate graves for when the patent expires or someone releases a similar medication delivery system and undercuts the Epi-pen.

FYI, the old Hep-C treatments that were replaced by Daklinza were six-figures in total cost. The pill is cheaper.

That's fantastic news on the HEP-C treatment. It's still wrong to charge one thousand dollars for a 1 dollar pill. However, admittedly I don't know what the research costs were and what the recoup rate is at the thousand dollar price tag.

Either way I posted an article a while ago on how Epi-Pen (Mylan) and other Medical device and pharma companies are applying value based pricing to their products. That's ethically and morally wrong and it will bankrupt them and us.

 

[St. Clown]

Re: The PPACA Thread Part III - Let's have a healthy debate!

That's fantastic news on the HEP-C treatment. It's still wrong to charge one thousand dollars for a 1 dollar pill. However, admittedly I don't know what the research costs were and what the recoup rate is at the thousand dollar price tag.

Either way I posted an article a while ago on how Epi-Pen (Mylan) and other Medical device and pharma companies are applying value based pricing to their products. That's ethically and morally wrong and it will bankrupt them and us.

It's the old line, "The next pill costs $1 to make. The first pill cost $400,000,000 to make." Also, how many people do you know who've had Hep-C? The market size for that cure is far more limited than most drugs we see in our day-to-day lives. It's going to take a long time for Bristol Meyers Squibb to recoup their R&D costs on Daklinza.

 

[ScoobyDoo]

Re: The PPACA Thread Part III - Let's have a healthy debate!

It's the old line, "The next pill costs $1 to make. The first pill cost $400,000,000 to make." Also, how many people do you know who've had Hep-C? The market size for that cure is far more limited than most drugs we see in our day-to-day lives. It's going to take a long time for Bristol Meyers Squibb to recoup their R&D costs on Daklinza.

Then you would be correct that it's a horrible example and the thousand dollars is justified. However, just imagine how easy that would have been to explain without the Skirelli and Epi-Pen examples?

And thus there's the problem. And thus there's the failure of insurance companies, and government.

 

[Rover]

Re: The PPACA Thread Part III - Let's have a healthy debate!

No. What is stupid is the system you endorse.

A needs to buy services from B.

A works for C, who in partial exchange pays money to D, who then pays money to E to help manage the A/B relationship, while at the same time A and C pay money to Government Agency (GA), and then some combination of D/E/GA pay B for A's services.

Your explanation is nonsense.

 

[Jimjamesak]

Two things:

1) I see no good reason to ditch employer based insurance. That's where most adults get their coverage. Not a perfect system but what is?

No. No. It's a terrible system for those us in the actual working class. When you have to depend upon your employer for something so basic and necessary, your employer has you by the balls. Even for unionized workers the biggest fight at CBA time is health care. Even my employer doesn't do health care anymore, they shifted it all to the union.

It's even worse for most working class people because there's very few options for jobs so employers have all the leverage. Costs going up? Time to double the rates! And that's even if your employer offers it in the first place. Most places just bump your pay slightly and tell you to hit the marketplace.

 

[ScoobyDoo]

No. No. It's a terrible system for those us in the actual working class. When you have to depend upon your employer for something so basic and necessary, your employer has you by the balls. Even for unionized workers the biggest fight at CBA time is health care. Even my employer doesn't do health care anymore, they shifted it all to the union.

It's even worse for most working class people because there's very few options for jobs so employers have all the leverage. Costs going up? Time to double the rates! And that's even if your employer offers it in the first place. Most places just bump your pay slightly and tell you to hit the marketplace.

Correct. Consumer/worker has zero power in relationship.

 

[Handyman]

Re: The PPACA Thread Part III - Let's have a healthy debate!

It's the old line, "The next pill costs $1 to make. The first pill cost $400,000,000 to make." Also, how many people do you know who've had Hep-C? The market size for that cure is far more limited than most drugs we see in our day-to-day lives. It's going to take a long time for Bristol Meyers Squibb to recoup their R&D costs on Daklinza.

Leave out the Hep-C pill, look what they did to the Schizophrenic drugs. There is plenty of examples of how the current pricing model is a joke.

 

[Wisko McBadgerton]

Re: The PPACA Thread Part III - Let's have a healthy debate!

The way the policies are currently constructed, you can't afford to have a major medical expense. Not with super high deductibles.

In my house, the little McBadgerton has a chronic illness. My total recurring annual costs (premiums plus out of pocket $$) has increased by more than $10,000 since the ACA has come in. (Same employer, same carrier) I'm fortunate, but how in the world does that work for an average family making $60k (which is above median) and spending 20-30% of their income on health care costs alone? To borrow a phrase from a former President, "It's the craziest thing in the world."

You fix it...

Why is it people on the Right cant seem to understand you dont have to just burn the house down when the rook leaks...

Right! That's exactly what all the morons to the right of The President should do; Get out of the way so the Hillary can fix it. Again. Or in other words:"Sorry about all the goofs, but TRUST us! Just a few more fixes like the last one and we'll be good! You'll save money! This time we really mean it! Seriously!"

To borrow another former President's phrase, "Fool me once shame on me, Fool me -- you can't get fooled again."

