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  1. #51
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    Obamacare was supposed to make insurance markets more compe ive and it hasn't. First UnitedHealth pulled out of a number of states - now Humana. The health insurance companies are merging and Obama's DOJ is trying to stop them. Government and its unintended consequences - thought the article fit here better than the usual Obamacare thread.
    yep, BigInsurance is pulling out of some markets because it can't screw over sick people for as much money as before.

    That's not ACA's fault, it's the for-profit BigInsurance.

    The last thing BigCorp wants is true compe ion.

  2. #52
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    The minority set asides are even a bigger scam.

    They "pay to play" and get contracting officers to divert the paperwork to them so it's easy for the contracting officers to meet their quotas.

    It works like this:

    Lets say Lackland or Randolph need something (material, or a turn key job done)

    The guys at the base call me.

    I meet or talk with with the guys at the base, they give me the specifications, I give them a price.

    Then a couple weeks later I get a call from one of these minority resellers giving me a purchase order.

    I do all the work or supply the material working directly with the guys at the base.

    When I am done, the guys at the base accept the material/job.

    I then bill the minority reseller.

    They take my invoice, mark it up 25% and bill the government.

    The only thing they do for that 25% is issue a PO and issue a check. They never leave the office except to keep bribing the contracting officers.
    Sickening. And we wonder about government waste.

    OT: The government wants to look like they're reducing size - contracts out IT work and signs a SEVEN year contract with private company which has to abide by all the security/government rules - next administration on the hook for a long time.

  3. #53
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    yep, BigInsurance is pulling out of some markets because it can't screw over sick people for as much money as before.

    That's not ACA's fault, it's the for-profit BigInsurance.

    The last thing BigCorp wants is true compe ion.
    The mandated essential benefits drive the price of policies up - not enough people buy - not worth it for the big insurance companies. Face it, boutons, unless one gets a subsidy, Obamacare is crap.

  4. #54
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    The mandated essential benefits drive the price of policies up - not enough people buy - not worth it for the big insurance companies. Face it, boutons, unless one gets a subsidy, Obamacare is crap.
    Without the ACA, the usual "catastrophe insurance" is crap

    Face it, RMT, American for-profit health has been sucking Americans' wealth for 35+ years.

    That's not ACA's fault.

  5. #55
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    Obamacare was supposed to make insurance markets more compe ive and it hasn't.
    But you just posted an article that says exactly the opposite (The law promotes corporatism on the theory that larger systems are more efficient).

    Barrycare, in a way, tried to do both: Disincentive compe ion by not allowing it across state lines, while trying to incentive compe ion at the local level with the (now failed) Coops, among other things.

    But I feel it's wrong to point that as the biggest failure of the law. It's kinda missing the forest from the tree, and it really avoids talking about the real failure: cost. The real failure is that it didn't address cost. With that unchecked, the rest is just a fallout from that. That's why proposals that have very mild or no cost control at all are doomed to fail, and are going to keep costing Americans way, way more than the rest of the world (which really means we keep subsidized them). HSAs aren't going to fix that. Compe ion across state lines are not really going to fix that either. As long as the service providers (drug makers, device makers, hospitals, etc) can charge whatever they want, due to patent protections or based on what the market will bear, as opposed to what it costs them + a modest profit, nothing is going to change. All those providers and insurance companies don't have a duty to the patients, they have a duty to their shareholders to extract as much money as they can. There's nothing inherently wrong about that, it's "free market" after all, but every country not named the US had to, at some point, put on the table if "profit motive" is more important that a healthy citizenship. The US has been avoiding that like the plague, and we're paying through the nose for that.

    The system prior to Barrycare had the exact same problem, and if there's anything to lament from Barrycare is that it was a wasted opportunity to actually address the crux of the problem. On the other hand, there's too many players sucking up too much money out of this (and the previous) system, so actually doing something about it is going to take a massive popular uproar about it.

  6. #56
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    But you just posted an article that says exactly the opposite (The law promotes corporatism on the theory that larger systems are more efficient).

    Barrycare, in a way, tried to do both: Disincentive compe ion by not allowing it across state lines, while trying to incentive compe ion at the local level with the (now failed) Coops, among other things.

