Healthcare Question: If we don't force people to get coverage....Who pays if they get sick or injured??

Ultimately it increases the costs for those who do have insurance.

Alan

This is really the crux of the whole issue. Even if one's own personal morals allow them to say "if you can't pay, you won't get treatment," this isn't a realistic policy at this point. We as a society have decided that buying healthcare is fundamentally different from buying other goods, and that people should not be priced out of necessary treatment.

So while people try to frame the whole issue as "socialized medicine/the ACA require YOU to pay for other people's treatment," the reality is that we are paying for treatment for those who can't afford it one way or another. The only decision to be made is whether we want to have a rational plan for paying for this care.

The ACA isn't perfect by any means, but it's generally better to provide care for people before an emergency arises than to have poor people wait for an emergency and then show up at the hospital to receive care as mandated under EMTALA. Given that we are going to pay for that person's care either way, I'd rather pay for ongoing management of their diabetes than pay for them to be brought in on the edge of death and end up with a multiple day hospital stay at many times the cost.

Art is correct. Ultimately the bills will go unpaid or be classified as uncollectable, and to cover these losses, rates and deductibles are increased on those who are insured. This was one of the concepts Obamacare tried to address.

the general republican view is that not having health insurance is a choice, and choices equal freedom, and freedom = godliness.

I'm serious - they see not having health insurance as being a solid choice that we can all make.

What most people see as a problem, the repubs see as a giant benefit.

better free than healthy I suppose.

One of the biggest problems with ACA was that the penalties were not high enough. If you don't want health insurance and the penalty is less than the cost of coverage then it's a no brainer. One solution is tying the penalty to the cost of coverage. 1.5-2x cost of least expensive plan.

Remove state lines. Even if it's been proven to not actually lower costs. It "looks good".

If you're going to go with expanded government run healthcare it's going to cost a lot. You're going to have to increase taxes. I know it's been all the rave since Reagan to just not pay our bills but it's illogical.

Alan

eric a blair wrote:

the general republican view is that not having health insurance is a choice, and choices equal freedom, and freedom = godliness.

I'm serious - they see not having health insurance as being a solid choice that we can all make.

What most people see as a problem, the repubs see as a giant benefit.

better free than healthy I suppose.

This twisted logic is constantly used in other debates, it somehow makes people emotional and is simplistic enough for any Joe Dirt to feel empowered and knowledgeable.

The reality is this is one of many issues which the whole country pays for everyone else's choices and misfortunes. It's such an easy reality to grasp yet politicians keep telling people it doesn't have to work like that somehow. Our country is so fat and sick and our system so corrupt that it will be difficult and expensive to get on the right track (ACA-type structure), but we really never had a choice and have been kicking the can down the road.

It will never be perfect or smooth. I wish the healthcare/insurance system was more closely tied to one's health and lifestyle. Sure I may pay less than others because I'm younger and healthier, but it's peanuts less than the 300lb smoker down the road. That part I find unfair, but I prefer to make sure that fata$$ is covered because we are all paying for him anyway. Until we are at the point that hospitals can deny services to people, we are going to have to pay dearly for an all-inclusive system.

Maybe I'm wrong but this issue seems pretty simple. We either pay for the uninsured now or later. The costs have to be MUCH higher later. My analogy would be it's cheaper to change the oil in your car than it would be to neglect the maintenance and replace the engine.

It doesn't take a rocket scientist to see this, I truly don't understand the Republican point of view. Unless they are saying turn people away at the emergency room.

Hope this is not dumb question wrote:

Maybe I'm wrong but this issue seems pretty simple. We either pay for the uninsured now or later. The costs have to be MUCH higher later. My analogy would be it's cheaper to change the oil in your car than it would be to neglect the maintenance and replace the engine.

It doesn't take a rocket scientist to see this, I truly don't understand the Republican point of view. Unless they are saying turn people away at the emergency room.

they see a fundamental evil in forcing people to do something they don't want to do. They see the ACA mandate as pretty much evil and prioritize eliminating that over good health.

And there isn't a whole lot more to it.

The problem is regulating health insurance rather than the high cost of health care. I know people will jump in here and cry socialism etc., but, we need to start thinking of health care as a basic need like schooling. Not everything needs to exist to make profit only. Medical care is big business in the states, and that is the fundamental problem. If you stopped wanting to profit off people getting sick you could find a better solution.

