Trump's Promises

[Just_A_Guy]

1 hour ago, anatess2 said:

On January 20, Congress can repeal it again.  But Trump will not sign it unless it comes with a replacement bill.  He has expressed several times including one just a couple weeks ago on a press interview that there will not be a lapse between the repeal of Obamacare to the replacement of Obamacare - they will go simultaneously.  The replacement Bill passed the house last year but got stuck in the Senate.  They're still working on it.  Trump wants his own platform ideas put in it, so they're going to have to go back to square 1 on that replacement Bill.  This is a good thing - because Trump's ideas include the HSA to replace/supplement insurance so that insurance can, once again, only have to apply to catastrophic illnesses including pre-existing conditions of such catastrophic illnesses instead of mandating that insurance covers for everything and the kitchen sink.

NPR had some Republican Senate mucky-muck on about a week ago, and he was suggesting that they might vote for a repeal that only goes into effect in 2018--basically giving themselves a two-year deadline to come up with a replacement.  I don't know where Trump is on such a scheme, but I'm filing it in my "what-could-possibly-go-wrong?" drawer.

[Just_A_Guy]

1 hour ago, anatess2 said:

 That's why it was sooooo frustrating for that mandate to be supported by the SCOTUS!

Now that we've decided the Feds can force you to purchase a product you yourself don't believe you need, Trump ought to include a measure in his gun legislation to the effect that every American adult must purchase at least one firearm. 

Much hilarity will ensue.

[anatess2]

12 minutes ago, Just_A_Guy said:

NPR had some Republican Senate mucky-muck on about a week ago, and he was suggesting that they might vote for a repeal that only goes into effect in 2018--basically giving themselves a two-year deadline to come up with a replacement.  I don't know where Trump is on such a scheme, but I'm filing it in my "what-could-possibly-go-wrong?" drawer.

I'm hoping Trump won't make that mistake of allowing the Republicans 2 years to come up with the replacement.  Because then, all the termed Republicans will all be gone in 2018 (seriously, the people are not that patient anymore!).... and with the Democrats in disarray, there is still no substantial Democrat opposition to single-payer so even when we replace them all with "reasonable" Democrats, they won't be able to stand up to their loud voices.

My coin is on Paul Ryan.  Trump up top, Paul Ryan in the House... apply squeezing pressure on the Senate... let's go Repubs!

Edited November 29, 2016 by anatess2

[Just_A_Guy]

1 hour ago, unixknight said:

This.  And the individual mandate cannot be removed unless the law doesn't force companies to cover pre-existing conditions... and that, I think, is going to be the sticking point.  With the massive cost of healthcare people with pre-existing conditions are screwed otherwise.  It locks people into jobs if they can't switch health plans, and Heaven help someone who loses their job involuntarily and is forced to switch health plans. 

That's a problem that needs fixing, but the solution of just passing a law to force companies to do it is idiotic.

There's still a train of thought out there, to the effect that Obamacare was intended to create an environment where it would be unsustainable in the long-run to operate a private-sector health insurer; thus paving the way for a "more practical" single-payer system.  So, yeah . . . whatever the Republicans replace this with, needs to be rock-solid; else it will be pitched by the leftist media as just another capitalist failure demonstrating the need for single-payer utopia.

[anatess2]

6 minutes ago, Just_A_Guy said:

There's still a train of thought out there, to the effect that Obamacare was intended to create an environment where it would be unsustainable in the long-run to operate a private-sector health insurer; thus paving the way for a "more practical" single-payer system.  So, yeah . . . whatever the Republicans replace this with, needs to be rock-solid; else it will be pitched by the leftist media as just another capitalist failure demonstrating the need for single-payer utopia.

I don't want to be so cynical... but I believe that we have some right-wingers wanting a single-payer utopia as well....

[unixknight]

1 hour ago, anatess2 said:

HSA's - nobody.  That's a SAVINGS account.

Does everybody have a savings account, or can afford to put money into one?

