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Old 11-26-2016, 08:40 PM
 
142 posts, read 103,135 times
Reputation: 50

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It will be repealed fully and even Trump can't stop it anymore.

 
Old 11-26-2016, 08:43 PM
 
18,794 posts, read 8,420,430 times
Reputation: 4125
Quote:
Originally Posted by ALackOfCreativity View Post
Hm, you make a good point. There's a balance to be struck with not having copays so high that they discourage needed care and I have never heard of the transfer issue before but that does make sense. Is there any literature on that (I trust your POV as a doctor [apologies if you're not, thought you were] so believe you without it, just genuinely curious)?
I have no link, yes I'm a doc. Insurance companies might know since they would want to know the risks/losses vs copays/outcomes.
 
Old 11-26-2016, 08:43 PM
 
1,850 posts, read 817,604 times
Reputation: 815
Quote:
Originally Posted by ALackOfCreativity View Post
Okay, sure, agreed, people won't use enough preventative care and will use too much ER care and to a lesser extent too much inpatient care regardless of copay structure. That's the default. I'm not saying that smart plan design can improve on that default. Simply that through it you can offer subsidized care without making that default much worse than it already is. You will do some harm, but the level can be managed.

Your beef seems to be more to do with EMTALA than with the ACA. Which, I dunno, do you really want the ER doc turning you away because you left your insurance card at home the day you got into a car wreck or had a heart attack?
Actually, you don't get "turned away because you left your insurance card at home." You get treated and are allowed to prove you have insurance at any point you want. I'm sure you actually know that, however.


Also, you blandly state that "you can offer subsidized care without making that default much worse than it already is" with no evidence. It's like when Obama just blandly said that insuring the uninsured would save money when everyone knew he was blatantly lying. Talk is cheap.
 
Old 11-26-2016, 08:49 PM
 
1,850 posts, read 817,604 times
Reputation: 815
Quote:
Originally Posted by Hoonose View Post
A public option would be just that, open to the public. Rich or poor. And like you I would support the continuance of relatively free market HC options as well. From both the HC delivery and the provider side. Many docs don't want to be forced to participate in any public option.
Ah, so you generously allow people to decide whether they want to have their healthcare paid for by other people or not. That's interesting.
 
Old 11-26-2016, 08:57 PM
 
20,187 posts, read 23,806,587 times
Reputation: 9283
Obamacare is going to be repealed... get ready for Trumpcare... I know you liberals hate the idea that Trumpcare is going to be legacy where the name lives on... even Obama hates it... Merry Christmas...
 
Old 11-26-2016, 08:58 PM
 
Location: Living rent free in your head
42,783 posts, read 26,093,782 times
Reputation: 33927
Quote:
Originally Posted by njquestions View Post
I think you're not grasping my point, so let me try to clarify.

It doesn't matter if you or I have a copay. First of all, as I said, it is indisputable that even people who have insurance through private sources (like their job and not the government) do not follow maintenance and prevention schedules for their health. I presume you wouldn't dispute that. It is equally clear that people who are given their insurance by the government or heavily subsidized by the government do not then go out and enthusiastically start going to maintenance and prevention visits. You could actually make it free to go to a doctor's office for a poor person (assuming you could find someone who would accept their terrible government insurance) and it's likely they wouldn't go because they often find it too onerous to make and keep an appointment. Instead, they just utilize the ER, which they always have, which is what is seen. There is NOBODY who claims that ER visits are declining as the poor "appropriately" now go to see primary care doctors. Not even Obama claims that.

Meanwhile, on the flip side of things, these poor patients with numerous medical problems that they don't maintain or care about wait until they have some critical problem and then appear at a hospital and utilize hundreds of thousands of dollars of care. They receive all the best testing, get to see all the best specialists available, could get transferred to higher level hospitals, get any surgeries and medicines they need, and are even maintained on life support for as long as they need if they need it. In other words, they pay little to nothing and utilize vast amounts of resources. And liberals want people to believe that's sustainable and, in fact, that this will actually save people money, which turned out to be a predictable lie.
Part of the problem with overutilization of ER's by people on medicaid is that there aren't enough primary care physicians who will accept medicaid patients. It's not fun or convenient to go to an ER, sometimes there is a wait of several hours, but if you have a kid running a high temperature and you either can't find a local doctor or they are booked up for weeks, you go to the ER. And if you research the subject, you would find that most people who go to the ER do so with a condition that warrants them being there. .

And the other problem is that even with private insurance, Doctors frequently can't see you for several weeks. Several years ago my husband became ill but didn't feel that he needed to go an ER. He called his doctor who said they couldn't see him for two weeks, so they told him to go to the ER which was totally unnecessary & at the time we had excellent employer sponsored insurance.

I think part of the problem is that you are basing all of your arguments on a set of preconceived ideas about the poor being irresponsible, lazy wastrels which is simply not true.
 
Old 11-26-2016, 09:00 PM
 
31,955 posts, read 14,955,784 times
Reputation: 13594
Quote:
Originally Posted by njquestions View Post
Thanks for admitting that a socialized system cannot support itself without vast amounts of funding from people who don't participate in it. You're a very honest person.
Everyone needs to participate in our healthcare system. Young people think they are immuned. But what if they have a car accident or get cancer. Why do the rest of us have to pay for their stupidy
 
Old 11-26-2016, 09:02 PM
 
1,850 posts, read 817,604 times
Reputation: 815
Quote:
Originally Posted by natalie469 View Post
Everyone needs to participate in our healthcare system. Young people think they are immuned. But what if they have a car accident or get cancer. Why do the rest of us have to pay for their stupidy
Agreed. And why should anyone be forced to pay for anyone else's stupidity?


You see, you have it absolutely right, you just don't follow your statement to its logical conclusion.
 
Old 11-26-2016, 09:03 PM
 
3,614 posts, read 3,871,447 times
Reputation: 2293
Quote:
Originally Posted by njquestions View Post
Actually, you don't get "turned away because you left your insurance card at home." You get treated and are allowed to prove you have insurance at any point you want. I'm sure you actually know that, however.
I do know that. It's the law. However, I don't see a way to address your complaints without changing that.


Quote:
Also, you blandly state that "you can offer subsidized care without making that default much worse than it already is" with no evidence. It's like when Obama just blandly said that insuring the uninsured would save money when everyone knew he was blatantly lying. Talk is cheap.
Copay differentials work. You can still subsidize the majority of the cost while generating a fraction of the additional wrong-place-of-service care if you set the copay within the right band of levels. IMO this is prima facie obvious however since you asked for data:

http://www.namcp.org/journals/jmcm/a.../copayment.pdf
 
Old 11-26-2016, 09:05 PM
 
31,955 posts, read 14,955,784 times
Reputation: 13594
Quote:
Originally Posted by njquestions View Post
Agreed. And why should anyone be forced to pay for anyone else's stupidity?


You see, you have it absolutely right, you just don't follow your statement to its logical conclusion.
Well duh, we all pay for the uninsured.
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