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Caution, no joy in Massachusetts over collapse of Republican plan to end health insurance for millions

WBUR interviews people who think a lot about health care, including the CEO of Boston Medical Center, on what happens now that Republicans who campaigned against Obamacare for seven years couldn't repeal it even after taking control of the federal government.

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Comments

A Dem MA Gov allowed a shit federal plan to take over a function state plan implemented by a Rep.

We're ALL worse off because of Deval and it a conversation which has completely been skipped. Premiums are going to continue to climb in tandum with deductibles.

Also never forget, Deval spent $1B on a website.

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IIRC, some states that had a good pre-existing (not medical condition, insurance plans) setup got a waiver. Probably limited, because the state approved plans weren't up to Federal standards of covering abortions, contraceptives, addictions, etc.

The 'one size fits all' doesn't work.

I was puzzled by how the hell can you spend a billion $$ on a website. I read an article years ago that seemed to explain it. All you have to do is integrate inputs from about nineteen different govt agencies using different computers and operating systems. It was doomed.
Well, not so good.

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Thank God for the likes of Sen. Rand Paul M.D. (R-KY) for urging a clean repeal of disastrous Obamacare and blocking any equally bad Trumpcare. The Dems own the current mess, "If you like your Doctor you can keep your Doctor" with it's massive premiums and deductibles.

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What policy proposals would you support to help slow down the massive premiums and deductibles? Repealing Obamacare won't do that on its own. Growth in health care spending will continue with the law in place or not. Before the ACA premiums were on the rise and millions couldn't even access the system without going deep into debt. Advocate a "clean repeal" if you must, but you must have some idea how to replace it if you've diagnosed the problems as "massive premiums and deductibles".

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Cure more diseases

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Expensive to keep the bio shell going. Who needs it? Better off without it

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There is view held by many in the GOP (and likely commenter FISH) that those without health insurance should go without healthcare, even if it leads to pain or death.

They see nothing wrong with denying care to the poor since, in their mind, one "chooses" to be poor. If they can't afford healthcare it's their own fault and society owes them nothing.

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I know no one who thinks that. I have very conservative friends as well as very liberal friends.
You actually know someone that wishes people dead.

I'd find better friends. Or, I'd pipe down on the hyperbole.

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"If they can't afford healthcare it's their own fault and society owes them nothing."

So, instead of taking the rug rat to the doctor for an appointment for that cough, you wheel him into the emergency room. You can't be denied, and you're costing the system at its most expensive point.

When I was a kid, the City of Boston had health clinics set up where we lived. Schools gave out shots and did exams. So, poor folks had some access to health care.

I don't think anyone wants poor people to just go away and die, but if costs aren't controlled the system will come apart at the seams.

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Unless you're poor or unemployed. Obamacare was passed on the backs of the middle class during a period when the middle class was disappearing. For free shit paid for by the working class.

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Not literally, of course, but maybe you forgot the part where the main reason for Republicans to repeal Obamacare was to end the tax on the 1% that in large part funded the subsidies for the poor and, yes, middle class.

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Citation please.

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You must not read the actual news - just flashy in-group memes on Alt-Right shitposting sites.

Sad little bunny.

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The conversation was going relatively well until you showed up.

IMAGE(http://i.imgur.com/5qAVZbo.jpg)

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Since you are a fan of people losing healthcare coverage, why don't we take yours away too? If you really were a cop then taxpayers have been subsidizing you. Lets kick you off and make you pay for everything else yourself. Fair is fair right?

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To whatever extent the public pays for retired police healthcare, I'm grateful. I also pay in as a retiree and paid more while active. Still, we have huge deductibles for an office visit and significant co-pays for prescriptions. Luckily, I'm in good health but the nature of the job, even more so for firefighters, offers significant health risks and many of the guys and gals die young.