    But I feel it's wrong to point that as the biggest failure of the law. It's kinda missing the forest from the tree, and it really avoids talking about the real failure: cost. The real failure is that it didn't address cost. With that unchecked, the rest is just a fallout from that. That's why proposals that have very mild or no cost control at all are doomed to fail, and are going to keep costing Americans way, way more than the rest of the world (which really means we keep subsidized them). HSAs aren't going to fix that. Compe ion across state lines are not really going to fix that either. As long as the service providers (drug makers, device makers, hospitals, etc) can charge whatever they want, due to patent protections or based on what the market will bear, as opposed to what it costs them + a modest profit, nothing is going to change. All those providers and insurance companies don't have a duty to the patients, they have a duty to their shareholders to extract as much money as they can. There's nothing inherently wrong about that, it's "free market" after all, but every country not named the US had to, at some point, put on the table if "profit motive" is more important that a healthy citizenship. The US has been avoiding that like the plague, and we're paying through the nose for that.

    The system prior to Barrycare had the exact same problem, and if there's anything to lament from Barrycare is that it was a wasted opportunity to actually address the crux of the problem. On the other hand, there's too many players sucking up too much money out of this (and the previous) system, so actually doing something about it is going to take a massive popular uproar about it.
    To me, the biggest failure of Obamacare is the cost - I believe that allowing true compe ion will lower costs. I've already posted about my $80 diagnostic (not screening which is cheaper) and $80 bilateral (again a step up) ultrasound when paying directly (no insurance). I've posted links to $69 comprehensive blood test batteries at direct labs.com and reasonable surgery prices at surgerycenterok.com. And when my parents used to hit the Medicare doughnut, I'd order their drugs from Canadian pharmacies - much cheaper than from the US. These are just a few examples of what is already out there - of course, hardly any one knows about these prices or uses them because of the way insurance and in particularly Obamacare with its mandated essential benefits already baked in is. If the majority of the US - the young, healthy, people with non-major health problems (maybe just hypertension, pre-diabetes, etc) could buy catastrophic insurance and make use of HSAs, that would leave a whole lot of money/resources to treat the relatively few people with major health problems. This compe ion would encourage, not stifle innovation of medical products, drugs, etc.

    Instead, we have Obamacare which does encourage merging of health insurers, big hospital systems, consolidation of physicians, etc. - all things which HIDE the true cost of healthcare and run up costs with extra administration, insurance coding, medical records, etc and no regard to cost. What we should have is many smaller, cheaper, stand-alone businesses which compete and cater to a specific healthcare need (see lasik and my above examples), outpatient clinics, and urgent care/walk-in clinics. Then we can truly comparison shop for our healthcare as we do everything else. Only true emergencies and immediate surgeries should be at the hospital - that alone would cut down costs significantly.

    Please take a look at the GOP replacement policy. The 2 things I would add is to allow use of HSA dollars to anyone (non-immediate family members) - friends, parents, aunts, etc. and passing the HSA on to heirs (takes away the incentive to waste money on unnecessary end-of-life procedures). I'd even extend use of HSA for medical tourism - if it can be done cheaper elsewhere, why not.

    http://abetterway.speaker.gov/_asset...olicyPaper.pdf

  7. #57
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    For those of you who are Christians and are struggling with the cost of healthcare, you might want to consider Christian Healthcare Ministries. For as little as $45 per month, you are covered for $125,000 per illness (additional coverage available with Brother's Keeper). Pre-existings go away after 3 years and are covered 1st year at $15k, 2nd year at $10k and 3rd year at $25k. There are other health sharing ministries but only CHM and Liberty HealthShare allow pre-existing conditions. They are valid ACA replacements - no penalty.

    http://www.chministries.org/programs.aspx

    And all kids count as only 1 unit.
    Last edited by rmt; 07-25-2016 at 03:48 PM.

  8. #58
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    "biggest failure of Obamacare is the cost"

    1000s of orgs, docs refuse to treat Medicare/Medicaid patients because of lower compensation.

    If ACA had really regulated prices, BigHealthCare would have blocked ACA.

    iow,
    BigHealthCare makes govt policy through its proxy legislators.

    "allowing true compe ion will lower costs."

    No "true compe ion" in FOR-PROFIT BigHealthCare America!


    Last edited by boutons_deux; 07-25-2016 at 05:18 PM.

  9. #59
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    "biggest failure of Obamacare is the cost"

    1000s of orgs, docs refuse to treat Medicare/Medicaid patients because of lower compensation.

