Trump tastes failure as U.S. House healthcare bill collapses

[Jingthing]

Political issues around health care don't ever end when a nation becomes civilized and moves to nationalized health care. Nobody is suggesting there is any perfect answer but the fact that the advanced civilized nations in the world have chosen imperfect nationalized systems vs. the train wreck that is the U.S. system is worth paying attention to. Another case where American exceptionalism actually means exceptionally BAD.  

Edited March 29, 2017 by Jingthing

[mogandave]

The train-wrecked for me a year after the ACA passed. Up until then I had good insurance. Now I pay more and get less.

While I know a lot of people have been forced to sign up for the same crappy policy, I wonder how many people are actually enjoying a better quality of care than they were getting.




Live, love, laugh

[Jingthing]

8 hours ago, mogandave said:

The train-wrecked for me a year after the ACA passed. Up until then I had good insurance. Now I pay more and get less.

While I know a lot of people have been forced to sign up for the same crappy policy, I wonder how many people are actually enjoying a better quality of care than they were getting.




Live, love, laugh

You want to get personal, please be more specific.

Are you buying insurance in the private market or getting through employment?  If from the private market what level of ACA subsidies are you getting, if any?

If in private market and no subsidy then it's obvious that you make a healthy income.  As someone that sees ACA as a step forward to the concept of health care as a basic civil right for all Americans, I totally get there are flaws in it and that some people are worse off under it than the pre ACA status quo.

You may indeed be one of them. 

That's not a good reason to scrap it entirely. It's a good reason to massage it and work on addressing the flaws.

[mogandave]

You want to get personal, please be more specific.
Are you buying insurance in the private market or getting through employment?
If from the private market what level of ACA subsidies are you getting, if any?
If in private market and no subsidy then it's obvious that you make a healthy income.
As someone that sees ACA as a step forward to the concept of health care as a basic civil right for all Americans, I totally get there are flaws in it and that some people are worse off under it than the pre ACA status quo.
You may indeed be one of them. 
That's not a good reason to scrap it entirely. It's a good reason to massage it and work on addressing the flaws.

As I mentioned in a previous thread, I am insured through my employer. My deductible went from zero to over $5k, and I pay almost twice as much as I was paying. I have BCBS of I.

What kind of insurance do you have?

Do you get subsidies?

I would be much happier subsidizing free clinics in poor neighborhoods that drive down the cost of healthcare than subsidizing crappy insurance that drives the cost up.

[Jingthing]

Your employer pays for your plan and now I recall you have cost sharing kick in as well.

That is very different than on the private market.

The subsidy situation is about the ACA private market. You're not in that market.

I am not knowledgeable on the full impact of ACA on employer paid insurance except to know under the ACA law employers with over 50 staff need to provide it. (trumpcare would have scrapped that rule, one of many very crappy things in that happily failed bill from hell.)

I live in Thailand so the personal question irrelevant to me currently unless I repatriate. 

You've made your political POV very clear. You actually think that overall the status quo before ACA was better. It may indeed have been better for you. That seems very plausible. I'm not here to defend everything about ACA as everything about ACA isn't defensible. But the concept of health care for all American citizens is very defensible as ACA was a step forward OVERALL in that very worthy goal. trumpcare would have been a step backwards. Let's go FORWARD, shall we? 

 

Edited March 29, 2017 by Jingthing

[mogandave]

Your employer pays for your plan and now I recall you have cost sharing kick in as well.
That is very different than on the private market.
The subsidy situation is about the ACA private market. You're not in that market.
I am not knowledgeable on the full impact of ACA on employer paid insurance except to know under the ACA law employers with over 50 staff need to provide it. (trumpcare would have scrapped that rule, one of many very crappy things in that happily failed bill from hell.)
I live in Thailand so the personal question irrelevant to me currently unless I repatriate. 
You've made your political POV very clear. You actually think that overall the status quo before ACA was better. It may indeed have been better for you. That seems very plausible. I'm not here to defend everything about ACA as everything about ACA isn't defensible. But the concept of health care for all American citizens is very defensible as ACA was a step forward OVERALL in that very worthy goal. trumpcare would have been a step backwards. Let's go FORWARD, shall we? 
 

