The policy and politics of Trumpism

tattooguy21

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I assume the so-called "political fallout" will be no more than the fallout that occurred after ACA adoption and implementation, which screwed over millions more Americans than it ended up "helping".
I give a crap about political fallout (though that's likely what politicians are concerned with.)

I'm speaking of those on a program which, if terminated, essentially terminates their insurance. If the program is repealed, the insurers have the loophole they need to discontinue service. So if you're an insurer, and federal subsidies you were receiving are gone cause the program is dead, are you gonna take the inevitable loss in profits to keep it going? No
 

CharminTide

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The problem has always been that there are some people who are too lazy, cheap or poor to get their own insurance and ready to take the chance that they wont need it. When bad tings happen to some of them, they wind up getting free treatment since they never repay while the rest of us wind up subsidizing their bills through paying higher costs for ours.
Conceptually, I like the German system. Buying into coverage essentially locks your rate so long as your coverage is continuous. Should your coverage ever lapse, you have to buy in again, which is guaranteed to be at a much higher rate than had you not lapsed (since the rate increases with age). It incentivizes the young to join the risk pool and lower costs across the board, and does so by appealing to personal responsibility rather than resorting to more draconian measures (like Switzerland, where if you don't have insurance, the government will garnish your wages to force you into a plan, possibly even imprison you). They also have both a private market and government run insurance (I.e. public option) that exist side by side quite well.

ACA nearly had the same private/public setup until Leiberman killed it. And I prefer their version of a "mandate" over the ACA implementation.
 

Tide1986

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The wife's company had insurance prior, so they didn't have to play ACA games. She says they did compare in case it was cost/service effective, but saw that it was not, Shi they stayed with what they had.
They play whether they shove their employees out to the exchanges or not. The Cadillac Tax will require plan changes if the plan is deemed "too rich/nice" under the ACA. Many many businesses have been jacking up deductibles to avoid paying the Cadillac Tax.
 

crimsonaudio

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Actually, I suspect he's correct - all it takes is one more person paying higher insurance rates than someone who gets a discounted insurance rate. Just about everyone I know has seen their rates increase rather dramatically over the last year due to ACA. Small data sample, sure, but I'm betting more families are paying more than they would be if the ACA didn't exist. It is what it is.

I still think the ACA is a failure as it's putting a bandaid on the issue instead of diving into the core of the issue - if we had serious tort reform and worked to control costs by reducing some regulations, the rates could be lowered and more affordable for everyone.

I'd also like to point out that whoever started this discussion on the national level did a brilliant job of rolling 'all healthcare' into an 'insurance' discussion. I've always used health insurance like I do auto insurance - I don't expect State Farm to pay for oil changes and new tires, I expect them to be there in case of a serious issue - same with my health insurance. But early on in the discussion, it changed from insurance to care - two big differences - and it radically affects the discussion.
 
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selmaborntidefan

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Actually, I suspect he's correct - all it takes is one more person paying higher insurance rates than someone who gets a discounted insurance rate. Just about everyone I know has seen their rates increase rather dramatically over the last year due to ACA. Small data sample, sure, but I'm betting more families are paying more than they would be if the ACA didn't exist. It is what it is.
I don't think it's nearly as small a sample size as some here might wish.

I still think the ACA is a failure as it's putting a bandied on the issue instead of diving into the core of the issue - if we had serious tort reform and worked to control costs by reducing some regulations, the rates could be lowered and more affordable for everyone.
The whole thing was designed to be a failure and result in socialized medicine. Several folks - and not all of them right-wingers - have even acknowledged as much.


One can apply a very simple common sense test to realize that the ACA is far more unpopular than it is good (and that can only be true if more folks are in worse shape than better):

I pass this great bill that's going to give everyone health care insurance. The bill is so good that: a) I don't know what's in it; b) I'm gonna do an end run around the Constitution and make some deals with folks who don't like it (Cornhusker kickback, Blanche Lincoln) to get it passed; c) even though it's REALLY GREAT and folks REALLY like it I'm gonna wait until AFTER my re-election campaign to enforce it; d) then I'm gonna delay it some more after another election; e) despite all the extra time, I'm gonna have trouble screwing up the computer launch of it.