If I knew a perfect solution to healthcare, I'd be in Washington but many of the questions seem easily answered. A 27 year-old healthy, single male shouldn't have to pay for gynecology. If someone is in good health and doesn't want insurance, they should have the right to refuse. I think a lot of the "Republicans stripping coverage" is from people who don't want it forced upon them. Insurance should be allowed to cross state lines with policies for the bare minimum like GEICO and State Farm on cars. Of course tort reform will never happen with all of the lawyers in Congress but before quitting at age 75, my Harvard educated PCP told me that "defensive medicine" was putting him out of business. Maybe a cap on the John Edwards ambulance chasing crowd could help control costs.

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If someone is in good health and doesn't want insurance, they should have the right to refuse.

So if they don't buy it and get sick, who should pay? Currently if they can't afford it (or skip out on the bill) the hospital eats the tab and they pass that onto everyone in the form of higher fees.

A 27 year-old healthy male shouldn't have to pay for gynecology.

Well, the 27 year-old is only alive because their Mother got these sorts of care. Woman pay for urology and men pay for gynecology if it makes you feel better.

I agree with needed Tort reform but most experts have said it wouldn't dramatically change the cost dynamics. And something tells me if a doctor screwed up and did something wrong to you, you wouldn't just shrug and say "Mistakes happen".

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A 27 year-old healthy, single male shouldn't have to pay for gynecology.

I see a lot of lot arguments similar to this kicking around, but they run counter to the way that insurance actually works. If we had a system where people only pay for the services that they expect to use, then you end up with an a la carte system where every pool is high risk, premiums are basically equivalent to what it costs to pay for the services out of pocket without insurance, and people are not covered for unforeseen emergency situations. It doesn't work.

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Huge proponent of universal care. We just need to make it less complex and less costly.

Hiwever, the argument about gender specific care is not valid. It's the equivalent of telling someone that doesn't drive that they need auto insurance.

You buy insurance to pool risk. If you don't face that risk, you shouldn't but insurance for it.

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Is that you don't (expletive) your car and maybe get it pregnant. I don't love paying for other peoples' care by fiat, but there's a benefit in spending some money to get women to the gyno, because then they can be told for the record that they don't have an STD, and then they can enter the messing around pool free and clean. That benefits my interests.

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Stevil's mommy didn't tell him about where babies come from yet.

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Nobody has told Sock_puppet how insurance works yet.

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That's a tax. Kinda like everyone thinks social security is a tax. It's not. It's insurance (and the worst run insurance in the country save Medicare).

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NO VIAGARA FOR YOU

And NO PROSTATE EXAMS, NO SCREENING FOR YOUR PENIS. NOTHING.

Oh, but that's different?

Go fuck yourself, asshole.

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...is not like the other.

"NO VIAGARA FOR YOU

And NO PROSTATE EXAMS, NO SCREENING FOR YOUR PENIS. NOTHING."

Well?

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It takes TWO PEOPLE to make a baby.

No sex for men again ever ... is that the world you want?

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A healthy fifty year old man with back problems shouldn't have to pay for diabetes coverage. A hyperactive child with a blazing fast metabolism shouldn't have to pay for Cushing's syndrome. An old lady with emphysema shouldn't have to pay for erectile disfunction treatment.

This should be a board game.

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Insurance isn't ordering off a menu. Men don't pay specifically for OBGYN coverage and even if it's listed as a covered option. Insurance companies know men won't be needing pregnancy services and most woman won't be needing prostate exams. It all evens out.

There are low risk and high risk people but that's mostly a factor of uncontrollable factors such as age and genetics. For "lifestyle" decisions such as smoking they are allowed to charge different policy amounts.

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...don't let them get their hands on your genetic profile.

Whoops, too late!

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A healthy fifty year old man with back problems shouldn't have to pay for diabetes coverage. A hyperactive child with a blazing fast metabolism shouldn't have to pay for Cushing's syndrome. An old lady with emphysema shouldn't have to pay for erectile disfunction treatment.

Translation: Instead of standard coverage with underwriting based on only 4 questions (age, sex, occupation, zip code) we go back to the old 30 page application, leading to that libertarian paradise of "coverage customized just for you." And then the insurance company gets to deny your claim for leukemia treatment, because you neglected to mention on the 30 page application form that you had acne when you were 15. ("Lied on the form? Claim denied!")

