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

[Jazzhead]

Hard working Americans can find themselves facing ruin from medical expenses.   This is not the false meme of the virtuous being forced to subsidize sinners.   Those who lack access to health insurance often work harder than those who, by dint of good fortune,  work for employers able to provide such insurance.   

ISARFR, you and your family could be ruined by uninsured medical expenses just as surely as I can.   This is exactly the sort of risk that deserves to be apportioned fairly and not on the basis of something as arbitrary as whether or not one is is lucky work for a large employer.   

[r9etb]

Hard working Americans can find themselves facing ruin from medical expenses.   This is not the false meme of the virtuous being forced to subsidize sinners.   Those who lack access to health insurance often work harder than those who, by dint of good fortune,  work for employers able to provide such insurance.   

ISARFR, you and your family could be ruined by uninsured medical expenses just as surely as I can.   This is exactly the sort of risk that deserves to be apportioned fairly and not on the basis of something as arbitrary as whether or not one is is lucky work for a large employer.

There are two issues here, and it's important not to conflate them.

The first issue is how to deal with catastrophic medical expenses when one cannot, for whatever reason, afford insurance.

The second issue is how -- or whether -- to ensure that poor people have meaningful access to basic medical and dental care.

The underlying question is moral -- do we as a society have a duty to those who cannot afford medical care or insurance?  I think the answer is yes, and the discussion is actually just about ways and means.

[Bigun]

Individual liberty and personal responsibility are inextricably linked together! You CANNOT have one without the other!

"The problem with socialism is that eventually you run out of other people's money!"

Maggie Thatcher

She could not have been any more right!

[Jazzhead]

There are two issues here, and it's important not to conflate them.

The first issue is how to deal with catastrophic medical expenses when one cannot, for whatever reason, afford insurance.

The second issue is how -- or whether -- to ensure that poor people have meaningful access to basic medical and dental care.

The underlying question is moral -- do we as a society have a duty to those who cannot afford medical care or insurance?  I think the answer is yes, and the discussion is actually just about ways and means.

Well said, r9etb.   I agree that a great nation such as ours has a moral obligation to do something more than consign the poor to medical neglect and emergency rooms.   And you've correctly identified the two areas for which that moral obligation exists -  basic medical care and catastrophic care.  As you may know,  the ACA addresses the former by requiring insurance to cover annual check-ups and many preventive medications free of charge.   Whether you agree with that approach or not,  the idea is not only to provide everyone with access to basic medical care, but to encourage folks to see a doctor before a nascent medical condition becomes more serious - and expensive.   

The approaches to financing basic care and catastrophic care can and should be different.  Perhaps basic medical care can be provided by single payer insurance financed by general tax revenues.  Persons could supplement such basic coverage through private insurance in a marketplace that offers a variety of choices.  Or choose to forego supplemental insurance and pay for care out of one's own pocket, perhaps up to a dollar limit above which a form of "stop loss" insurance would kick in.   

There are a variety of options,  which I can perhaps address in future posts if folks are interested.

[Smokin Joe]

Hard working Americans can find themselves facing ruin from medical expenses.   This is not the false meme of the virtuous being forced to subsidize sinners.   Those who lack access to health insurance often work harder than those who, by dint of good fortune,  work for employers able to provide such insurance.   

ISARFR, you and your family could be ruined by uninsured medical expenses just as surely as I can.   This is exactly the sort of risk that deserves to be apportioned fairly and not on the basis of something as arbitrary as whether or not one is is lucky work for a large employer.

Obamacare cost me my insurance, so now I get to pick up the tab for any medical care out of pocket AND pay the penalty, too.

You see, I just checked the cheap plan available in my state for my family, just out of curiosity. It's over 28K a year. That's with 14K in deductibles. For a family which usually spends less than 8K a year in health CARE costs (all out of pocket), that is a non-starter.
I had a high deductible plan that worked for me. this mess does not.

 KILL IT NOW.

[Bigun]

Obamacare cost me my insurance, so now I get to pick up the tab for any medical care out of pocket AND pay the penalty, too.

You see, I just checked the cheap plan available in my state for my family, just out of curiosity. It's over 28K a year. That's with 14K in deductibles. For a family which usually spends less than 8K a year in health CARE costs (all out of pocket), that is a non-starter.
I had a high deductible plan that worked for me. this mess does not.

 KILL IT NOW.

And salt the ground so it can never come back!  Things like that are incompatible with F R E E D O M ! ! !

[skeeter]

Obamacare cost me my insurance, so now I get to pick up the tab for any medical care out of pocket AND pay the penalty, too.