    If ACA had really regulated prices, BigHealthCare would have killed ACA. iow,
    BigHealthCare makes govt policy through its proxy legislators.

    "allowing true compe ion will lower costs."

    No "true compe ion" in FOR-PROFIT BigHealthCare America!


    With HSAs and no insurance involved, my kids' annual checkup at pediatrician was $90. Toss in a few blood tests every couple of years - cheap. $75 if they have the flu - no extra insurance personnel - catastrophic insurance for them would be dirt cheap - this is how it would be for the majority of the US. C'mon, you're the one against BIGxxx. Why should the doctors, blood labs, diagnostic centers, etc object - they'd get all the money and not deal with insurance. Don't dismiss it summarily just because it's the repub plan.

  10. #60
    🏆🏆🏆🏆🏆 ElNono's Avatar
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    To me, the biggest failure of Obamacare is the cost - I believe that allowing true compe ion will lower costs. I've already posted about my $80 diagnostic (not screening which is cheaper) and $80 bilateral (again a step up) ultrasound when paying directly (no insurance). I've posted links to $69 comprehensive blood test batteries at direct labs.com and reasonable surgery prices at surgerycenterok.com. And when my parents used to hit the Medicare doughnut, I'd order their drugs from Canadian pharmacies - much cheaper than from the US. These are just a few examples of what is already out there - of course, hardly any one knows about these prices or uses them because of the way insurance and in particularly Obamacare with its mandated essential benefits already baked in is. If the majority of the US - the young, healthy, people with non-major health problems (maybe just hypertension, pre-diabetes, etc) could buy catastrophic insurance and make use of HSAs, that would leave a whole lot of money/resources to treat the relatively few people with major health problems. This compe ion would encourage, not stifle innovation of medical products, drugs, etc.

    Instead, we have Obamacare which does encourage merging of health insurers, big hospital systems, consolidation of physicians, etc. - all things which HIDE the true cost of healthcare and run up costs with extra administration, insurance coding, medical records, etc and no regard to cost. What we should have is many smaller, cheaper, stand-alone businesses which compete and cater to a specific healthcare need (see lasik and my above examples), outpatient clinics, and urgent care/walk-in clinics. Then we can truly comparison shop for our healthcare as we do everything else. Only true emergencies and immediate surgeries should be at the hospital - that alone would cut down costs significantly.

    Please take a look at the GOP replacement policy. The 2 things I would add is to allow use of HSA dollars to anyone (non-immediate family members) - friends, parents, aunts, etc. and passing the HSA on to heirs (takes away the incentive to waste money on unnecessary end-of-life procedures). I'd even extend use of HSA for medical tourism - if it can be done cheaper elsewhere, why not.

    http://abetterway.speaker.gov/_asset...olicyPaper.pdf
    I did. It does nothing to control costs. Compe ion from what, insurance companies? They need to pay the service providers and make money on top of that, otherwise, they'll close doors. There's no pushing service providers when they hold a patent and nobody else can manufacture their . That's why medical patents are cir vented all the time in 3rd world countries, or pharma is simply forced to grant a local lab a license to produce a drug at a severe discount (India is a good example of that).

    I just finished paying over $8000 for an ambulance ride, emergency services for about 2 hours and one night stay at a hospital. That's with a 70% discount from the hospital (which originally billed over $12000).

    They're ridiculous numbers, and there's no shopping around when you have an emergency. For anything I can shop around, it's just much cheaper for me to head to Argentina with the family and get done there (any expensive dentistry, etc, including the $2000 flight trip), but that's besides the point of the fact that costs are way out of control here in the US. It's a perverse system too, where actual costs are hidden under insurance if you have it. If you're too poor, you get Medicaid and you're covered. If you're too rich, then well, you can probably afford to buy insurance (at an exorbitant price, compared to the rest of the world). If you run a small business or are self-employed and you're a bit tight on money, you gotta go at it without insurance, which amounts nearly to bankruptcy if you get hit with anything serious. If this sounds a lot like the system before Barrycare, it's because it's exactly how it was. Barrycare didn't do anything about cost, so you're basically on the same boat, but with expanded coverage for the poor segment, and possibly more expensive coverage for the richer segment. Unless cost is actually addressed, nothing is going to change.
    Last edited by ElNono; 07-25-2016 at 06:11 PM.