The whole point of insurance is to spread the risk. That means people who are lucky enough not to have a kid with cerebral palsy pay a little extra, so that the people with the bad luck to have a kid with cerebral palsy can catch a break.

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"This should be a board game."

Maybe you're right.

"Huge proponent of universal care. We just need to make it less complex and less costly."

I've dealt with high risk pools in the past in real estate. 'Red-lining' was a system of denying property in certain areas coverage. Usual solution was some type of state run insurance pool to spread the risk using reinsurance. Did it work? Well, poor areas had the highest insurance rates. Not the ideal solution.

Maybe it should be a board game...pools of different scaled risks are insured at different rates.
25 year old non smoker...pretty good risk, coverage for most stuff, probably doesn't want gyno, or dental, but, hey it's your choice. Lower the premium even more with a high deductible.

High risk person that totally can't afford shit for coverage (We won't cover heart problems, Mr. AGGGGGHHHH) get help from a high risk pool.

Pools. Saunas. Get what you need or can afford. You want Cadillac? Pay for Cadillac. Or BCBS. You want minimum? Get it.

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With a functioning sarcasm detector shouldn't have to pay to cover humor disfunction.

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Fine. A healthy 27-year old woman shouldn't have to pay for erectile dysfunction.

This is not how insurance works.

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If you are pooling risk, that's insurance.
If you are forced to pay for pooling someone else's risk by the government, that's a tax.

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Drive the cost down because they're creating less claims to the company than the sicker people, who drive those numbers up.

Also, if you have an issue on what your insurance covers, talk to your employer. They're the ones that create the coverage. Not the insurance companies. That and the DOI makes everything specific, so go ahead and fight with them too.

I work for insurance. Don't mess with me, bro.

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Absolutely nothing to do with my comment.

But lovely

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That would have me as a member.

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Obamacare seemed to make it just one big pool, possibly leading up to single payer when it crashes.
Probably a better way of doing it is to let the companies set tiered risk pools, with the most expensive ones, the hopelessly expensive ones, with significant subsidies.

There's a reason the Shriners Hospital in Boston doesn't have a billing department.

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You keep talking about "risk" but that is such an unknown factor that it is nearly meaningless and the argument should be framed around pooling coverage.

It doesn't matter what the specific treatment is for, it's about actuarial tables and how there are segments of the population that have high medical costs and segments of the population that have low medical costs (an an accident can put that healthy 27 year old into the high medical cost without warning). So with a very large pool, preferably the entire population, if you're in the latter you pay a little bit more to cover the former so that if/when you end up in the former you don't go bankrupt and get the coverage you need thanks to the folks who are at that time in the latter pool.

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Nobody should ever have to be in an insurance pool with people sicker than him.

You should call Ryan with this insight!

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Meaning, back to the argument in which a healthy 27-year old man shouldn't have to pay for gynecology is equal to a healthy 27-year old woman shouldn't have to pay for erectile dysfunction.

Healthy persons offset ill persons. You may be healthy now, but eventually you will get sick.

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Insurance should be allowed to cross state lines

Translation: If the citizens of a state want to provide some level of consumer protection by regulating insurance, the insurance companies can circumvent that by operating out of some other state and selling the policy across state lines.

Casting the gutting of consumer protection as "freedom" is one of the major triumphs of the corporate lackeys in Congress.

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Hypothetically, of course...say the Commonwealth decides that all policies have to cover gender reassignment surgery. Say that I think I'm at low risk for that cost to the insurance company. I decide to forgo that coverage.

Hello, out of state coverage.

Sounds crazy? Well, a while back a doctor was jailed for killing his wife. He wanted a gender reassignment surgery. Commonwealth said "FU". He went to court...

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I will go out on a limb and posit that you will never have any need of pregnancy, abortion or endometriosis care. If you're a good 1%-loving Republican, then you want a policy where you don't have to sully your premium fees with those. That, in fact, is what the Republicans were proposing. Strangely, nobody ever proposed making prostate cancer a "preexisting condition."