I live in Thailand as well.

My employer pays 80% of the cost. I used to have Cigna (a plan I liked but could not keep) because (apparently) it did not meet the requirements of the ACA.

Employers with over 50 full-time staff, so if your at 53, cut a few heads, if your at 500, cut 460 to 30 hours a week and hire another 200 part time. How did the all benefit?

Providing insurance is much different from providing care. As I indicated previously, I would be much happier being taxed to subsidize 0free clinics in poor neighborhoods than subsidizing useless insurance policies.

You can provide everyone with insurance, but yo can never provide everyone with care, people need to want care to get it

I used to work in a union sheet metal fabricating facility in California. Medical, dental, vision, no deductible, $5 co-pay, $5 prescriptions, $15 twice a month single, $20 for family. None of these guys were making less than $20 an hour, yet many would not sign up. Company loves that...

I can eat $5k, but "selling" a poor family a policy with a $5,000 deductible is not helping them, it's helping the insurance companies.

[Rhys]

the lavar ball of poltics

 

 

[Jingthing]

1 hour ago, mogandave said:

 

I live in Thailand as well.

My employer pays 80% of the cost. I used to have Cigna (a plan I liked but could not keep) because (apparently) it did not meet the requirements of the ACA.

Employers with over 50 full-time staff, so if your at 53, cut a few heads, if your at 500, cut 460 to 30 hours a week and hire another 200 part time. How did the all benefit?

Providing insurance is much different from providing care. As I indicated previously, I would be much happier being taxed to subsidize 0free clinics in poor neighborhoods than subsidizing useless insurance policies.

You can provide everyone with insurance, but yo can never provide everyone with care, people need to want care to get it

I used to work in a union sheet metal fabricating facility in California. Medical, dental, vision, no deductible, $5 co-pay, $5 prescriptions, $15 twice a month single, $20 for family. None of these guys were making less than $20 an hour, yet many would not sign up. Company loves that...

I can eat $5k, but "selling" a poor family a policy with a $5,000 deductible is not helping them, it's helping the insurance companies.
 

 

You live in Thailand and you have a U.S. based employer health insurance plan? Not sure what you're talking about now or if you're even being sincere.  Why are you berating me with detail problems with ACA? I am perfectly aware of the flaws.  trumpcare was worse. Much worse. But happily that's history. You know perfectly well I'm for single payer but failing that major reform of ACA that actually makes better sense is better than nothing. As it stands now, it's another political football and it's very doubtful anything significant (either way) even has a chance of getting started before the next midterm election. 

Again, please don't even bother trying to put me in the position of defending everything about ACA except for my assertion that overall post ACA was better than pre ACA based on three things--

Expanded Medicaid (sadly the republicans blocked that in many states)

Preexisting conditions policy (huge change and hugely popular)

Subsidies for private plans for lower income people 

 

Edited March 29, 2017 by Jingthing

[Jingthing]

Trevor's take on it:

 

[mogandave]

You live in Thailand and you have a U.S. based employer health insurance plan? Not sure what you're talking about now or if you're even being sincere.  
 

I am talking about being an US employee of a US company. The company has operations in Thailand and I am based in Thailand.

I have a BCBS of I Global plan, pay for my care and submit the forms for reimbursement.

Clear?

I don't blame you for not wanting to discuss details.

To be clear, t think the idea of quality healthcare for everyone is great, it in the details where he wheels fall off.

[mogandave]

Trevor's take on it:
 

I don't hear well, is there a transcript?

[Jingthing]

1 minute ago, mogandave said:

 

I don't hear well, is there a transcript?

 

Click on CC to see subtitles.

