Vegas Free-for-All - Adios Obeymecare

Adios Obeymecare

pjstroh

Nov 12, 2016
1:12am

Note to billryan...do not engage AlanLeroy in the historical facts of the ACA and how it was formed. I've tried it before. I used to believe ALanLeroy was the centrist he pretends to be.

The "rammed-through" ACA took over a year to compile and pass....and the president extended an amazingly generous olive branch to Republicans giving them a 50/50 representation on the committee to formulate the bill which Republicans abandoned amidst angry tea-partiers who were furious with their cooperation.

AlanLeroy will explain to you how it was Obama's fault that Republicans took their ball and went home only to complain about being stiff-armed out of the process.

alanleroyII

Nov 12, 2016
1:20am

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Originally posted by: pjstroh

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Originally posted by: alanleroyII
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Originally posted by: malibber2
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Originally posted by: alanleroyII
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Originally posted by: billryan
I've never understood how the Federal Government permitting insurance companies to operate across state lines jibed with the rights call for more power to be given to the state level.
Because then it falls under the Commerce clause. The Congress shall have Power... To regulate Commerce...among the several States. The states could continue to regulate insurance that operates completely within their borders.

That is not how the commerce clause works. Once the Feds take over an area under the Commerce Clause, the individual states can no longer regulate in that area because any state regulation would be an undue burden on Interstate Commerce. The concept is referred to as preemption. Selling health insurance across state lines would legally speaking be the Federalization of the health insurance industry.
A state should be able to regulate a business incorporated there that does not engage in interstate commerce. The Federal Government should be able to certify and regulate insurers that freely operate across state lines. Consumers should be allowed to choose between a state licensed insurer and a national insurer. Now states put up barriers to enter their markets because it bolsters their bureaucracy and tax coffers rather than serving the people.

Just like the federal government exerts a lot of control over the banking industry, each state still has some operation that oversees state-licensed financial institutions, including banks, credit unions, industrial banks, savings associations, trust companies, foreign banking organizations, business and industrial development corporations and on and on. Banking across state lines wasn't always allowed. Just like Selling Health Insurance across state lines. I think it can be done with an act of congress that allows State and National Insurers. The constitution didn't change.

You should read the 1000 page law that nobody read. There is nothing in Obamacare that prevents states from purchasing plans from other states...it leaves this decision at the state level....and there are a handful of states that allow for it. The GOP idea is to take away this discretion and force states to accept plans from other states. So if you are someone that believe in giving states more authority over their health insurance then you would be vehemently opposed to this idea.

I'm someone who believes in giving consumers more choices. I'd set up a federal authority to certify health insurers and allow any certified insurer to offer their plans in any state. This would be in competition to any State authorized insurers. I'd also require all group insurers to offer individual plans without regard to pre-existing conditions.

But I'd really focus on the crap that has caused medical costs to skyrocket. Like getting everyone to sign a DNR so we don't waste so much money preserving the last couple miserable months of life in the ICU. If you don't sign a DNR your health insurance is tripled. If you're grossly overweight, it's doubled.

alanleroyII

Nov 12, 2016
1:26am

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Originally posted by: pjstroh
Note to billryan...do not engage AlanLeroy in the historical facts of the ACA and how it was formed. I've tried it before. I used to believe ALanLeroy was the centrist he pretends to be.

The "rammed-through" ACA took over a year to compile and pass....and the president extended an amazingly generous olive branch to Republicans giving them a 50/50 representation on the committee to formulate the bill which Republicans abandoned amidst angry tea-partiers who were furious with their cooperation.

AlanLeroy will explain to you how it was Obama's fault that Republicans took their ball and went home only to complain about being stiff-armed out of the process.

"You have to pass the bill to know what's in the bill". Just look at the vote. I know exactly how it was formed and what went down. Stop with you god damn false narrative.

I have always said that the President should not have signed the bill without any Republican votes. Regardless of the circumstances that led up to it. He should have sent it back and used the bully pulpit. He should have reengaged and compromised more if necessary. That's what non-partisans demand.

