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Old 08-19-2015, 03:25 PM   #21
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Stop getting sick? Patients to stop demanding costly but ineffectual treatments?
FIFY. I just read the following story from Cancer: The Emperor of All Maladies.

Autologous bone marrow transplantation (ABMT) was being tested by researchers for breast cancer treatment, when the word got out. Desperate patients demanded this experimental procedure before it was proven. One patient sued her insurer and won $8.1M. That set a precedent. Overnight, clinics opened up to provide this expensive treatment as it was now legally required, before it was rigorously tested by the medical profession.

Several years later, calmer examination of medical records showed that this costly treatment was completely ineffectual and caused severe negative side effects.
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Old 08-19-2015, 03:53 PM   #22
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After reading the article, not much of a plan IMHO. Seems to give the insurance companies a better way to sell expensive policies all over the country. Not that I believe ACA is perfect, I'd like to think if it's changed we change it for the better.
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Old 08-19-2015, 04:05 PM   #23
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Aren't the rates that health care providers charge somewhat tempered by the relative bargaining power of the provider compared to the insurer?

In other words, a big insurance company can bargain down charges from a smaller hospital, whereas a big hospital system can demand higher compensation from a smaller insurance company.

In that case would not a larger, multi-state insurer have more leverage to contain costs?
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Old 08-19-2015, 04:14 PM   #24
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I think the biggest change would be requiring posting pricing for all services. Posting hourly rates is a step in the right direction.
+1. Everyone with or without insurance should pay the same (or close) price as in the listed price for a service.
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Old 08-19-2015, 05:18 PM   #25
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Another article on the subject:
Walker's healthcare plan is perfect, if you want almost no insurance at all - LA Times
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Old 08-19-2015, 05:23 PM   #26
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Allowing insurers to cross state lines will kill competition instead of encouraging it. Look at what happened to credit cards, they all relocated to the two most favorable States (Delaware/South Dakota). It only took congress 30 years to get around to begin addressing this problem.
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Old 08-19-2015, 05:28 PM   #27
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There are a number of problems with the proposal as I understand it:

1. The proposed subsidies are well below the actual cost of insurance now -- without medical underwriting. With medical underwriting they would be sky high.

2. The problem with high risk pools in the past is that states had limited funds available for them and costs were really high and there were often limits on coverage (lifetime limit for example).

3. I think that Walker's plan requires coverage for those with pre-existing conditions but have to have continuous coverage. That may be a problem for people who don't currently have coverage or for people who lose jobs and can't afford Cobra.

4. The idea of letting insurers well across state lines on the surface has a lot of appeal. But, I remember what happened with credit cards. Once they could go across state lines, the credit card companies all went to the states with the laxest regulations. This brought a lot of money to these states. Basically it was incentive to states to write the most industry friendly regulations possible since it brought money to the state to be industry friendly and to have as little consumer protection possible.

If insurers could sell across state lines, don't you think that they would want to go to to the states that regulated premiums and consumer protection the least? Be careful what you wish for.....
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Old 08-19-2015, 06:00 PM   #28
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I didn't see anything about the individual mandate. Without that, you can't get the younger, healthier people into the system to help balance the costs for everyone. Just like the good drivers in an auto insurance system, they are paying for the possibility that they will need to access the insurance system.
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Old 08-19-2015, 06:05 PM   #29
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Cross state lines. Who advocates for the out of state resident?
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Old 08-19-2015, 07:03 PM   #30
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After looking over Walker's plan..
Walker's plan scraps the ACA entirely up front. That removes the Medicaid ACA expanded group (18-64 yo) with the single <138% FPL test. This also removes the 100% - 90% Federal funding for the group. He then completely reshapes the "old" Medicaid into some block grant scheme run by the states.

His plan is a disaster for low income people who are reverted back to the emergency room and face bankruptcy due to impossible medical bills for a single health event.
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Old 08-19-2015, 07:53 PM   #31
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Who here has car insurance provided thru an employer… where the employer selects the companies and policy coverage options… what a mess… imagine how much worse if they made health insurance coverage something to be provided by employment…
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Old 08-19-2015, 08:07 PM   #32
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It would great for me to bring back underwriting....I would save hundreds a month based on how my insurance went up when it ended this year. Until of course its my turn in the barrel, and I am sure it wouldn't take much of a health issue to toss me into it.


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Pre ACA Underwriting under the California dept of insurance reg's. made me un-insurable by the time I was mid 30's. Kennedy / Kasenbaum provided some short term releif , by continuing coverage , albeit at very high prices , under a former group policy, until that policy is changed. Then I would have been un-insurred. Most groups change policy's / carriers every few years.

CA reg's pre ACA was take the insured with all his/her warts , etc. , or decline. So they usually declined, even with the ability to surcharge 300%. And generally the insurance lobby wrote the legislation. Just the way things work.

The CA state high risk pool was truly pathetic, like $800/mo in 2005 dollars with an $80k lifetime max, 6 mo. elimination, and, IIRC 2 year coverage limit.

