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Old 11-12-2010, 02:58 PM   #2476
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Re: leading the horse to water again, and then beating it long after it's dead

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Originally Posted by Hank Chinaski View Post
so will it be saying "no" more than it does now? will things that were approved in 2009 be denied in 2020?
Honestly, I wish we as a nation could admit to ourselves that we would be better off if they did (on the basis of sound medical science and not just the bottom line, of course).

Last edited by Adder; 11-12-2010 at 03:01 PM..
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Old 11-12-2010, 02:58 PM   #2477
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Re: leading the horse to water again, and then beating it long after it's dead

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doesn't get anyone anywhere except closer to the first* cocktail.


*or, for some of us, third.
That is the only goal.
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Old 11-12-2010, 03:00 PM   #2478
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Re: leading the horse to water again, and then beating it long after it's dead

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Originally Posted by sebastian_dangerfield View Post
They'll put the insurance companies into a crisis and blame on Democrats. "If we'd never had this dumb plan, none of this would have happened!" They know the public will never dig deep enough to figure out how they sabotaged it.
You may discover that if the Republicans get some resistance from their own base on an approach to cutting that throws the insurance companies into bankrtupcy, but I think you are exactly right that this is the pressure point. If the Rs really undercut funding, health insurance is going to be a very bad industry to be in, and the mess will be to clean them up.

Realize there are a lot of people who would not be sad to see them go (me not among them, by the way, I think they're salvagable).
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Old 11-12-2010, 03:01 PM   #2479
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Re: leading the horse to water again, and then beating it long after it's dead

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So, how is it that the not-quite-poor-enough-for-Medicaid are able to pay for private medical insurance? Is it the tooth fairy?
Two ways: the exchanges and subsidies.

The individual market is insane, so the exchanges are designed to create groups that are large enough to spread the risk among tens to hundreds of thousand and therefore keep costs down. The plans are administered and run by insurance companies, but the states make sure that they meet certain criteria. I suspect that over the course of time, more and more people will prefer to be on the exchanges so they can have more control over the type of insurance they have instead of relying upon their employers.

There are also subsidies for various individuals depending on income level as a percentage of the federal poverty level. This is a tool by the Kaiser Family foundation that helps figure out how much subsidy you may qualify for.

I think that the anticipation is that about four percent of the population will not be covered after all is said and done.
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Old 11-12-2010, 03:03 PM   #2480
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Re: leading the horse to water again, and then beating it long after it's dead

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How fucking dumb are you? Seriously.
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Old 11-12-2010, 03:04 PM   #2481
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Re: leading the horse to water again, and then beating it long after it's dead

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why would i enjoy that? i voted for a dem last time. I'm the only one here that needs two parties because I'm the only one that considers who to vote for from the two parties (and no voting for the Greens every so often does not make you a "two party guy.")
In Mass the real choices happen in primaries; mostly the Rs put up pederasts and imbeciles (quite literally).

We'll see what happens, but I'm not writing off Scott Brown at this point. I believe he is the only Republican in Washington today with credibility to say that he has sought compromise with the Dems more than they have sought it with him.
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Old 11-12-2010, 03:04 PM   #2482
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Re: leading the horse to water again, and then beating it long after it's dead

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I understand that - it's a risk sharing pool and the pool will fit the bill. But it can be done and I believe people would be willing to pay.
If that were true, the insurers would already offer the option. They do not, as far as I know, without pre-existing exclusions and waiting periods for any substantial expenses related to possibly pre-existing conditions--e.g., pregancy, diabetes, etc.
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Old 11-12-2010, 03:05 PM   #2483
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Re: leading the horse to water again, and then beating it long after it's dead

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Originally Posted by Greedy,Greedy,Greedy View Post
You may discover that if the Republicans get some resistance from their own base on an approach to cutting that throws the insurance companies into bankrtupcy, but I think you are exactly right that this is the pressure point. If the Rs really undercut funding, health insurance is going to be a very bad industry to be in, and the mess will be to clean them up.

Realize there are a lot of people who would not be sad to see them go (me not among them, by the way, I think they're salvagable).
I'd love to see the whole goddamn thing fail. The only true reform that would make docs and patients happy would be a direct fee for service system. But that's pure fantasy. The ship sailed long ago, when some asshole decided to create a tax structure incentivizing employers to pay for plans and insurers to become health care "managers" (they're no really insurers at all, as no true insurer pays for preventative or diagnostic care for your home, auto, etc...).
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Old 11-12-2010, 03:06 PM   #2484
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Re: leading the horse to water again, and then beating it long after it's dead