  11. #61
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    I did. It does nothing to control costs. Compe ion from what, insurance companies? They need to pay the service providers and make money on top of that, otherwise, they'll close doors. There's no pushing service providers when they hold a patent and nobody else can manufacture their . That's why medical patents are cir vented all the time in 3rd world countries, or pharma is simply forced to grant a local lab a license to produce a drug at a severe discount (India is a good example of that).

    I just finished paying over $8000 for an ambulance ride, emergency services for about 2 hours and one night stay at a hospital. That's with a 70% discount from the hospital (which originally billed over $12000).

    They're ridiculous numbers, and there's no shopping around when you have an emergency. For anything I can shop around, it's just much cheaper for me to head to Argentina with the family and get done there (any expensive dentistry, etc, including the $2000 flight trip), but that's besides the point of the fact that costs are way out of control here in the US. It's a perverse system too, where actual costs are hidden under insurance if you have it. If you're too poor, you get Medicaid and you're covered. If you're too rich, then well, you can probably afford to buy insurance (at an exorbitant price, compared to the rest of the world). If you run a small business or are self-employed and you're a bit tight on money, you gotta go at it without insurance, which amounts nearly to bankruptcy if you get hit with anything serious. If this sounds a lot like the system before Barrycare, it's because it's exactly how it was. Barrycare didn't do anything about cost, so you're basically on the same boat, but with expanded coverage for the poor segment, and possibly more expensive coverage for the richer segment. Unless cost is actually addressed, nothing is going to change.
    For routine/small health events, compe ion from those non-hospital businesses I mentioned above - paid directly by HSA dollars - no insurance companies involved - some are already out there but not enough because of the way insurance is set up (cost invisible to the user). What I'm advocating is virtually eliminating policies by insurance companies except for catastrophic insurance. Then only emergencies and true major health problems (like cancer) would fall under insurance. The rest of routine, non-emergency, non-major events would be comparison-shopped (prices posted everywhere) - that, I think, covers the majority of non-Medicare US. The GOP plan allows for continuation of employer-sponsored insurance (so as to cause less disruption) but if given the choice between that and catastrophic/more flexible HSA combo, many might eventually transport to the combo.

    Emergencies cannot be comparison-shopped - but that's what catastrophic insurance should be about. I sympathize with those in the middle (I'm one of these) - too rich for Medicaid and straddled with these high premiums, deductibles and co-pays. May I suggest that you take a look at the health sharing ministries below as a model? The gold level (with Brother's keeper [unlimited assistance]- about $5500/yr for a whole family) would be the equivalent of employer-sponsored insurance [without routine checkups/labs] and the bronze ($1720/yr for a family) would be like catastrophic insurance. It's only for Christians but it has worked for many years since iirc 1981 - self-sustaining - very little going toward administration - and all routine/small events taken care of by user (or what I advocate for the general population - HSA $s). It's flexible - covers any doctor/hospital anywhere in the US - Liberty HealthShare even covers internationally as long as the receipt is in English.

    Can you afford $1720/yr for your family in catastrophic insurance (rhetoric question)? Why can't the US use something like this model? Because we are trained/conditioned to expect coverage for routine checkups/labwork and not shop like we do for everything else? If it's my (HSA) dollars, you bet I'm gonna find the cheapest, best reviewed xxx around. I don't have the answer to new drugs/medical products for which there are patents as far as cost (controls) are concerned that would not discourage research. Other un-patented drugs can be shopped - Metformin and amoxicillin is free at my local Publix (supermarket). Walmart has a lot of $4 drugs, etc.

    http://www.chministries.org/programs.aspx
    Last edited by rmt; 07-25-2016 at 08:38 PM.

  12. #62
    🏆🏆🏆🏆🏆 ElNono's Avatar
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    For routine/small health events, compe ion from those non-hospital businesses I mentioned above - paid directly by HSA dollars - no insurance companies involved - some are already out there but not enough because of the way insurance is set up (cost invisible to the user). What I'm advocating is virtually eliminating policies by insurance companies except for catastrophic insurance. Then only emergencies and true major health problems (like cancer) would fall under insurance. The rest of routine, non-emergency, non-major events would be comparison-shopped (prices posted everywhere) - that, I think, covers the majority of non-Medicare US. The GOP plan allows for continuation of employer-sponsored insurance (so as to cause less disruption) but if given the choice between that and catastrophic/more flexible HSA combo, many might eventually transport to the combo.

