How's that Obamacare Repeal Working Out For You?

[TheReal_ND]

[jbird4049]

It's very cheap to allocate health care via the ER system in terms of cost. But in terms of the price that you and your insurer pays.. it's fucking ridiculously high.

Here's the thing dude. All these stupid niggers like myself didn't pay them back. I didn't have that money. I never will. And all the other stupid niggers piling in their doors don't either.

What do now socialist?

Yeah, but I'm guessing it probably costs about $250 maybe less to treat your hand. Most people can pay that at least in small increments. No, you get a hugely inflated bill that you will never be able to pay. The socialism we're talking about then doesn't apply to the average Joe.

[TheReal_ND]

It apples to the average nigger like me though. Us real niggers don't do shit that involves papers and banks man. We keep it hood. We go down best beleef whitey going to pay doe.

[Hanarchy Montanarchy]

A real gangsta ass nigga never runs his fuckin' mouth 'cause real gangsta ass niggas don't start fights.

[clubgop]

When does the Burn It All Down start?

This turd belongs to the GOP now. Let them smear it all over themselves.

The GOP proves that it has no ideas, no problem solving desire or skills, no imagination, no guts.

Did they not have a sufficient number of years to come up with anything?

Freaking morons, if they have any brains (in a political, Machiavellian sense), they would have said health care reform comes last, first we're doing tax reform, etc. But they are simply too stupid.

Clubby, what am I missing here?

What you are missing is that the ACA and healthcare itsekf is all wrapped up in the tax code now. No point in passing a tax reform when you dont know what the landscape is going to be a big facet of it.

[clubgop]

Does anyone here expect this bill to pass?

I can't imagine it getting through the Senate.

My irrational hope right now is that the bill fails, Congress has to move on, and Trump's words about letting the ACA blow up come true.

Actually this was crafted with the Senate in mind. The reason the ACA is half chewed dogshit is the same reason this is half chewed dogshit is that it can be passed in budget reconciliation. Otherwise you need 60 votes in the Senate. Some other conservatives or libertarian minded congressman say go with Rand Paul's bill and let the Senate dems hold it up while Obamacare collapses all around them.

[Speaker to Animals]

Some other conservatives or libertarian minded congressman say go with Rand Paul's bill and let the Senate dems hold it up while Obamacare collapses all around them.

That's a better strategy, in my opinion.

[atanamis]

There's nothing wrong with using the ER for practical care, there's plenty of bandwidth. In fact, my experience was in that environment: Highland Hospital in E. Oakland & Lincoln Hospital in S. Bronx. It's not much different than using the NHS in England.

The VA does this to some extent. It's actually cost-effective when you think about it, but the hospitals charge huge markups on all things ER-related, so the final price tag most people see makes it seem like a terrible idea. But by design the ER is a very efficient method to deliver care.

This is completely correct. Emergency Rooms should be staffed to be able to handle actual emergencies. But you need to have staff there in the middle of the night and throughout the day to handle possible emergencies that aren't actually happening. Currently we engage in abusive staffing practices, booking doctors and nurses for long shifts with the assumption that they will likely not remain busy the entire time. Instead, they should be booked based on the normal high load for a reasonable shift length if they were to be busy the whole time. But that means that we will have expensive resources sitting around a large amount of the time with insufficient emergencies to work on. This is time when they can readily see walk in patients who are willing to wait for a slow time to be seen by a doctor.

I would absolutely want the triage staff to notify these people that they were not experiencing an emergency condition and can wait to make an appointment with a doctor if they would like. I want this so that people who don't need to wait don't do so for hours because they aren't aware that their condition isn't critical. The triage staff might even tell the person to wait in a monitored area, come back up for triage again in an hour, and then leave if there is no change. But if someone is willing to wait for the next available doctor, I see absolutely no harm in their being allowed to do so. Waiting for a doctor with nothing better to do doesn't make that treatment more expensive, nor is waiting room space at a premium cost for storing people. As with an emergency situation, I have no problem charging them for medicines or bandages or other consumables used, but that cost will be the same at any doctor. The ONLY downside of using an ER for your primary care needs should be that you can't make appointments and will be seen in order of most urgent medical need.

Ok. Here's an example. One time I got drunk and my wife as well. We got into an argument over something stupid and I thought I should punch a solid oak door set in a 1960's frame.

I didn't have insurance and to set the bones in my hand back in place at the ER costed me (read somebody because I sure as fuck didn't pay them,) two thousand dollars.

Extrapolate a bunch of niggers like me doing that two thousand times a day only instead of punching doors they are shooting each other over crack deals or getting life flights in to a hospital because a Chinese lady cut them off in traffic.

Imagine all this if you will, and extrapolate that over the course of a fucking year.

Quit going to the ER over nonsense you stupid fucking niggers! You are taking up valuable resources and the guy behind you in line might have just been gutted with an outboard motor for all you know. They are under staffed and everyone there is making bank. Stop it.

I appreciate your example. It actually demonstrates more about my point that ER prices are stupid though than that ER care is expensive. You pay $1k in an ER just for walking in the door. Literally. My story about my wife being looked at for 15 minutes by a doctor and getting billed $1k demonstrates this. You are paying for the existence on an ER and of an MRI machine which you didn't use but might have needed. But that's NOT the cost of you using an ER to the hospital. When you walk into a hospital with a non-critical condition, the hospital doesn't page out more doctors who they need to pay overtime to. They don't buy more equipment to serve you. They triage you, and if you aren't an urgent case they make you wait until they have nothing better to do than to treat you. Treating you is essentially "free" to the hospital since the doctor would have had to be there regardless.