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If that were true, the insurers would already offer the option. They do not, as far as I know, without pre-existing exclusions and waiting periods for any substantial expenses related to possibly pre-existing conditions--e.g., pregancy, diabetes, etc.
The insurers don't offer some viable options because they'd undercut more profitable ones. Once the answer was tax-exempt charitable entities as insurers, but they've all morphed to look just like the regular insurers.
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Old 11-12-2010, 03:08 PM   #2485
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Re: leading the horse to water again, and then beating it long after it's dead

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Originally Posted by sebastian_dangerfield View Post
How fucking dumb are you? Seriously. The insurer denies AFTER the fact. The overconsumption problem is in people forcing providers to run all sorts of tests and procedures for which they never get paid. If we applied your asinine cure, we'd have already fixed HC years ago by having the govt step in and tell insurers to cover less items. And under your imbecile paradigm, Voila!, people would magically stop showing up at the providers' offices!
Wait, I thought the newly insured were going to do all kinds of extra special overconsuming because the government is now going to be the third party payer. You mean that isn't right?

ETA: Yes, I know that was exceedingly assholish. Sorry.

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ETA: More simplistically, the answer to too many people overusing insurance isn't giving more people insurance.
Of course not, but overconsumption isn't the only problem.
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Old 11-12-2010, 03:08 PM   #2486
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Re: leading the horse to water again, and then beating it long after it's dead

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Originally Posted by Replaced_Texan View Post
Two ways: the exchanges and subsidies.

The individual market is insane, so the exchanges are designed to create groups that are large enough to spread the risk among tens to hundreds of thousand and therefore keep costs down. The plans are administered and run by insurance companies, but the states make sure that they meet certain criteria. I suspect that over the course of time, more and more people will prefer to be on the exchanges so they can have more control over the type of insurance they have instead of relying upon their employers.

There are also subsidies for various individuals depending on income level as a percentage of the federal poverty level. This is a tool by the Kaiser Family foundation that helps figure out how much subsidy you may qualify for.

I think that the anticipation is that about four percent of the population will not be covered after all is said and done.
In all seriousness, thank you, helpfully clear as always.

But, as I'm sure you knew, it was a rhetorical question aimed at Adder's "it's not the Gubmint" misinterpretation.
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Old 11-12-2010, 03:10 PM   #2487
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Re: leading the horse to water again, and then beating it long after it's dead

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Originally Posted by Hank Chinaski View Post
why would i enjoy that? i voted for a dem last time. I'm the only one here that needs two parties because I'm the only one that considers who to vote for from the two parties (and no voting for the Greens every so often does not make you a "two party guy.")
Whatever, man. I've voted for more Rs than Ds in the last three elections (where there was a choice), and probably would vote for more if the Rs (1) ran viable candidates and (2) didn't give me options of voting for Alan Keyes and other people like him.
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Old 11-12-2010, 03:11 PM   #2488
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Re: leading the horse to water again, and then beating it long after it's dead

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Why not?
Because covering someone with pre-exisiting conditions is really, really expensive. It's why HIPAA's preexisting condition language is limited to employer plans instead of indidvidual plans. So the insurance companies aren't going to do it unless they have a healthy risk pool to draw from. Healthy people on the individual market tend not to buy health insurance if they don't have to, so the risk pool is pretty expensive to cover. The premiums would be outrageous and we'd be in the same exact place we are now: ridiculously expensive individual coverage with very few individuals able to afford it.
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Old 11-12-2010, 03:12 PM   #2489
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Re: leading the horse to water again, and then beating it long after it's dead

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Originally Posted by sebastian_dangerfield View Post
I'd love to see the whole goddamn thing fail. The only true reform that would make docs and patients happy would be a direct fee for service system. But that's pure fantasy. The ship sailed long ago, when some asshole decided to create a tax structure incentivizing employers to pay for plans and insurers to become health care "managers" (they're no really insurers at all, as no true insurer pays for preventative or diagnostic care for your home, auto, etc...).
Works reasonably well in dentistry, but there aren't a whole lot of $500,000+ total-cost dental procedures.
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Old 11-12-2010, 03:14 PM   #2490
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Re: leading the horse to water again, and then beating it long after it's dead

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Wait, I thought the newly insured were going to do all kinds of extra special overconsuming because the government is now going to be the third party payer. You mean that isn't right?

ETA: Yes, I know that was exceedingly assholish. Sorry.



Of course not, but overconsumption isn't the only problem.
You;re not going to win that point either. Yes, it will be even worse when they think the govt is supposed to pay for it. Again, having $30mil in HC paper in my office right now, I couldn't hope to guess how many people refuse to pay for something on the basis, "I thought Medicare covered that!" Hell hath no fury like some old coot who thinks because his brother was in Korea and he worked at the local battery plant, between the govt and his pension, he should get every last penny of his fourth yearly checkup covered.

Overconsumption is a huge driver of costs. The providers eat so much they have to raise prices to outrageous levels.
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