Hillis
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From Obamacare To "Wedontcare"

Tue Mar 07, 2017 10:02 am

Reading over the first take of the GOP's healthcare proposal. And, like everything else with the GOP, the wealthy will benefit greately while the poorest Americans and older Americans will take the biggest hit. A person making $774,000.00 a year, would see a $33,000 tax break, while someone making $20,000 would lose approximately $1300 , or about 40% of what they get under ACA. And the fact that under this plan, the Federal Government would throw much of the burden of health care to the states, who simply can't afford it, many who are now insured will probably lose their coverage.

http://money.cnn.com/2017/03/06/news/ec ... index.html

Once again, it shows the GOP doesn't care for anyone but the wealthiest. This one is going to be hard to sell.
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tommy1808
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Re: From Obamacare To "Wedontcare"

Tue Mar 07, 2017 10:25 am

Well, they can't round up democratic voters and shoot them, so their plan is killing them by restricting their access to healthcare. Add to that their refusal of raising minimum wage and forcing employers to pay for overtime, and you arrive at a nice German phrase: "Arbeit macht frei".

Best regards
Thomas
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einsteinboricua
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Re: From Obamacare To "Wedontcare"

Tue Mar 07, 2017 12:10 pm

Four Republican Senators already oppose this, and it's not a sure thing that the House is set to vote on it. While Ryan may have the unofficial majority of the majority, there are enough TP House members who deem this as either Obamacare 2.0 or Obamacare Lite that they'll oppose it and derail it.

To address their concerns means it's probably dead on arrival at the Senate where 3 GOP defections are too many (and there are at least 4). And that's not considering the filibuster which McConnell cannot overcome unless he decides to change the rules of the Senate (knowing then that when they become the minority again, they'll be steamrolled).
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casinterest
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Re: From Obamacare To "Wedontcare"

Tue Mar 07, 2017 2:44 pm

So far to me,. it looks like the president lied again. Nothing less expensive, unless you are rich.

"So as soon as our secretary is approved and gets into the office, we’ll be filing a plan. And it was actually, pretty accurately reported today, The New York Times. And the plan will be repeal and replace Obamacare.

We’re going to have a health care that is far less expensive and far better. OK.."

https://www.nytimes.com/2017/01/11/us/p ... .html?_r=0
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MaverickM11
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Re: From Obamacare To "Wedontcare"

Tue Mar 07, 2017 2:50 pm

Insurance for the rich, but hey, the poor still have insurance: it's called prayer. Jesus will cure your cancer.
casinterest wrote:
So far to me,. it looks like the president lied again. Nothing less expensive, unless you are rich.

"So as soon as our secretary is approved and gets into the office, we’ll be filing a plan. And it was actually, pretty accurately reported today, The New York Times. And the plan will be repeal and replace Obamacare.

We’re going to have a health care that is far less expensive and far better. OK.."

https://www.nytimes.com/2017/01/11/us/p ... .html?_r=0

Trump “We're going to have insurance for everybody”..."they’ll be beautifully covered"
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moo
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Re: From Obamacare To "Wedontcare"

Tue Mar 07, 2017 2:53 pm

Image

Obamacare on the left, GOP replacement on the right.
 
tommy1808
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Re: From Obamacare To "Wedontcare"

Tue Mar 07, 2017 3:19 pm

moo wrote:
Image

Obamacare on the left, GOP replacement on the right.


Trump after drawing his Obama Care replacement (without his Toupet):
Image

MaverickM11 wrote:
Insurance for the rich, but hey, the poor still have insurance: it's called prayer. Jesus will cure your cancer.


And i do have the feeling that one of those loony toon´s will sooner or later say something along those lines. Just like Ben Carson just called kidnapped slaves immigrants......

best regards
Thomas
This signature is a safe space for Trump supporters....
 
wingman
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Re: From Obamacare To "Wedontcare"

Tue Mar 07, 2017 4:03 pm

I like the premium surge replacing the mandate. You get laid off at 50 and you don't need insurance until you get cancer, then you just pay 30% extra on your premiums to pay for $500,000 in procedures and chemo. All the while payments into the program have been cut by some 20M people. Insurance cos are gonna love that one. Imagine going to GEICO and saying you wrecked your Bentley and wnat to pay $600 a month starting now so they can pay your for your $90,000 fender bender. The when it's done you just cancel.