But that is not how insurance works - any more than the idea that you should get a tax rebate for the cost of fire protection because your house didn't burn down last year.

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Please, knock it off with the 1% bullshit. This is Massachusetts. The one percent here is probably more left than right. Anyway, as far as my premiums go...

Ever hear of 'family' plans? That's when I pay to insure my family.

So, years ago, my wife, a NICU nurse at Tufts (HI to all Tufts nurses!) decides at thirty two weeks babby was being formed (obscure). It might have been my son's fault, who knows. Long time in the BW and kid spent a month in the NICU there. Oh, by the way, she had an endometriosis thing before that, too.
There was no friggin way I was paying the freight on that one. Of course, my insurance covered most of it.
I understand how insurance works. See other posts about 'pools' and all.

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Actually Adam, I get a generous discount on homeowners and auto for a "claim free" history. You should look into it if you're not getting it. Also a discount for combining homeowners and auto with same company.

I go to the doctor once a year for a physical. Between age 12 and 45 I never went but either my family or I dutifully paid into our HMO. I have friends that go to the ER at the first sniffle or sneeze. We had a regular 911 caller who would take the ambulance to the hospital to visit the store next door for cigarettes. No ailment but you couldn't refuse her and of course the ambulance billed for stethoscope, blood pressure, oxygen, gloves, hand sanitizer, the whole bit. This went on several times a week. In the USA, we should be able to pick and choose the private coverage we want or no coverage at all, not forced to subsidize others who take advantage. I would be open to a pool for pre-existing conditions but disagree that folks should be forced to buy unwanted, unneeded coverage.

For instance, I don't take "towing" on my car insurance because I know all of the tow operators where I live. If I travel out of state, that's the risk I take.

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And it's merely a coincidence that every credit card is based in North Dakota or Delaware.
/s

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pensions and health insurance for police and firefighters. I have no issue with providing these benefits to other public employees. Every cop and fireman I know vote republican and proceed to expect a free pass when it comes to their benefits. So lets treat them as they wish to treat others. As republicans shouldn't these public servants want to privatize their jobs?

In an equally amusing exercise, I love reading how insurance functions through the words of the uninformed. An insurance pool only works with multiple lives across all ages and demographics. No men don't have a uterus and women don't have prostate. Segregating people and condition by sex or illness is not insurance. It's dumb, but dumb got the Russian agent elected.

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"An insurance pool only works with multiple lives across all ages and demographics"

So insurance was a total fail until Obamacare?

What you just described is single payer. Do an online search for "that kid in England whose parents raised enough money to fly him to the US but the govt won't let him go".

Russian agent...please...

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What you just described is single payer. Do an online search for "that kid in England whose parents raised enough money to fly him to the US but the govt won't let him go".

Are we going to reason from actual aggregate data or from cherry-picked gut-wrenching individual stories?

Outcomes are way better under Canadian (and even grossly underfunded British) healthcare than under American. Look at the statistics for stuff that actually might affect you: rates of morbidity and mortality from preventable, treatable causes. There's big money being spent to make sure you've heard of that kid in England. Unfortunately, there's nobody bankrolling an equivalent PR campaign to make sure you've heard of the retired steelworker dying of cancer whose insurance company keeps denying his claims.

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Wrong argument.

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Lol. If Trump is a Russian agent, so is Hilary Clinton.

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Why are Trump supporters so obsessed with Hillary Clinton? The election has been over for 8 months, guys. Time to move on.

P.S. Your comment doesn't make any sense anyway.

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Many of them don't seem to understand what reality is even when it smacks them upside the head. They certainly aren't able to cope with terms like "preponderance of evidence" or "how to google".

Note the Drumpf supporters who insist that they won't lose their healthcare.

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You support a traitor.

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Seems to me for a guy who claims to be a retired cop you have a lot of gall to be commenting on what other Americans may want or need for healthcare coverage.