[Jingthing]

8 minutes ago, mogandave said:

 

 

I am talking about being an US employee of a US company. The company has operations in Thailand and I am based in Thailand.

I have a BCBS of I Global plan, pay for my care and submit the forms for reimbursement.

Clear?

I don't blame you for not wanting to discuss details.

To be clear, t think the idea of quality healthcare for everyone is great, it in the details where he wheels fall off.
 

 

 

I'm not sure how your specific plan would have changed purely based on the passage of ACA. I've heard you complain many times about it but I'm skeptical that you know how the ACA law actually caused the specific changes, or whether there were other reasons for some of/most of the changes. Pre ACA insurance plans from employers changed frequently but then there was no "Obama" boogeyman to blame it on. 

A funny thing about ACA is that so many people that are on it don't know it and many people not on it think they are on it. Then there are people that like ACA but hate "Obamacare" but it's the same thing. 

Edited March 30, 2017 by Jingthing

[mogandave]

I'm not sure how your specific plan would have changed purely based on the passage of ACA. I've heard you complain many times about it but I'm skeptical that you know how the ACA law actually caused the specific changes, or whether there were other reasons for some of/most of the changes. Pre ACA insurance plans from employers changed frequently but then there was no "Obama" boogeyman to blame it on. 
A funny thing about ACA is that so many people that are on it don't know it and many people not on it think they are on it. Then there are people that like ACA but hate "Obamacare" but it's the same thing. 

I don't doubt you're skeptical about anything anyone says that interferes with your agenda, I know I am.

Again, I had Cigna, but as the plan (apparently) did not meet some of the requirements of the affordable care act, the company quit offering it, and offered the BCBS plan in it's place. Incidentally, it is my understanding that Cigna and BCBS are (or at least were) both part of the same company.

As far as what requirements the Cigna plan did not satisfy, I could only guess at as I have not and likely will not study either of the plans in depth as I see no benefit in it.

I think many things could and should be done that would drive the cost of healthcare down and make it more affordable, and available but I don't think moving toward single payer is one of them, and as you are loathe to discuss any details I don't think I will be convinced otherwise likely.

Being constantly attacked as a heartless, greedy spiteful, uneducated buffoon is not going to change my position.

I am not well versed in the Thai medical system, but from what I know, see and have experienced it seems pretty good, but I'm guessing discussing it in any depth would be considered off topic.

[Jingthing]

Dude, I'm not really interested in convincing you single payer is the best answer. I know a hopeless case when I see one. I reckon the young Americans that so strongly supported Bernie Sanders over time will effect that well needed and wise change. They won't need everyone that is clinging to an irrational socialist-phobic past. 

Thank you for explaining your understanding of why your pre-ACA paid by employer plan was not offered anymore. That sounds like a plausible reason. 

[Scott]

There are no doubts that there are problems with Health Care.   In the US here is some of what I believe are the problems:

 

1.   The limiting of the number of doctors which is in part a political move by the AMA.   This has a knock-on effect for providing health care services for very poor areas and for rural areas.  

 

2.   The immense power of Big Pharma in controlling, or the uncontrolled is a better way of saying it, cost of life-saving drugs.   Something which foreign countries won't put up with and thus get many drugs at a greatly reduced cost.   

 

3.   The problem of the high cost of malpractice insurance for doctors.  

 

4.   The complicated manner in which the gov't tries to appease the insurance companies and incorporate them into the system.

 

 Health care costs all US citizens a lot of money when people do not have coverage.   First, there is little preventive medicine, and this means a lot end up going to the costly emergency room and receiving expensive treatment for what could have been prevented or mitigated sooner.   Most hospitals have to provide care for indigent people and that cost is then passed on to the taxpayers.   So, in the end, we do pay for the cost of care for everyone, but at a more expensive rate.

 

As a country like the US moves toward broader care, there will be what many will see as a poorer quality service.   It's not unlike education systems in poorer countries -- as they include more children, the overall level of education drops.   When you no longer select only the best and brightest, the average scores will drop.   The same is true of medical services.  