    Emergencies cannot be comparison-shopped - but that's what catastrophic insurance should be about. I sympathize with those in the middle (I'm one of these) - too rich for Medicaid and straddled with these high premiums, deductibles and co-pays. May I suggest that you take a look at the health sharing ministries below as a model? The gold level (with Brother's keeper [unlimited assistance]- about $5500/yr for a whole family) would be the equivalent of employer-sponsored insurance [without routine checkups/labs] and the bronze ($1720/yr for a family) would be like catastrophic insurance. It's only for Christians but it has worked for many years since iirc 1999 - self-sustaining - very little going toward administration - and all routine/small events taken care of by user (or what I advocate for the general population - HSA $s). It's flexible - covers any doctor/hospital anywhere in the US - Liberty HealthShare even covers internationally as long as the receipt is in English.

    Can you afford $1720/yr for your family in catastrophic insurance (rhetoric question)? Why can't the US use something like this model? Because we are trained/conditioned to expect coverage for routine checkups/labwork and not shop like we do for everything else? If it's my (HSA) dollars, you bet I'm gonna find the cheapest, best reviewed xxx around. I don't have the answer to new drugs/medical products for which there are patents as far as cost (controls) are concerned that would not discourage research. Other un-patented drugs can be shopped - Metformin and amoxicillin is free at my local Publix (supermarket). Walmart has a lot of $4 drugs, etc.

    http://www.chministries.org/programs.aspx
    Here in New Jersey, the cheapest catastrophic insurance for an individual like me is ~$300 a month. And that's with subsidies and like a $4000 deductible. I looked, it's an absolute rip off. I'm also generally a healthy individual that's not too old either.

    I actually do have access to doctors (and a free physical), because I worked on the healthcare industry for many years and made friends, but a most people don't have any of that.

    CHM sounds nice, but it's not an insurance and you get the whole bill, which then you forward to them for charity reimbursement. It's charity care, not insurance. It's not a solution to the cost problem at all.

    You first recommend buying discount drugs from Canada (which big pharma made sure it's illegal, BTW), but then tell me that cost-control kills research here in the US? I mean, who do you think it's subsidizing Canada's cost controls? We, the suckers that live in the US, and pay 40x more for the same drug.

    Fortunately we're making good money this year, and I'll probably will sign up for something at the end of the year. But that's besides the point: the cost problem is very real and unaddressed, and until it is addressed, we're going to continue being the suckers.

    One thing I though was positive about Barrycare is that it shook the status quo, which, IMO, was a good thing, even if ACA itself was . Hopefully we stop being suckers, move to something like a mixed single-payer system, like the rest of the modern world, tbh... unfortunately, there's too much money in this thing to do what's better for the American people.

  13. #63
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    BTW, I'm not against your comparison shopping strategy for non-catastrophic coverage, but HSAs don't reduce costs by themselves. Doctors have to pay for the machines and supplies too. There's no such thing as a thriving compe ive market for a lot of that stuff. Heck, getting devices or supplies approved is a major cost sink already, so it's little surprise certain megacompanies enjoy certain monopolies in some of those areas (like GE Health, etc).

    And again, we hit the patent problem. Can we really wait 8 years or so to go from catscans to MRI because a company wants to milk it? How many Americans have to die so a few fatcats can stuff their pockets?

  14. #64
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    Here in New Jersey, the cheapest catastrophic insurance for an individual like me is ~$300 a month. And that's with subsidies and like a $4000 deductible. I looked, it's an absolute rip off. I'm also generally a healthy individual that's not too old either.

    I actually do have access to doctors (and a free physical), because I worked on the healthcare industry for many years and made friends, but a most people don't have any of that.

    CHM sounds nice, but it's not an insurance and you get the whole bill, which then you forward to them for charity reimbursement. It's charity care, not insurance. It's not a solution to the cost problem at all.

    You first recommend buying discount drugs from Canada (which big pharma made sure it's illegal, BTW), but then tell me that cost-control kills research here in the US? I mean, who do you think it's subsidizing Canada's cost controls? We, the suckers that live in the US, and pay 40x more for the same drug.

    Fortunately we're making good money this year, and I'll probably will sign up for something at the end of the year. But that's besides the point: the cost problem is very real and unaddressed, and until it is addressed, we're going to continue being the suckers.