Presumably your coverage is paid for by the taxpayers. Given that, and I want to be respectfully, why don't you go back in the corner, stick you fat thumb back into your Trump trap hole and shut the f up. Adults are talking right now.

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do.

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Horrors

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Interesting how you ignore the millions who Trump wants to take away healthcare coverage from. I guess Trump had such a good experience declaring bankruptcy over and over after his countless failed businesses went under that he wants millions of Americans to have to declare bankruptcy too the first time they get sick without coverage.

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Is it "taking away" healthcare or just not requiring/forcing folks to purchase insurance? You're conflating issues here.

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Taking away the ability to purchase health care at any reasonable rate, or, better yet - actually taking away health care, at least in the case of Mass Health here.

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Are you talking about purchasing Insurance or purchasing healthcare? Those are two different things, albeit related. Anyone can walk into the ER and access healthcare therefore nothing is being "taken away." Sure you're gonna have to pay for said trip to the ER but the option to go there is still available...

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No, YOU'RE going to pay for that person's trip to the ER if that person doesn't have insurance.

It's really not difficult to understand. If you don't have insurance, you can't afford healthcare except maybe for the most basic services. God forbid you have a serious injury, develop diabetes, cancer, etc. Without insurance you're not going to the ER and getting regular treatment for those. It's a death sentence.

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That's precisely the (expletive) problem! Again, how much would your cancer treatment cost if I could learn how to treat it for $1,000, got the drugs for another $1,000, and then treated you in my garage? There's an insane amount of money in healthcare, and it stays that way because there's an insanely high barrier to entry. If we're going to spend federal money on this, spend some to lower that barrier. It's like George Carlin said: "Education doesn't help them. They just want you smart enough to run the machines and do the paperwork."

The question "is healthcare a right?" misses the point. It's a business. Humans who demand nice things provide the service. Your life is not more or less important than theirs. 330 million Americans will never agree on how to share wealth.

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So Joe decides not to buy health insurance.

He gets sick.

He doesn't go to the doctor while the problem is small, because going to the doctor costs him big bucks.

He gets very sick.

He goes to the emergency room.

The hospital will not turn him away to die in the street.

The hospital treats his condition -- very expensively, when it could have been treated earlier for much less.

The hospital writes off the bill as uncollectible/charity.

Because of the large number of uncollectible/charity writeoffs, the hospital raises its prices. A lot.

I buy insurance.

I get sick.

I go to the hospital and get treated.

The hospital bills my insurance company a price that is grossly inflated to cover the charity write-offs.

My insurance company must charge me a premium that reflects those prices.

I'm paying for Joe's health care.
Joe is free-riding on my back.
I don't like that.

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He gets sick.
He doesn't go to the doctor while the problem is small, because going to the doctor costs him big bucks.

Not to mention another set of hidden costs. He misses time from work. He is walking around infecting other people when he could be treated.

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That Joe doesn't have the (expletive) money? If the choice is free or $150 a month, and he can spend $50 a month, what do you think he ends up with? And when government takes away the free, then what does he have?

I would like to have an entire conversation about health care in this country without the word "insurance" being uttered once.

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That Joe doesn't have the (expletive) money?

There are really only two choices: Joe pays for Joe's healthcare, or I pay for Joe's healthcare.

If Joe doesn't have the money, it's cheaper, more effective, and better policy for me to subsidize (via my taxes) his coverage so that he gets preventive care, than it is for me to pay for his emergency care through higher premiums.

Also, you use the word "free" but I don't think it means what you think it means. In this case, there is no "free" -- either Joe pays or I pay.

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Joe doesn't get treatment. I don't love that idea, but, again, there's a finite amount of money to spend, and hospitals and doctors, for a variety of reasons, demand a lot of it.

So, fine, let's pay for Joe now, and then let's also pay for everybody else's birth control so that we don't end up with a generation even bigger than the pool of boomers now who will demand extensive and expensive health services in 75 years.

