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Tags Affordable Care Act , AHCA , donald trump , health care issues , health insurance issues , obamacare , Trumpcare

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Old 8th March 2017, 04:51 AM   #761
ponderingturtle
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Originally Posted by Skeptic Ginger View Post
I notice you went with all your moral reasoning and completely ignored where the free market fails health care.
Fails or wins? Think of how much you can make if you have someone who will die with out something only you are in a position to sell them? That is the libertarian dream. Imagine how profitable ambulance companies will be if they can say "Ok I will give you this epipen and save your child but first you have to sign this bill for $25,000" Genius!

That is a libertarian utopia.
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Old 8th March 2017, 04:56 AM   #762
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Originally Posted by marplots View Post
My contention was that decoupling payment from services in a consumer-driven environment leads to increased use, in contrast to your experience where people avoided going to the doctor. The data I had handy was about increased consumption in the US - that's all.
Just like with fire departments. If people knew they had to pay a few thousand dollars to get the fire department to show up they would more seriously evaluate the severity of their fire before calling them.
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Old 8th March 2017, 05:04 AM   #763
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Originally Posted by ponderingturtle View Post
Fails or wins? Think of how much you can make if you have someone who will die with out something only you are in a position to sell them? That is the libertarian dream. Imagine how profitable ambulance companies will be if they can say "Ok I will give you this epipen and save your child but first you have to sign this bill for $25,000" Genius!

That is a libertarian utopia.
Ah, but because of the free market, dozens of ambulances will actually turn up and as a consequence a bidding war will erupt. After only a few hours of haggling with the various paramedics (who will, like used car salesmen, have to refer each offer "back to their manager"), you'll be able to get an epipen for a few dollars.

Of course your child will have died whilst you were negotiating but it's not like there's no cost to the free market....

Or at least this model will survive until one company drives out all competition and creates monopoly in which case we're back to your example
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Old 8th March 2017, 06:40 AM   #764
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Originally Posted by Skeptic Ginger View Post

And why the hell shouldn't people have the right to life? That doesn't mean taxpayers need fund everything from food to flu shots, but the society as a whole benefits when they are at least part of the process.
The biggest reason there shouldn't be a right to medical care is the process of our organs failing due to age or disease is as equal a part of life as anything else. Medical care is active interference in the process of life.
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Old 8th March 2017, 07:01 AM   #765
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I'm starting to think that this will never reach the president's desk. With or without amendments.

http://talkingpointsmemo.com/dc/obamacare-gop-divisions
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Old 8th March 2017, 07:05 AM   #766
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Originally Posted by Puppycow View Post
I'm starting to think that this will never reach the president's desk. With or without amendments.

http://talkingpointsmemo.com/dc/obamacare-gop-divisions
That is why they should just have kept the proposal they all voted for last year.
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Old 8th March 2017, 07:47 AM   #767
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Originally Posted by quadraginta View Post
Imagine a country withe libertarian road building. A conservative dream. No government interference ... or funding.

At least people would spend more time at home.

Forget the roads, somebody's going to have to build the pavement (sidewalk). Make the right investment and anyone that can't fly would have to pay you just to leave their house.
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Old 8th March 2017, 07:51 AM   #768
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Originally Posted by Kestrel View Post
No. Members of Congress, Senators and their staff are required to have insurance just like most legal US residents. A clause in the ACA requires them to choose from the policies available to any DC resident on the healthcare exchange. The government pays about 80% of the premium and they pay the rest.

Here's a simple start.

Let anyone in the country sign up for the same plan that the congresscritters use, at the same out-of-pocket prices they pay.