That's what I interpreted from the top-line bullet points, I hope that isn't right. I trust seven years of hard thinking by Repubs would produce better math than that.
 
DLFREEBIRD
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Re: From Obamacare To "Wedontcare"

Tue Mar 07, 2017 5:10 pm

i am concerned about lifetime limits and yearly maxs. Right now ACA protects us from both. Insurance companies are not allowed to deny claims for that reason. .


can someone tell me if they are going to keep that provision with this new health care plan?
 
sccutler
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Re: From Obamacare To "Wedontcare"

Tue Mar 07, 2017 5:52 pm

DLFREEBIRD wrote:
i am concerned about lifetime limits and yearly maxs. Right now ACA protects us from both. Insurance companies are not allowed to deny claims for that reason. .


can someone tell me if they are going to keep that provision with this new health care plan?


The "protection" in the ACA is illusory, in that it is financially unsustainable, and the proclaimed "successes" of the ACA are also illusory; but I am looking for something more tangible as a replacement.
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DLFREEBIRD
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Re: From Obamacare To "Wedontcare"

Tue Mar 07, 2017 5:55 pm

sccutler wrote:
DLFREEBIRD wrote:
i am concerned about lifetime limits and yearly maxs. Right now ACA protects us from both. Insurance companies are not allowed to deny claims for that reason. .


can someone tell me if they are going to keep that provision with this new health care plan?


The "protection" in the ACA is illusory, in that it is financially unsustainable, and the proclaimed "successes" of the ACA are also illusory; but I am looking for something more tangible as a replacement.



you don't know what you are taking about. on my health care statement from UHC it clearly showed i have reached my lifetime max. when i call UHC, the rep told me not to worry that ACA protects me by law. They have to pay my claims.

so what that means. is that it doesn't matter if i get insurance at reasonable rate through my employer, once i meet my lifetime max. i'm screwed.
 
wingman
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Re: From Obamacare To "Wedontcare"

Tue Mar 07, 2017 6:18 pm

The truth is there is merit to both points, because healthcare expenses in general are unsustainable. So Scutler is correct in that regard as DL is in that the law protects coverage NOW. But if there's no funding then it doesn't matter what the law says.

The vast majority of Americans approve of the key mandates in the ACA, it's basic human nature to care for your fellow man/woman. Maybe not a universal sentiment but certainly a majority have come to love the 26 rule and the pre-diagnosed protection. The key now is that to maintain these benefits one must address the expense equation, either through funding as in the individual mandate, or some other reasonable replacement of the mandate, and then the biggie...cutting costs. The ultimate question in my opinion will be, is quality healthcare a pure free market profit play, or is there some balance made there for the less fortunate where the government steps in to legislate costs. It would be a beautiful day if a bipartisan group could legislate a solution on that fundamental question.
 
DLFREEBIRD
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Re: From Obamacare To "Wedontcare"

Tue Mar 07, 2017 6:29 pm

wingman wrote:
The truth is there is merit to both points, because healthcare expenses in general are unsustainable. So Scutler is correct in that regard as DL is in that the law protects coverage NOW. But if there's no funding then it doesn't matter what the law says.

The vast majority of Americans approve of the key mandates in the ACA, it's basic human nature to care for your fellow man/woman. Maybe not a universal sentiment but certainly a majority have come to love the 26 rule and the pre-diagnosed protection. The key now is that to maintain these benefits one must address the expense equation, either through funding as in the individual mandate, or some other reasonable replacement of the mandate, and then the biggie...cutting costs. The ultimate question in my opinion will be, is quality healthcare a pure free market profit play, or is there some balance made there for the less fortunate where the government steps in to legislate costs. It would be a beautiful day if a bipartisan group could legislate a solution on that fundamental question.



i think you're missing the point. What's the point of keeping your kids on your health insurance until they reach 26
and what's the point of covering pre-existing conditions, if your going to have a lifetime benefit cap limit?

it doesn't take a rocket scientist to figure out that those who are the most sick, will lose their affordable coverage almost immediately through the cap.


the whole idea of health insurance coverage to begin with was to share the risk, if you have caps, then you are not sharing the risk.
 
rfields5421
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Re: From Obamacare To "Wedontcare"

Tue Mar 07, 2017 6:52 pm

casinterest wrote:
So far to me,. it looks like the president lied again. Nothing less expensive, unless you are rich.