We need to attack this from both sides. There wouldn't be a bunch of people without health care if we simply had fewer people. The notion that anybody in 2017 should become pregnant or impregnate another person by any means other than through specific forward planning for that specific outcome is a crock. I want rubbers in every nightstand, and a Planned Parenthood in every county.

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Yes! It's time to acknowledge that health care is a human right. Time for single payer or something similar, so that if someone can't afford care, or is in between jobs, they don't go bankrupt trying to get necessary treatment.

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Yes! It's time to acknowledge that health care is a human right.

Many people (myself included) flat out reject the entire concept of positive rights.

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That Joe doesn't have the (expletive) money? If the choice is free or $150 a month, and he can spend $50 a month, what do you think he ends up with? And when government takes away the free, then what does he have?

How dare the evil, overreaching government force poor Joe to spend money on maintaining the brakes on his car? He needs that car to get to work, and he just doesn't have the money to spend on maintenance.

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You need the brakes fixed (almost) immediately. You might not need the health services you pay for until decades later.

Also, Joe not fixing his brakes is already paid for if he hits me in Massachusetts. We insure that too.

Also, Joe might still have that money if we didn't tax a quarter of his income to pay for tanks for small town police departments or for DEA agents chasing some guy selling marijuana.

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You need the brakes fixed (almost) immediately. You might not need the health services you pay for until decades later.

You used your health insurance last year even if you never got sick and never went to the doctor. Just like I used my life insurance last year even though I didn't happen to die.

Consider this (apologies to Nick Taleb):

You and I go out to lunch. We decide we'll flip a coin for who pays. We flip, I lose the flip and pick up the tab.

A concrete thinker is going to say that I paid for lunch. An abstract thinker is going to say that we split the cost of lunch 50 50.

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if Joe can't afford to maintain his car, he can get rid of it, and rely on uber, friends/family, and his own two feet.

owning a car is a choice, owning a body is not.

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if Joe can't afford to maintain his car, he can get rid of it, and rely on uber, friends/family, and his own two feet.

Unfortunately, Joe couldn't afford health care and his diabetes went untreated for too long. Joe had to crawl to the emergency room and had both feet amputated.

Now Joe has no car and no feet.

/s

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That, Bob, is exactly why universal healthcare was a conservative idea to begin with. Everyone should be responsible for themselves and their family's healthcare so the rest of us don't end up on the hook. And the only way to pay is with insurance because no one can pay for even minor health misfortune without it drastically hitting you financially, if you can pay at all.
The downstream effect you described is already happening as hospitals anticipate a less insured population. It's affecting their contract negotiations with health plans like Blue Cross, especially in states where Medicaid expansion is likely to be reversed. The hospitals know they'll have less paying (insured) patients so they're asking for bigger rate increases from the insurers. Next stop higher trend premium increases, then on to employers passing along more of the cost to employees.

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For the provisions of either Obamacare or Trumpcare which allocate funds to get more hospitals built, more foreign doctors into our country, and more international pharmacy shipments into our country.

Both sets of legislation are obnoxious farces.

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Why can't we educate more American doctors? Oh... that's right the AMA & friends crap the # of medical schools and seats available to artificially create a labor shortage.

Why can't .Gov stop that cartel crap?

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Cartel operation is precisely the raison d'etre of big government.

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Stop lumping things into all good or all bad. It's a cynical view that is destructive to any kind of progress. I absolutely agree that neither is the perfect solution or that we can stop worrying about improving our system, but to say both are terrible and throw up your hands is dumb.

One plan provides healthcare to tens of millions more, ensures that plans include actually useful benefits, and ensures preexisting conditions are covered by those benefits. This is the clearly better option. It's just not debatable.

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Of course he agrees, the pre-existing conditions amendment was originally pushed by republicans during the passage of the ACA!

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From during the ACA debate: "the Republican bill, unlike the Democratic bills, doesn't specifically bar insurers from excluding pre-existing conditions, even though that policy has broad support in both parties."

http://www.politifact.com/truth-o-meter/article/2010/feb/26/gop-health-c...