At that point, a rational person pretty much knows all they need to know about it. I haven't even mentioned folks suddenly watching their prescription meds rise and everything else.

I'd also like to point out that whoever started this discussion on the national level did a brilliant job of rolling 'all healthcare' into an 'insurance' discussion. I've always used health insurance like I do auto insurance - I don't expect State Farm to pay for oil changes and new tires, I expect them to be there in case of a serious issue - same with my health insurance. But early on in the discussion, it changed from insurance to care - two big differences - and it radically affects the discussion. =
The one thing folks DO have a legitimate beef about is the old "I pay insurance for twenty years and never go to the doctor - now I go and they suddenly drop me." That's a legit beef. And that's where my old man the right-winger said from day one, "If the idiot will focus on INSURANCE reform and not health care reform, he'll actually accomplish what needs to be done. Naturally, I expect him to screw it up."

And he did.
 

bama_wayne1

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many of those heavy industry jobs have been lost to productivity improvements.
I only have about 40 years of experience managing businesses, but I have managed through waves of process improvements which reduced employees. Every one of them made our product cheaper which increased sales. When that happened we needed more capacity. Then we hired those people back and a few more. While I realize that won't always happen but over my years it did about 85% of the time. I do know that whatever you reward you will get more of. So we must be careful about offering incentives to not work.

If and When politicians get serious about controlling healthcare costs they will pass torte reform. Without that there will be no way to make any major changes to cost.
 
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92tide

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Actually, I suspect he's correct - all it takes is one more person paying higher insurance rates than someone who gets a discounted insurance rate. Just about everyone I know has seen their rates increase rather dramatically over the last year due to ACA. Small data sample, sure, but I'm betting more families are paying more than they would be if the ACA didn't exist. It is what it is.

I still think the ACA is a failure as it's putting a bandaid on the issue instead of diving into the core of the issue - if we had serious tort reform and worked to control costs by reducing some regulations, the rates could be lowered and more affordable for everyone.

I'd also like to point out that whoever started this discussion on the national level did a brilliant job of rolling 'all healthcare' into an 'insurance' discussion. I've always used health insurance like I do auto insurance - I don't expect State Farm to pay for oil changes and new tires, I expect them to be there in case of a serious issue - same with my health insurance. But early on in the discussion, it changed from insurance to care - two big differences - and it radically affects the discussion.
you also have to figure in the 15+ million who never had access to insurance who do now.

there are a lot of ways to skin the cat and there are a lot of working examples across the world (we are one of the few, if not the only, first world industrialized nations without some form of universal care), but we keep being told the only acceptable solutions are tort reforms, hsa and selling across state lines and expecting market forces to work to reduce costs.
 
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92tide

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I don't think it's nearly as small a sample size as some here might wish.



The whole thing was designed to be a failure and result in socialized medicine. Several folks - and not all of them right-wingers - have even acknowledged as much.


One can apply a very simple common sense test to realize that the ACA is far more unpopular than it is good (and that can only be true if more folks are in worse shape than better):

I pass this great bill that's going to give everyone health care insurance. The bill is so good that: a) I don't know what's in it; b) I'm gonna do an end run around the Constitution and make some deals with folks who don't like it (Cornhusker kickback, Blanche Lincoln) to get it passed; c) even though it's REALLY GREAT and folks REALLY like it I'm gonna wait until AFTER my re-election campaign to enforce it; d) then I'm gonna delay it some more after another election; e) despite all the extra time, I'm gonna have trouble screwing up the computer launch of it.


At that point, a rational person pretty much knows all they need to know about it. I haven't even mentioned folks suddenly watching their prescription meds rise and everything else.