You jumped the shark with freedom = godliness.

I didn't vote for the Repubs, but I 100% agree that the Federal gov't should not coerce people into paying for healthcare.

Healthcare is not a right. It's a service that costs a lot of $. You either pay for it or you don't. Most HHs get it via one HH member's job.

If you don't and you get sick, the new plan, as I understand it, penalizes you 30% for not signing up during an open enrollment period.

If you cannot afford it, there are tax credits, available in advance, based on your age and family size--the two variables that drive premium costs.

If you do none of the above, you show up at the emergency room, just like today.

To address the specific question:

Very poor people have Medicaid. Our taxes pay for their regardless of the current ACA law.

At an income level above that, an uninsured person receiving care would owe the whole bill, just like someone without comprehensive vehicle coverage would pay if their car was smashed and they wanted it fixed.

If the bill doesn't get paid, it's the same as any company that has unpaid receivables.

It gets written off and the expense is absorbed.

That drives up costs and makes it more expensive for others to get care or coverage.

That's where the Republican plan adds to the cost.

Hope this is not dumb question wrote:

Maybe I'm wrong but this issue seems pretty simple. We either pay for the uninsured now or later. The costs have to be MUCH higher later. My analogy would be it's cheaper to change the oil in your car than it would be to neglect the maintenance and replace the engine.

It doesn't take a rocket scientist to see this, I truly don't understand the Republican point of view. Unless they are saying turn people away at the emergency room.

I think we should cover everyone, either through a tax or a mandate, but I'm pretty sure it's "cheaper" (in the sense of total healthcare spending) to have more uninsured rather than less uninsured under our current system. Uninsured people don't really get no-strings-attached free healthcare. The law requires them to receive emergency treatment but they can't go to the doctor every time they feel ill and walk out with nothing to pay. Doctors and hospitals will send the wolves out to get any money they can. Certainly it might increase the costs under some circumstances if some major illness pops up that could have been prevented. However, most of the time uninsured people are healthy and won't consume healthcare as much as they would if they had a plan (they'll stay home from work if they have a cold rather than visiting their doctor). Even when they do get seriously ill, it probably costs less, as they'll wait and wait until their cancer or heart disease is extremely advanced and they'll die a month after diagnosis. An insured individual with the same condition might go through years of expensive treatment. The GOP plan does save money vis a vis Obamacare.

As stated, I don't think this is a good thing, just that it may not necessarily be more expensive to not insure everyone.

I know the various European style plans are cheaper than the US and cover everyone but some of that has to do with economies of scale and cost controls, not because of preventative care for poor people. Singapore's system, which is universal but requires everyone to buy a plan and pay something each time they visit the doctor (thus lowering overall consumption of healthcare) is the cheapest system by far in the developed world.

Hope this is not dumb question wrote:

What if these people don't have money to pay for their services? Is this cost factored into the Republican plan? Are there any estimates on this cost?

The solution is simple. Two words: FREE MARKET. Here's the plan....

1) US Healthcare is a mess.

2) Solution: free market!

3) ?????

4) Profit

Why does everybody think healthcare is so complicated? EVERYTHING in life is black and white, very simple, and can be fully explained in 140 characters or less.

#MAGA #unpresidented #whoknewhealthcarewassocomplex

#grabembythepu$$y

Also, I'm talking about total spending going down, not necessarily insurance premiums for covered individuals.

GOP deep thinker wrote:

Hope this is not dumb question wrote:

What if these people don't have money to pay for their services? Is this cost factored into the Republican plan? Are there any estimates on this cost?

The solution is simple. Two words: FREE MARKET. Here's the plan....

1) US Healthcare is a mess.

2) Solution: free market!

3) ?????

4) Profit

Why does everybody think healthcare is so complicated? EVERYTHING in life is black and white, very simple, and can be fully explained in 140 characters or less.

#MAGA #unpresidented #whoknewhealthcarewassocomplex

#grabembythepu$$y

It's always funny to hear an R's reaction when you argue for free market solutions to, say, highway funding.

R: "Let the free market decide!"

Me: "I completely agree. We should sell the highways and allow private companies to toll the roads. This would reduce congestion and put the cost of roads on the people who use them, allowing for economic efficiency and eliminating the need to subsidize the highway trust fund from general fund revenue."