 

[FreshFish]

Re: The PPACA Thread Part III - Let's have a healthy debate!

So think of something better...something that wont screw all those people who have insurance now but didnt before and that is a start. We can discuss repealing it when you can replace it completely.

Repeal entirely at the federal level, make health insurance premiums tax-deductible to everyone, not just corporate employees, and concentrate reforms at the state level.

Even better, eliminate corporate-sponsored health insurance entirely. The only reason we have corporate-sponsored health insurance in the first place is a result of the wage-price controls during WWII -- wages were frozen while fringe benefit spending was not. Duh.
-- almost no mandates (e.g., PPACA makes men and post-menopausal women acquire maternity coverage, to force them to contribute to others' insurance coverage payment). We don't need the state chiropractic association forcing everyone in the state to acquire chiropractic; make it an option.
-- broaden the risk pool by using open enrollment windows and pooled coverage through association-based pricing (not employer based any more at all)
-- people with certain risk profiles receive direct subsidies from the state budget, just like they used to before PPACA was shoved down our throats
-- allow high-deductible plans, catastrophe only plans, and allow FSAs to roll over from year to year
-- we already have Medicaid for the poor, most of the so-called "expansion" in coverage merely went to increase the Medicaid rolls, not to offer insurance to people who did not have any access to it earlier: the "problem" never was "access" to insurance, it was the ability to afford premiums. PPACA merely put a majority of the uninsured into Medicaid while screwing over the self-employed (as per WJC, it was just "crazy" to do so).

The National Association of Insurance Commissioners is a very competent and professionally-staffed organization that can research and coordinate implementation of the best reforms across all the states while allowing for local flexibility to adjust to local demographics. They know what they are doing and do a very good job of it, and they have to deal with the day-to-day consequences of their decisions. The feds fail, they shrug their shoulders and say, "oh well that's too bad." No accountability is the biggest problem; the states are definitely accountable where the feds are not.

This "come up with a better solution" is total bovine fecal matter, and deep down you probably know it. There are plenty of better solutions around. The feds are gridlocked and never ever should have been involved in the first place; other than equalizing the tax treatment of premium payments between self-employed and corporate-employed, they should have stayed out.

Even better, make individually purchased health insurance tax deductible while making corporate sponsored health insurance a taxable fringe benefit. Incentives work way better than mandates when they are thought through ahead of time and applied consistently.

 

[SJHovey]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Your explanation is nonsense.

There is nothing wrong with my explanation. It's the program that's nonsense.

This, by the way, is a perfect example of why the system will never be corrected even with HRC in the White House and Dems in control of Congress. If left wing sheeple like Rover are going to demand we stay the course with a broken system, how will the Dems push through real change that works?

 

[FreshFish]

Re: The PPACA Thread Part III - Let's have a healthy debate!

What matters more, ineffectual good intentions or actual unfortunate results?

Market leaders that are continuing to sell coverage through HealthCare.gov or a state equivalent have been granted average premium increases of 30% or more in Alabama, Delaware, Hawaii, Kansas, Mississippi and Texas, according to information published by state regulators and on a federal site designed to highlight rate increases of 10% or more.

In states including Arizona, Illinois, Montana, Oklahoma, Pennsylvania and Tennessee, the approved rate increases for the market leader top 50%. In New Mexico, the Blue Cross Blue Shield plan agreed to resume selling plans through the online exchanges after sitting out last year, but has been allowed to increase rates 93% on their 2015 level.

Dominant insurers in Connecticut, Georgia, Indiana, Kentucky, Maine, Maryland and Oregon have been allowed to raise premiums by 20% or more, and rate increases from similarly situated carriers in Colorado, Florida and Idaho are brushing up against that threshold.

Beyond rate increases, provider networks are becoming more restrictive, and the number of insurance companies available to choose from continues to decline.

Cheerleaders who continue to proclaim, "who are you going to believe? Me? or your own eyes?" must be losing all credibility by now, no?

 

[dxmnkd316]

Re: The PPACA Thread Part III - Let's have a healthy debate!

My insurance went up $3/month but the out-of-pocket max went up $2,000.

 

[St. Clown]

Re: The PPACA Thread Part III - Let's have a healthy debate!

My insurance went up $3/month but the out-of-pocket max went up $2,000.

My enrollment process doesn't begin until next month. I'll learn the damage then. I'm not excited about this as I likely have some shoulder surgery on the horizon.

 

[FreshFish]

Re: The PPACA Thread Part III - Let's have a healthy debate!

My insurance went up $3/month but the out-of-pocket max went up $2,000.

beyond rate increases, the shrinking of provider networks also means longer waiting time to get an appointment. You might need to find a new provider, and then call them and be told that the next available opening is four months from now.

 

[dxmnkd316]

Re: The PPACA Thread Part III - Let's have a healthy debate!

beyond rate increases, the shrinking of provider networks also means longer waiting time to get an appointment. You might need to find a new provider, and then call them and be told that the next available opening is four months from now.

Not really. I've been with the same provider literally since the day I was born.

 

[FadeToBlack&Gold]

Re: The PPACA Thread Part III - Let's have a healthy debate!

I have little problem getting an appointment, except for an annual physical. My doctor is booked out 4 months in advance on those, but that was also the case pre-ACA.