The one thing folks DO have a legitimate beef about is the old "I pay insurance for twenty years and never go to the doctor - now I go and they suddenly drop me." That's a legit beef. And that's where my old man the right-winger said from day one, "If the idiot will focus on INSURANCE reform and not health care reform, he'll actually accomplish what needs to be done. Naturally, I expect him to screw it up."

And he did.
there was focus on insurance reform. you can no longer be dropped because of lifetime caps, you cannot be denied coverage because of pre-existing conditions, insurance plans must provide a basic amount of coverage.

people have always hated insurance (for many good reasons) and now all of that hatred gets laid at the feet of the aca (obamacare)

i am not going to look it up now, but there has been a decent amount of polling in the past few years showing a lot of public support for the provisions of the aca. but that public support plummets when it is called obamacare.
 
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92tide

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I only have about 40 years of experience managing businesses, but I have managed through waves of process improvements which reduced employees. Every one of them made our product cheaper which increased sales. When that happened we needed more capacity. Then we hired those people back and a few more. While I realize that won't always happen but over my years it did about 85% of the time. I do know that whatever you reward you will get more of. So we must be careful about offering incentives to not work.

If and When politicians get serious about controlling healthcare costs they will pass torte reform. Without that there will be no way to make any major changes to cost.
i don't think we are going to see large amounts of good paying/good benefit heavy industry jobs return to the u.s.
 

Bamabuzzard

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Actually, I suspect he's correct - all it takes is one more person paying higher insurance rates than someone who gets a discounted insurance rate. Just about everyone I know has seen their rates increase rather dramatically over the last year due to ACA. Small data sample, sure, but I'm betting more families are paying more than they would be if the ACA didn't exist. It is what it is.

I still think the ACA is a failure as it's putting a bandaid on the issue instead of diving into the core of the issue - if we had serious tort reform and worked to control costs by reducing some regulations, the rates could be lowered and more affordable for everyone.

I'd also like to point out that whoever started this discussion on the national level did a brilliant job of rolling 'all healthcare' into an 'insurance' discussion. I've always used health insurance like I do auto insurance - I don't expect State Farm to pay for oil changes and new tires, I expect them to be there in case of a serious issue - same with my health insurance. But early on in the discussion, it changed from insurance to care - two big differences - and it radically affects the discussion.
I'm of the mindset that if one of the "side effects" of a program is financially harming (on a material level) families and those who it helps still remain just as poor as they were. Then the "program" isn't a success. I've only encountered (personally, not on the internet) a handful of people whose insurance premiums went down. And even then, their deductible (compared to their old policy) went WAAAAY up to the point that it was almost like they didn't have insurance at all.
 

cbi1972

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I'd also like to point out that whoever started this discussion on the national level did a brilliant job of rolling 'all healthcare' into an 'insurance' discussion. I've always used health insurance like I do auto insurance - I don't expect State Farm to pay for oil changes and new tires, I expect them to be there in case of a serious issue - same with my health insurance. But early on in the discussion, it changed from insurance to care - two big differences - and it radically affects the discussion.
One problem is that in medicine, proactive prevention is often more efficient than reactive treatment. Someone who never sees a doctor, delays treatment of a condition until they're too weak to move, and is too busy working two or three jobs to schedule an appointment with a doctor whose first availability is in two months, so ends up going into the emergency room is going to cost more overall than someone who has routine checkups and feels comfortable seeking treatment when they feel something is wrong, but not debilitating.

I'm afraid there's no good answer. I'm a big believer in personal responsibility, but what are you going to do about some old guy with type 1 diabetes who can't work? Or someone with schizophrenia that thinks they have 19 dread diseases, none of which match the 9 actual diseases they have, including schizophrenia? Or children with ailments their parents can't deal with financially? Once upon a time, these sorts of things were handled with voluntary charity, but over time, our culture has come to expect that these things will be treated as a collective obligation, rather than a fate to either be endured or succumbed to.