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I literally pointed out what the actual problems are in American health care in my initial post in this string. Here, I'll make it a little more pithy by offering my favorite rhetorical question: How much would treatment cost if you had it performed in the doctor's garage?

How much does it cost in money and time to become a physician? Hell, how much does it cost in money and time to become any kind of specialist? We demand that a person give up almost a decade of their lives and hundreds of thousands of dollars to enter the profession. And when they get there, they have but a handful of hospital owners for whom to work. You essentially have a handful of corporations who have an entire field of all-in professionals by the balls.

I paid a $521 fine to the feds last year for not buying what I deem to be an overpriced product for the services that I (don't) use. What has the federal government done with that money which they seized from me? Did it help one sick person get already overpriced care? Or did it go towards the actual betterment of health services in our community?

This is even bigger than the housing bubble and the student loan bubble, yet, mainstream media seems to report very little on this existing and still-looming paradox. I hope that this endless debate on how to get health services for Americans is finally the impetus which makes us all realize that you simply can't govern a country with this many people. Only two countries have more people than we do, and one of them has far less awareness among its populace due to the absence of a free press.

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overpriced product for the services that I (don't) use

You "didn't use" your health coverage last year in precisely the same sense that I "didn't use" my life insurance or liability insurance.

That's a bullshit argument.

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Insurance isn't a bank. I don't get paid interest on claiming the fruits of the premiums 40 years after I pay them. A corporation gets to control the float and use it as they see fit.

In this regard, I've gotten even: 50 shares of Berkshire Hathaway have proved to be a profitable investment since 2009.

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Warren Buffet also invests heavily in Foreign drug makers....

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Because Berkshire does a great job of spending insurance float to make money. That's $4,700 in appreciated value I'm sitting on before taxes. Honestly astonishing how many people will spend $1,600 a month on some studio apartment instead of buying stocks.

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.

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"You "didn't use" your health coverage last year in precisely the same sense that I "didn't use" my life insurance or liability insurance. "

There is a difference. Some people use their access to health care all the time. I don't use the car insurance, but I have no problem using the health insurance to avoid using the life insurance.

FU*# YOU, TICK.

(The above was meant for the tick, not you.)

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Lack of preventative care is a huge reason - that includes not getting primary care, not getting follow up care, and not getting care that is less expensive but keeps people out of crisis.

We spend a lot of money taking care of people in crisis.

https://www.bloomberg.com/news/articles/2016-09-29/u-s-health-care-syste...

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...this is why dental plans offer free checkups.

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In what sense does an agreement, made through a legitimate democratic process constrained by constitutional limits, that we're all going to pay for something collectively -- be it a road, an aircraft carrier, or anything else, constitute "seizure?"

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Is somebody coming after me with a firearm.

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Did it help one sick person get already overpriced care?

Yes, I believe John McCain is getting excellent care for his blood clot courtesy of tax revenue that pays for gold-plated health care for our elected officials.

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Yes thousands of people are alive today because of the ACA and Medicare expansion, no lifetime maximums and no exclusions for preexisting conditions

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Correct me if I'm wrong (and I could be), but these "shipments" are often drugs that were originally made in the US and eventually copied and patented in other countries when the US patents ran out. We have those drugs here, they just cost more because US companies aren't subsidized like other countries and there are no price controls.

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Federal government R&D, anyone?

It is the massive marketing and advertizing and promotion budgets that blow the expenses massively out of proportion, not a lack of government subsidy.

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Be careful with that. I've seen people make the argument that "The Canadian FDA is comparable to ours so why shouldn't we be able to get drugs from Canada?" Which sounds reasonable on its surface but without adequate regulatory protection there are holes you could drive a truck through to abuse that system. Even today companies sell drugs "from" Canada but they are not approved to be sold in Canada but are purchased through a Canadian company and what you're getting are drugs made in places like India where there is little or weak regulatory oversight that would not be approved for sale in the US or Canada.