You see, I just checked the cheap plan available in my state for my family, just out of curiosity. It's over 28K a year. That's with 14K in deductibles. For a family which usually spends less than 8K a year in health CARE costs (all out of pocket), that is a non-starter.
I had a high deductible plan that worked for me. this mess does not.

 KILL IT NOW.

I'm betting my 2017 healthcare costs, copay plus deductible, will not exceed the $17k my plan's premium alone would have cost me this year, so will pay out of pocket as well.

KILL the ACA mess now.

[r9etb]

As you may know,  the ACA addresses the former by requiring insurance to cover annual check-ups and many preventive medications free of charge.   Whether you agree with that approach or not,  the idea is not only to provide everyone with access to basic medical care, but to encourage folks to see a doctor before a nascent medical condition becomes more serious - and expensive.

Even if one agrees with the idea, the details are important.  As a practical matter the ACA has failed to achieve the goal.  The statistics I've seen suggest that Obamacare made few improvements to actual access, and probably made it worse.  Even if one is "covered," it is often difficult or impossible to find a doctor within reach who will accept the coverage, for the simple reason that Medicaid is a significant money-loser for them.  One yardstick -- ER usage for routine medical issues -- is apparently no better and sometimes worse in many locations.

The approaches to financing basic care and catastrophic care can and should be different.  Perhaps basic medical care can be provided by single payer insurance financed by general tax revenues.  Persons could supplement such basic coverage through private insurance in a marketplace that offers a variety of choices.  Or choose to forego supplemental insurance and pay for care out of one's own pocket, perhaps up to a dollar limit above which a form of "stop loss" insurance would kick in.

I'm against the single-payer idea for the simple reason that it doesn't actually work.  Medicare and Medicaid are essentially "single-payer" systems, and the tremendous regulation, overhead, and minimal payments are such that doctors either limit or altogether avoid people under those plans.  Plus which, the "tax as you go" approach is fiscally unsustainable and will become moreso as the ratio of beneficiaries to taxpayers continues to increase.

The House GOP plan apparently approaches the problem by offering so-called "tax credits," which is perhaps a fancy way of saying "means-tested subsidies" that can be used for premiums or HSAs.  If these can be applied with minimal regulatory overhead then I think it's not perfect but about as good as can be expected.

[Jazzhead]

And salt the ground so it can never come back!  Things like that are incompatible with F R E E D O M ! ! !

Dying while waiting in line at an emergency room is freedom too.  Honestly, the narrow-minded selfishness of some here astonishes me.  Bigun,  you're old enough to be eligible for Medicare - congratulations, you're the lucky recipient of single payer!  Let the poor enjoy their "freedom" to get sick and die while you enjoy your socialist utopia.   Flippin' phony you are.     

[Weird Tolkienish Figure]

Dying while waiting in line at an emergency room is freedom too.  Honestly, the narrow-minded selfishness of some here astonishes me.  Bigun,  you're old enough to be eligible for Medicare - congratulations, you're the lucky recipient of single payer!  Let the poor enjoy their "freedom" to get sick and die while you enjoy your socialist utopia.   Flippin' phony you are.     

There are so many "conservatives" on medicare and social security and they will all say "we paid into it our whole life". Well I'm paying for government largess too! gimmedat!


Tired of the hypocrisy as well.

[Bigun]

There are so many "conservatives" on medicare and social security and they will all say "we paid into it our whole life". Well I'm paying for government largess too! gimmedat!


Tired of the hypocrisy as well.

BOTH of you are full of CACA!  I spent a lifetime trying to make a deal with the government whereby they would just keep what they had already stolen from me in exchange for just leaving me the hell alone!  They refused!

And furthermore I would be fine without either SS or Medicare! I'm NOT a socialist and never will be one!

[Weird Tolkienish Figure]

BOTH of you are full of CACA!  I spent a lifetime trying to make a deal with the government whereby they would just keep what they had already stolen from me in exchange for just leaving me the hell alone!  They refused!

And furthermore I would be fine without either SS or Medicare! I'm NOT a socialist and never will be one!

I'm not directing this at you. If you support damping down Medicare and SS payments then you're not a hypocrite in my eyes.


I'm saying I have seen this opinion though.


GOVERNMENT HANDS OFF MY MEDICARE AND SOCIAL SECURITY!


You're cool in my book Bigun.

[Smokin Joe]

Dying while waiting in line at an emergency room is freedom too.  Honestly, the narrow-minded selfishness of some here astonishes me.  Bigun,  you're old enough to be eligible for Medicare - congratulations, you're the lucky recipient of single payer!  Let the poor enjoy their "freedom" to get sick and die while you enjoy your socialist utopia.   Flippin' phony you are.     