This isn't the President's healthcare plan / replacement for Obamacare.

This is the Republican House leadership plan, which is mainly focused on keeping the Republicans in the House from flat out repealing ACA with NO replacement.

The Republican Party has never supported Trump's broadly outlined proposals. The House Republicans are showing him who is really in charge.

-------------

The point I don't understand is that dozens of countries around the world have better health plans for the majority of their citizens, many are public, but some are mostly private.

All of those countries do allow those who choose to do so, and can afford the costs, to use private healthcare rather than the government plan.

I don't understand people who say the US is too poor, too backward, too business profit focused to provide healthcare for its citizens.
 
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casinterest
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Re: From Obamacare To "Wedontcare"

Tue Mar 07, 2017 7:21 pm

rfields5421 wrote:
casinterest wrote:
So far to me,. it looks like the president lied again. Nothing less expensive, unless you are rich.


This isn't the President's healthcare plan / replacement for Obamacare.



But it is his party. So far they aren't following through on his promises. So just like Obama got dragged under, so too will Trump.

-------------
rfields5421 wrote:
The point I don't understand is that dozens of countries around the world have better health plans for the majority of their citizens, many are public, but some are mostly private.

All of those countries do allow those who choose to do so, and can afford the costs, to use private healthcare rather than the government plan.

I don't understand people who say the US is too poor, too backward, too business profit focused to provide healthcare for its citizens.


We have too many states with different rules, and the age old fight of who is in charge. State or Feds. The previous change, and this new change will do nothing but increase costs.

The current plan under the house spreads the tax credits across a wider income range, but it assumes that folks that are older are making a lot more money( Up to 5 times the premiums of younger folks) . Plus when they hit medicaid age, they suddenly don't pay in? There is nothing sustainable in it.
It also assumes all younger folks make no money which is not the case.

Could tax credits be spread out more failrly? Yes, but is the current plan the way to do it? I would argue it is not.
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MSPNWA
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Re: From Obamacare To "Wedontcare"

Tue Mar 07, 2017 7:30 pm

This is Obamacare Lite. Yuck. Well, I know Ryan is a sell-out and not a true conservative, so sadly I'm not surprised. Hope it fails.
 
sccutler
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Re: From Obamacare To "Wedontcare"

Tue Mar 07, 2017 7:39 pm

...and none of this addresses the core reality that the ACA is financially unsupportable, as crafted.
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rfields5421
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Re: From Obamacare To "Wedontcare"

Tue Mar 07, 2017 7:44 pm

I'm a bit biased about healthcare because except for one period of seven years with no primary insurance, and a 12 year period of commercial insurance through my employer (Aetna & United Healthcare) I've been on US government provided healthcare for over 45 years.

First in the US military active duty.

Then from 1992 to 2004 with military retiree Champus/ Tricare as a secondary payee.

Then 2004 to today with the Hillary Clinton/ John McCain improved Tricare as secondary- moving to primary in 2009.

I receive limited care from the VA directly for my service connected medical needs.

I've also worked with the VA for my father's care from 2001-2015 (his death from leukemia).

I've also worked with the VA for my son's care from 2003 when he came back from Iraq thru today.

My wife has been primary Medicare, secondary Tricare for Life since 2009.

We don't live near a military base, so only use military treatment facilities if something happens while we are traveling.

Frankly, I have better healthcare than any one else in my family. That includes an MD in Louisiana, a pharmacist in Alabama. Major company employees in four states, teachers in two states and railroad employees in two states.

My coverage under Aetna and United Healthcare was limited, costly and very non-responsive to my needs. I guess that is what a Fortune 100 company employee with a 'Cadillac' healthcare plan has to put up with.

My daughter in law works in hospital billing where my son receives his main VA funded care. She tells me that the hospital loves VA/ Medicare/ Tricare patients. With one payor, one claims submission system, one easy to understand set of diagnosis codes and procedures.

