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zonohedron
Aug 14, 2006


Leon Trotsky 2012 posted:

EugeneJ posted:

So wait - right now if I'm on an employer health plan, my employer contributes part of the premium and I pay the rest - but I don't get any premium assistance otherwise. Will employer plans qualify for the new tax credits?
No. Employer plans are not touched by subsidies at all.

However, they are subject to regulations under PPACA, like "no lifetime cap on coverage" or "you can only make someone pay out of pocket so much per year". They won't be, if this turd of a plan manages to pass.

With at least two Republicans disliking it because it's not evil enough, and at least four Republicans disliking it because their states have benefitted enormously from expanded Medicaid, though, we have a good chance of that not happening. Right? :ohdear:

This is kind of alarming, though:

Leon Trotsky 2012 posted:

- People (especially single women) who are under 35 and sicker than average (more than $1,000 a year in out of pocket health costs)

$1000 a year out of pocket is more than average? Really?

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zonohedron
Aug 14, 2006


Bueno Papi posted:

It's insane that the AHCA rollout happened like this. My assumption was that the WH took this as "a good first step", I think that's how Trump put it, and expected it to be worked over with amendments to bring in the other votes. But nope, Costa is saying that the WH is full speed ahead on AHCA. Why didn't the WH do a full court presser to try to shape the narrative? They let house release it and gave the media an entire day before they started their spin. I like to think Boehner is watching this and is screaming at the TV saying, "Amateurs."

I like to think Boehner is watching this with popcorn. "Bet you wish you weren't in charge of this mess, don't you, Paul? Better you than me!"

The problem is that they had to do SOMETHING, and the sane option of "until we do <other thing> we can't give health care the attention it deserves" was a little too sane, the sensible option of "since we've been bitching about this for seven years, here's the plan we've been crafting all that time" didn't happen, they knew they didn't have enough votes for repeal-without-replace, and so we got... this. Nobody tried to smooth the release because everybody knew it was terrible, and they're desperately hoping it fails to get votes so they can say "welp we tried" rather than be stuck with "we successfully destroyed a thousand hospitals and killed a million little kids, go us" as a legacy.

blackmet posted:

Sigh.

A smartphone costs, at max, $700. Which makes no real sent in a major medical procedure, especially without insurance.

Also, there's a reason smartphones have 90+% market penetration in 10 years. They give you a nearly free source of entertainment and news, allow you to call your friends/family/job/emergency services, and let you apply for jobs online.

Fun fact: a cheap pre-paid smartphone that looks a lot like an iPhone costs $20. A Samsung prepaid costs $50. And my first smartphone -- a 1 generation old iPhone -- was given to me for free by a friend who had it sitting in a drawer and gave it to me when I mentioned in passing that I was interested in a deal I saw for them through AT&T.

It's one of the best investments a poor person can make.

Unless you're being ironic...in which case I apologize for the tangent.

I assumed that was a reaction to Jason Chaffetz saying, "Americans have choices. And they've got to make a choice. And so maybe rather than getting that new iPhone that they just love and they want to go spend hundreds of dollars on that, maybe they should invest in their own health care. They've got to make those decisions themselves."

zonohedron fucked around with this message at 03:16 on Mar 8, 2017

zonohedron
Aug 14, 2006


Mechafunkzilla posted:

Do you guys think medicare-for-all is a saleable idea for the American people?

I dunno. My immediate reaction is negative (that is to say, I wouldn't want it) but that's because at least two of the doctors I see regularly don't take Medicaid and one of the two doesn't take Medicare either. In that circumstance, if I could have government-funded insurance, private insurance companies have even less incentive not to be horrible, but not having private insurance would leave me worse off than I am now.

zonohedron
Aug 14, 2006


Pollyanna posted:

It took people almost six months to realize that actually, Trump was gonna gently caress them over, so I have no faith in them realizing this.

To be fair, they were hearing from all sides, "Take him seriously, not literally," "Campaigning is different from governing," "He'll pivot and become more presidential," etc. I mean, people generally don't want to accept that they made a bad decision, or that someone they support has done something wrong, or that they've been lied to. Trump voters made a bad decision, the person they supported has done bad things and is doing more, and they've been lied to non-stop, but that's very hard for anyone to accept - and even people who voted for anyone or anything else were generally hoping (at least a little bit) that Trump wouldn't be as bad as they feared.

They've only had since January 20th - not quite two months - to realize that, actually, they made a bad decision and it's going to hurt them personally.

zonohedron
Aug 14, 2006


Rhesus Pieces posted:

I wouldn't be surprised if he's genuinely mixing them up in his head due to a strong belief in a just world. To him, sickness and poverty are different leaves on the same branch of irresponsibility and flawed character. Meanwhile, he's a healthy male in his 40s who runs marathons and does p90x. Obviously overall health is up to the individual and it's unfair for people like him to subsidize laggards who can't get it together and have their hands out.

Right. My thyroid clearly needs to pull itself up by its bootstraps, even if that requires it to grow feet and buy boots first.

zonohedron
Aug 14, 2006


evilweasel posted:

unsuprisingly your view on government spending money on things to create jobs tends to vary with your view on the value of the things being made

There's also the idea - and I don't know if it's true or not - that once the F-35 orders are complete, that's it, you've made the planes, goodbye, but PPACA's effects on hospitals, doctor's offices, insurance companies, etc, are perpetual because people are perpetually being born, getting sick, getting hurt, and so forth.

zonohedron
Aug 14, 2006


Peven Stan posted:

Why not just repeal the employer mandate and the token tanning bed tax and call it a day GOP? Give them an inch and they'll try and take a mile, the crazy bastards

There's literally no plan, no matter how benevolent, malevolent, or ineffectual, that the current GOP congresscritters could ever agree on. Some of them wouldn't be happy unless every state that expanded Medicaid was forced to un-expand it and every requirement that health insurance actually provide meaningful coverage was rescinded. Some of them wouldn't be happy if their own state's Medicaid expansion was negatively affected in any way, shape, or form. Nearly all of them campaigned on "repealing Obamacare", which to most of their voters means "ending the individual mandate".

