Senate Healthcare Bill Released (zombied for now)

Tide1986

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Re: Senate Healthcare Bill Released

I think it's reasonable to criticize the importance the CBO places on the individual mandate.


This critique seems like a bit of cherry picking to me. The 2010 CBO estimates made two primary mistakes:

1. Overestimated the number of people that would enroll in exchanges.
2. Underestimated the number of people that would enroll in Medicaid.

However, it's worth noting that:

1. While the CBO was wrong about exchange enrollment, they were still roughly correct about the overall increase in number insured.
2. Any criticism of Medicaid enrollment numbers is disingenuous since the ability for states to decline Medicaid expansion was due to a Supreme Court ruling that the CBO could not have predicted.
3. The CBO's estimates of Obamacare were still more accurate than a number of other contemporaneous estimates.

The implied criticism in this piece is that, if the CBO made some mistakes on their ACA projections, it must also be wrong about the current Senate bill. But the CBO was largely correct on the broad scope of insurance coverage changes, and independent reviews have not shown their estimates to be inaccurate. LINK and LINK. On a more practical note, if you eschew the CBO projections, what other method of predicting the effects of this legislation would you turn to?
I don't believe in the original bill anyway, so I'm not concerned about the "impact" of the proposed tweaks.

It is interesting to note that the vast majority of people who would "lose" health insurance under the proposed House and/or Senate tweaks would do so by choice unlike those who lost the plans and doctors that they liked prior to the ACA.
 

Tide1986

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Re: Senate Healthcare Bill Released

My wife fell and fractured L3 vertebra last week, right above the L4/L5 fusion she had done at the end of November. The normal treatment is to blow the vertebra back up to normal size and shape and inject a fast-setting cement. It's very brief procedure. They texted me at 7:00 they'd started. They texted me at 7:18 they were finished with good result. The bill arrived today - $259,000. True, Medicare only allowed $20,900, but if we weren't on Medicare, with backup insurance, that would have been our bill. This is just the hospital cost. It doesn't include the various doctors' fees. IIRC (and I'll go back and look), my bypass, which took four hours, was a little short of $300K, without the surgeon's fee, anesthesiologist, etc. These crazy costs, which look ridiculous when compared with the same procedures in Europe, are the real heart of the problem. No truly affordable national plan can support these costs. They make self-insurance and medical savings accounts a joke, a bad joke. The only real alternative is getting elected to Congress. Their plan is bullet-proof...
Generally speaking, I believe self-insurance and medical savings account approaches are founded on one owning major medical (catastrophic) insurance (i.e. a high deductible health insurance plan), which ostensibly would have covered much of the cost you noted above.
 

CharminTide

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Re: Senate Healthcare Bill Released

Generally speaking, I believe self-insurance and medical savings account approaches are founded on one owning major medical (catastrophic) insurance (i.e. a high deductible health insurance plan), which ostensibly would have covered much of the cost you noted above.
How does a plan with a $7,000 deductible help the 38 million Americans who make less than $10,000?
 

uafanataum

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How does a plan with a $7,000 deductible help the 38 million Americans who make less than $10,000?
Why do 38 million Americans make less than 10k $ ? I made more than that with no marketable skills whatsoever except that I promised to work hard and always be on time.
 

Bamaro

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Re: Senate Healthcare Bill Released

Generally speaking, I believe self-insurance and medical savings account approaches are founded on one owning major medical (catastrophic) insurance (i.e. a high deductible health insurance plan), which ostensibly would have covered much of the cost you noted above.
That would work fine for a financially reasonable person. However because of questionable spending styles a significant part of the population goes into a major meltdown if their $30 toaster craps out.
 
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TIDE-HSV

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Re: Senate Healthcare Bill Released

Generally speaking, I believe self-insurance and medical savings account approaches are founded on one owning major medical (catastrophic) insurance (i.e. a high deductible health insurance plan), which ostensibly would have covered much of the cost you noted above.
These are not catastrophic. A standard ER visit requiring stitches can easily run $25-$30K. Those are stupid, out of control costs...
 

TIDE-HSV

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Re: Senate Healthcare Bill Released

Sorry I missed this post from the other day. I guess that’s what I get from not living on this board 24/7. This post is curious to me because it’s essentially a rehash of argument I dispatched earlier. Eh, I suppose I can go through this again. Disagreements are fine, but some positions really should be adequately supported (like how government is not a trillion-dollar waste machine). Government waste is not compassion; quite the opposite, actually.



So, there are several problems here. One is that the extreme is not the norm. When one continually falls back on the extreme emotional example, it reveals that the statist argument is very narrow and lacks broader rational thought. An extreme example can be found for anything, and any tale of woe will understandably garner sympathy. But the extreme case should not be used to make policy for the entire country. You acknowledged that earlier, but you then circle back on this talking point. Second, this is a tweet. Are you basing your statist position on social media posts? Third, there’s so much missing regarding the information needed to make a legitimate argument. How old is this woman? What is her income? Is she married? What is her husband’s age and income? And on and on. And even then, this case is an extreme rarity. It’s not the norm.