    One thing I though was positive about Barrycare is that it shook the status quo, which, IMO, was a good thing, even if ACA itself was . Hopefully we stop being suckers, move to something like a mixed single-payer system, like the rest of the modern world, tbh... unfortunately, there's too much money in this thing to do what's better for the American people.
    But unlike CHM, HSA is like a debit card - at point of sale. Theoretically, with the cost savings of only a catastrophic policy, employer and/or user would pre-fund the HSA (or ac ulated from previous years or with my suggestion to be able to get funds from others). Let's use the existing CHM and pretend that it opens up to you - you pay $45 per month with a $5000 deductible [and $25/quarter for extra $100k coverage] - you put the difference between the $300 and $45 per month into an HSA - $255 per month and it ac ulates over time - from which you can use for routine events or eventually for the deductible in case of emergency. This system has worked since 1981 (without the HSA) and paid with taxed $s but other than ALL the special interests which would be against a model like this, why could this not be a viable, cost-effective healthcare model? I have used CHM, shopped and paid for routine care (and been astounded at how cheap it really is paying DIRECTLY to the provider) and it is far cheaper than Obamacare or what came before - even paying for everything with taxed dollars.

    I didn't know big pharma made buying discount drugs from Canada illegal. It wasn't a couple years ago but then Lipitor came off patent and my parents didn't hit the doughnut anymore. Yes, we are the ones subsidizing it but how do you think imposing cost controls will encourage research of new drugs? So do we not have new drugs/medical equipment if there is no profit incentive and therefore research money? What are your suggestions regarding the drugs?

    Sorry, but I don't agree with single-payer. Anything government gets into is usually rife with waste and inefficiency - also, without the profit motive, we will not attract the best and brightest as doctors, researchers, inventors, etc (you can see how little reimbursement there is for Medicaid patients). I prefer catastrophic insurance with heavy HSA use.

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    But unlike CHM, HSA is like a debit card - at point of sale. Theoretically, with the cost savings of only a catastrophic policy, employer and/or user would pre-fund the HSA (or ac ulated from previous years or with my suggestion to be able to get funds from others). Let's use the existing CHM and pretend that it opens up to you - you pay $45 per month with a $5000 deductible [and $25/quarter for extra $100k coverage] - you put the difference between the $300 and $45 per month into an HSA - $255 per month and it ac ulates over time - from which you can use for routine events or eventually for the deductible in case of emergency. This system has worked since 1981 (without the HSA) and paid with taxed $s but other than ALL the special interests which would be against a model like this, why could this not be a viable, cost-effective healthcare model? I have used CHM, shopped and paid for routine care (and been astounded at how cheap it really is paying DIRECTLY to the provider) and it is far cheaper than Obamacare or what came before - even paying for everything with taxed dollars.
    Why do I pay $45 a month if I have to fork off a $5000 deductible out of pocket? That's crazy. $5000 is a lot of money. For $5000 you get amazing healthcare, and not on third world holes, but countries like Germany. People here in the US really have a completely distorted idea of what the costs of care are. Aside that incident last year, which was the first ever for me, I've never ever in my life spent more than $500 in healthcare in a single year. So what's the point of handing out $45 a month?

    And HSA is a savings account. To get the highest interest rate (0.25%), you have to have at least a $10000 balance. That interest rate can't even keep up with inflation, much less how much gouging goes on in healthcare prices in the US. The math just doesn't add up. Not only that, it doesn't address cost, because you're still paying full price for all services. How does that discourage pricing to what the market will bear? It doesn't.

    I didn't know big pharma made buying discount drugs from Canada illegal. It wasn't a couple years ago but then Lipitor came off patent and my parents didn't hit the doughnut anymore. Yes, we are the ones subsidizing it but how do you think imposing cost controls will encourage research of new drugs? So do we not have new drugs/medical equipment if there is no profit incentive and therefore research money? What are your suggestions regarding the drugs?

    Sorry, but I don't agree with single-payer. Anything government gets into is usually rife with waste and inefficiency - also, without the profit motive, we will not attract the best and brightest as doctors, researchers, inventors, etc (you can see how little reimbursement there is for Medicaid patients). I prefer catastrophic insurance with heavy HSA use.
    That's why I prefer a mixed system, like in a lot of counties like Australia or Germany (IIRC, Germany is multi-payer, but basically the same thing). You get the base coverage from the state, with price controls, and if you want better service and can afford it, then you can go purchase a private plan. But you don't have to worry about going bankrupt if you hit the emergency room. Not only that, our system is absurdly inefficient. People crowd emergency rooms for regular care, then get billed a ton of money, most of which is never paid and the government ends up footing the bill for anyways. The expansion of Medicaid was supposed to alleviate that, but it really hasn't happened.