 

For those with full employment including health care and private insurance, they should see few problems. 

 

The cost of health care is not going to get cheaper under Affordable Care or Trump Care.   Costs can't be contained until you have adequate medical personnel and the cost of drugs is controlled.  

 

I am not inclined to get into the discussion as it relates to the political situation involved in health, but I do believe that the more comprehensive care available to US citizens, the better it is for all.  

[Gulfsailor]

Just to put the cost of US healthcare into perspective here some numbers on USA and two other developed countries with similar GDP, and as a bonus Thailand. 

 

Life expectancy 2017

USA 79.13

Canada 81.93

UK 80.77

Thailand 74.94

 

GDP per capita 2016

USA 57,300

Canada 46,200

UK 42,500

Thailand 16,800

 

Healthcare cost per annum per capita in USD (ppp) 2014

USA 9,403

Canada 4,641

UK 3,377

Thailand 950

 

Edited March 30, 2017 by Gulfsailor

[thaibeachlovers]

On 3/30/2017 at 0:08 AM, tuktuktuk said:

When I dream about a single payer healthcare system I imagine somebody like Nancy Pelosi being in charge and the sweet dream turns into a long national nightmare.  We'll just have another tax like social security and medicaid that those idiots (dems and republicans alike) can dip into to pay for all sorts of other things that both you and I would agree are foolish. Maybe those other countries don't elect idiots like her and her fellow congressmen.

IMO ( having worked in the British NHS ) the NHS is run by people like Pelosi, and is  becoming unaffordable, having become a monster that was never envisaged by the people of good will that set it up.

A single payer system is what Obama should have set up, but if it had been the risk is that it would be hijacked by the politicians and ruined.

Edited March 30, 2017 by thaibeachlovers

[thaibeachlovers]

18 hours ago, mogandave said:

 

I don't doubt you're skeptical about anything anyone says that interferes with your agenda, I know I am.

Again, I had Cigna, but as the plan (apparently) did not meet some of the requirements of the affordable care act, the company quit offering it, and offered the BCBS plan in it's place. Incidentally, it is my understanding that Cigna and BCBS are (or at least were) both part of the same company.

As far as what requirements the Cigna plan did not satisfy, I could only guess at as I have not and likely will not study either of the plans in depth as I see no benefit in it.

I think many things could and should be done that would drive the cost of healthcare down and make it more affordable, and available but I don't think moving toward single payer is one of them, and as you are loathe to discuss any details I don't think I will be convinced otherwise likely.

Being constantly attacked as a heartless, greedy spiteful, uneducated buffoon is not going to change my position.

I am not well versed in the Thai medical system, but from what I know, see and have experienced it seems pretty good, but I'm guessing discussing it in any depth would be considered off topic.

 

While off topic I have been in the Thai health system as a private patient, and it was not at all what I would expect from a "pretty good" system despite costing 53,000 baht for 3 days with only a drip for medical treatment. Not going into the details here, but for sure, if a public hospital patient pretty hellish- relatives sleeping under the bed so they can look after the patient as the nurses won't ( they only give drugs and do dressings etc ) and such like.

[Ramen087]

http://nypost.com/2017/03/30/why-trump-should-embrace-single-payer-health-care/

 

Could a single payer system be an acceptable solution between the AV and the recently pulled plan?  This opinion piece makes a decent case.  Interesting reading for those who care about this issue.

 

 

[Jingthing]

It might be his only hope to save his presidency. However, as he's clearly a self destructive (and nationally and internationally destructive) mental case, NO CHANCE he will do it. 

[thaihome]

Here is an excellent article on one problem with US medical care. No politics, it shows how hospitals and doctors are gaming the medical code system to inflate the the cost of care. The patient had no insurance and was billed over $300k for care that was estimated to cost about  $85k.