Instead of using emotions to justify government waste on a ridiculous scale, I use real life experience plus academic and practical knowledge of human nature, incentives, finance, economics, government, etc. I will not be using a tweet or any other social media post to base my argument.

Because I have no information on this case I’ll have to make assumptions. My solution for this woman will be based from my own experience, as well as that of my wife. One of our investments is for our daughter’s college tuition. When she turned one-year-old (I should have started when she was born) I started investing $100/paycheck for her future education. It’s been right at 10 years and, per the last quarterly statement, Lily currently has about $35k in that investment account. So, $100/paycheck over 10 years yields $35k. (Compounding interest on investments is awesome!)

So, now for the back-of-the-envelope calculations using the returns above of personal experience ….. I’m going to assume this lady’s health insurance premium for her family is the same as mine. So, $700/paycheck. If that money were invested instead and earmarked for health costs (including buying catastrophic coverage) …. Over 10 years that’s $245k.

But, she’s not investing for 10 years, she’s more than likely working for at least 40 years. That’s $980k.

Now what about her husband? He would add to that $980k. What about other family members who did the same thing and could help out if needed? (I know you have a cynical view of human nature, but families tend to help each other.) What about friends? (They also tend to help each other.) Her church? The kindness of strangers? As I have discussed before, I (and many others) provide assistance to a couple of families in our community who have fallen on hard times. Government intervention is impersonal destroys the sense of community.

So, while you list $231k as the cost (without my suggested catastrophic insurance coverage), this family has it covered. It’s a steep price for sure, but that’s why one invests for such events.

And that still leaves a lot of money for other potential incidents or to pass along to their children so that their investment is off to a great start. In no time (often within one generation), very few people would even consider turning to the government for help. (And that, of course, is why statists hate individual freedom and free market economics.)

The point is there is a massive amount of potential wealth out there. The plan you prefer strangles this wealth in the crib. The result is massive debt, waste, fraud, wealth redistribution, and economic stagnation. I know you’ve completely ignored all the government waste I’ve listed in this thread, but maybe you should think about it if you are serious about helping people. You can’t seriously think the government solution is favorable.



I see your low view of human nature include me as well. LOL! Um, no. I wouldn’t wag my finger at her. Why would I? Ever? I have a generally positive view of human nature. My default position is that people are intelligent enough to take care of their own business. It’s the statists with their cynical view of human nature that do the finger wagging. They think people are infants and can’t do anything without government assistance.

Strangely enough, though, while I have maintained throughout that I’m nothing special and that anyone can do basic investing if allowed to do so, it’s the statists that never seem to hold themselves to the same condescending view of other people. I wonder why that is? Care to tell us?

So, while I’m not the finger-wagging type, the group that deserves such a reaction are the statists who support policies that destroy billions of dollars in wealth and create trillions of dollars in waste. I would suggest that the statists smarten up before they drive this country to economic ruin.



LOL! Again with the very low view of human nature. People aren’t as stupid as you think. This lady is a nurse. It’s not an easy profession; few people can do this work well. She rightly earns a good living, is working in a noble profession, and is deserving of respect.

And if you are going to use economic concepts, please use them correctly.



So, thank you for making my point. What was $231k is down to $50k per my preferred plan. Still a lot of money, but they have it covered.



Again, the extreme is not the norm. Anyway, I’ve been clear that I would leave it to individual choice on how one invests (I would strongly suggest professional advice) and what type of insurance one purchases. $10,000? You have to work very hard at not working hard to only make $10k a year. My wife, her sister, her brother, and her dozens of friends came to this country with nothing, including no English language skills. Some ended up going to college; some kept going to graduate school; some bypassed higher education and went straight into the workforce. Now they are all very well off; some are millionaires many times over. This is all through achieving various job skills and hard work over 20-25 years. It’s not some secret on how to be a productive citizen. A little effort. If they did it, anyone can do it. If I did it, anyone can do it. Unfortunately, the government encourages many people to underachieve. And statists seem to be ok with that.
You are the perfect example of that. The problem is that the everyday Joe hasn't the chance of a snowball in hell of duplicating your success but your beliefs are predicated up on all of the Joes being able to do so...
 

Bodhisattva

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Re: Senate Healthcare Bill Released

You are the perfect example of that. The problem is that the everyday Joe hasn't the chance of a snowball in hell of duplicating your success but your beliefs are predicated up on all of the Joes being able to do so...
Thank you for the compliment, but I don't consider what I've done anything special. Millions of people invest better than I do. I don't expect Joe to be a money manager or a venture capitalist; they don't need to be. The new arrangement could be quite simple. Almost every Joe invests to some extent (retirement accounts, their house, etc.) even if they don't realize it. I just think the threshold is very low to have a better plan that what the government provides - which is debt, waste, programs that begged to be gamed, etc. For the typical person the money is already there (premium deductions, taxes) that they never take home. Have that money go towards something like a 401(k)-style or 529-style account for health care plus a smarter insurance arrangement.

This trust in government to solve problems .... well, how many trillions of dollars in bad ideas is enough?
 