Then subsidize the people who can't afford it.
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Old 8th March 2017, 07:51 AM   #769
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Originally Posted by 3point14 View Post
Forget the roads, somebody's going to have to build the pavement (sidewalk). Make the right investment and anyone that can't fly would have to pay you just to leave their house.
Yes. So what?
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Old 8th March 2017, 08:35 AM   #770
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Originally Posted by 3point14 View Post
Forget the roads, somebody's going to have to build the pavement (sidewalk). Make the right investment and anyone that can't fly would have to pay you just to leave their house.
Hundreds (possibly thousands) of people negotiate rights of way (called easements) on or through their properties every day in the US. What you anti-free marketeers think are problems are not really problems.

The same thing is true for health care. Only 2% of health care spending in the US is on emergency room care, and only a fraction of that is on immediate, life-threatening injuries or illnesses. Everything else is quite amenable to free market forces. Even the immediately life-threatening stuff can be handled by free market insurance and/or pre-negotiated contracts.

It is a myth that the health care sector is somehow special in that a free market can't work properly there. All of the examples that people have provided (Skeptic Ginger in particular) are either silly or represent a tiny fraction of transactions in the health care market (usually they're just silly).

Unfortunately, I've learned that it is impossible to change anybody's mind about this myth. Critical thinking really goes out the window when it comes to health care. In part it's because the beliefs are too deeply held. In part it's because the topic can easily become emotional. Everybody has a story of a loved one or a friend who has suffered or died because they were denied (for this reason or that) a treatment that may have helped.
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Old 8th March 2017, 08:47 AM   #771
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So here is the question that needs to be asked about this healthcare bill: What is the goal?

I mean, aside from merely being a replacement for the ACA. What is the objective? What SHOULD it be?

It seems obvious that the goal of any healthcare system should be to provide healthcare to as many people as possible for as cheap as possible, where cheap can mean a lot of things (costs to the public, cost to the government). To what extent does this bill advance those objectives?

Who is going to ask the sponsors these questions?
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Old 8th March 2017, 08:50 AM   #772
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Originally Posted by sunmaster14 View Post
Hundreds (possibly thousands) of people negotiate rights of way (called easements) on or through their properties every day in the US. What you anti-free marketeers think are problems are not really problems.

The same thing is true for health care. Only 2% of health care spending in the US is on emergency room care, and only a fraction of that is on immediate, life-threatening injuries or illnesses. Everything else is quite amenable to free market forces. Even the immediately life-threatening stuff can be handled by free market insurance and/or pre-negotiated contracts.

It is a myth that the health care sector is somehow special in that a free market can't work properly there. All of the examples that people have provided (Skeptic Ginger in particular) are either silly or represent a tiny fraction of transactions in the health care market (usually they're just silly).

Unfortunately, I've learned that it is impossible to change anybody's mind about this myth. Critical thinking really goes out the window when it comes to health care. In part it's because the beliefs are too deeply held. In part it's because the topic can easily become emotional. Everybody has a story of a loved one or a friend who has suffered or died because they were denied (for this reason or that) a treatment that may have helped.
Maybe you think it's impossible to change anybody's mind because it's not as simple as you say it is. I've seen compelling arguments on both sides of the issue, so the jury is out IMHO.

Ultimately I'd ask what is it exactly about any of the types of single payer systems already successfully in use throughout the world that prevents you from even considering the concept? Deep down something tells me there's just a tiny bit of ideology involved.
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Old 8th March 2017, 08:52 AM   #773
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Originally Posted by pgwenthold View Post
So here is the question that needs to be asked about this healthcare bill: What is the goal?

I mean, aside from merely being a replacement for the ACA. What is the objective? What SHOULD it be?

It seems obvious that the goal of any healthcare system should be to provide healthcare to as many people as possible for as cheap as possible, where cheap can mean a lot of things (costs to the public, cost to the government). To what extent does this bill advance those objectives?

Who is going to ask the sponsors these questions?
You might think that. There are many other people who think that the goal should be for them, and their nearest and dearest, to get the healthcare they need for the very lowest cost to them personally.

