Serious question what will replace obama care?

Its gotta be said wrote:

How will Trump cover everyone and reduce cost of health insurance?

Honest question.

A fcking job.

Honest Answer.

joedirt wrote:

Simple, replace Obamacare with a simple mandate. Any company that sells group health insurance policies in a state is required by law to offer individual policies regardless of pre-existing conditions at no more than a 25% premium on the exchanges where people can choose what coverages they want. Plans would renew annually to discourage people from not carrying coverage when they don't feel they need it. Provide optional riders for pregnancy, mental health, and HIV to keep premiums lower for the general population.

Here's a tip: any solution for repealing and replacing the nation's healthcare system that starts with "simple" is a terrible idea.

I'll answer this question with a question: What is Trump and Republicans going to do when it suddenly dawns on them that Obamacare is a Republican plan and the big health insurance companies like it? Republicans only hate Obamacare, because a black Democrat President shamelessly sold out to the health industry and took credit for it before they ever did. My prediction: Trump makes some relatively minor changes to Obamacare but the basic substance of Obamacare is retained. Then in classic Trump style he makes a big media blitz to spin those minor changes into a story that he destroyed Obamacare and created a new and better system.

Its gotta be said wrote:

How will Trump cover everyone and reduce cost of health insurance?

Honest question.

Actually, it does. The canadian system used in the US is called Medicare. There periodically is a proposal on the table to let people 55-64 buy into it early at a non subsidized rate, about $9000 a year as an individual. It would be cheaper than my current high deductible plan ($12,000 a year) and be easier to use because everybody takes medicare. I am a healthy 59 year old.

asdfasdfa wrote:

Blah Blah Blah. wrote:

Trump's plan is on his website:

https://www.donaldjtrump.com/positions/healthcare-reform

What he recommends will definitely improve quality or care and reduce costs.

Unlikely. Pretty much all of the recomendations have been looked at as part of other plans and they have all had minimal to negative changes.

And some are fantasy land stuff. He plans on 10 billion dollars savings by paying 0 cents for illegal immigrants. Sounds great. But in reality, how many billion do you think it will cost to deport something like 12 million people AND prevent more people from coming in? To save that 10 billion, you might need to spend 100 billion.

You can solve the illegal immigration problem by penalizing companies that employ illegals and make them pay for the cost of the enforcement and the deportations. If there is no job market for illegals, they won't come (or they will work in black markets). Actually if Trump really does rework the NAFTA treaty, it will cause more illegals to try and enter the country (that's why the Peso took a beating today).

Consolidate Medicare and Medicade and the Department of Health Services into the national health care program ran under the Surgeon General.

I only thought of that now. Do you love me now?

You've been drinking too much Medicade, haven't you?

Blah Blah Blah. wrote:

Trump's plan is on his website:

https://www.donaldjtrump.com/positions/healthcare-reform

What he recommends will definitely improve quality or care and reduce costs.

What a load of %$#@ Health care saving plans? For people with crap jobs? Tax savings? What tax savings when you don't pay any taxes again because you have a low paying job? Free market for insurance and drug companies? Yea, that worked out before... rates were going up 15-20% per year during the "W" years.

Price transparency... excuse me Ms. Ambulance Driver... how much is my heart attack treatment going to be at Hospital A... oh no, go to Hospital B that is an hour drive away.. I can hold on.

You people are delusional (magical thinking... I won't ever get sick, or old).

Obamacare is a flawed law in many respects, the process by which it was created was terrible -- the Republicans basically sat on the sidelines and didn't participate, hoping to be obstructionists. Dems found loopholes to get it passed. What I'm saying is, any law written and passed by one party is probably going to suck. So, I'm not holding out hope that a Republican president and Congress are going to magically come up with something better. A truly bipartisan solution is needed.

I get my coverage through my employer. We had several years of ~20% increases prior to Obamacare. The biggest increase since Obamacare has been 8%, and this year, our costs DECLINED 3% -- the first time that has ever happened.

I don't know if Obamacare had anything to do with our costs stabilizing and declining or not, but I sure don't want to go back to the days of 20% increases, either.

joedirt wrote:

Simple, replace Obamacare with a simple mandate. Any company that sells group health insurance policies in a state is required by law to offer individual policies regardless of pre-existing conditions at no more than a 25% premium on the exchanges where people can choose what coverages they want. Plans would renew annually to discourage people from not carrying coverage when they don't feel they need it. Provide optional riders for pregnancy, mental health, and HIV to keep premiums lower for the general population.

I don't have a simple solution (there isn't one), but what you've described won't work and I'll explain why. This is how insurance works.

Private companies are in business to make a profit within the rules. The new rule you add will either force companies to exit the insurance market within a state or increase the cost of group coverage such that the aggregate risk pool would be adequately funded for each insurer. This would lead to fewer and fewer group policies being purchased, leading to further cost increases above and beyond inflation.

Its gotta be said wrote:

How will Trump cover everyone and reduce cost of health insurance?

Honest question.