    I can't deny I feel like a sucker for actually being a stand up individual and paying every one of those bills.

    As far as research, there's still money to be made there, even if it's not the $500 billion dollars a year (of which half end up going to marketing anyways). Price control doesn't mean sell at cost. Plus, we were researching a ton of drugs and devices in universities, here in the US and overseas, way before we had the full blown corporatization of healthcare. Heck, a lot of these drugs and discoveries are actually researched in universities, some of them federally subsidized, then sold for exploitation to some company. Furthermore, research nowadays is guided towards what can reap more profits, not actually what people really need. We have a crisis in anti-biotics now with all new kinds of superbugs, but, hey, the money is on anti-cancer now.

  16. #66
    🏆🏆🏆🏆🏆 ElNono's Avatar
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    BTW, I enjoy the conversation, even if we don't agree on every (or most) things. I think this stuff needs to be talked about more, tbh... instead of the echo chamber that is our politics today.

  17. #67
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    BTW, I enjoy the conversation, even if we don't agree on every (or most) things. I think this stuff needs to be talked about more, tbh... instead of the echo chamber that is our politics today.
    Ditto - nice to toss around ideas without the partisan stuff and name calling - one thing for sure, we can't keep going on like this in healthcare - it's gonna bankrupt us.

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    Y'all are naive if you think the USA is going to stop over-paying for healthcare by $1T+ per year.

    Will you ever get the message that the USA is owned and operated by VRWC/1%/BigCorp through their corruption/ownership of politicians to suck wealth from the 99%?

    Hillary tried to get costs down "too much" and so her health plan was "Harry and Louise-d" to death by BigHealthCare.

    ACA survived ( didn't get "Harry and Louise-d" )only because it didn't address health care cost as the fundamental problem.

    ACA was "3rd world" humanitarian effort to get health care for "third world" Americans.

    Reducing healthcare cost is reducing Big HealthCare profits. Ain't gonna happen.

    Medicare/Medicaid set prices, and lots of providers refuse those patients, not enough profit.

  19. #69
    dangerous floater Winehole23's Avatar
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    The relative decline of St. Louis—along with that of other similarly endowed heartland cities—is therefore not simply, or even primarily, a story of deindustrialization. The larger explanation involves how presidents and lawmakers in both parties, influenced by a handful of economists and legal scholars, quietly altered federal compe ion policies, an rust laws, and enforcement measures over a period of thirty years. These changes, which enabled the same kind of predatory corporate behavior that took the Rams away from St. Louis, also robbed the metro area of a vibrant economy, and of hundreds of locally based companies. This economic uprooting, still all but unaddressed by today’s politicians or presidential candidates, accounts for much of the relative stagnation of other Middle American communities, and for much of the anger roiling voters this election cycle.
    http://washingtonmonthly.com/magazin...ould-be-angry/

  20. #70
    dangerous floater Winehole23's Avatar
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    The Interstate Commerce Act of 1887 applied common carriage rules to railways, and sapped their industrialist owners of the power to discriminately pick winners and losers. The Sherman An rust Act of 1890 addressed the anticompe ive practices of monopolists. Years later, the Mercantile National Bank of St. Louis president Festus J. Wade celebrated these laws, especially a 1912 decision based on them to break up a railroad monopoly that was choking off commerce from entering the city. “Railroad managers,” he said, “can no longer combine against an industry and crush it out of existence because of a disagreement with the head of a manufacturing establishment.”


    The Federal Reserve Act of 1913 created a central banking system in which decisions over national monetary policy were made by twelve regional Federal Reserve banks, one of which was built (and still exists) in St. Louis. The McFadden Act of 1927 likewise dispersed lending activity by confining national banks to their headquartered states. This rule preserved the flow of capital within local communities, made bankers attuned to their community’s needs, and prevented New York financiers from gobbling up St. Louis banks. It also addressed the public’s concern that if large banking organizations operated in multiple regions, they would evade adequate supervision.