Used to be you got diagnosed with something terrible, you made peace with it and died. Now, we want someone else to pay a million dollars to fix it.

Is it fair? No, but it never was.
 

crimsonaudio

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you also have to figure in the 15+ million who never had access to insurance who do now.
I am, that's my point. How many millions are paying more monthly now in order to subsidize those? I'm betting it's a lot more than 15 million...

there are a lot of ways to skin the cat and there are a lot of working examples across the world (we are one of the few, if not the only, first world industrialized nations without some form of universal care), but we keep being told the only acceptable solutions are tort reforms, hsa and selling across state lines and expecting market forces to work to reduce costs.
Tort reform and reductions in regulations are some of the ways in which those other countries have curbed health insurance costs.

Beyond that, however - and you know this as you've likely travelled around Europe - the difference in lifestyle is pretty radically affected. I have friends who are extremely wealthy who live in FR, their houses are considered rather lavish, etc - yet heir fit and finish is less than the average McMansion over here. We pay far less in taxes than those countries, so we have to decide what we want - do we want Uncle Sam taking a majority of our income in order to take care of everyone or do we want to minimize his invasion into our finances so we can decide what we want?

For the most part, people in the US choose the latter. And there's little middle ground - healthcare is very expensive (even in FR), and there's a finite amount of money out there.

So yah, we can what amounts to (in my opinion) radically change the fabric of our society in order to mimic those who offer universal healthcare, or we can find an alternative. I'd rather do the latter. And while I feel for those who do not have coverage - for a few years I had zero coverage after our first child was born and it was rough - it's really not my responsibility to pay for them unless I choose to be a part of that system. As much as people continually repeat the mantra that healthcare is some sort of inherent right, it's really not.

And again, if people actually used health insurance as health insurance instead of health care, things might be different for all of us.
 

crimsonaudio

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Used to be you got diagnosed with something terrible, you made peace with it and died. Now, we want someone else to pay a million dollars to fix it.

Is it fair? No, but it never was.
I get it, I do. It's one of those situations where there's really no 'easy' or 'fair' answer - someone is getting screwed.

My point is unless / until we reduce the abuse of the system and get rid of onerous regulations that cause increased costs we're screwing people on both sides...
 

92tide

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I am, that's my point. How many millions are paying more monthly now in order to subsidize those? I'm betting it's a lot more than 15 million...


Tort reform and reductions in regulations are some of the ways in which those other countries have curbed health insurance costs.

Beyond that, however - and you know this as you've likely travelled around Europe - the difference in lifestyle is pretty radically affected. I have friends who are extremely wealthy who live in FR, their houses are considered rather lavish, etc - yet heir fit and finish is less than the average McMansion over here. We pay far less in taxes than those countries, so we have to decide what we want - do we want Uncle Sam taking a majority of our income in order to take care of everyone or do we want to minimize his invasion into our finances so we can decide what we want?

For the most part, people in the US choose the latter. And there's little middle ground - healthcare is very expensive (even in FR), and there's a finite amount of money out there.

So yah, we can what amounts to (in my opinion) radically change the fabric of our society in order to mimic those who offer universal healthcare, or we can find an alternative. I'd rather do the latter. And while I feel for those who do not have coverage - for a few years I had zero coverage after our first child was born and it was rough - it's really not my responsibility to pay for them unless I choose to be a part of that system. As much as people continually repeat the mantra that healthcare is some sort of inherent right, it's really not.

And again, if people actually used health insurance as health insurance instead of health care, things might be different for all of us.
yes and i think that tort and regulatory reform should be dealt with as part of healthcare/insurance reform, but this has long been presented as some sort of panacea. this is an extremely complex issue with a lot of differing outcomes for different folks.

i get what you're saying, but i don't think it would radically change our society to provide universal coverage for healthcare. (note - i do not see marginal increases in taxes and/or healthcare expenses to be radical changes).

a lot of folks don't have the luxury (myself included as of 6 years ago) to choose whether or not to use health insurance as health care, so i think that presenting it like that oversimplifies things. our oil changes and regular maintenance are in the thousands of dollars every single year and that is with insurance.
 