Instead he celebrated it as a great victory. It was not. Instead it intensified our divided nation and gave the Republicans 8 years of fodder. And there is no doubt it led to the largest congressional losses in history---the 2010 midterms. I just hope President Trump doesn't make the same mistake. I have also said that they should work together to fix it and offered a dozen ways to really make it affordable. But PJ conveniently forgets the many times I've suggested the democrats and republicans work together on it. Preferring instead to change the subject by his whining about Republicans...I ain't one of those.

billryan

Nov 12, 2016
1:45am

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Who was he supposed to engage and compromise with? The Republicans were doing their best boilerman imitations and saying this was all about free stuff. It used to be you don't reward people for throwing tantrums. I thought that's how a civil society works. The party in the minority is supposed to offer compromise, not refuse to play at all. Republicans were wrong then, and if democrats do it now, they will be just as wrong.

pjstroh

Nov 12, 2016
1:52am

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Originally posted by: alanleroyII
I just hope President Trump doesn't make the same mistake.

He most certainly will (if you want to call partisan legislation a mistake) - and I look forward to listening to you rationalize it. Oh - and your other big complaint about Obamacare being more than 20 pages long....that wont be the case with TrumpCare either. And you'll be rationalizing that too.

Lets revisit in 6 months.

malibber2

Nov 12, 2016
4:16am

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Originally posted by: alanleroyII

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Originally posted by: malibber2
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Originally posted by: alanleroyII
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Originally posted by: malibber2
No matter what he does with it, he says he wants to keep it guaranteed issue and allow kids to stay on it until they are 26.
Trump has always stated that pre-existing conditions must be covered by health insurance. We didn't need the ACA to do that.

The reality is for-profit insurance companies don’t want to insure people with pre-existing conditions, people that live in rural areas, (because there isn’t sufficient competition among service providers) and even in urban areas where there is a lack of competition. .

You cant always get what you want

As long as Republicans are willing to take ownership of all the healthcare systems failures under the banner of Trumpcare, I am all for it. Go ahead, and try to run for reelection on canceling the insurance of 20 million people, hospitals all across the country going bankrupt and group insurance premiums spiraling out of control. Oh, and you officially have come out of the closet as an anarchist.

Are you calling me an anarchist or the Antichrist? Ah...maybe you misunderstand my rolling stones reference. You said the For Profit Insurance Companies don't want to insure people with pre-existing conditions. I'm saying THEY can't always get what THEY want. They didn't want to cover pre-existing conditions for group policies either.

One of my biggest objections to the ACA was the way the Democrats rammed it through. They should have worked with Republicans to get something more bipartisan---Even if they didn't get every thing they wanted. This led directly to their massive 2010 midterm failures and Republican Whining for 8 years. If Republicans had any skin in the game, they would have worked with Democrats to improve it over time. They had none.

And just like you're chomping at the bit for the Republicans to use the same tactics and ram through a Republican Failure, I'd prefer they take a step back and try to do something that is a success where both sides get some agreement. Otherwise they simply make the same mistakes the Democrats did and the people suffer.

I apologize Alan. I misunderstood your point. Now that I understand it, how is making insurance companies that sell group insurance policies sell to individuals any different than Obamacare? You still end up with a subsidized premium. In your plan, you are just making employers that already buy their employees insurance subsidize those that don’t. You are rewarding free riders.

Furthermore, a group insurance premium is based upon the collective health of the group insured. Say a company is paying $1,300 per month per employee and has 1,000 employees participating in a group. What rate is an individual charged that comes along and buys an individual policy from the insurance company that is providing group insurance to the unique group?

Your understanding of group insurance also doesn't seem to account for how it has evolved in the last twenty years. Most group insurance is now done via self-insurance and a reinsurance arrangement. That is the employer is considered the insurer of their employees, not the insurance company. Using our example above, a typical arrangement might be that the employer sets aside two million dollars a year for claims. The employer gives this money to the insurance company to hold in trust and pay out claims with. And then once/if the employee’s collective claims exceed two million in a year the insurance company starts paying out of their funds. If there is money left over because the collective claims were less than two million, it is refunded to the company at the end of the year. How would an individual buy into this type of scheme?