One aspect of ACA which the insurance companies fought was going to a common claims submission system. It looks like that requirement has disappeared in the new House proposal.
 
rfields5421
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Re: From Obamacare To "Wedontcare"

Tue Mar 07, 2017 7:49 pm

sccutler wrote:
...and none of this addresses the core reality that the ACA is financially unsupportable, as crafted.


Then how do other countries support their healthcare systems? We constantly hear from the Republicans and conservative media that the US had the highest taxes on businesses, on the most productive taxpayers.

How is it that countries the Republicans say have lower taxes have better healthcare for a much highest percentage of their population.

The main difference I can see is that most healthcare in the US is provided by for profit companies.
 
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casinterest
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Re: From Obamacare To "Wedontcare"

Tue Mar 07, 2017 7:49 pm

sccutler wrote:
...and none of this addresses the core reality that the ACA is financially unsupportable, as crafted.



It's just as financially unsupportable as the current house bill.

Neither bill addresses issues with pharmaceuticals, and care across state lines.
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bhill
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Re: From Obamacare To "Wedontcare"

Tue Mar 07, 2017 8:01 pm

sccutler wrote:
...and none of this addresses the core reality that the ACA is financially unsupportable, as crafted.


The ENTIRE US Health Care Industry is unsustainable in it's current for profit existence.
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cpd
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Re: From Obamacare To "Wedontcare"

Tue Mar 07, 2017 9:25 pm

rfields5421 wrote:
casinterest wrote:
So far to me,. it looks like the president lied again. Nothing less expensive, unless you are rich.


This isn't the President's healthcare plan / replacement for Obamacare.

This is the Republican House leadership plan, which is mainly focused on keeping the Republicans in the House from flat out repealing ACA with NO replacement.

The Republican Party has never supported Trump's broadly outlined proposals. The House Republicans are showing him who is really in charge.

-------------

The point I don't understand is that dozens of countries around the world have better health plans for the majority of their citizens, many are public, but some are mostly private.

All of those countries do allow those who choose to do so, and can afford the costs, to use private healthcare rather than the government plan.

I don't understand people who say the US is too poor, too backward, too business profit focused to provide healthcare for its citizens.


I have private health insurance, which I use for things like hospital visits/procedures. But the run of the mill things like visiting the local doctor are under the government funded thing. Funny thing, I rarely ever need to use my private insurance. I also fortunately rarely need to see a doctor either. Maybe only if I've had a racing accident and need to be patched up, other than that, I'm fairly healthy.
 
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pvjin
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 12:35 am

Trump is doing God's work. This planet is severely overpopulated and our specie is about to go extinct if nothing changes, modern medicine should be accessible only to the rich and intelligent who know not to make too many children. Survival of the fittest would be good for the gene pool also.
"Optimism is the madness of insisting that all is well when we are miserable." - Voltaire
 
einsteinboricua
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 1:27 am

pvjin wrote:
Trump is doing God's work. This planet is severely overpopulated and our specie is about to go extinct if nothing changes, modern medicine should be accessible only to the rich and intelligent who know not to make too many children. Survival of the fittest would be good for the gene pool also.

And this is precisely why you're in my ignore list.
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rfields5421
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 2:04 am

Interesting to watch the various coverage on some networks web sites.

CNN is featuring a meeting with Trump and some House Republicans, warning them if they do not pass an effective replacement for ACA, the 2018 election will be a 'bloodbath' for the Republicans.

Fox is featuring 'conservatives' who say the replacement is too expensive and too much like the ACA. Warning that if this bill is passed, conservatives will not support it and the 2018 election will see most of the incumbent Republican congressmen replaced.

ABC is focusing on Spicers statement that the proposal is a 'starting point' for additional negotiations and modifications.
 
BestWestern
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 2:47 am

Are there any redeeming features to this bill that could improve healthcare?
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Hillis
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 4:03 am

BestWestern wrote:
Are there any redeeming features to this bill that could improve healthcare?


Only if you're very wealthy or very young. For everyone else, it's a disaster.
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330west
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 4:13 am

pvjin wrote:
Trump is doing God's work. This planet is severely overpopulated and our specie is about to go extinct if nothing changes, modern medicine should be accessible only to the rich and intelligent who know not to make too many children. Survival of the fittest would be good for the gene pool also.