1 hour ago, anatess2 said:

Now, who gets to pay for the healthcare costs of poor folks who can't afford it and has no HSA money to their name?  The STATE.

And in what way does that help lower the cost of healthcare?

[Just_A_Guy]

1 hour ago, anatess2 said:

HSA's - nobody.  That's a SAVINGS account.  Everybody has their own and you can pass it to your children or grandchildren or whoever gets to control your estate when you die.  The possibility of private institutions - like the Church or your birthday party guests - to contribute to your HSA - is exciting.  And... the possibility of people who win money like lottery winners or Las Vegas winners or Jeopardy! winners... can avoid the 40% tax on their winnings by putting it into their HSA... or instead of sending your earnings to Switzerland to avoid taxes you can, instead, put the money in the HSA to avoid tax penalty.  Wouldn't that be awesome?

Now, who gets to pay for the healthcare costs of poor folks who can't afford it and has no HSA money to their name?  The STATE.  This is already in place in Harris County, Texas and the entire state of Massachussets.  Before Obamacare.  Each State gets to figure it out on their own and come up with their own solution.  The Trump Plan is for the Feds to simply give bloc funds to the State to subsidize any plan they come up with.

One thing you might try, is making it a mandatory payroll deduction like Social Security is--but funnel it into a privately-managed account rather than some mythical collective "trust fund".  Heck, you could even allow people in a pinch to raid that account for non-health-care related purposes--say--once every year or two; but with the standard tax penalties that apply to any HSA withdrawal that is used for unauthorized purposes. 

I don't really like the idea of forced savings--especially those administered by the feds.  But if something like the above worked well, it might create a precedent that could later be used for serious Social Security reform based--again--on individualized accounts.

Edited November 29, 2016 by Just_A_Guy

[unixknight]

9 minutes ago, Just_A_Guy said:

There's still a train of thought out there, to the effect that Obamacare was intended to create an environment where it would be unsustainable in the long-run to operate a private-sector health insurer; thus paving the way for a "more practical" single-payer system.  So, yeah . . . whatever the Republicans replace this with, needs to be rock-solid; else it will be pitched by the leftist media as just another capitalist failure demonstrating the need for single-payer utopia.

This.  ObamaCare was always meant to fail.  That's why nobody bothered to understand it before ramming it into place.  That's also why not a single Republican voted for it.  The plan has always been to get us to a single payer, state funded system.  Of course, they couldn't just shut down health insurance companies over night, so instead this ObamaCare garbage causes them to wither and die.

[anatess2]

40 minutes ago, unixknight said:

Does everybody have a savings account, or can afford to put money into one?

See, this is the thing... it's a cultural shift.  The HSA is a tax-exempt account.  It is a tax shelter.  And it becomes part of your estate so you can hand it down like any investment you own.  Now, you might ask...  I can't afford to put money in the HSA (that's the current culture - everybody can afford cellphone service but nobody can afford cough medicine - that's the mindset).  Well, if you can't afford to invest in your health, then you try to take steps so you don't get sick.  Because, if you're not interested in putting money in the HSA while you spend $ on a Large tub of Pocorn and 64 oz of Coke at the theater, you're not going to succeed in the system.  So, the thing is, if you can't put too much money on the HSA, then you get encouraged to live a healthier lifestyle so you lower the chances of getting sick.  Contrary to the common American mindset, it is not expensive to stay healthy... it is a matter of motivation and education.

But, like Trump said... he's not going to allow people to die on the streets.  So he has the healthcare subsidy bloc to supplement the State's healthcare solution for people that would, otherwise, die on the streets.

So, how exactly do you want to solve the problem of healthcare when you don't want the government paying for it?  Healthcare doesn't grow on trees.  You make people accountable for their healthcare.

 

40 minutes ago, unixknight said:

And in what way does that help lower the cost of healthcare?