Competition will replace Obamacare. Prices on insurance will fall but you will have to buy insurance. There is not free ride unless you roll the dice and don't buy it. We already have Medicaid for the poor and Medicare for the elderly so vulnerable people are already covered.

sub3over40 wrote:

Its gotta be said wrote:

How will Trump cover everyone and reduce cost of health insurance?

Honest question.

Competition will replace Obamacare. Prices on insurance will fall but you will have to buy insurance. There is not free ride unless you roll the dice and don't buy it. We already have Medicaid for the poor and Medicare for the elderly so vulnerable people are already covered.

Competition won't work for the system as a whole. Here is why.

Company B offers a lower cost option to Company A, but it covers less. This appeals to the healthier individuals (who need less) so they switch to company B. The folks left at Company A, now cost more per capita (the healthy folks are now in company B) so rates have to go up.

You can keep adding companies and see that it will always end up with sicker patients getting priced out.... Overall costs won't go down, though healthier people may pay lower premiums.

This is termed cherry picking.

What about setting a fixed list of covered items and asking insurers to compete on price? Better, though most insurers have creative ways to add cherry picking back into the mix (like a financial bonus for meeting some fitness metric)

Keep in mind that we, the population, are still paying the salaries of the insurance executives and the profits for the company as part of our premiums.

In order to understand why we have our current health insurance (not healthcare) system, we have to take a little history lesson. The whole system was an outgrowth of government implemented price controls during WWII. That's right, our current for-profit system was unplanned and not sought. The US was deeply concerned at the beginning of WWII that it would not be able to afford the full cost of conducting war. Most able bodied men were fighting and there was a serious shortage of labor to produce war material. The government implemented sweeping price controls to ensure that the price of a bullet in 1942 was the same as the price of a bullet in 1945. Simple economics meant that a shortage of labor meant that wages should rise, but companies were not allowed to do so. To attract labor companies instead started offering benefits including health insurance.

After the war, we were the obvious victors and the system was never dismantled because at the time there was no political drive to do so. We had the only remaining industrial base and thus had a ready made market where the whole world was forced to purchase U.S. goods. Economically, we won huge and were able to continue this higher costing and complex health insurance system. More importantly, every other nation had sweeping political changes or entirely new political regimes because the populace was sick of war and/or the losers of the conflict. This paved the way for every other post-WWII nation to choose their own form of health insurance. Effectively, every other nation had a politically blank canvas whereby policy makers and the populace could choose their preferred system. Interestingly, despite having the US as a stand out example of excellence, they chose something different where everyone was covered despite employment status.

What has happened in the ensuing 70 years? The world recovered economically and restored their ability to manufacture. The U.S. no longer enjoys a monopoly on our goods abroad. Our companies large and small are put at a significant disadvantage compared to international competition because they are throttled with the burden of this patchwork of health insurance systems. This is one of the major reasons why businesses have actively chosen to sell or move abroad. All you have to do is look to the thread yesterday where a small business owner is drowning under the administrative burden of insuring his 25 employees let alone the cost of dealing with it.

We need to collectively realize that our health insurance system was never chosen by us, it is the inherited child no one thought they would have to deal with. This system was never expected to be contorted into the fragmented mess it is today let alone survive past the War. Honestly, nothing short of a revolution will change this system because a select few powerful people / companies profit well at the majority's expense.

If we as a people could see through the fog, the answer is clear. Our current system puts our companies at a significant disadvantage from their international counterparts. Also, each employee or entrepreneur is handicapped. Employees are saddled with our employer until we can find another employer with decent health insurance. This is a problem because people's employment choices should be based upon work, not insurance. When the economy tanks, millions of people lose insurance overnight as they lose jobs. Finally, it becomes that much harder to start a company because to do so means that you may forgo having health insurance and thus are at risk of losing your company to unforeseen health problems. Ultimately, by decoupling health insurance from employment means a more flexible and more adaptable workforce.

I've seen a few people ponder what decoupling health insurance from employment would mean and I felt the need to opine.

The fundamental problem with US health insurance is that it has two entirely juxtaposed goals. The first goal is to provide financial coverage for those insured within the plan based upon the medical needs of those within the plan. The second goal is to maximize profit of the company and therefore shareholder value. In order to fulfill the needs of one side, the other loses ground and it is a constant battle. Unfortunately, the shareholder wins more battles than the medical consumer.

The reason for this is simple. The insurance company must negotiate with three separate entities. First, the provider. Most providers are very large companies as well that make it their business to provide care and push hard to get paid for it. Second, is the company which purchases the insurance plan (employer). They too have a bottom line they need to protect. They can negotiate, but at the end of the day, there is a minimum profit the insurance company is willing to earn. This drives employers to cheaper and cheaper plans or shouldering less of the premium. Any 30 year employee has seen this drifting of benefits over their lifetime. Third, are the employees / plan holders. They have virtually no negotiating power. By the time the choice comes to an individual, you will have a small handful of plans to pick from and the open marketplace is guaranteed to be worse unless you have income below poverty. This is why the burden of expense has drifted towards the individual and the ACA does little to affect this balance. In all actuality the ACA was a boon to the insurance industry in disguise. In addition, the consumer has no negotiating power on the cost of any drug or the cost of any care.