This is seriously one of the stupidest things I've ever read and being an American, I have a lifetime of experience with the ignorant.

I'd add that your mention and apparent acknowledgement of a higher power("God") indicates intellectual and ethical deficiencies not worth perpetuating(in a perfect world).
 
seb146
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 5:44 am

Besides pvjin's statement, one of the most ignorant of the current health care debate was from Jason Chaffetz about how easily "the poor" can afford health care if they just give up their iPhone.

https://www.washingtonpost.com/news/won ... f8a3df13cb
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tommy1808
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 7:26 am

rfields5421 wrote:
Then how do other countries support their healthcare systems? We constantly hear from the Republicans and conservative media that the US had the highest taxes on businesses, on the most productive taxpayers.

How is it that countries the Republicans say have lower taxes have better healthcare for a much highest percentage of their population.

The main difference I can see is that most healthcare in the US is provided by for profit companies.


Well, in most countries healthcare is provided on a for profit basis. However, in most countries health insurances have much more negotiating power to get pricing for medication and treatment down. Most countries don´t allow those ridiculously high penalty payments in case of male practice, saving tons of money on insurance premiums for doctors. And of course you have a strong regulatory instance that just tells you "nope, you are not charging that price", if your greed becomes to big. Not that they force you to sell cheaper, they just don´t allow any health insurance to pay for your medication. Same for hospitals, need an appendix removed? This is the maximum number of days the health insurance is going to pay since that is the best practice average, and if you don´t keep staff and equipment on state of the art level and need more time? That is your problem, modernize or file for bancrupcy. Thsi also helps hospitals in rural areas, while they have less patients and therfore "loadfactor", their base costs are usually lower, so they have higher yields per pax.

best regards
Thomas
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Francoflier
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 8:26 am

Predictably, this heap of a bill is sustaining heavy fire from both sides.

The democrats decry another republican plan that will take from the working classes to give to the rich, republican senators are divided on the merits of the bill, the alt-right is up in arms because the poorer and immigrants will still benefit instead of letting them die.
The President, who doesn't seem to be able to manage this mess of a government is tweeting furiously about how 'wonderful' the bill is in the face of an 'imploding' Obamacare and that everyone should endorse it, or else...

http://www.bbc.com/news/world-us-canada-39200733

At least it's fun to watch the republicans grappling with the harsh realities of playing with people's lives instead of just sitting there opposing everything Obama did just because Obama could do no good...
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SOBHI51
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 3:09 pm

pvjin wrote:
Trump is doing God's work. This planet is severely overpopulated and our specie is about to go extinct if nothing changes, modern medicine should be accessible only to the rich and intelligent who know not to make too many children. Survival of the fittest would be good for the gene pool also.


Wow.
Hitler is a KG student compared to you.
The easiest way to get to your goal is WWIII.
I am against any terrorist acts committed under the name of Islam
 
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pvjin
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 3:19 pm

SOBHI51 wrote:
pvjin wrote:
Trump is doing God's work. This planet is severely overpopulated and our specie is about to go extinct if nothing changes, modern medicine should be accessible only to the rich and intelligent who know not to make too many children. Survival of the fittest would be good for the gene pool also.


Wow.
Hitler is a KG student compared to you.
The easiest way to get to your goal is WWIII.


WWIII of some kind is inevitable once we really start running out of resources and the climate change starts taking its toll. If I could choose the world population would be brought to sustainable levels peacefully through forced one child policy and restrictions on economic consumption, but as that won't happen we will have a total collapse instead.

More one studies history, society and economics, better one realizes how unsustainable the world of ours has become.

As far as Hitler comparison goes, I would like myself to be compared to this guy instead:

https://en.wikipedia.org/wiki/Pentti_Linkola

He's a famous Finnish ecologist who has received awards for his work. Unlike most environmentalists he tells things as they are, sad and brutal.