The cultural shift.  I've had experience in this because I have an HSA with just a catastrophic insurance (hospital and surgical only, didn't even cover my pregnancy).  The thing is, when the money is YOURS, you try your best not to spend it on things you don't need to spend it on.  So, you're probably gonna be more motivated to eat right and exercise and get regular (cheap) checkups... And, you won't just go to the ER and spend $$ for the common cold.  Or you won't just go spend $$ on prescription meds that you can get for much cheaper in the generic market, etc. etc.... so, lookie here... we're back to a capitalistic paradigm!  The healthcare industry will have to respond to earn your business.

In addition... it is also a cultural shift for the doctors.  Currently, Medicine - starting with Medical Schools - teach doctors to diagnose by Insurance.  They see the problem but instead of looking for creative solutions, they only issue what "the insurance will cover".  So, even if the best solution to your unique problem is... say... getting an MRI... they won't tell you to get an MRI because the insurance won't cover it unless he goes through several other solutions first.  This is why my brother did not accept that job in Georgia.  He doesn't want the insurance company to dictate how he treats his patients.  Not only do doctors lose their creativity, they also lose patient empathy.  The patient becomes an insurance card holder.  Now, when standard medicine is at the behest of the patient and not the insurance industry, the doctor can once again work with the patient to solve their unique problems in the most creative ways with both of them taking into consideration the cost of care.

Edited November 29, 2016 by anatess2

[yjacket]

Yeap, I love the HSA.  I have never had a regular health care plan. . . I've had multiple kids with it, some major surgeries and other stuff.  It has almost always been cheaper than the full blown plan. What I generally do to fund my HSA is wait until tax time and then fund it (you can apply the funds to the previous tax year), then I use my tax return to replenish the account the HSA funds came from.

Let me tell you putting in about 6k a year and not pulling much out really makes that sucker grow-it's like a 2nd savings account.  Plus you can then invest the funds in some basic mutual funds and watch it grow even more. Add a catastrophic insurance with it and you are good for most things except major illnesses.

Edited November 29, 2016 by yjacket

[yjacket]

46 minutes ago, unixknight said:

This.  ObamaCare was always meant to fail.  That's why nobody bothered to understand it before ramming it into place.  That's also why not a single Republican voted for it.  The plan has always been to get us to a single payer, state funded system.  Of course, they couldn't just shut down health insurance companies over night, so instead this ObamaCare garbage causes them to wither and die.

Except the thing I can't figure out is why the big insurance companies lobbied for it . . .were they not bright enough to see what would eventually happen? Were they thinking they would get access to more government cheese?

[anatess2]

7 minutes ago, yjacket said:

Yeap, I love the HSA.  I have never had a regular health care plan. . . I've had multiple kids with it, some major surgeries and other stuff.  It has almost always been cheaper than the full blown plan. What I generally do to fund my HSA is wait until tax time and then fund it (you can apply the funds to the previous tax year), then I use my tax return to replenish the account the HSA funds came from.

Let me tell you putting in about 6k a year and not pulling much out really makes that sucker grow-it's like a 2nd savings account.  Add a catastrophic insurance with it and you are good for most things except major illnesses.

Yes... and the major illnesses... you can mitigate that risk by making use of genetic statistics.  For example... racial profiles do show differences in health risks.  But, more specifically, your family history can show some patterns in health risks.  My father's side is prone to cancer.  There are 9 of them siblings, 4 had cancer.  So, if we go back to the capitalistic paradigm instead of the cadillac insurance coverage... I can draw insurance for hospital and surgical and then tack on cancer coverage...

[yjacket]

55 minutes ago, Just_A_Guy said:

So, yeah . . . whatever the Republicans replace this with, needs to be rock-solid; else it will be pitched by the leftist media as just another capitalist failure demonstrating the need for single-payer utopia.

But that is the problem . . .unless you get rid of the whole thing and just simply let the free market work whatever they replace it with will eventually fail.  

The solution to health care is to let hospitals refuse service. You can't pay, you don't get service.