Arguments are often made by insurers that these new plans "put you more in control" or that it "allows you to understand the cost of care". The problem with this statement is it ignores the way unique way people consume healthcare. Healthcare in general is highly inelastic meaning it is not price sensitive regardless of the cost. If you have a heart attack, you don't wait to get a preauthorization and then instruct the ambulance to send you the cheapest hospital while you shop around. If your kid has leukemia, you don't find the cheapest solution. You search for the best solution to save someone that you love more than money.

To further obfuscate the problem is the cost of everything is highly fungible based upon who is paying / the source of funds. What I mean is that providers can rarely have the same price for the same service for two separate buyers. They do this to maximize revenue and thus maximize their own profit. They often have to do this because the insurance companies make it their job to whittle that bill down as much as possible.

Okay, so I just stated a whole lot about the current situation without providing solutions. I have my own strong opinions, which is why I withheld them until now. The following is why I say change from the current situation requires nothing short of a revolution. The solution requires trade offs, different freedoms, and several huge puzzle pieces to be aligned.

First: decouple employment from health insurance. Statistically speaking, those recently unemployed or under employed are most likely to require healthcare. People need access to care regardless of their current ability to work. A healthier population ultimately works more; earns more; and thus pays more taxes.

Second: eliminate the profit motive from the health insurance companies. This one is huge and nearly impossible. One possible example for guidance is Germany. Germany does not have a single payer system yet has universal coverage. They have many different insurers. However, German insurers are not permitted to make a profit. If premiums are too much, they must return those to the policy holders in the form of lower premiums the next year. What is to motivate the insurance companies then? Their right to exist. They compete for customers / policy holders rather than shareholder value. If they charge too much, customers seek other insurers. This system does work. The Germans have used the framework set down by Bismarck for decades.

Third: end political intervention that favors the pharmaceutical industry / providers. A great example of this abuse is Medicare Part D (prescription drug coverage). Medicare is not permitted to negotiate with the drug companies for drugs provided to seniors. That means that the taxpayers are on the hook for the full retail price of the drugs. This is a huge failing and a public disservice because Medicare is being barred from pursuing one of its primary purposes which is to negotiate for the collective welfare of our senior citizens. A nationwide single payer / multi payer system must be empowered to negotiate aggressively with multinational drug companies.

Fourth: we have to overhaul the tort system so doctors, hospitals, and the medical establishment can't be sued into oblivion. A significant portion of our healthcare costs come from high medical malpractice insurance premiums as well as the collateral damage from expensive unnecessary suits. What we lose by doing this is the ability to enrich a few based upon the mistake of a medical professional. If a doctor screws up, they should lose their job and license, not put another attorney in the Hamptons. This reduces the expenses doctors pay and thus doctors can be paid less and still keep a high standard of living.

Fifth: End the for profit university system. Another significant contributor to the expense of healthcare is that medical professionals can graduate up to a quarter of a million dollars in debt before they even start working. They are in-turn compensated with high salaries (theoretically). If college education was based upon academic ability rather than how much money you have / can borrow, we would not have the same costs in healthcare. Voila, everyone gets paid less, but they can still maintain their high standard of living without being burdened with huge debt loads. Again, Germany does this through their taxpayer funded college system which provides free higher education to its citizens.

The trade offs can be varying. We as a nation would be accepting that we can no longer individually choose to believe we will always be healthy and therefore pocket a couple bucks that year in reduced premiums. We also lose the ability to get rich off a doctor’s mistake. However, if it is done correctly, it can benefit nearly every American by providing them with more health care security, greater employment flexibility, and equal or greater care at potentially lower costs.

I am not saying that moving away from our current insurance model will make the world perfect. Far from it. To those that say the transition cannot be done, look to Switzerland. They switched from our model to universal coverage in the 90s and there isn't a hint of that population demanding the old system back.

Its gotta be said wrote:

How will Trump cover everyone and reduce cost of health insurance?

Honest question.

He will repeal and replace it. Obvs. That's what he's said over and over again. He'll replace it with "something better"

Actually, the real reason why competition cannot improve health insurance is called information asymmetry.

The reason healthcare is so much cheaper in Europe is because their governments have price controls on the cost of care and drugs. Drug companies can't extort people there. Unless our government is willing to do that prices won't drastically drop.

HSA's are paired with HDHCP's and those do not have a co-pay meaning the insured individual must pay 100% of cost after insurance until their premium is met. So that $40 co-pay to just see the doctor may become $300 depending on an individual's insurance plan.

Interesting take. It definitely got me thinking.

Of your five steps, I think the 5th one would actually have more unintended consequences. You probably would shift the debt to the parents if tuition coverage and college selection is based on academic scores. Parents would likely be more inclined to take out loans to send kids to better private schools if it means they have a better chance to score higher and get their tuition paid for. This would likely put low income families and inner city areas at an even more disadvantage.

On the athletics side, how do you offer athletic scholarships if tuition is already paid for? This would probably be a death blow to the NCAA.