So if you break your hand you might be able to call your doctor and get an appointment in an hour or two to have it fixed. But if you walk into an ER they will make you wait until they have no conditions to treat more urgent than "guy with a broken hand". If someone walks in 3 hours after you with a more serious condition, they will ALWAYS jump in front of you. You get treated when doctor doesn't have anything else to do. (Yes, even the doctor taking his 15 minute coffee break comes before his having to treat your non-urgent condition.) At that point, the doctor's time is essentially free. They have to be there in case someone gets into a car accident and is about to die. That is what taxpayer money should be paying them to do (be ready). But that's not happening right now. So might as well use that under-utilized resource to fix some idiots hand. You pay for the cost of the cast and the painkillers, but the ER and the doctor are free. Does that make sense?

We cannot really tackle our health care problems without addressing the unbelievable prices, the byzantine pricing structures, billing, etc. We are basically getting fleeced by doctors and medical care providers. Everybody fixates on the insurers, who certainly have some bad history behind them, but the insurers are not the real problem here. The insurers just figure out how much to charge people in order to pay out the promised services and still make a profit. It's the providers who keep jacking up prices. It's also the pharmaceutical companies jacking up prices.

100% agreed. And that is what my entire model was designed to address. I didn't actually remember to mention the pharmaceutical element, but suffice to say that it starts with importing medicines from other countries and ends with eminent domain being applied to critical patents (including fair compensation to the research company for the development of the patent). If we have a cure for cancer, it makes sense for the government to just pay the researcher for the patent and make that medication available for the cost of manufacture. Patents ARE a government mandated monopoly on knowledge, and SHOULD be manipulated for the good of the people in all cases. We want to incentivize innovation, but if you are using patents to extort the people then you can expect to have it taken from you (especially since it is a government created construct to begin with).

[Speaker to Animals]

I wonder if we could expand the flexible spending account idea so that people are given the ability (responsibility) of managing their health care services. They pay into the program a certain amount each year, which goes into a kind of account. The actual amount that is spendable is some multiple of how much they have put into the account (sort of like a margin account). This way they know how much they can spend each year, and every time they do spend, they are still hitting the account consisting of money they put into system.

Simultaneously, we should somehow make providers list upfront what they will charge for services so people are even able to make rational decisions about their health care choices. People should be able to go online and see a chart for the costs of services upfront at all the providers almost like a standardized menu, or that nutritional chart on food products. Then they should be able to compare the costs with third party metrics regarding customer satisfaction and complaints.

People who cannot afford health insurance should go to a socialized health care system like the VA. I would put veterans on a voucher program to buy insurance wherever they want. Rebrand the existing VA hospital network as a public option. Put all the poor into that system, and give anybody else the option of buying into it (which would likely be cheaper than private insurance). You'd probably need to require that states participate in the program to cover some of the costs of their own working poor -- which would serve as an incentive to actually work for the interests of their own people instead of just corporations. States could also shift that burden onto cities that deliberately carry out policies that make life more difficult for the working poor (Looking at you San Francisco and Seattle).

Also, remove restrictions on health insurance policies that only cover emergencies. Obamacare seems to have criminalized the only legitimate form of health insurance that most people need in the first place. Ideally, we should be able to just pay cash for routine services based on upfront pricing. I should be able to go to a doctor, look at the services provided, and order exactly what I want, paid for upfront in cash no differently than I do any other service. Insurance should come into play when something catastrophic happens. I don't bill my homeowners insurance every time I need to paint the house or hire a pest control guy to come out.

[atanamis]

It's very cheap to allocate health care via the ER system in terms of cost. But in terms of the price that you and your insurer pays.. it's fucking ridiculously high.

Here's the thing dude. All these stupid niggers like myself didn't pay them back. I didn't have that money. I never will. And all the other stupid niggers piling in their doors don't either.

What do now socialist?

I would like to address this point as well. Currently, emergency rooms in the US are required to provide care regardless of the patient's ability to pay. They may be allowed to turn away non-urgent cases, but what that means is that they have a mandate to provide care but no guarantee that they will be paid. This is part of why ERs are so expensive. They need to cover the expenses of all those doctors being available, and they need to get that money from the patients who will actually pay their bills. We already provide free care to those who walk in and will never pay it. If the fixed costs of the ER being there were socialized, then people who needed cheap care COULD pay for it at ERs (at the expense of wait times).

I wonder if we could expand the flexible spending account idea so that people are given the ability (responsibility) of managing their health care services. They pay into the program a certain amount each year, which goes into a kind of account. The actual amount that is spendable is some multiple of how much they have put into the account (sort of like a margin account). This way they know how much they can spend each year, and every time they do spend, they are still hitting the account consisting of money they put into system.

So I hate "Flexible Spending Accounts". They require that you spend the money in them each year, and have a cap on what you can put into them. I vastly prefer "Health Savings Accounts", which allow you to accrue money tax free in an investment account. They are restricted by law currently only to people on high deductible health insurance plans, which is incredibly stupid. They also have contribution limits which I dislike. I would very much like to see Health Savings Accounts be made available to all taxpayers, and for people to be encouraged to accrue money in them throughout their lifetimes for the time when they will eventually have higher medical costs. Doing this would also allow everyone to spend tax free money and investment income on their health care expenses. I would pair these with a new loan type called "Health Loan Accounts", which would be much like a federal student loan program for medical care. What I'd like to see would be a model where more people have "emergency only" insurance that might kick in at around $10k in spending, but where people could get a $10k loan from the government to help them in case their savings can't cover the expense. The idea of merging these two into a margin account style model is one I hadn't considered, but I like it!

The rest of your ideas sound like my "Mandate honest pricing" and "The uninsured" items from my monster post. I totally agree that the VA should be the vehicle for implementing the public option I specified.