[anatess2]

54 minutes ago, Just_A_Guy said:

One thing you might try, is making it a mandatory payroll deduction like Social Security is--but funnel it into a privately-managed account rather than some mythical collective "trust fund".  Heck, you could even allow people in a pinch to raid that account for non-health-care related purposes--say--once every year or two; but with the standard tax penalties that apply to any HSA withdrawal that is used for unauthorized purposes. 

I don't really like the idea of forced savings--especially those administered by the feds.  But if something like the above worked well, it might create a precedent that could later be used for serious Social Security reform based--again--on individualized accounts.

Instead of raiding... you can take a loan against it equal to x% of the HSA balance... of course, you'll have to pay it back otherwise you pay the fines.  That will probably work better.

[Just_A_Guy]

20 minutes ago, yjacket said:

Except the thing I can't figure out is why the big insurance companies lobbied for it . . .were they not bright enough to see what would eventually happen? Were they thinking they would get access to more government cheese?

I suspect it was some combination of individual corporate bigwigs trying to make the right friendships and feather their beds for their next gigs; in conjunction with a lot of HMO types who sincerely believe that their business model's days are numbered and that they may as well get while the getting was good. 

17 minutes ago, yjacket said:

But that is the problem . . .unless you get rid of the whole thing and just simply let the free market work whatever they replace it with will eventually fail.  

The solution to health care is to let hospitals refuse service. You can't pay, you don't get service.

Generally, yes; but when it comes to immediate lifesaving care--I don't think such a policy is politically possible.  If people keep dying on hospital doorsteps . . . there are going to be demands to Do Something. 

13 minutes ago, anatess2 said:

Instead of raiding... you can take a loan against it equal to x% of the HSA balance... of course, you'll have to pay it back otherwise you pay the fines.  That will probably work better.

A good option; though in my limited bankruptcy experience (and I was definitely working with a skewed sample)--the type of people who would need to take an HSA loan are, 75% of the time, the people who just won't be able to pay it back.  That's why I prefer a straight-withdrawal (subject to conventional tax penalties)--it's their money, after all.  But limit the withdrawal frequency to every couple of years, so that there's always at least a couple thousand bucks to get things started.  Or, only allow loans/withdrawals provided that a certain minimum balance remains in the account.

Edited November 29, 2016 by Just_A_Guy

[anatess2]

16 minutes ago, Just_A_Guy said:

I suspect it was some combination of individual corporate bigwigs trying to make the right friendships and feather their beds for their next gigs; in conjunction with a lot of HMO types who sincerely believe that their business model's days are numbered and that they may as well get while the getting was good. 

Generally, yes; but when it comes to immediate lifesaving care--I don't think such a policy is politically possible.  If people keep dying on hospital doorsteps . . . there are going to be demands to Do Something. 

A good option; though in my limited bankruptcy experience (and I was definitely working with a skewed sample)--the type of people who would need to take an HSA loan are, 75% of the time, the people who just won't be able to pay it back.  That's why I prefer a straight-withdrawal (subject to conventional tax penalties)--it's their money, after all.  But limit the withdrawal frequency to every couple of years, so that there's always at least a couple thousand bucks to get things started.  Or, only allow loans/withdrawals provided that a certain minimum balance remains in the account.

If they can't pay it back, then it becomes the same as a straight-withdrawal... with fines/penalties.  Right?

I'm just thinking that the objective is so that we can get rid of this culture that thinks they can't afford healthcare.  If they raid their HSA, they'll never get out of that thinking.  It's quite a shocking thing to see your HSA balance and think... why, I can buy a new kidney if mine ever breaks... or something to that effect.  Okay, so this came from my dad - we were led to believe we were poor because he was a penny pincher... then he got lung cancer and we thought we're financially doomed as he didn't carry health insurance... well, my dad was a secret multi-millionaire keeping his money for the proverbial rainy day... which came up to be lung cancer.  We pitched in for his treatment, not because he needed the money, but so all my dad's money gets saved for my mom's rainy day.  Now, we're not worried about anything that my mom could possibly get... which is kinda funny that my mom is living with my sister who pays for everything she needs including buying her underwear... my sister still doesn't believe that my mom can buy a department store of underwear if she wants... we're all in my dad's mindset of... rainy day...