Jon

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the problem here, like in most things is that there are far too many people making money on all these things that want to protect their interests and get their $$$ regardless of the cost to us and they have bought both parties.

The left doesn't want to see Tort reform as the Trial Lawyers don't want it, the right doesn't want coverage for pre-existing conditions as it harms the insurance companies that fund them. What we need is true bi-partisan reform which we are unlikely to ever get

but maybe I'm just a pessimist on this issue
 

crimsonaudio

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yes and i think that tort and regulatory reform should be dealt with as part of healthcare/insurance reform, but this has long been presented as some sort of panacea. this is an extremely complex issue with a lot of differing outcomes for different folks.
Agree 100%.

i get what you're saying, but i don't think it would radically change our society to provide universal coverage for healthcare. (note - i do not see marginal increases in taxes and/or healthcare expenses to be radical changes).
I think we'd be looking at significant tax increases to match the coverage you see in most European countries - which is why their tax rates are way higher than ours. Of course, they aren't spending the tax dollars on the military industrial complex like we are, so there's that...

a lot of folks don't have the luxury (myself included as of 6 years ago) to choose whether or not to use health insurance as health care, so i think that presenting it like that oversimplifies things. our oil changes and regular maintenance are in the thousands of dollars every single year and that is with insurance.
Again, I get it, BTDT.

Ultimately, it comes down to this - MOST people can afford health insurance without subsidies. MOST can. Because MOST people have flat-screen TVs, MOST have cell phones with monthly bills, MOST have relatively nice cars to drive around in. There are some truly poor folks in the US, but there are tons who 'cannot afford insurance' but can afford lots of life's luxuries.

I guess ultimately, if you're going to take money from my family in order to help someone else, you best make sure they need it. I'm a very charitable person, but I also use discernment before giving money to fill a 'need'. And no, this is not some sort of 'welfare abuse' comment, I'm simply reiterating the point that healthcare isn't not some innate right, so if you're going to force me to pay someone's way, we should at least be certain they cannot afford it.

This sort of subject really gets my libertarianism fired up.
 

Bamabuzzard

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Agree 100%.


I think we'd be looking at significant tax increases to match the coverage you see in most European countries - which is why their tax rates are way higher than ours. Of course, they aren't spending the tax dollars on the military industrial complex like we are, so there's that...


Again, I get it, BTDT.

Ultimately, it comes down to this - MOST people can afford health insurance without subsidies. MOST can. Because MOST people have flat-screen TVs, MOST have cell phones with monthly bills, MOST have relatively nice cars to drive around in. There are some truly poor folks in the US, but there are tons who 'cannot afford insurance' but can afford lots of life's luxuries.

I guess ultimately, if you're going to take money from my family in order to help someone else, you best make sure they need it. I'm a very charitable person, but I also use discernment before giving money to fill a 'need'. And no, this is not some sort of 'welfare abuse' comment, I'm simply reiterating the point that healthcare isn't not some innate right, so if you're going to force me to pay someone's way, we should at least be certain they cannot afford it.

This sort of subject really gets my libertarianism fired up.

My feelings EXACTLY. For two years we rented two of our rental properties to employees from an Italian company working in our area. I got to know them quite well. They paid a 48% income tax rate on top of other taxes that were nothing more than another form of income taxes administered by their government. They basically paid over half their income to the government. These guys were engineers yet due to the tax rates in their country they lived what would be equivalent to lower middle class in our country. I couldn't believe it. No way I'm putting in that type work, effort and time to hold a career like that to live like that. Simply wouldn't be worth it to me.
 
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