Ultimately though, I see him as a true humanist. I would prefer humankind to exist 1000 years from now, and the ideas Linkola advocates would guarantee that much better than anything else. The idea that world's population should be allowed to reach 10 billion and everyone should try to reach western standards of living is the most evil out there as it's a death sentence to future generations.
"Optimism is the madness of insisting that all is well when we are miserable." - Voltaire
 
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WildcatYXU
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 3:58 pm

tommy1808 wrote:
Well, in most countries healthcare is provided on a for profit basis. Most countries don´t allow those ridiculously high penalty payments in case of male practice, saving tons of money on insurance premiums for doctors.

best regards
Thomas


Actually, those penalty payments seem ridiculous only until until you're on the receiving end of malpractice.
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sovietjet
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 4:16 pm

pvjin wrote:
Trump is doing God's work. This planet is severely overpopulated and our specie is about to go extinct if nothing changes, modern medicine should be accessible only to the rich and intelligent who know not to make too many children. Survival of the fittest would be good for the gene pool also.


Alright then, so when your child gets a serious sickness or is in an accident that requires hospitalization, I expect you to just say "well tough luck, better my child dies because the planet is overpopulated anyway. My child is not fit enough to survive!".
 
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pvjin
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 4:42 pm

sovietjet wrote:
Alright then, so when your child gets a serious sickness or is in an accident that requires hospitalization, I expect you to just say "well tough luck, better my child dies because the planet is overpopulated anyway. My child is not fit enough to survive!".


If I could get my child healthcare I would obviously take it, after all I'm a hypocrite just like most people. Besides, if 999 out of 1000 people use government healthcare, what good would one dissident do in the big picture? As I see it environmental problems could be solved only through enforced and authoritarian government level legislation, as people will ultimately make only think of themselves and those close to them in their daily choices.

Tbh I don't even think healthcare is the real issue despite my provocative post, people living long would be no problem if nobody made more than one child.
"Optimism is the madness of insisting that all is well when we are miserable." - Voltaire
 
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Tugger
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 5:06 pm

tommy1808 wrote:
need an appendix removed? This is the maximum number of days the health insurance is going to pay since that is the best practice average,

Well that's bad idea and a bad way to manage things. "Average" in general doesn't truly exist in the real world. It is just an attempt to find what is the most common of something that actually exists in a range, often a wide range. It means "middle" (basically) statistically, and that means that roughly half of the stays are over that amount so roughly half the population being served will be managed improperly. Forced out early. And it also likely means the other half (those that stay shorter) may also be mismanaged as some may think "Oooh, its too early to let you out.".

Averages are a bad way to manage many things that are in the real world. You may budget based on averages but you have to know and plan to ranges and then manage that. And then there is the fact that averages are based on past data and of course "past performance is no guarantee of future performance".

Tugg
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einsteinboricua
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 5:25 pm

I am particularly interested in seeing how the removal of the provision in the ACA that dictates that profits be used for healthcare and not bonuses is looking out for the middle class.

The fact that the $500,000 deductible will now be doubled to $1M if this becomes law is very worrisome. We again go back to the for-profit mentality.

Source
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tommy1808
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 5:43 pm

WildcatYXU wrote:
Actually, those penalty payments seem ridiculous only until until you're on the receiving end of malpractice.


My family has been and I still find them rediculous. Money doesn't give you a leg back. Whatever it costs to enable a as normal as possible life plus a reasonable amount of cash for.the pain does well enough. There is no reason to have all insured pay for your misfortune, incompetent physicians can be removed much easier than squeezing them.out of their insurance.

Tugger wrote:
Well that's bad idea and a bad way to manage things. "Average" in general doesn't truly exist in the real world.


In a large enough sample averages are very real. Hospitals have sample sizes well large enough.

Best regards
Thomas
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moo
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 5:44 pm

The Republican healthcare bill H.R.1275 now officially has a new name:

World's Greatest Healthcare Plan of 2017


And no, thats not a joke, thats how its listed on congress.gov:

Image
 
rfields5421
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 6:56 pm

Limits on the number of days hospitalization for procedures are the norm in the US with private for profit insurance companies.

Most non-emergency procedures require pre-authorization and the hospital has to agree to X days at rate Y for the procedure/ hospitalization.

In emergencies, the insurance company will tell the hospital how many days will be covered.

Many to most hospitals will not even try to keep a patient who needs additional care. The paperwork is too much and the insurance company review process can often leave the hospital having to absorb cost for 'denied' days.