Edited November 29, 2016 by anatess2

[Just_A_Guy]

23 minutes ago, anatess2 said:

If they can't pay it back, then it becomes the same as a straight-withdrawal... with fines/penalties.  Right?

I'm just thinking that the objective is so that we can get rid of this culture that thinks they can't afford healthcare.  If they raid their HSA, they'll never get out of that thinking. 

Yeah; but there's going to be a subset of people who really can't afford it--especially in the first couple of years while the market is still bringing prices down, before the damage of years of cartel-ish behavior has been fully undone.  I can appreciate the need to give those folks some breathing room--let there be a (strong) presumption in favor of using the HSA as-intended; but let's also not have temporarily-unemployed people losing their homes while they have $10K sitting in an untouchable HSA.

Edited November 29, 2016 by Just_A_Guy

[unixknight]

1 hour ago, anatess2 said:

See, this is the thing... it's a cultural shift.  The HSA is a tax-exempt account.  It is a tax shelter.  And it becomes part of your estate so you can hand it down like any investment you own.  Now, you might ask...  I can't afford to put money in the HSA (that's the current culture - everybody can afford cellphone service but nobody can afford cough medicine - that's the mindset). 

It may surprise you to learn that there are plenty of people who can't afford to stash money away in an HSA account AND aren't blowing their disposable income on popcorn and movie tickets.

This is one of the things about this oversimplification that I find irritating.  It just assumes that if only people managed their money better everybody could afford everything.  Turns out, no.  Surgery is expensive, and it doesn't take much to propel the cost of a procedure into the 5 digit range.  If you can imagine a single mother with a couple of kids, a low income job who is barely making rent, then you tell me how she will magically be able to stash away enough in an HSA to deal with it if she were to be diagnosed with cancer or one of her kids is in a severe accident.  As I've been saying repeatedly, the core issue is healthcare itself is too expensive to begin with.  We can argue all day long about ways to help people pay for it but the real solution is to fix the disease, not he symptom.  (c wat I did thar?)

1 hour ago, anatess2 said:

So, how exactly do you want to solve the problem of healthcare when you don't want the government paying for it?  Healthcare doesn't grow on trees.  You make people accountable for their healthcare.

Start addressing the factors that artificially jack the price up instead of ignoring them and chasing our tails trying to find more money which, as you said, doesn't grow on trees to pay for it.

[unixknight]

1 hour ago, yjacket said:

Except the thing I can't figure out is why the big insurance companies lobbied for it . . .were they not bright enough to see what would eventually happen? Were they thinking they would get access to more government cheese?

Yeah I have wondered about that too and I think you're right.  They probably expected subsidies to help pay for the extra burden. 

Oopsie.

[NeuroTypical]

HSA's - a great way to pay 10-15% less for your medical care.  I know living paycheck to paycheck is rough, and of course you do need a paycheck to make something like this work, but if you're going to be paying for medical care either way, why would you not want to pay less for it?

Gotta be good at record keeping and doing paperwork.  

I'm gonna spend 1000 on healthcare.
Way #1: Spend 1000 on healthcare.
Way #2: Put 1000 in your HSA, pay for your healthcare with your HSA, pay taxes on 1000 less income than you actually made.  (In my case, that thousand is actually many thousands).

 

Edited November 29, 2016 by NeuroTypical

[yjacket]

1 hour ago, unixknight said:

As I've been saying repeatedly, the core issue is healthcare itself is too expensive to begin with. 

No, this isn't the problem.  The problem is we think healthcare should be cheap but the reality is that it's not cheap.  

