Why Trump Should NOT Repeal or Replace ObamaCare (Just Let It Die)

[skeeter]

I'd even go for that, and patching up critical care patients who weren't citizens (and sending the illegals home from the hospital).

Hospitals should have discretion they currently don't have when it comes to treatment in their ERs. Surely some definite guidelines could be developed to guarantee critical care cases aren't turned away but that hospital services aren't abused.

I'm sure that would set immigrant & homeless advocates to howling.

[Maj. Bill Martin]

This article -- like so many others -- completely misses the point on ObamaCare.  The core of it is not the individual mandate.  The core of it is the expansion of Medicaid, which essentially made health care for everyone an entitlement.

[Weird Tolkienish Figure]

This article -- like so many others -- completely misses the point on ObamaCare.  The core of it is not the individual mandate.  The core of it is the expansion of Medicaid, which essentially made health care for everyone an entitlement.

We need to start making Medicaid Receipients... pay for Medicaid then.

[r9etb]

Putting aside the animus many feel toward Obama, the Dems and the ACA,  what are folks general thoughts about addressing the access issue by means of single payer vs. a private insurance system supported by "fascist mandates"?   

Wouldn't an ACA that's fixed so it actually provides affordable options be superior to single payer?  Why or why not?

The ACA as it currently stands is an "end justifies the means" sort of thing.  The ACA echoes the authoritarian tendencies of the people who wrote it: only the bureaucracy, armed with the power of financial coercion, is capable of fully comprehending and addressing the true needs of the people.

When you look at it, the utter failure of the ACA can be laid at the very feet of the authoritarian solutions; hence, the millions of people who were thrown out of "non-compliant" plans that were nevertheless sufficient to their needs, and forced to less suitable and much more expansive plans.

Part of the problem with health care costs in general has to do with the whole "insurance model" of medical care.  There is no "free market" in medicine -- it's already controlled by large, inefficient, and intractable corporate bureaucracies.  A single-payer system doesn't fundamentally change the economics of the current system, except probably to make it even less responsive.

There is a good moral argument to be made for ensuring that everybody gets some basic and sufficient level of care.  Probably the least intrusive approach would be some sort of means-tested subsidy for plans that meet some basic standards of service; and those subsidies are almost certainly best applied at the state rather than national level.

[Maj. Bill Martin]

We need to start making Medicaid Receipients... pay for Medicaid then.

Or punt it to the states.  Kasich campaigned on being this budgetary whiz, and he's now complaining that the feds will stop funding the Medicaid expansion.  But why should that matter?  If Kasich thinks the expansion is so worthwhile, why not fund and administer it on the state level?

[Weird Tolkienish Figure]

Or punt it to the states.  Kasich campaigned on being this budgetary whiz, and he's now complaining that the feds will stop funding the Medicaid expansion.  But why should that matter?  If Kasich thinks the expansion is so worthwhile, why not fund and administer it on the state level?

He wants something for nothing, like every other person in this country? :)

[Jazzhead]

There is a good moral argument to be made for ensuring that everybody gets some basic and sufficient level of care.  Probably the least intrusive approach would be some sort of means-tested subsidy for plans that meet some basic standards of service; and those subsidies are almost certainly best applied at the state rather than national level.

Perhaps the "means-tested subsidy" could be in the form of a cash contribution or credit to a medical savings account that can be used, as the recipient sees fit, for the payment of insurance premiums or direct reimbursement of health care costs.   Pay for it by an increase in FICA taxes imposed on wages,  tariffs placed on imported goods, or a national consumption tax or VAT.   I'd prefer the financing for such a means-tested contribution be done at the national level, with regulation of medical insurance policies left at the state level.   

[r9etb]

Perhaps the "means-tested subsidy" could be in the form of a cash contribution or credit to a medical savings account that can be used, as the recipient sees fit, for the payment of insurance premiums or direct reimbursement of health care costs.

Yes, something of that sort.  It could be implemented by something like a Flexible Spending Account card.  And I could see it working to the benefit of entrepreneurial "concierge care" clinics, which don't operate according to the standard insurance model.

Pay for it by an increase in FICA taxes imposed on wages,  tariffs placed on imported goods, or a national consumption tax or VAT.   I'd prefer the financing for such a means-tested contribution be done at the national level, with regulation of medical insurance policies left at the state level.

That's fine, so long as the federal government can be enticed to leave off the strings.  (Probably the most important part of the Obamacare ruling was that the Feds cannot place such strings on block grants to states...).