Easier for the hospital to ship the patient to a rehab facility (nursing home) or send them home with a request for Home Health.
 
sccutler
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 7:14 pm

rfields5421 wrote:
sccutler wrote:
...and none of this addresses the core reality that the ACA is financially unsupportable, as crafted.


Then how do other countries support their healthcare systems? We constantly hear from the Republicans and conservative media that the US had the highest taxes on businesses, on the most productive taxpayers.

How is it that countries the Republicans say have lower taxes have better healthcare for a much highest percentage of their population.

The main difference I can see is that most healthcare in the US is provided by for profit companies.


You've asked the key questions, and have identified the key failure of the ACA (and, why its failure was, to anyone who grasps basic bureaucratic behavior, inevitable.
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tommy1808
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 7:21 pm

rfields5421 wrote:
Limits on the number of days hospitalization for procedures are the norm in the US with private for profit insurance companies.


But those may be different for each insurance? In that case those are simply financial caps without consideration for state of the art medical care and without consistant optimization pressure. Best strategy for a hospital in that case is to optimize for those insurances that pay more days, and ship off all customers they can, if their insurance is below the threshold, and not best overall cost efficiency.
I may have phrased it a little bad, hospitals here don't get a day limit, they get a per case sum. That sum is based on best practice costs. So, the hospital strategy has to balance customer appeal (food, rooms, good quality medical care, staff availability etc.) vs. Cost control to stay in business and profitable. Removing an appendix for a young, otherwise healthy patient for example is 2100 Eur. Since we have that system, hospital stays have become 40% shorter. Without "bloody discharge" I hear does happen in the US if your days are up.

Best regards
Thomas
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rfields5421
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 9:38 pm

Hospital stay limits in a number of days are pretty standardized across insurance companies in the US. They very closely follow Medicare/ Medicaid guidelines.

A total cost of procedure would be very difficult to implement in the US.

The hospital provides basic room, food and nursing services at a flat rate per day basis. Drugs are an added cost item, as are most medical supplies such as bandages, IV lines, etc.

Some medical equipment is also billed separately. The pharmacy may be run by the hospital or may be contracted out to a separate company. The same with the hospital lab, some are inhouse, some are contracted.

Doctors are always billed separately. Not just your personal primary care physician who of course is not a hospital employee but who is in overall charge of your case.

Even the ER doctors, surgeons, radiologists, who work regular schedules in the hospital are employed by another company, and of course billed separately.

To make matters worse for the patient, the hospital and the primary care physician are almost certainly 'in network' and the hospital physicians and specialists frequently are not.

By 'in network' the doctor/ hospital has a contract with that insurance company to accept their standard fees for services, and the patient accepts the standard deductible and co-pays for the hospital and doctor.

'Out of network' doctors and other medical companies bill what they want, and try to get the patient to pay what the insurance company will not.

Last summer I had cataract surgery on both eyes two weeks apart. The basic fees for my surgeon, the day surgery center and the anesthesiologist were paid by my Tricare insurance. Each of them was 'in network' so there were no surprise fees/ bills. I did ask to be sure the anesthesiologist was in network.

A friend of mine had the same surgery but did not have an 'in network' anesthesiologist and was hit with an unexpected $900 bill. He was able to negotiate that down to $600.

My total out of pocket cost per eye was about $250. The anesthesiologist co-pay was $25.75 per eye. My friend paid a little over $950 per eye using private insurance.

The doctors and day surgery center got the same amount of money from the insurance companies.
 
Hillis
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Re: From Obamacare To "Wedontcare"

Wed Mar 08, 2017 11:24 pm

sovietjet wrote:
pvjin wrote:
Trump is doing God's work. This planet is severely overpopulated and our specie is about to go extinct if nothing changes, modern medicine should be accessible only to the rich and intelligent who know not to make too many children. Survival of the fittest would be good for the gene pool also.


Alright then, so when your child gets a serious sickness or is in an accident that requires hospitalization, I expect you to just say "well tough luck, better my child dies because the planet is overpopulated anyway. My child is not fit enough to survive!".


Oh, the two Communists are having a spat! :duck:
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blueflyer
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Re: From Obamacare To "Wedontcare"

Thu Mar 09, 2017 6:57 am

tommy1808 wrote:
rfields5421 wrote:
Well, in most countries healthcare is provided on a for profit basis. However, in most countries health insurances have much more negotiating power to get pricing for medication and treatment down. Most countries don´t allow those ridiculously high penalty payments in case of male practice, saving tons of money on insurance premiums for doctors.