Hyperventilate much? I can see why you are so concerned. What I found interesting was that the quote bot asked my age, sex, and whether or not I was a tobacco user.
Ditto for dependents.
What it did not ask that might materially affect the amount the insurance company shells out: Do you use or have you ever been addicted to IV drugs? Do You consume alcohol, and if so in what amounts? Do you engage in unprotected sex? Do you have multiple sex partners? Are you homosexual?  BMI or such data?

Nope, none of that very relevant information for the purposes of underwriting risk was considered. Nor did it even ask me how much tobacco I consumed, how, or how long I had been consuming it. (Actually, I give smokeless tobacco credit for curing an undiagnosed ulcer forming at the junction of the duodenum and small intestine--a relative who had far better doctors found out that that was what caused his symptoms, which were identical to my own.)

[Bigun]

Hyperventilate much? I can see why you are so concerned. What I found interesting was that the quote bot asked my age, sex, and whether or not I was a tobacco user.
Ditto for dependents.
What it did not ask that might materially affect the amount the insurance company shells out: Do you use or have you ever been addicted to IV drugs? Do You consume alcohol, and if so in what amounts? Do you engage in unprotected sex? Do you have multiple sex partners? Are you homosexual?  BMI or such data?

Nope, none of that very relevant information for the purposes of underwriting risk was considered. Nor did it even ask me how much tobacco I consumed, how, or how long I had been consuming it. (Actually, I give smokeless tobacco credit for curing an undiagnosed ulcer forming at the junction of the duodenum and small intestine--a relative who had far better doctors found out that that was what caused his symptoms, which were identical to my own.)

I don't see what JH posts unless someone quotes it but since I have seen it He can stick his socialism where the sun doesn't shine! He has well and truly exposed himself for what he truly is and I, for one, want nothing further to do with him ever again!

[r9etb]

Hyperventilate much? I can see why you are so concerned.

He may have overstated the case a bit, but the question of whether "freedom" for some, means that poor people can't get medical care -- that's a valid question.  Do we, as a society, have a moral obligation to ensure access to basic medical care?

What I found interesting was that the quote bot asked my age, sex, and whether or not I was a tobacco user.
Ditto for dependents.
What it did not ask that might materially affect the amount the insurance company shells out: Do you use or have you ever been addicted to IV drugs? Do You consume alcohol, and if so in what amounts? Do you engage in unprotected sex? Do you have multiple sex partners? Are you homosexual?  BMI or such data?

Nope, none of that very relevant information for the purposes of underwriting risk was considered. Nor did it even ask me how much tobacco I consumed, how, or how long I had been consuming it. (Actually, I give smokeless tobacco credit for curing an undiagnosed ulcer forming at the junction of the duodenum and small intestine--a relative who had far better doctors found out that that was what caused his symptoms, which were identical to my own.)

That looks like a consequence of regulatory overreach....

[Bigun]

He may have overstated the case a bit, but the question of whether "freedom" for some, means that poor people can't get medical care -- that's a valid question.  Do we, as a society, have a moral obligation to ensure access to basic medical care?

That looks like a consequence of regulatory overreach....

Which is the result of socialism EVERY single time it's tried!

[r9etb]

Which is the result of socialism EVERY single time it's tried!

So, answer me a basic question: do we as a society have any moral obligation to ensure that people who can't afford it, have access to basic medical care?

[Weird Tolkienish Figure]

So, answer me a basic question: do we as a society have any moral obligation to ensure that people who can't afford it, have access to basic medical care?

Tough question to answer.


Other tough questions:


Do we have a moral obligation to make people pay for other's healthcare, by force?


If we have a moral obligation to force other to pay taxes to pay for healthcare, what does it stop?


Are people responsible for any part of their own well being?


And so on and so forth...

[r9etb]

Tough question to answer.
Other tough questions:
Do we have a moral obligation to make people pay for other's healthcare, by force?
If we have a moral obligation to force other to pay taxes to pay for healthcare, what does it stop?
Are people responsible for any part of their own well being?
And so on and so forth...

I notice you didn't answer the original question. 

[Weird Tolkienish Figure]

I notice you didn't answer the original question.

I said it's tough to answer.


That's the truth.


IMO I have no problem with forcing hospitals with providing life saving care. I think there is room for some government encouragement of health care through FSA's and such.


Ideally we'd all be responsible for ourselves of course. Politically speaking that's probably a nonstarter.

[Bigun]

So, answer me a basic question: do we as a society have any moral obligation to ensure that people who can't afford it, have access to basic medical care?

That had been the law in this country LONG before the ACA ever came along and, as far as I can determine, still will be if the ACA is fully repealed!

Health CARE and Health INSURANCE are not the same thing!

[Smokin Joe]

He may have overstated the case a bit, but the question of whether "freedom" for some, means that poor people can't get medical care -- that's a valid question.  Do we, as a society, have a moral obligation to ensure access to basic medical care?

