tag:blogger.com,1999:blog-8512362.post6751667230829499191..comments2024-03-10T13:59:19.230-04:00Comments on xpostfactoid: CSR windfall: Will it have bronze or gold cast?Andrew Sprunghttp://www.blogger.com/profile/17601269968798865106noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-8512362.post-66834881843968227592017-11-02T16:02:34.163-04:002017-11-02T16:02:34.163-04:00I agree with your comment that cost control is pla...I agree with your comment that cost control is placed almost entirely on the patient. Us poor patients are like the kamikaze pilots of cost control. Only if we exhaust ourselves in desperate bargaining, or even harm ourselves by refusing needed care, can we force providers to even consider lowering their prices.<br /> The way to get lower prices in any market is to have the ability to walk away from a bad deal. In medicine that is a very hollow ability.<br />Bob Hertzhttps://www.blogger.com/profile/08889826739646491269noreply@blogger.comtag:blogger.com,1999:blog-8512362.post-25302645906229029832017-11-01T08:34:15.282-04:002017-11-01T08:34:15.282-04:00Bob:
I do not remember many of the middle class g...Bob:<br /><br />I do not remember many of the middle class going to war over the uninsured before the ACA. In many cases the attitude was the best expressed the same as Trump's alternative facts lady Kellyanne Conway's "Get a job that has insurance" when such jobs were unavailable. If one could not get a job in my state and you were an adult, there was no healthcare insurance. If you were part of the working poor and eligible, the insurance was limited.<br /><br />In any case, this is not the reason for their cost issues. There are several factors I believe support your complaint though. The same as working to get Medicaid, there was a mentality of having skin in the game when going for ACA healthcare as if that would cause you to negotiate or not go at all. Raising deductibles and then not being eligible for the negotiated rate till that deductible was satisfied is BS also. I tried that negotiation routine when I had pneumonia with my PCP and had poor insurance. It does not work. One clerk finally told me to go to a private imaging and urine test facility to save the money.<br /><br />The second emphasis is the cost control which is entirely on the insured through premiums, deductibles, co-payments, exclusions, etc. . Insurance is mostly reflective of the cost (it has its issues). The commercial healthcare industry and the service for fees business model are the majority drivers of cost. If Congress will do it, it is time to visit how healthcare product is costed and delivered. <br /><br />There are 15 million people in the individuals market above 400% of FPL who I believe are the loudest complainers. If we did raised the subsidy level to 350% and 500%, it would only be good for a little while before deductibles and costs would catch up to those limits either to the government or individuals. It is a temporary fix. We need to move to something better.run75441https://www.blogger.com/profile/03790826995006015721noreply@blogger.comtag:blogger.com,1999:blog-8512362.post-32481818398975777502017-10-29T09:55:33.074-04:002017-10-29T09:55:33.074-04:00I never heard Hillary speak loud and clear about c...I never heard Hillary speak loud and clear about capping premiums in a debate or stump speech. I had to search for the proposal on her website.<br />Granted, it was not going to be easy to get an extra $10-$15 billion a year out of a Congress that was busy "repealing" the whole ACA. But I barely heard the effort.<br /><br />I have read about ten articles about ACA beneficiaries who voted for Trump. In general, these voters were not one bit studious about the law and maybe we can just chalk it up to hillbilly gullibility. However one common theme is that the people with ACA subsidies were deeply jealous of the people on Medicaid. Medicaid has next to zero premiums and no deductibles...that is what the Trump voters actually wanted for themselves.<br /><br />I sometimes curse the Democrats for passing a program with cliffs! Better a smaller benefit for all citizens, than Cadillacs for the poor and a rusty oxcart for the middle class.bob.hertzhttps://www.blogger.com/profile/09686373408419885558noreply@blogger.comtag:blogger.com,1999:blog-8512362.post-119851114867625272017-10-28T07:46:11.815-04:002017-10-28T07:46:11.815-04:00Bob, in my experience Dems do not deny that the AC...Bob, in my experience Dems do not deny that the ACA needs fixing. Everyone from Schumer on down has acknowledged problems. Clinton had a package of proposals to ease out-of-pocket costs and premiums -- including capping premiums as a % of income at all income levels. I think it's a virtual consensus that the ACA has helped the poor and near-poor but fallen short (for a host of reasons in which sabotage looms large) for those over 200% FPL.Andrew Sprunghttps://www.blogger.com/profile/17601269968798865106noreply@blogger.comtag:blogger.com,1999:blog-8512362.post-23394677711528322722017-10-28T07:28:36.291-04:002017-10-28T07:28:36.291-04:00As you point out, the extra benefits for the '...As you point out, the extra benefits for the 'lower middle class' (defined by income) are in contrast to the horrible situation of the unsubsidized market (i.e. the new uninsured) Yesterday I quoted a premium of $1300 a month for a crap ass silver plan for a 60 year old in Iowa who makes $5000 a month before taxes. I advised this person to look for a Christian health plan as he did not have pre existing conditions.<br /><br />As I look back over the last few years on this issue, I am struck by the lack of proposals to extend the subsidies to all income levels, or at least to 500% or 600% of poverty.<br /><br />The Republicans in the main are apparently determined that government programs are worthless, and that Obama in particular had to be humbled. The Repubs have done nothing for one of their main constituencies.<br /><br />The Democrats constantly fell back on the annoying claim (at least annoying to me) that the ACA was helping the poor and therefore it was great.<br /><br />A program that helps the poor yet hurts the middle class will not survive in the long run. Most Democrats seem not to understand this.<br /><br />We have no lack of ideology in our national politics. What baffles me is the lack of interest group politics on health care.<br />bob.hertzhttps://www.blogger.com/profile/09686373408419885558noreply@blogger.com