Healthcare is no different than any other industry.  Take computers, 35 years ago a computer cost 20k+, now it's $500.  35 years ago we couldn't kill certain types of cancer and getting cancer was almost certainly a painful death. Now we have people who can survive cancers that weren't survivable when I was a kid. Getting to the point of literally saving people's lives through medicine isn't cheap and isn't not like building a computer where you can engineer it, test it, re-design, etc.  The human body doesn't work like that.

Billions and billions of dollars of private money has been thrown at solving cancer . . .and miraculously today you can survive some types of cancer with a medical bill of maybe 500k (with no insurance).  Hmm 500k today or being dead 35 years ago.

Basic healthcare is not expensive.  A physical, doctor's apt. cavities, etc. are all on the order of $100. That's like getting a new pair of brakes.

You basic surgery is on the order of 3k-5k. And considering you are under general for a couple of hours, there is generally a team of 4-5 people working on you, cost of liability insurance etc, that's not bad.  It's like getting a new transmission.

Major surgery is 10k and buying a used car can be about that much and major surgery should happen about as often.

Healthcare is just like any other industry, the desire for profit and competitive will drive prices down.  The only thing that prevents it is government meddling.  I guarantee you the more you get government out of healthcare the cheaper it will be.

The folly is the thinking that everyone deserves a certain level of healthcare-ain't no such thing, you don't deserve a car, a house, food, etc. You've got to either work for it or rely on charity from others.  Unfortunately due to government meddling we've taken charity out of it and rely on stealing other people's money to provide for the poor.

Edited November 29, 2016 by yjacket

[unixknight]

3 hours ago, yjacket said:

No, this isn't the problem.  The problem is we think healthcare should be cheap but the reality is that it's not cheap. 

I didn't say it should be cheap.  I said it's too expensive.  And the reasons are obvious.  Excessive overhead costs associated with hiring staff to handle endless paperwork, skyrocketing malpractice insurance premiums, and the fact that things always get more expensive when they get subsidized.  (Like college tuition). 

[Just_A_Guy]

22 minutes ago, unixknight said:

I didn't say it should be cheap.  I said it's too expensive.  And the reasons are obvious.  Excessive overhead costs associated with hiring staff to handle endless paperwork, skyrocketing malpractice insurance premiums, and the fact that things always get more expensive when they get subsidized.  (Like college tuition). 

I'm not intimately familiar with malpractice issues; but it shouldn't be forgotten that honest-to-gosh medical malpractice can shatter one's quality of life, and earning potential, permanently.  Obviously you get abusive filings; but I don't really have a lot of heartburn over a doctor('s insurer) having to pay out a few million bucks for botching a surgery on a kid's knee and rendering him a cripple for life.

Malpractice insurance will always be expensive, and standards of care will always be somewhat intrusive; because the consequences of malpractice are so potentially catastrophic.

Edited November 30, 2016 by Just_A_Guy

[unixknight]

22 minutes ago, Just_A_Guy said:

I'm not intimately familiar with malpractice issues; but it shouldn't be forgotten that honest-to-gosh medical malpractice can shatter one's quality of life, and earning potential, permanently.  Obviously you get abusive filings; but I don't really have a lot of heartburn over a doctor('s insurer) having to pay out a few million bucks for botching a surgery on a kid's knee and rendering him a cripple for life.

Malpractice insurance will always be expensive, and standards of care will always be somewhat intrusive; because the consequences of malpractice are so potentially catastrophic.

I'm not saying malpractice suits shouldn't be a thing.  If course they should.  But people are often very quick to file a lawsuit and that contributes heavily to the problem.  Here in MD doctors have been leaving the state because state laws don't provide enough protection against frivolous suits.  Either way, it's a fact that malpractice insurance is a major factor in healthcare cost, and frivolous suits make it worse.

[Guest MormonGator]

26 minutes ago, unixknight said:

  But people are often very quick to file a lawsuit and that contributes heavily to the problem

Yup. Lawsuits should be like missiles. (Sorry @Just_A_Guy, nothing but love) Only use them when you absolutely have no other option.. 

Edited November 30, 2016 by MormonGator