There are others who see healthcare as a means to further their personal agendas whether it's income and wealth distribution, suppressing access to sex ed/contraception/abortions, creating a free market, eliminating government interference in (to them) non-critical areas.
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Old 8th March 2017, 08:54 AM   #774
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Originally Posted by pgwenthold View Post
So here is the question that needs to be asked about this healthcare bill: What is the goal?
It appears to be a massive tax cut for the rich designed to make healthcare more expensive for the poor and elderly.

Quote:
The biggest losers under the change would be older Americans with low incomes who live in high-cost areas. Those are the people who benefited most from Obamacare.

For some people, the new tax credit system will be more generous. The winners are likely to be younger, earn higher incomes and live in areas where the cost of health insurance is low.

Obamacare's subsidies were structured to limit how much low- and middle-income Americans could be asked to pay for health insurance. Under the G.O.P. proposal, many of the people whose tax credits would fall sharply would be likely to end up uninsured. For people with few resources, a gap of several thousands of dollars between their tax credit and the cost of coverage would be impossible to make up.
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Old 8th March 2017, 08:56 AM   #775
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Originally Posted by The Don View Post
You might think that. There are many other people who think that the goal should be for them, and their nearest and dearest, to get the healthcare they need for the very lowest cost to them personally.
Yeah, I guess I was thinking about it from the perspective of the government, and, you know, the people who wrote the thing. Certainly they had a goal in mind. I wonder what their goal was?

Aside from, of course, "replacing Obamacare."

Personally, I suspect that it really doesn't go any further than that.
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Old 8th March 2017, 09:00 AM   #776
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Originally Posted by BobTheCoward View Post
Yes. So what?

By your own admission your ideology trumps any considerations of pragmatism or workability.

The world you want to live in doesn't actually function.

I deeply respect your consistency, but I'm not getting into a conversation where I have to justify people being able to walk outside their own houses
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Old 8th March 2017, 09:18 AM   #777
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Originally Posted by Stacko View Post
That sounds about right for what they would want.
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Old 8th March 2017, 09:33 AM   #778
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Originally Posted by marplots View Post
The incentives are different. Under the NHS and free care, it costs me the same amount whether I get professional care or not. Under Obamacare, some options cost me more than others. Under the newly proposed system (Trumpcare?) the costs may be hugely different.

So yes, in a sense I have the same options, but there are different incentives pushing me toward one option over another. Income also has an influence - I might not see much difference between spending $32 and $14, or that may be meaningful if I'm poor enough.

(Also, I'm assuming the NHS is free, but I'm not very familiar with it.)
Your original comment (that I was asking about) was about having less choice, but as far as I can see there is no difference in the choices available to you either before ACA, now or with the new proposed scheme.
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Old 8th March 2017, 09:41 AM   #779
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Originally Posted by BobTheCoward View Post
The biggest reason there shouldn't be a right to medical care is the process of our organs failing due to age or disease is as equal a part of life as anything else. Medical care is active interference in the process of life.
Rubbish, guess what effects overall health and longevity? That's right, poverty. If you are born into a family in poverty not only will you not get out of poverty yourself your life expectancy will be less than someone born into wealth. As well as being more likely to have a reduced quality of health due to health issues.

This even happens in countries with universal health care, the USA system will tend to exacerbate that problem.
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Old 8th March 2017, 09:53 AM   #780
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Originally Posted by twinstead View Post
Maybe you think it's impossible to change anybody's mind because it's not as simple as you say it is. I've seen compelling arguments on both sides of the issue, so the jury is out IMHO.

Ultimately I'd ask what is it exactly about any of the types of single payer systems already successfully in use throughout the world that prevents you from even considering the concept? Deep down something tells me there's just a tiny bit of ideology involved.
Single payer is not free market. I believe in the free market to a considerable extent. Externalities always exist, and it is appropriate for the government to make regulations (or impose taxes or even negative taxes) to account for them. But, in general, the free market works because it allows individuals to express their preferences, and it allows the price system to transmit those preferences to provide the optimal incentive for the production of resources.