For example, my sister's company makes their entire yearly bonus system contingent upon there being money left in such an account. My sister didn’t get her bonus (usually around 10k) one year and the company sent all the employees a letter stating that because two female employees had babies with complications, there was no money to pay out bonuses that year. Of course, they didn’t name the employees but being a small company with a couple of hundred employees everyone knew who they were. It became such a hostile environment that both the women ended up leaving the company a short time later. In a nutshell, that is what is wrong with group insurance. The incentives are currently set-up, so any employee that develops a serious illness is gotten rid of.

malibber2

Nov 12, 2016
4:38am

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Originally posted by: alanleroyII

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Originally posted by: pjstroh
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Originally posted by: alanleroyII
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Originally posted by: malibber2
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Originally posted by: alanleroyII
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Originally posted by: billryan
I've never understood how the Federal Government permitting insurance companies to operate across state lines jibed with the rights call for more power to be given to the state level.
Because then it falls under the Commerce clause. The Congress shall have Power... To regulate Commerce...among the several States. The states could continue to regulate insurance that operates completely within their borders.

That is not how the commerce clause works. Once the Feds take over an area under the Commerce Clause, the individual states can no longer regulate in that area because any state regulation would be an undue burden on Interstate Commerce. The concept is referred to as preemption. Selling health insurance across state lines would legally speaking be the Federalization of the health insurance industry.
A state should be able to regulate a business incorporated there that does not engage in interstate commerce. The Federal Government should be able to certify and regulate insurers that freely operate across state lines. Consumers should be allowed to choose between a state licensed insurer and a national insurer. Now states put up barriers to enter their markets because it bolsters their bureaucracy and tax coffers rather than serving the people.

Just like the federal government exerts a lot of control over the banking industry, each state still has some operation that oversees state-licensed financial institutions, including banks, credit unions, industrial banks, savings associations, trust companies, foreign banking organizations, business and industrial development corporations and on and on. Banking across state lines wasn't always allowed. Just like Selling Health Insurance across state lines. I think it can be done with an act of congress that allows State and National Insurers. The constitution didn't change.

You should read the 1000 page law that nobody read. There is nothing in Obamacare that prevents states from purchasing plans from other states...it leaves this decision at the state level....and there are a handful of states that allow for it. The GOP idea is to take away this discretion and force states to accept plans from other states. So if you are someone that believe in giving states more authority over their health insurance then you would be vehemently opposed to this idea.

I love consumer choice Alan. Personally, I don't have a problem with Federal authority, but one of the right wing's primary beefs with Obamacare was that it was a "Federal Takeover." Federal authority would be a federal takeover. I already discussed the pitfalls of your requirement that group insurance companies be required to offer individual policies in the prior post, so I won't address them again. As to your certified health insurers setting up national plans, that was already included in Obamacare, but not very many people know about it. It seems none of the health insurance companies currently in existence wanted to set-up a national plan even with guaranteed profits. They said it was too risky, so there are no national plans offered in the marketplace.

DNR's - You will never get mandatory ones or incentivized ones because of all the prior cries of death panels. All Obama wanted was for patients to get a list of end of life options and conservatives called that death panels. A lot of those cries were rooted in conservative anti-abortion/right to life beliefs. Most movement conservatives believe you have to keep someone alive as long as they or their family want assuming you are technologically able to do so. You may have forgotten the Terri Schiavo case. Indulging kooky conservative beliefs has always been expensive, but what can be done about it?

alanleroyII

Nov 12, 2016
8:29am

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Originally posted by: malibber2

Now that I understand it, how is making insurance companies that sell group insurance policies sell to individuals any different than Obamacare?

Requiring all health insurers to offer individual plans spreads the risk instead of allowing them cherry pick the most profitable customers. Obamacare is imploding because many companies that offered individual plans are retreating from that market and focusing on their lucrative group plans. The vast majority of Americans are insured under a group plan. They are insured without regard to pre-existing conditions. Contrary to what you claim most companies do not underwrite their own insurance.