The root of the problem in the US compared to other industrialized nations with drug prices is that other countries have a nationalized health care system where the country can negotiate prices for drugs sales to the entire population which gives them strong negotiating power. In the US we've essentially given that right away. The VA is allowed to do it but Medicare/Medicaid cannot. So the single largest drug purchaser in the US is currently tied to paying a set percentage related to the best price that a private insurance company pays. Now, do you really think that the largest insurance company in California has the same negotiating power of Medicare/Medicaid?

tl;dr The US gets screwed on drug pricing because we don't have single payer, not because we can't get drugs from another country.

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This conversation wouldn't even exist if Obama and the Democrats didn't destroy our healthcare system in the first place!! Why isn't this mentioned?

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Destroyed? You can't see a doctor anymore?

But I speak as somebody on a Romneycare/Obamacare policy. Millions of people now have insurance. Perfect? No, but far, far better than the alternative.

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It was mentioned by people who don't know anything like Trump. It just wasn't true. Millions of people have access to healthcare now that didn't before because of Obamacare. Lets stick to facts here.

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Except all those other forms that have been tried.

And Obamacare is the worst health care reform, except all those other forms the Republicans can think up.

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There's more than two parties then. The French grew a pair and figured that out. Our turn.

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Republicans, you had 8 years to come up with a plan. You have NO IDEAS.

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It's just not in their interest to implement all of them. I have the idea of giving a million dollars to Planned Parenthood, I just don't have the means to actually do it.

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Since we've nearly conclusively proven that the country does not have the stomach for a cash & carry approach to healthcare we are probably drifting towards Medicare for all in some way or form. No politician that rejects the Medicaid cuts as cruel is going to want to spearhead a push to reverse EMTLA for example and then move healthcare to the same level as any other service industry.

You're not going to buy a coffee if you can't pay for it, and you're not going to buy treatment in the ER after you get rear-ended by someone if you can't pay. But do we want to live in that type of society? There's no appetite for that type of approach, at least I don't think there is. The closest people to that argument are the ones saying they don't need to pay for obstetric services, prostate exams, or whatever pool of individuals they happen to latch onto that they don't see a need for. Pooling risk and money spreads the costs out and given the "right" amount of government support makes it affordable for everyone.

We're still not anywhere near the level of rational discourse that we need after the monstrosity that failed in the Senate. At best there will be some thoughtful fixes applied to the cost sharing subsidies for ACA. But I expect there will be a deliberate effort to not make them thoughtful enough and keep the ACA teetering because it's more important to score a political win than to actually provide healthcare for people.

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Just implement a single payer system and be done with it already.

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Two states already tried and failed. Vermont and California abandoned single payer before it even got started. Why? Overwhelming and crippling costs. How would the entire US be any different?

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Send us a link and we'll discuss it.

Vermont is really too small to pull it off alone - no leverage against the drug and healthcare lobbies who colluded to squash the attempt.

California has had a bill fail in the senate ... but has never tried to actually implement a program. That's not a failure to IMPLEMENT or a failure of a PROGRAM - its a failed attempt to LEGISLATE a program. Very very very very very different things. Something that never happened is very different from something that isn't sustainable.

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You're my hero, Swirls. Wish you were running the show in politics...

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I think its important to remember that Americans don't use more healthcare than other countries, its that we pay a lot more for everything compared to other countries. A national single payer system would allow the government to negotiate with pharma companies for better rates. The health insurance industry isn't the problem, their profits aren't through the roof. It's how much we pay for all the services we get.

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The past eight-year (and beyond) saga of national healthcare policy suggests to me that we're a long, long way of implementing any change on the national level, except for systems like Obamacare that do have significant shortcomings (my personal beef is the conflation of "health insurance" with "healthcare"), and that are hard to reform for reasons that should be obvious to anyone with even a room temperature IQ. But I think we could do it in some states with enough population and facilities, and Massachusetts would not be a bad place to start. In fact, there's an effort under way now to do just that. I believe that single-payer/Medicare for all in Massachusetts would be a significant improvement over anything else.

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I believe that single-payer/Medicare for all in Massachusetts would be a significant improvement over anything else.

Let's do it!

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