I used to be disgusted, and now I try to be amused.

[sebastian_dangerfield]

Originally Posted by taxwonk

Not to mention all the employers who shitcanned better policies when the ACA gave them cover for putting in the Walmart-level of benefits.

That was a feature, not a bug.

[sebastian_dangerfield]

Originally Posted by Hank Chinaski

Speculation is fact in these here parts! Look at Ty: people who have seen rates, co-pays and deductibles spike up under ACA aren't getting more expensive, worse, coverage. BECAUSE if not for ACA HC would have gotten more expensive anyway. See?

The figure I'd like to see is:

$ paid in by the 30mil new consumers created by ACA - $ spent for care for them

You can pull that from tax records and provider reimbursements.

[Tyrone Slothrop]

Originally Posted by Hank Chinaski

Speculation is fact in these here parts! Look at Ty: people who have seen rates, co-pays and deductibles spike up under ACA aren't getting more expensive, worse, coverage. BECAUSE if not for ACA HC would have gotten more expensive anyway. See?

It's like you just forgot that health care costs were increasing before the ACA. You probably blame your teeth on Obama too.

[Tyrone Slothrop]

Originally Posted by sebastian_dangerfield

What Trump voters think or don't think has nothing to do with this discussion. What I wrote is a fact.

They are both in there. But one's there a whole lot more than the other. Which is all I said.

Objectively, I don't know what that sentence is supposed to mean or how you'd ever prove it. Subjectively, it means that you care about one more than the other, but we all knew that already.

[sebastian_dangerfield]

Originally Posted by Tyrone Slothrop

Objectively, I don't know what that sentence is supposed to mean or how you'd ever prove it. Subjectively, it means that you care about one more than the other, but we all knew that already.

I'll prove (or disprove) it like this. Compare the cost savings accruing from ACA to date (offsetting the well documented decrease in HC spending since 2008 caused by the financial crisis) to the amount spent to date to provide HC insurance under the ACA to those 30 million new consumers. It's an imperfect measure, but that ratio would be telling.

And stop trying to paint me as a Trump voter. It's quite transparent, and cheesy, particularly coming from someone like you, who obviously knows better. If you could put 46 million people w/o HC insurance, largely because they cannot afford it, onto a plan and create savings for all, I'd happily pay extra taxes for it! What I don't like about the ACA is the fact that it's bullshit, because what I just wrote is impossible. I don't like being told to "embrace complexity" in the numbers because some pack of policy twits think either:

1. They can perform financial alchemy; or,
2. Slide a doomed bill past the goalie because, hey, voters and Congress are pretty stupid.

Voters and Congress are generally not that bright. But in a circle like this one, where we've a few extra brain cells to spare, please - don't try to sell the bullshit that this plan would've created savings in excess of the cost of adding tens of millions of people to the rolls most of whom can barely afford the rent.

The only thing more annoying than being lied to is being lied to badly.

[sebastian_dangerfield]

Originally Posted by Tyrone Slothrop

It's like you just forgot that health care costs were increasing before the ACA. You probably blame your teeth on Obama too.

Unlike you, because my HC insurance costs are dollars my family would otherwise put in our pockets, I actually watch the number pretty closely. I see no unusual increase caused by the ACA. The upward trajectory of costs has been pretty constant since 2007.

Other business owners I know have very different stories. A lot of them echo Hank's.

[Greedy,Greedy,Greedy]

Originally Posted by sebastian_dangerfield

And stop trying to paint me as a Trump voter.

You are a big part of Trump's victory. Stop denying it. We will all call you out for it.

[Adder]

Originally Posted by taxwonk

Besides, rural America doesn't need to be depopulated.

No, but if you're living in a town where there are no jobs, why are you staying?

And it's not just a rural/urban. The rust belt is pretty urban, but still full of towns and cities whose time is in the past.

In fact, moving everybody from rural areas to urban areas would hasten a ton of health and environmental problems

This is a really weird superstition you have. And it's wrong. Moving people into cities and out of long car trips has pretty strong positive environmental effects.

I know you think I'm a doddering old nut for arguing against agricultural subsidies for corporate farms and a return to family farming, but that move would do wonders for soil rehabilitation, water reclamation, lowering food prices, creating work for people in places where there never was and never will be a Zenith plant, and improve overall health in the US as people go back to eating ingredients instead of shit made out of hydrolyzed soy protein, CAFE-produced meat, and high fructose corn syrup.

It's not the family farm you need. It's sustainable farming.

And probably some Pigovian taxes on crap food.