I have not found any of the arguments for why health care is "different" to be persuasive in the least. I do not believe health care if fundamentally different. I could more easily make an argument that food is different or water, but we have a free market in food, and we could have one in water (although we don't because nobody seems to care all that much about the efficiencies that could be captured there).

As for the claim that single payer works in other countries, I will just ask the question "compared to what?" The extent to which something works is relative. The fact that these systems cost less than the US's system is not meaningful for evaluating the potential for a free market in health care for three reasons:

(1) The US doesn't have a free market in health care, and hasn't had one since WWII;

(2) Comparing US health care costs to other countries' costs is apples to oranges because the US has different demographic profile and a different culture (e.g. Americans have a huge problem with obesity, no pun intended).

(3) To a large extent, other countries free-ride off of the US's profligacy in health care; the US health care market is so profitable for drug companies and medical device companies that the US provides the lion's share of the incentive for research and development (and has for 50 years). If the US had gone single payer 50 years ago, I doubt we would have made anywhere near the progress in medical care that we've made.
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Old 8th March 2017, 09:56 AM   #781
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Originally Posted by Darat View Post
Rubbish, guess what effects overall health and longevity? That's right, poverty. If you are born into a family in poverty not only will you not get out of poverty yourself your life expectancy will be less than someone born into wealth. As well as being more likely to have a reduced quality of health due to health issues.

This even happens in countries with universal health care, the USA system will tend to exacerbate that problem.
I don't see a problem. What you posted is not in conflict with what I said.
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Old 8th March 2017, 10:29 AM   #782
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Originally Posted by sunmaster14 View Post
Single payer is not free market. I believe in the free market to a considerable extent. Externalities always exist, and it is appropriate for the government to make regulations (or impose taxes or even negative taxes) to account for them. But, in general, the free market works because it allows individuals to express their preferences, and it allows the price system to transmit those preferences to provide the optimal incentive for the production of resources.

I have not found any of the arguments for why health care is "different" to be persuasive in the least. I do not believe health care if fundamentally different. I could more easily make an argument that food is different or water, but we have a free market in food, and we could have one in water (although we don't because nobody seems to care all that much about the efficiencies that could be captured there).

As for the claim that single payer works in other countries, I will just ask the question "compared to what?" The extent to which something works is relative. The fact that these systems cost less than the US's system is not meaningful for evaluating the potential for a free market in health care for three reasons:

(1) The US doesn't have a free market in health care, and hasn't had one since WWII;
It hasn't since the FDA got founded after it turned out to be legal and not a big deal to put ethylene glycol in medication and kill a few hundred people.
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Old 8th March 2017, 10:35 AM   #783
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I think part of the problem is here, I think many conservatives believe in 'winners and losers.' You don't see this philosophy expressed much in diverse settings like this message board (though you do on other more raucous boards) -- probably because they know it won't play well here -- but I think we have all had private conversations with diehard conservatives where they express this philosophy. It's basically the idea that having a decent health care package is no different, and should be no different, than being able to afford an expensive new car.

That people who are earning a big income or have jobs that provide a generous healthcare benefit are the 'winners' and the government should not be in the position of helping the 'losers' get better healthcare. Especially because the government uses tax money to do it. Diehard conservatives reason, why should I have to help pay to provide healthcare for the losers who can't afford to provide their own? What's the sense of being a winner if the losers don't suffer?

I have even seen and heard the thought expressed that, not providing the 'losers' with decent healthcare will benefit society in the long term by getting the losers out of the gene pool.

I think this also in part explains the almost fanatical allegiance expressed towards Trump. That for the first time -- at least since Reagan -- conservatives feel they have someone in the White House who "gets it." And they're thrilled!
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Old 8th March 2017, 10:40 AM   #784
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Originally Posted by marplots View Post
The main choice is whether or not to pay for healthcare or forego it and keep the money. In the US, we pay part of the cost (co-pays/deductables) even though having insurance is mandatory. I believe the NHS in the UK is funded by tax dollars whether or not someone uses it and they don't recover costs by not seeking treatment. (I'm not under the NHS and don't know it very well.)