I would of had no quarrel with self insurance, except for: how do you negotiate a fair rate when you are in the ER with trauma injuries from an accident , Heart Attack stroke etc. ?

ACA came along too late to help me, I stuck it out in a job I disliked, largely for access to medical insurance. A few years earlier, and I am sure my life path would be radically different.
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Old 08-19-2015, 08:15 PM   #33
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16+ 2 candidates is a lot of plans. 15 months until the election is a lot of time to get specifics on what the few remaining candidates are proposing. Then it's just a proposal--Congress writes legislation. So--it's a little early to get exercised about this.
The "this will throw people out in the street" depends on how well the Medicaid is funded. The "this will bankrupt us" depends on >lots< of factors, including methods to control costs (either market-based or rule-based). In so many cases, the true value of a plan depends a lot on small details, and none of these plans have provided them yet.
I agree that the key to reducing medical insurance costs is to reduce the cost of medical care. So, I'll be looking for a plan that improves on what we have now in that regard.
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Old 08-19-2015, 08:18 PM   #34
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Cross state lines. Who advocates for the out of state resident?
The assumption is that there would continue to be in state plans, but people would have the option to shop outside their own state.

States have different definitions of what an "essential health benefit" - for example California and Washington cover acupuncture, other states don't. This obviously can lead to different costs.
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Old 08-19-2015, 08:23 PM   #35
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16+ 2 candidates is a lot of plans. 15 months until the election is a lot of time to get specifics on what the few remaining candidates are proposing. Then it's just a proposal--Congress writes legislation. So--it's a little early to get exercised about this.
The "this will throw people out in the street" depends on how well the Medicaid is funded. The "this will bankrupt us" depends on >lots< of factors, including methods to control costs (either market-based or rule-based). In so many cases, the true value of a plan depends a lot on small details, and none of these plans have provided them yet.
I agree that the key to reducing medical insurance costs is to reduce the cost of medical care. So, I'll be looking for a plan that improves on what we have now in that regard.
IMO, the only way to reduce cost's is to ration care , and nobody running on any ticket would dare touch that electrified rail.
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Old 08-19-2015, 08:27 PM   #36
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It is time to stop "tinkering" with the U.S. healthcare system and in fact reform it once & for all. The U.S. does not need a "GOP" plan or a "Democrat" health plan but rather universal access to quality healthcare.

Physicians for a National Health Program

What is Single Payer? | Physicians for a National Health Program

"Single-payer national health insurance, also known as “Medicare for all,” is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands. Under a single-payer system, all residents of the U.S. would be covered for all medically necessary services, including doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs."
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Old 08-19-2015, 09:02 PM   #37
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It is time to stop "tinkering" with the U.S. healthcare system and in fact reform it once & for all. The U.S. does not need a "GOP" plan or a "Democrat" health plan but rather universal access to quality healthcare.



Physicians for a National Health Program



What is Single Payer? | Physicians for a National Health Program



"Single-payer national health insurance, also known as “Medicare for all,” is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands. Under a single-payer system, all residents of the U.S. would be covered for all medically necessary services, including doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs."

It might cost me a bit more, but I say slap the VAT tax on to fund the single payer system and everyone has a skin in the game. Hire fraud detection investigators on a commission basis only to root out the excess charges and fraud the system would want to put on government and pay them a quarter of the recovered savings.


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Old 08-19-2015, 09:06 PM   #38
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IMO, the only way to reduce cost's is to ration care , and nobody running on any ticket would dare touch that electrified rail.
Right, it certainly won't be brought up by candidates. Care is rationed now, it was rationed before the ACA, and it is rationed in every country with taxpayer-funded health care. It gets rationed directly ("the service isn't covered"), or indirectly (with long wait times, layers of gatekeepers/validators to discourage patients, etc).

Probably the best we can hope for is a combination of self-imposed reduction in health care use (driven by co-pays, maybe lower insurance costs/incentives for various behaviors), and reduced costs for treatments. Insurance companies are in the best position to drive down the cost of treatments (they've got the expertise, access to information, and the motivation to do it). Patients then need information presented in an accessible manner so they can make an informed decision on which insurer offers the best value. Patients seek best value from insurers --> insurers seek best value from medical providers.
Right now most patients/customers either aren't able to make a choice (because their employer chooses for them) or the have a choice but don't have sufficient information to be informed consumers, so there's no meaningful pressure on insurers to improve service.
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Old 08-19-2015, 09:10 PM   #39
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Insurance costs are the symptom, not the problem.
+1
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Old 08-19-2015, 09:57 PM   #40
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Right, it certainly won't be brought up by candidates. Care is rationed now, it was rationed before the ACA, and it is rationed in every country with taxpayer-funded health care. It gets rationed directly ("the service isn't covered"), or indirectly (with long wait times, layers of gatekeepers/validators to discourage patients, etc)...
+1

The truth is that no country can afford "all you can eat" when it comes to medical care, or anything else for that matter.
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