[Adder]

Originally Posted by Hank Chinaski

Can someone who understands financial stuff explain how Trump's election has caused the stock market to go up?

It's preparing for a orgy of government spending and tax cuts.

It apparently does not believe in monetary offset.

[Greedy,Greedy,Greedy]

Originally Posted by taxwonk

I agree with you that ACA may have provided an improvement for people who are hit with catastrophic health issues in some cases. But the vast majority of people don't get those sort of catastrophic illnesses and if they do, they die long before they get any benefits because they can't afford to pay for care to keep them alive until they meet a $5000 deductible.

So you get people who are forced to choose between losing their job or spending all day in a clinic if they get pancreatitis or have an arrhythmia. The clinic is packed with people who are suffering from everything between diabetes, heart disease, and allergies and morphine withdrawal. So everybody gets a minimal look-see and a scrip for extra-strength Tylenol, a set of x-rays, and an order to make another appointment, which they may or may not get because the clinic hits capacity for the day by 8:00 so the appointment gets canceled.

If I have $30/week in income after rent, day care, almost enough food, and utilities, how am I going to pull together the $125 a real doctor will require to see me, let alone pay for the $175 prescription? I'm dead long before I ever make the $5000 deductible.

I agree you can't make the perfect the enemy of the better. But if poor people still can't see a doctor, can't get basic wellness care or care for a chronic disease, and can't pay for the drugs they need to manage disease, where is this "better" of which you speak?

I count myself very lucky because it's been about 20 years since I or any member of my family have had to make doctor/food choices, and I know you almost always choose food and then wait for the shit to hit the fan and the trip to the E/R. This is hardest by far on those with chronic but not catastrophic issues. But I do think there is a lot of better here.

The trip to the E/R after you've chosen food over doctor quite frequently results in the bill well beyond the $5000 deductible, assuming there is a need for some imaging and a few days stay, and the fact that the excess is insured rather than in the free care pool (at least in places like the Northeast, where we have the free care pool) improves the care and keeps the house from getting foreclosed on by the healthcare providers as a result of getting care. It doesn't replace the income lost, and no healthcare plan I've seen would.

20 million new insured is nothing to sneeze at; yes, that insurance is a difficult cost for many of them. A lot more difficult than the expenses Hank is whining about. But I don't think those catastrophic cases are all that rare.

The difference between the folks we know who have to deal with these issues despite barely making ends meet may well be that many of the people I know dealing with these struggles I've met in connection with our mutual catastrophic illnesses.

By the way, the biggest impact on cost of care for people dealing with chronic conditions is likely still to come, if it doesn't get killed before then. That is the change in focus to outcome oriented payments.

[Adder]

Originally Posted by Hank Chinaski

i wanted to quote this so it is preserved after you come off whatever bender made your fingers type this. When Sebby talks about the people who spout political views of all sorts at smart cocktail parties, I can't help but wonder if there's a little bit of bullshit going on. With what you say here, I'm not wondering.

You are the only person I know who thinks the ACA made their health care worse.

On the other hand, I know lots of cancer patients who say it made things a lot better.

[Greedy,Greedy,Greedy]

Originally Posted by Adder

No, but if you're living in a town where there are no jobs, why are you staying?

At the end of 2015, white unemployment in Wisconsin was 3.5%, in Michigan was 3.7%, and in Pennsylvania was 4.3%. California is 4.5% and Massachusetts is 3.5%.

Where are these rural white communities without jobs?

[Adder]

Originally Posted by sebastian_dangerfield

People who've been forced to wait longer because massive #s of new entrants have started consuming services have a right to be pissed.

No they don't.

[Adder]

Originally Posted by sebastian_dangerfield

The upward trajectory of costs has been pretty constant since 2007.

Unless there's something weird about you specific situation, it goes a lot farther back than that.

[Adder]

Originally Posted by Greedy,Greedy,Greedy

At the end of 2015, white unemployment in Wisconsin was 3.5%, in Michigan was 3.7%, and in Pennsylvania was 4.3%. California is 4.5% and Massachusetts is 3.5%.

Where are these rural white communities without jobs?

One of the local alternative non-profit media outlets ran a post-election, "where there's economic anxiety in Minnesota" story, focusing on Koochiching County, way up by the Canadian border. It contrasted economic conditions in the metro (idk 3-4% unemployment) to up there, where things were really different, at 6.9%.

6.9%. That's not good or anything, but when you're picking out the worst available rural county (where something like 13K people live), that's not a shockingly high number.