[Emjay]

Complaints about the "fascist mandate" would disappear if the government would simply allow hospitals to turn away non-paying individuals at the emergency room.   Pass a law insulating hospitals from lawsuits for refusing to provide uncompensated care.    Free riders count on the rest of us picking up their costs when they get sick.   Let 'em die.  Saves on Social Security costs, too.   

 

Please don't mistake me for a bleeding heart liberal but I cannot share your opinion ... which you may have posted as a joke or sarcasm.

[Emjay]

Considering that Medicaid, Medicare, private insurance, and even private payment cover a lot, letting someone die of medical neglect in the lobby because they didn't have an insurance card with them is going a bit far.
Then, too, it could have been something which could have been fixed, but failure to do so will leave someone able to draw Disability for the rest of their life. Net savings? No.

My other objection is this: You can be crossing in the crosswalk and get hit by some jerk, or be driving and have the same thing happen. Are you going to be left to die because someone else hit you if you don't have insurance?  @Jazzhead Funny that someone who would force a Christian florist to provide flowers for a homosexual wedding would let people die in the ER. I guess butthurt matters more than human life to some people.

None of this emergency room stuff has a thing to do with Obamacare.  Obamacare should be repealed like yesterday.  Don't let any of its creepy tentacles remain to foul up health care.  Just repeal it.  Damn the torpedoes ... full speed ahead.

[Emjay]

Emergency rooms do not and should not turn people away.

When my husband was having heart problems that led to a few emergency room visits, I observed ER abuse.

Example:  While waiting with him, two families came in, one after another, with children who had head lice.  Head lice is not an emergency.  These were minority families who, oddly enough, did not want their children to have head lice.

I listened as ER personnel treated both families with care and respect and helped them with dealing with this problem.  I have no problem with this.

And this was way before Obamacare.

[Idaho_Cowboy]

No, no, no and a thousand times NO! Nuke the gawd ammed thing from orbit, kill it with fire, and put the ashes on a spacecraft headed for a black hole!

[r9etb]

I listened as ER personnel treated both families with care and respect and helped them with dealing with this problem.  I have no problem with this.

And this was way before Obamacare.

The problem is that people treat the ER like their doctor's office, which leads to overcrowding; plus which, the ER is intrinsically a high-cost option. 

This is one of the problems that Obamacare was supposedly going to address; but of course it did not work out as claimed -- the primary reason being the serious difficulty in finding doctors who will actually accept Medicaid patients.

[Idaho_Cowboy]

The problem is that people treat the ER like their doctor's office, which leads to overcrowding; plus which, the ER is intrinsically a high-cost option. 

This is one of the problems that Obamacare was supposedly going to address; but of course it did not work out as claimed -- the primary reason being the serious difficulty in finding doctors who will actually accept Medicaid patients.

CHIP had/has (don't know if it is still around) the same problem. Families could get there kids covered even if there wasn't a single doctor in the state that would treat them. We need fewer money sucking boondoggles, not more.

[Jazzhead]

Please don't mistake me for a bleeding heart liberal but I cannot share your opinion ... which you may have posted as a joke or sarcasm.

My point is that those who play by the rules end up subsidizing those free riders who don't play by the rules.   Hospitals are not going to throw free riders into the street - but they will pass the costs along to those of us who have insurance.   (That is, the insurers will pay more and increase their rates accordingly.)

That's why it's so important for every responsible individual to have insurance.  Free riders should be scorned, not praised for opposing a "fascist mandate".   There IS an alternative to the "fascist mandate" - a single payer system financed with general tax revenues.   Those who demand the ACA be scrapped need to face reality - the alternative is single payer.     

[Emjay]

Agreed, and this is why it's a mistake to say the US health care system is "the best in the world". It has it's good points, but a lot of bad ones too.

It is not a mistake.  Did you watch Ted Cruz debate the ancient socialist on this issue.

Bernie kept citing other countries with government run health care supposedly available to all as better than the U.S.

Ted countered by giving facts about how long people had to wait in these countries for needed procedures.  If you live in one, just pray you don't need a knee or hip replacement.

Government should not be in the health care business.  They WILL foul it up.

I had a dear friend who was born in England and came over as a war bride (WW II).  She made a life here and had a very good job as a bank executive.  But she always had that nostalgia for England and decided to go back to be with family and be where health care was paid for and available.

It wasn't 3 months until I got a letter from her.  So sad.  Her family was not as supportive as she had hoped.  She had been out of their lives too long.  She sold everything she had to get over there and the health care was the worst.  She could NOT get health care.  It took her a year to save up enough to get back.  She told me it was the worst mistake she'd ever made.