R: "What? No! That would be terrible! You can't charge people to use roads!"

Me: "Oh, right, the free market is only for luxuries like healthcare, not for necessities like subsidizing your God given right to live in the middle of nowhere."

eric a blair wrote:

the general republican view is that not having health insurance is a choice, and choices equal freedom, and freedom = godliness.

I'm serious - they see not having health insurance as being a solid choice that we can all make.

What most people see as a problem, the repubs see as a giant benefit.

better free than healthy I suppose.

It is very hard to take your post seriously. Not having health insurance is indeed a choice we all can make. Being free and being healthy is not an incompatible combination. You can be both.

zephito wrote:

However, most of the time uninsured people are healthy and won't consume healthcare as much as they would if they had a plan (they'll stay home from work if they have a cold rather than visiting their doctor). Even when they do get seriously ill, it probably costs less, as they'll wait and wait until their cancer or heart disease is extremely advanced and they'll die a month after diagnosis. An insured individual with the same condition might go through years of expensive treatment. The GOP plan does save money vis a vis Obamacare.

Yes, it certainly is cheaper for people to not seek healthcare and die quickly.

But I think healthy people in general, even those with healthcare coverage, do not consume healthcare.

So a healthy person paying premiums but not using healthcare is exactly what drives premiums and deductibles down.

As you are concerned here with total cost, not average cost per person with a plan, it still drives total cost up if people do not catch illnesses early and eventually get very expensive treatments when they find out they are in an advanced stage.

Routine cancer screenings at Planned Parenthood often saves money in the long run, not to mention saves lives.

And then there is this pesky idea that we want people to be healthy.

Hope this is not dumb question wrote:

Maybe I'm wrong but this issue seems pretty simple. We either pay for the uninsured now or later. The costs have to be MUCH higher later. My analogy would be it's cheaper to change the oil in your car than it would be to neglect the maintenance and replace the engine.

It doesn't take a rocket scientist to see this, I truly don't understand the Republican point of view. Unless they are saying turn people away at the emergency room.

I'm not surprised that you don't understand this issue. You seem to think that rocket scientists have knowledge of the medical industry. Are there rockets in hospitals?

Illegal immigrants cost $100 billion per year. Let's kick them out and use that $100 billion on healthcare. Democrats and liberals really seem to have no respect for other peoples' money and hard work. Just because someone else has money doesn't mean you are entitled to take it.

Every damn health insurance thread on Letsrun is terribly void of identifying the root of the problem with our health care system. Hasn't anyone taken an economics class around here? Jeez.

Here's what needs to be addressed in the US "health insurance" system:

1) It's based on a fee-for-service business model (incredibly inefficient), and 2) it is "managed" by a third party payment system (also incredibly inefficient).

The ACA did virtually nothing to address either of these characteristics. It approached the problem from the demand side. Which, of course, only exasperates the problem by increasing demand [for the inefficiently-provided care].

Neither party wants to actually fix the problem. If you believe otherwise, you're a fool.

Fixing the problem would involve reducing health insurers' involvement for basic health-related goods and services. Eliminating it in most cases. If I have a cold or flu, or have a basic broken finger, or need a prescription for something, I shouldn't need to have Mr Health Insurer come in and skim some off the top of every single transaction between me and the doctor/hospital. Those prices should be published and doctors/hospitals can compete for the business of helping me resolve these basic health problems.

Complimentary to the above, fixing the problem would involve more properly defining and allowing insurance companies to actually do what "insurance" is supposed to do (risk/actuarial management). They are currently NOT allowed to do this. I repeat: Insurance companies are not allowed to function as real insurance. Anyway, since the basic health-related issues would now NOT skimmed off the top by the health insurance companies, they'd be making their money here. We could have a true "risk pool" for the truly catastrophic health events that occur in our lives. And yes, go ahead and cover everyone here. This could be a relatively standard proportion of an individual's income, with perhaps some progressiveness built in for the upper few percentile folks.

With just these two changes (albeit major changes, in the current climate), we'd greatly reduce the fee-for-service business model and the third-party payment system we have in place, and costs would actually start to come down. And AFTER costs start to come down, then guess what you can do? That's right, you can COVER MORE PEOPLE.

Our genius lawyer-trained (also a FEE-FOR-SERVICE industry, mind you) politicians tried to cover more people first, and not deal with the costs at all second.