It is true that under my suggestion, Group Health insurance rates would rise IF YOU DID NOTHING ELSE TO CONTAIN HEALTHCARE COSTS. That's the real problem with the ACA. Even though it was called 'Affordable' it did virtually nothing to cut costs. It subsidized some citizens to make it more affordable for them...but as you have pointed out many times...it's only affordable if you don't get sick. If we were really smart, we could cut costs of healthcare in half without a change in standards of care. Then these policies might be affordable for everyone. I have about a dozen ways to do that if you're interested.

alanleroyII

Nov 12, 2016
8:41am

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Originally posted by: malibber2
DNR's - You will never get mandatory ones or incentivized ones because of all the prior cries of death panels. All Obama wanted was for patients to get a list of end of life options and conservatives called that death panels. A lot of those cries were rooted in conservative anti-abortion/right to life beliefs. Most movement conservatives believe you have to keep someone alive as long as they or their family want assuming you are technologically able to do so. You may have forgotten the Terri Schiavo case. Indulging kooky conservative beliefs has always been expensive, but what can be done about it?

All I know is until we address end-of-life costs there will never be affordable healthcare for anyone. I've heard estimates that up to half our medical resources are squandered keeping people barely alive in the ICU. They should be in hospice or at home full of morphine and die peacefully. Instead, we spend hundreds of thousands or even millions of dollars on one individual who has no realistic hope of recovery.

If so called conservatives want to be kept artificially alive for a couple of extra months they should be contributing a lot more to their insurance than those of us who have living wills ordering the doctors to not resuscitate. No death panel. No Terri Schiavo. It's choice and just simple capitalism that they should understand.

If you want to sit around as a vegetable for your last couple of months on Earth and soak the system for an extra couple of hundred grand then you should pay for that...not me. We could call it the Platinum Veggie Plan.

malibber2

Nov 12, 2016
9:35am

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Originally posted by: alanleroyII

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Originally posted by: malibber2

Now that I understand it, how is making insurance companies that sell group insurance policies sell to individuals any different than Obamacare?

Alan,

According to a 2000 report by the Employee Benefit Research Institute (EBRI), approximately 50 million workers and their dependents receive benefits through self-insured group health plans sponsored by their employers. This represents 33% of the 150 million total participants in private employment-based plans nationwide.

If it was 33% back in 2000, it is well over 50% now. In any event, if you mandate that group insurers offer individual policies whatever business they still have left in a traditional group will be converted to this style of business where they become the benefits administrator rather than the insurance company to avoid having to cover the individuals.

I do agree with you about the ACA and healthcare costs. The problem is pharmaceutical companies, hospital holding companies and Doctor's groups won't allow the costs to be cut. I have never met a doctor who doesn't think her or she is entitled to at least a 10% raise every year regardless of market conditions. I always think of Rand Paul when he said, "Doctors are entitled to a good living." If a hardcore tea partier who gets most of his fees from government programs thinks he is entitled to a good living, you can bet the rest of them do.

Maybe Trump will be more successful in getting them to cut costs, but I have my doubts. Pharmaceutical stocks are up because they expect there to be less pressure on their pricing under Trump than there would have been under Clinton.

I have also said many times the problem with the ACA is that the numbers simply don’t work. The way the ACA tried to make the numbers work were sky high deductibles, sky high out of pocket costs and incredibly narrow networks. I know another way they were cheating/cooking the books that has not been widely reported yet, but I was saving it for after the election. If we take Trump at his word and he is going to offer something terrific to replace the ACA, I don’t see how he makes the numbers work unless you adopt a patient not profit first system like the rest of the first world.

I know the one plan that is making its rounds on the news sites right now is the Mitch MooConnell Paul Ryan plan to simply defund the ACA subsidies due to the insurance companies, and replace them with nothing. That way they would still have a zombie Obamacare system to tout as their perpetual whipping boy, but get to avoid the responsibility of creating a functioning system themselves. I see this as more likely than thinking Republicans are suddenly going to get tough on lobbyists.

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