- if you end the individual mandate, you have to give the insurance companies SOMETHING because otherwise their lobbyists will flood your swamp with their crocodile tears
- if you don't end the individual mandate, you're at risk of being primaried because you didn't "repeal Obamacare"
- if you don't mangle Medicaid, you will lose votes
- if you do mangle Medicaid, you will lose votes

zonohedron
Aug 14, 2006


Peven Stan posted:

Everyone complains about the employer paid system but loves their particular employer sponsored plans since they can be incredibly generous.

The ACA would've dialed this down via the cadillac tax mechanism through the decades and gradually unwind that since virtually all plans would've hit the high value threshold in a decade or so. Then people can decide if they want to firm up the marketplace subsidies, reregulate plans to make them cover more doctors (no more narrow networks), or put in a public option or whatever.

The GOP plan seems to do what they've wanted to have done for decades, which is fire a shot directly into the heart of it and see what happens next.

In the nearly ten years I've been married and thus had insurance through my husband('s employer) rather than my parents, I don't think I've ever loved his insurance plan. If what I have is "incredibly generous" and would have hit a "high value threshold"... what on earth are "low" value plans covering? If what I have would be top-of-the-line in the individual market, and the GOP wants to make the individual market worse, why don't they just cut out the middleman and allow insurance companies to offer a laminated card with the insurer's phone number on it as the sole benefit of the policy?

zonohedron
Aug 14, 2006


axeil posted:

This "correctly diagnose your own appendicitis or face $20k in medical bills" bullshit is loving disgusting.

There's really no other word for it. Ban private insurance and give everyone Medicare.

And then at the end, the lady says that she'd go to an urgent care place for everything, and they'd have to "force her" into an ambulance... which, naturally, she'd pay through the nose for, especially if her eventual diagnosis was not something that might have killed her.

Not to mention Anthem says "call our nurse line", but a lot of the time nurse lines will tell you to go to the ER because they can't take the risk of saying "take a Tylenol and go to bed" and then have the person die in their sleep! (I got told to go to the ER with my two-year-old because he was complaining of abdominal pain and refusing to urinate. This is because a kid that little complaining of abdominal pain might need to fart or might be about to keel over dead.)

zonohedron
Aug 14, 2006


Devor posted:

* Formulary is provided for entertainment purposes only. Rely on information contained in the formulary at your own risk. The plan document shall govern in all cases.**

**Unless relying on the formulary would benefit the insurer***

***You agree to binding arbitration by Blue Cross Arbiters Inc.

My favorite was when United Healthcare sent my husband a letter saying that a medication he was on was in the "high cost" tier (it wasn't actually called that) from now on.

The letter looked like this:

quote:

Dear Mr. Hedron,

You're taking Medication X. Please discuss with your doctor switching to a more affordable medication from one of the suggested low tier or medium tier alternatives below.

Current Medication: Medication X (generic name: xqqqqqxqxqxine)

Low Tier Alternatives:

Medium Tier Alternatives:

Thank you,

Your friends at United Healthcare

No, I didn't forget to make up more medication names. Those two lines really were just blank.

zonohedron
Aug 14, 2006


Reik posted:

Saying how the system should be changed and saying what people should do today in their own best interest, because an Urgent Care visit will cost the policyholder significantly less as well, are two very different things.

Yes, it's insane that someone with a non-emergency issue gets tagged with the same ER facility charge as the person that has an emergency issue, but until we get that fixed people should go to an Urgent Care if one is nearby and open if they don't believe their life is in danger. If it turns out your issue is actually more serious, you'll probably actually see a doctor faster than if you went to the ER, and when the doctor realizes you are in danger, they can get you on an ambulance to the ER where you should receive appropriately prioritized treatment.

Except then you'll have to pay for the ambulance, too, and being referred by an urgent care isn't a guarantee that the insurance will agree that it was really an emergency. The consideration becomes "do I pay the ER disincentive fee, or do I hope that I'm only paying the urgent care copay and not urgent care + ambulance ride + ER disincentive anyway?" and if someone's pretty sure that they're not actively dying, they might just try to tough it out, which is not always the best choice. (It also requires the urgent care doc to actually recognize that this particular sore throat means "imminent doom" not "buy some cough syrup and go to bed", when by definition they aren't going to see imminent doom as often as someone who actually works in the ER...)

zonohedron
Aug 14, 2006


Willa Rogers posted:

It's bad because it takes the closest we have to an NHS-style system (VA) and the closest we have to a Canadian system (Medicaid) and subverts them into a (further) privatized Medicare system.

Okay, I'm not saying there's anything good about making anything part of Medicare, because I really don't know enough to say, but surely no one's saying that Medicaid or the VA are systems to emulate, right? You're only saying they'd be even worse (somehow) if blobbed into Medicare? Because I think of Medicaid and I think of doctors not taking it and states doing their best to cripple it, and I think of the VA and I think of interminable bureaucracy and wait times. If someone asked me "would you prefer your current high deductible plan with its random copays, or free access to both Medicaid and the VA?" I'd take my just-about-adequate plan in a microsecond.

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zonohedron
Aug 14, 2006


Accretionist posted:

What did you have in mind?

I think area's over-stated. For the most part, we're pretty consolidated

That suggests that the people in the frontier counties, as Public Law 94-171 apparently calls them, don't really matter. It also suggests that because "Texas Triangle" and "Front Range" are both population centers they can be treated identically, which is almost-certainly not the case.

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