    The Packers and Stockyards Act of 1921 broke up the “Big Five” meatpacking cartel that previously had manipulated prices across the nation, giving undue preference to certain businesses and localities, and controlling non-meat production in the warehousing, wholesale, and retail industries. That move gave smaller companies like the St. Louis Independent Packing Company, of the famed “Mayrose” jingle, the opportunity to compete fairly.


    The Wheeler-Rayburn Act of 1935 prohibited electricity, gas, and water utilities from speculating in unregulated businesses with ratepayers’ money and ensured that companies like Union Electric would remain locally headquartered and focused. The Robinson-Patman Act of 1936 protected small retailers by prohibiting manufacturers from giving larger discounts to chain stores, and the Miller-Tydings Act of 1937 did the same by permitting manufacturers to set a minimum price at which their goods could be sold. These laws safeguarded local-area retailers like Central Hardware and Bettendorf-Rapp supermarkets, as well as neighborhood pharmacies, bakeries, restaurants, clothing stores, and grocers—including those servicing the city’s predominant minority and African-American communities (see “Redlining From Afar”).


    After World War II, Congress continued strengthening these anti-monopoly laws. The 1950 Celler-Kefauver Act, for instance, closed a loophole that allowed companies to thwart compe ion by gobbling up compe ors’ regional suppliers. At the Wholesale Grocers Association convention held in St. Louis, the law’s cosponsor, Tennessee Senator Estes Kefauver, declared that the 1950 act would “blast out those pillboxes of monopoly . . . that threaten our free enterprise.”

  21. #71
    dangerous floater Winehole23's Avatar
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    under the Reagan administration, the federal government fundamentally changed course on an rust enforcement. The Reagan Justice Department wrote new guidelines that rejected regional equity or local control as considerations in deciding whether to block mergers or prosecute monopolies. Enforcers were instructed to wave through mergers and tolerate consolidation, as long as there was no active collusion and consumers didn’t immediately suffer higher prices. Even more, Reagan’s administration cut the budgets of the Federal Trade Commission and the Department of Justice, leaving both agencies with limited resources for enforcement.

    Between 1980 and 1985, sixty-two Fortune 500 companies were subject to corporate takeovers, and the single greatest increase in corporate acquisitions in U.S. history took place between 1984 and 1985. This relaxed enforcement philosophy, compounded by other legislative action, quickened the consolidation of specific industries.


    Throughout the 1980s, state politicians chiseled away at restrictions on interstate banking, and in 1994 the Clinton administration followed suit with the passage of the Riegle-Neal Interstate Banking and Branching Efficiency Act. Since 1984, the number of independent banks has fallen by more than half, from 15,663 to 6,799 in 2011. Of those now-defunct banks, more than 8,352 either merged or were consolidated.

  22. #72
    dangerous floater Winehole23's Avatar
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    These changes in anti-monopoly policy also affected local retailers. The Consumer Goods Pricing Act of 1975 overturned the Miller-Tydings Act of 1937, and led to the end of most “fair trade” laws. In the early 1980s, the Reagan administration’s Justice Department and FTC stopped enforcing the Robinson-Patman Act. Together, these changes led to consolidation among retailers and gave the new mega-retailers tremendous power over their suppliers.

  23. #73
    dangerous floater Winehole23's Avatar
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    The economic fates of their communities may not be the result of their own failings, or of an inability to lure educated “creative class” types, or of off-shoring or deindustrialization, or of the workings of a mysterious and immutable free market. Rather, their fates may be the result of decisions in Washington, influenced by a small group of legal scholars and economists, to overturn an rust laws passed by elected officials of both parties over the course of the twentieth century. These decisions quietly changed the rules of America’s economy to be more like the NFL’s, in which monopoly power isn’t fought but catered to, in which economic opportunity isn’t disbursed but consolidated, in which fewer cities—and fewer Americans—get a fair chance to compete.

  24. #74
    dangerous floater Winehole23's Avatar
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    ergo, inequality isn't a natural side effect of capitalism. capitalism needs the not so hidden hand of government to achieve that.

    politics counts too.

  25. #75
    Veteran Th'Pusher's Avatar
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    ergo, inequality isn't a natural side effect of capitalism. capitalism needs the not so hidden hand of government to achieve that.

    politics counts too.
    I don't know that you can draw that conclusion based on what you've posted. You've presented a case that government policy can exacerbate inequality. I don't think you've shown that unfettered capitalism would not also result in the same or worse.

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