TH 

 

https://www.nytimes.com/2017/03/29/magazine/those-indecipherable-medical-bills-theyre-one-reason-health-care-costs-so-much.html

[Traveler19491]

6 hours ago, thaibeachlovers said:

While off topic I have been in the Thai health system as a private patient, and it was not at all what I would expect from a "pretty good" system despite costing 53,000 baht for 3 days with only a drip for medical treatment. Not going into the details here, but for sure, if a public hospital patient pretty hellish- relatives sleeping under the bed so they can look after the patient as the nurses won't ( they only give drugs and do dressings etc ) and such like.

 

Don't know where you were treated, but I have been treated by both public and private (BKK Hospital), most recently in the public system for a minor heart attack and angiogram. I have been treated in Chiang Mai (public and private), Phitsanulok (public), Cha Am (public), and Hua Hin (public and private). I have never had anything but excellent treatment and care from both the doctors, nurses, and ancillary staff in either setting. I have always been treated courteously and with a smiling attitude. I have found the doctors and staff in both systems to be knowledgeable, effective, and friendly (with one minor exception regarding the "friendly" aspect). For my angiogram, I had the doctor's consultation and surgery, x-ray, meds, surgical theater, private room, and meds. Total cost in the US would have been between $5,000 - $15,000 (depending on where done), but my bill totaled 27,000 baht (roughly $800). In short, I have no complaints. Sorry for your bad experience.

[Jingthing]

41 minutes ago, thaihome said:

Here is an excellent article on one problem with US medical care. No politics, it shows how hospitals and doctors are gaming the medical code system to inflate the the cost of care. The patient had no insurance and was billed over $300k for care that was estimated to cost about  $85k.

TH 

 

https://www.nytimes.com/2017/03/29/magazine/those-indecipherable-medical-bills-theyre-one-reason-health-care-costs-so-much.html

Yes, things are totally out of control. It was before ACA and after. But any change just for change sake such as that crappy trumpcare bill is not the answer either. 

[mogandave]

Don't know where you were treated, but I have been treated by both public and private (BKK Hospital), most recently in the public system for a minor heart attack and angiogram. I have been treated in Chiang Mai (public and private), Phitsanulok (public), Cha Am (public), and Hua Hin (public and private). I have never had anything but excellent treatment and care from both the doctors, nurses, and ancillary staff in either setting. I have always been treated courteously and with a smiling attitude. I have found the doctors and staff in both systems to be knowledgeable, effective, and friendly (with one minor exception regarding the "friendly" aspect). For my angiogram, I had the doctor's consultation and surgery, x-ray, meds, surgical theater, private room, and meds. Total cost in the US would have been between $5,000 - $15,000 (depending on where done), but my bill totaled 27,000 baht (roughly $800). In short, I have no complaints. Sorry for your bad experience.

I have to agree, I have had great service from both Bangkok and more Recently Bumrungrad (in the BCBS network) hospitals and I have also used the local government hospital in the province for PT prescribed by Bumrungrad which is "free" with my Thai SS medical card.

Also have a great liver doctor at Chulakorn, (started seeing him at BKK) where my twice a year blood test, ultrasound and follow-up visit costs all of about Baht 3,000.

[Jingthing]

Come on dudes, such banter about your care in THAILAND is totally off topic here, eh? 

[mogandave]

Come on dudes, such banter about your care in THAILAND is totally off topic here, eh? 

People have been discussing and comparing Canadian and British healthcare in the thread, why is discussion of the Thai system off topic?

[Jingthing]

5 minutes ago, mogandave said:

 

People have been discussing and comparing Canadian and British healthcare in the thread, why is discussion of the Thai system off topic?

 

The context of the posts. You know that, so don't bother with the games. 

[stevenl]

The context of the posts. You know that, so don't bother with the games. 

He's been playing games in this thread from the beginning.

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[Scott]

Continued trolling will result in a suspension.   If you have nothing to add to the discussion, please stop posting.  

 

Do not reply to trolls.   I know it's a little like ignoring mosquitoes, but please try to ignore them.