That looks like a consequence of regulatory overreach....

Actually, they are just as free to go out and earn money and get their own damned medical care. The taxes I have paid paid for them, but so did the bills I paid out of pocket. Seven dollars for an aspirin? Really? I think that might have bought someone else a percocet or two.

It might have been far cheaper to establish means-tested 'free' clinics (not even necessarily a medical clinic, but a couple of hours of flat rate physician time a day) for the sniffles and clear the ERs of Medicaid patients and those who could only get health CARE by going to the ER, where they might wait a while, but would get served--only at greater expense.

No one is allowed to just bleed out in an ER because they can't find an insurance card. If you collapse with chest pains, you move to the head of the line. That's the way it worked.

Those who could get medicaid did.

It's simple, don't make much and divest yourself of all but 10K of assets.

At my age, nevermind. I have greatgrandkids, and assets I worked my entire life for which I won't chuck to sign up for another government program. so whatever my income may drop to in a bad year, Medicaid is out. Not old enough for medicare, so that isn't an option, and I will spend 28K a year keeping the lights, heat, food in the cupboards, etc. before i spend it on something I MIGHT need, but would have a 14K deductible anyway. Fuhgeddaboutit.

Without a requirement for me to have the stuff, I wouldn't look twice--and it would not be marketable. I'm just less scared of the possibility of being handed a bill--or the penalty--than knowing I'd spend 2/3 of last years "income" pulled from savings to buy something I am unlikely to use.

If someone else wants  more, they can damned well get out and earn it.

If it is a kid with Cancer call St Judes. Open a GoFundMe, there are many people out there, myself included who have donated to help folks who have been hit with unusual maladies or medical costs. But it is no longer a gift when it is required, when it is pulled from my pocket at gunpoint to hand to someone else, no matter how much they might be seen as deserving.
I can't give if the government takes it. Which not only robs me of my money, but the ability to perform acts of Christian charity as well.

[Bigun]

Actually, they are just as free to go out and earn money and get their own damned medical care. The taxes I have paid paid for them, but so did the bills I paid out of pocket. Seven dollars for an aspirin? Really? I think that might have bought someone else a percocet or two.

It might have been far cheaper to establish means-tested 'free' clinics (not even necessarily a medical clinic, but a couple of hours of flat rate physician time a day) for the sniffles and clear the ERs of Medicaid patients and those who could only get health CARE by going to the ER, where they might wait a while, but would get served--only at greater expense.

No one is allowed to just bleed out in an ER because they can't find an insurance card. If you collapse with chest pains, you move to the head of the line. That's the way it worked.

Those who could get medicaid did.

It's simple, don't make much and divest yourself of all but 10K of assets.

At my age, nevermind. I have greatgrandkids, and assets I worked my entire life for which I won't chuck to sign up for another government program. so whatever my income may drop to in a bad year, Medicaid is out. Not old enough for medicare, so that isn't an option, and I will spend 28K a year keeping the lights, heat, food in the cupboards, etc. before i spend it on something I MIGHT need, but would have a 14K deductible anyway. Fuhgeddaboutit.

Without a requirement for me to have the stuff, I wouldn't look twice--and it would not be marketable. I'm just less scared of the possibility of being handed a bill--or the penalty--than knowing I'd spend 2/3 of last years "income" pulled from savings to buy something I am unlikely to use.

If someone else wants  more, they can damned well get out and earn it.

If it is a kid with Cancer call St Judes. Open a GoFundMe, there are many people out there, myself included who have donated to help folks who have been hit with unusual maladies or medical costs. But it is no longer a gift when it is required, when it is pulled from my pocket at gunpoint to hand to someone else, no matter how much they might be seen as deserving.
I can't give if the government takes it. Which not only robs me of my money, but the ability to perform acts of Christian charity as well.

Which brings us right back to the point that has been made several times already by several different posters.  The ACA is not about healthcare to begin with!  It is ALL about cradle to grave control of YOU!

[Smokin Joe]

Which brings us right back to the point that has been made several times already by several different posters.  The ACA is about healthcare to begin with!  It is ALL about cradle to grave control of YOU!

Typical of Congress, the title is misleading. It wasn't "Affordable", had jack-all to do with "Care", it was just an Act.
It was an insurance scam from the git-go, and a control device all the way.

[Idaho_Cowboy]

He may have overstated the case a bit, but the question of whether "freedom" for some, means that poor people can't get medical care -- that's a valid question.  Do we, as a society, have a moral obligation to ensure access to basic medical care?

Food, housing, cellphones, Insurance, wifi, cars, jobs, college, labradoodles, Pappy Van Winkle...

Got to draw the line somewhere.