Many countries also subsidize higher education so doctors don't need to make a fortune just to pay off their student loans, and don't make their future doctors take four years of useless college courses before they can enter medical school. Insurance claims forms are also simplified and standardized to a point general practitioners do not need to hire someone for the sole purpose of filing reimbursement claims. Many don't even have a staff at all!

There are a lot of factors that make medical care in the US as expensive as it is.
Democracy 2016: 3 million California votes < 100,000 Midwest votes.
 
tommy1808
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Re: From Obamacare To "Wedontcare"

Thu Mar 09, 2017 7:05 am

rfields5421 wrote:
Hospital stay limits in a number of days are pretty standardized across insurance companies in the US. They very closely follow Medicare/ Medicaid guidelines.

A total cost of procedure would be very difficult to implement in the US. .


thank you for your fairly complete explaination why and how screwed up the US health system is. Administrative costs alone may be a nightmare and from your explanation i wouldn´t be too surprised if there are cases where those alone exceed the costs for the whole procedure in other places.

blueflyer wrote:
Many countries also subsidize higher education so doctors don't need to make a fortune just to pay off their student loans.


Or University education is simply for free.

best regards
Thomas
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rfields5421
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Re: From Obamacare To "Wedontcare"

Thu Mar 09, 2017 3:03 pm

One other key point to remember about the United States.

We do not have one government, we have 52 different governments. Many things like education and insurance are under the control of the individual states.

That is why the Obamacare implementation went very smoothly in some states and horribly bad in others. The state governments hate anything done on a national level.

Even this new bill implements greater state level controls for healthcare for the poor, ensuring once again that there will be great differences in coverage from state to state.
 
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casinterest
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Re: From Obamacare To "Wedontcare"

Thu Mar 09, 2017 3:21 pm

A good article showing the uphill rowing Trumpcare has to face if it is to pass and be enacted.

http://www.cnbc.com/2017/03/09/the-repu ... oters.html

"
Exit polls showed that just 10 percent of Trump's votes came from Americans earning $200,000 or more. Yet those voters would derive all benefits from the repeal of the two individual tax hikes targeting them: a 0.9 percent tax on their earnings, and a 3.8 percent tax on their investment income.

An even smaller group, the top 1 percent of earners, would receive an average tax cut of $33,000, according to the Tax Policy Center. The top 0.1 percent of earners would receive an average tax cut of $197,000.

..........
An Urban Institute study found that Obamacare reduced the number of noncollege whites without insurance by 6.2 million between 2010 and 2015, a drop of 39 percent. In 20 of the 30 states that Trump won, more noncollege whites gained coverage than any other group."


The Republicans are pushing hard on a bill that hurts their core constituency.

Will Trump and all try to push this health bill through so that reconciliation doesn't expire which would remove the majority vote needed for enactment?
Older than I just was ,and younger than I will soo be.
 
rfields5421
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Re: From Obamacare To "Wedontcare"

Thu Mar 09, 2017 6:12 pm

They will push something through. I have little expectation that the current bill will not get through the Congress and get passed.

Though there will definitely be modifications, so we won't see the final version until it lands on Trump's desk. Even then, the implementation regulations published later in the Federal Register will tell us more about exactly how the bill will work/ impact our daily lives.

My hope is that the Congress will be amenable to addressing specific issues and tweaking the law in the future.

No one expected the ACA/Obamacare to remain in place for several years as it was originally passed. Democrats, Republicans and the President all said at the time it was passed that there would need to be some adjustments and changes as the law was implemented and unforeseen consequences would need to be addressed.

However, the House Republicans absolutely refused to allow any changes to make the ACA a better law that served the needs of the people better. Their stance was only one possible change allowed - complete repeal.

I am certain that a year from now, enough unhappy voters will be talking to Congressmen seeking re-election - that they will want to make changes.

Heck, one year from today the Republican primaries in Texas will be over. Quite possibly several of the House Republicans from Texas spearheading the efforts to pass this bill might have felt voter anger and have lost their party primary.

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