Here's an example of how it might differ.
There is some dispute about whether or not senior citizens should take cholesterol reducing drugs. If you only have a few years to live, why bother?

So I'm 70, 75, or 80...
If I pay, I probably would rather not and stop taking the drugs.
If I pay partially, it might depend on the cost and my income.
If I pay nothing, I might take them "just in case."

That's the choice matrix - the idea that healthcare decisions, and the associated costs, don't happen in a vacuum and aren't so easy to put on the better-to-best scale.
IOW, you have no clue what the role is of the health care provider who helps that patient make that decision.
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Old 8th March 2017, 10:49 AM   #785
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The bill has been filed as - I **** you not - "The World's Greatest Healthcare Plan of 2017."
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Old 8th March 2017, 10:51 AM   #786
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Originally Posted by BobTheCoward View Post
The biggest reason there shouldn't be a right to medical care is the process of our organs failing due to age or disease is as equal a part of life as anything else. Medical care is active interference in the process of life.


Life suggests some people will crash their cars, some houses will burn.... your logic, sarcastic or not sarcastic (I can't tell) makes little sense.
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Old 8th March 2017, 10:59 AM   #787
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Adding another mistake in Libertarian thinking: the consumer will make the right choice.

Doctor says person need these tests and meds. Person decides they will take some, not all based on copay outlays. Forgoing meds/tests results in patient getting worse and in the long run needing more care than they would have had they followed the provider's advice.

Another scenario, doctor makes more money by prescribing more tests, many unneeded.

Another scenario, insurance company drags feet approving of treatment because if patient dies it is less costly to the insurance provider than treating the disease even if treatment would provide a cure.

All of these (and more) become problematic when you assume the free market is always the superior option when it comes to health care.
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Old 8th March 2017, 11:02 AM   #788
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Back to the ACA, false narrative of the day:

Supposedly the ACA gives you the insurance your government chose vs the GOP wants you to have the insurance you choose.

What a load of crap.
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Old 8th March 2017, 11:04 AM   #789
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Originally Posted by newyorkguy View Post
That people who are earning a big income or have jobs that provide a generous healthcare benefit are the 'winners' and the government should not be in the position of helping the 'losers' get better healthcare. Especially because the government uses tax money to do it. Diehard conservatives reason, why should I have to help pay to provide healthcare for the losers who can't afford to provide their own?
I know you're not asking the question, but for me the answer is that there are some things that simply should be available for all: education, healthcare and justice are the main three that come to mind.
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Old 8th March 2017, 11:11 AM   #790
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Originally Posted by Cleon View Post
The bill has been filed as - I **** you not - "The World's Greatest Healthcare Plan of 2017."
Jesus *********** christ. I was hoping this was a joke.
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Old 8th March 2017, 11:18 AM   #791
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Originally Posted by Cleon View Post
The bill has been filed as - I **** you not - "The World's Greatest Healthcare Plan of 2017."
No that is a seperate bill. The guy filled the same thing as the greatest healthcare bill of 2016 last year.
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Old 8th March 2017, 11:20 AM   #792
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Originally Posted by bonzombiekitty View Post
Jesus *********** christ. I was hoping this was a joke.
http://www.thedailybeast.com/cheats/...source=copyurl

It seems that is Pete Sessions bill not the house leadership bill.
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Old 8th March 2017, 11:22 AM   #793
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Old 8th March 2017, 11:24 AM   #794
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Originally Posted by newyorkguy View Post
I think part of the problem is here, I think many conservatives believe in 'winners and losers.' You don't see this philosophy expressed much in diverse settings like this message board (though you do on other more raucous boards) -- probably because they know it won't play well here -- but I think we have all had private conversations with diehard conservatives where they express this philosophy. It's basically the idea that having a decent health care package is no different, and should be no different, than being able to afford an expensive new car.