TIDE-HSV

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Thank you for the compliment, but I don't consider what I've done anything special. Millions of people invest better than I do. I don't expect Joe to be a money manager or a venture capitalist; they don't need to be. The new arrangement could be quite simple. Almost every Joe invests to some extent (retirement accounts, their house, etc.) even if they don't realize it. I just think the threshold is very low to have a better plan that what the government provides - which is debt, waste, programs that begged to be gamed, etc. For the typical person the money is already there (premium deductions, taxes) that they never take home. Have that money go towards something like a 401(k)-style or 529-style account for health care plus a smarter insurance arrangement.

This trust in government to solve problems .... well, how many trillions of dollars in bad ideas is enough?
You don't really get out much, do you?
 

TIDE-HSV

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Now, Trump wants a repeal of O-Care with no replacement. Clueless and heartless are a bad combination...
 

TIDE-HSV

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I've traveled and lived all over the country and abroad. You can have a low opinion of people's ability to do basic things if you'd like. I'm sure you are long since set in your ways.
It would appear not as much as you. Now, I'm very happy that you've managed to bootstrap as well as you have. Since you point out my looonnnng experience, I will say that I've run across many in my lifetime who are "self-made" and who have a huge blind spot - "If I can do it, anyone can." Thing is, it's true, for a few. The catch is that it doesn't work for millions - for millions of reasons. It is not I who is trapped in a box, my friend...
 

Bodhisattva

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It would appear not as much as you. Now, I'm very happy that you've managed to bootstrap as well as you have. Since you point out my looonnnng experience, I will say that I've run across many in my lifetime who are "self-made" and who have a huge blind spot - "If I can do it, anyone can." Thing is, it's true, for a few. The catch is that it doesn't work for millions - for millions of reasons. It is not I who is trapped in a box, my friend...
My friend, that's why I prefer a 529-style fund as an alternative to the current waste. It requires nothing proactive on the part of the participants. It's simply a re-direction of some current payroll deductions. There's no management required as the diversified fund automatically shifts to more conservative investments over time to lock in gains. It's idiot-proof. Surely one can look outside their government-solution-oriented box and see that a system that creates massive wealth is better than one that creates titanic debt.
 

TIDE-HSV

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My friend, that's why I prefer a 529-style fund as an alternative to the current waste. It requires nothing proactive on the part of the participants. It's simply a re-direction of some current payroll deductions. There's no management required as the diversified fund automatically shifts to more conservative investments over time to lock in gains. It's idiot-proof. Surely one can look outside their government-solution-oriented box and see that a system that creates massive wealth is better than one that creates titanic debt.
I will leave you in your impossible utopia and depart this "discussion." ;)
 

2003TIDE

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My friend, that's why I prefer a 529-style fund as an alternative to the current waste. It requires nothing proactive on the part of the participants. It's simply a re-direction of some current payroll deductions. There's no management required as the diversified fund automatically shifts to more conservative investments over time to lock in gains. It's idiot-proof. Surely one can look outside their government-solution-oriented box and see that a system that creates massive wealth is better than one that creates titanic debt.
Why do you hate poor people? You can't squeeze blood out of a turnip. They don't make enough money to deduct any meaningful amount for their magic 529-like medical accounts that you propose.

What you are suggesting will be just like 401K's and HSA's. The only people that will take full advantage make $100k+. I'm not sure how many people out there max out their HSA. The only ones I know that max them out are using them as an IRA like account not for medical expenses. Heck even if you max out the $3400 a year and have a serious medical issue it doesn't put a dent into what you owe on some of these high deductible plans. Plus if it is serious enough you are out of work. You think all these people have LTD insurance? Let's say they magically did. Now they are making 60% of nothing and have a medical account that can't cover their bills. What does that actually fix?
 
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Tide1986

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Why do you hate poor people? You can't squeeze blood out of a turnip. They don't make enough money to deduct any meaningful amount for their magic 529-like medical accounts that you propose.

What you are suggesting will be just like 401K's and HSA's. The only people that will take full advantage make $100k+. I'm not sure how many people out there max out their HSA. The only ones I know that max them out are using them as an IRA like account not for medical expenses. Heck even if you max out the $3400 a year and have a serious medical issue it doesn't put a dent into what you owe on some of these high deductible plans. Plus if it is serious enough you are out of work. You think all these people have LTD insurance? Let's say they magically did. Now they are making 60% of nothing and have a medical account that can't cover their bills. What does that actually fix?
I've had LTD, LTC, life insurance, and health insurance since I was around 23 years old making less than $40K a year.
 

2003TIDE

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I've had LTD, LTC, life insurance, and health insurance since I was around 23 years old making less than $40K a year.
EDIT sorry that was snarky and didn't add anything to the discussion.

So lets change your scenario. 35yrs old. 2 kids. One a newborn with a serious medical issue that will take years of surgeries and medical care. Wife has to quit her job because you can't afford daycare with the medical bills. I'm not sure that would be uncommon. You make $45k/yr.

How does a 529-like account help someone like this? Does withholding $200 or $300 into a medical account help someone like this? They are going to have massive bills with or without that money.
 
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