[Idaho_Cowboy]

My point is that those who play by the rules end up subsidizing those free riders who don't play by the rules.   Hospitals are not going to throw free riders into the street - but they will pass the costs along to those of us who have insurance.   (That is, the insurers will pay more and increase their rates accordingly.)

That's why it's so important for every responsible individual to have insurance.  Free riders should be scorned, not praised for opposing a "fascist mandate".   There IS an alternative to the "fascist mandate" - a single payer system financed with general tax revenues.   Those who demand the ACA be scrapped need to face reality - the alternative is single payer.     

We had that problems for decades prior to Obummer care. We can go back to having it for a while or we can work on real conservative solutions. More government is the problem, not the solution.

[Jazzhead]

Ted countered by giving facts about how long people had to wait in these countries for needed procedures.  If you live in one, just pray you don't need a knee or hip replacement.

Why should others pay for this sort of non-essential procedure?   Does your homeowner's insurance pay to patch a leak in your roof?  Or do you need to save for such a contingency yourself?   

Government should not be in the health care business.  They WILL foul it up. 

 Well,  when it comes to the health care FINANCING business, there are only four potential players - the government,  private insurance companies, charity, and one's own thrift and savings.  Take your pick.

[Emjay]

We had that problems for decades prior to Obummer care. We can go back to having it for a while or we can work on real conservative solutions. More government is the problem, not the solution.

That problem has always existed and always will.  Obamacare did not help it but penalized the rest of society.  It should be abolished.

It is one the issues people are most impatient about.  I've seen a bunch of posts on Facebook and other sites complaining that Trump has had a whole month and hasn't abolished Obamacare yet.

[Idaho_Cowboy]

Why should others pay for this sort of non-essential procedure?   Does your homeowner's insurance pay to patch a leak in your roof?  Or do you need to save for such a contingency yourself?   
 

 Well,  when it comes to the health care FINANCING business, there are only four potential players - the government,  private insurance companies, charity, and one's own thrift and savings.  Take your pick.

Hint. Government = others.

[Emjay]

Why should others pay for this sort of non-essential procedure?   Does your homeowner's insurance pay to patch a leak in your roof?  Or do you need to save for such a contingency yourself?   
 

 Well,  when it comes to the health care FINANCING business, there are only four potential players - the government,  private insurance companies, charity, and one's own thrift and savings.  Take your pick.

When you need a hip transplant, come on over and tell me how non-essential it is.

[Jazzhead]

We had that problems for decades prior to Obummer care. We can go back to having it for a while or we can work on real conservative solutions. More government is the problem, not the solution.

What is your "real conservative solution" for the access issue?    I'm tired of slogans ("More government is the problem, not the solution").   I am interested in specific policy proposals to provide affordable health care financing for all, including the poor and the sick.   What are yours?   

[Jazzhead]

When you need a hip transplant, come on over and tell me how non-essential it is.

So what's your proposed solution?   Just saying "scrap the ACA" isn't a solution.  How do you propose to pay for hip replacements for all?   

[r9etb]

It wasn't 3 months until I got a letter from her.  So sad.  Her family was not as supportive as she had hoped.  She had been out of their lives too long.  She sold everything she had to get over there and the health care was the worst.  She could NOT get health care.  It took her a year to save up enough to get back.  She told me it was the worst mistake she'd ever made.

Our neighbor had a similar story.  She'd long been dismissive of American health care and moved back to the UK, where she ended up injuring her shoulder.  The waiting list for a National Health Service MRI was months long, and it would have taken 2 years to get shoulder surgery.

Luckily for her they have the wherewithal to get into the private medical system, and she got her surgery.

They've since moved back -- they're more American now than anything else; but she willingly ate crow about her previous disdain for the "wasteful" American approach.

[Idaho_Cowboy]

What is your "real conservative solution" for the access issue?    I'm tired of slogans ("More government is the problem, not the solution").   I am interested in specific policy proposals to provide affordable health care financing for all, including the poor and the sick.   What are yours?   

I don't want to sound cruel here, but that isn't exactly what we fought a revolution for. Some things don't fall under the purview of the Federal Leviathan.

I'm failing to see how either Obama care or singler payer are step in the right direction compared to the emergency room problem. Better to subsidize the care than the insurance. Insurance isn't a god given right. Sorry.

States have the power, charities (and there are lots and I know from experience they can get the job done for a lot of folks) should have more ability to help.

Personally I think torte reform and opening insurance markets up across state lines would play a big role in bringing down prices for both care and insurance. From there we have 50 states; let them compete on the best way to solve this problem. That usually works better than the Federal Leviathan issuing and orders from on high that they have to pass to even find out what they passed.