That people who are earning a big income or have jobs that provide a generous healthcare benefit are the 'winners' and the government should not be in the position of helping the 'losers' get better healthcare. Especially because the government uses tax money to do it. Diehard conservatives reason, why should I have to help pay to provide healthcare for the losers who can't afford to provide their own? What's the sense of being a winner if the losers don't suffer?

I have even seen and heard the thought expressed that, not providing the 'losers' with decent healthcare will benefit society in the long term by getting the losers out of the gene pool.

I think this also in part explains the almost fanatical allegiance expressed towards Trump. That for the first time -- at least since Reagan -- conservatives feel they have someone in the White House who "gets it." And they're thrilled!
I, for one, don't believe you. I've never heard any conservatives express such a sentiment, except as an obvious joke or as a way to mock stereotypes liberals have of conservatives.
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Old 8th March 2017, 11:33 AM   #795
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Originally Posted by ponderingturtle View Post
http://www.thedailybeast.com/cheats/...source=copyurl

It seems that is Pete Sessions bill not the house leadership bill.
Yeah, it's still *********** ridiculous though. IMO, bills should not have names.
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Old 8th March 2017, 11:38 AM   #796
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Originally Posted by bonzombiekitty View Post
Yeah, it's still *********** ridiculous though. IMO, bills should not have names.
They all do though. It makes it easier to talk about things like the Americans with Disabilities act, the Affordable Care act and so on. Talking about HR 13762 wouldn't be quite the same at all.
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Old 8th March 2017, 12:10 PM   #797
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Originally Posted by eeyore1954 View Post
I tried to read this portion of the bill to understand it but did not have much luck.
SEC. 133. CONTINUOUS HEALTH INSURANCE COVERAGE IN- 17 CENTIVE.

Is this much different than the penalty currently imposed under ACA when you have no insurance?
It's more in line with the penalties currently imposed by Medicare for both Part B and Part D coverage. You're not required to have coverage... but if you delay coverage you will be charged a higher rate on a permanent basis.
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Old 8th March 2017, 12:14 PM   #798
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Originally Posted by Bob001 View Post
Prove it. The only way that would be possible would be for someone to file limited claims. But one of the primary complaints about the previous system was the practice of "rescission," where insurers looked for pretexts to cancel policies when someone started to file big bills. And nothing would prevent a company from refusing to renew a policy that started to cost them money. So those people you're talking about -- if you can find any -- might have been getting cheap office visits and flu shots, but if they ever needed lung cancer treatment or a heart transplant or expensive medication for a chronic condition, they'd be out in the cold. Some of them might have discovered that the hard way.

The ACA is certainly not perfect, as Obama himself acknowledged. But it was based on Republican proposals to expand coverage and share costs. Democrats going back to the '70s supported some variation of taxpayer-supported universal care, which still makes the most sense.
Rescission was never common. Certainly not as common as you seem to be implying.
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Old 8th March 2017, 12:15 PM   #799
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Originally Posted by sunmaster14 View Post
.....
(1) The US doesn't have a free market in health care, and hasn't had one since WWII;
.....
Why don't you explain exactly how your pre-World War II "free market" in health care would work?
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Old 8th March 2017, 12:16 PM   #800
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Originally Posted by Bob001 View Post
That's the key point. Health care is not an optional consumer good, like a new car or big TV or even a house. People buy it because they need it, and they are not in a position to haggle. And if they don't get it because they can't afford it, they end up worse off and we all ultimately absorb the cost one way or another. A "market" presumes that buyers and sellers compete on an equal footing. That's just not the case for health care.
It's even worse than that: In addition to the non-discretionary nature of most of the aggregate health costs*, there's also a financial intermediary. There is a discontinuity between supplier and consumer because of the role that insurance plays. Health insurance in the US has never really qualified as a free market.

* Not the volume of services, if you want more on this distinction let me know
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