quote:

What did people do before and would again? Bankruptcy

See above. I would carry a high-deductible catastrophic plan at a reasonable cost and cover my high deductible with my HSA. I don't buy car insurance for oil changes, nor would I want a third party payer for most of my routine doctor bills.
Yes, some people would "fall between the cracks" either due to their own incompetence or some disaster beyond their control.
See charity above.

quote:

Certainly the entire regulatory framework is not something that will be eliminated. Isn't a health care regime without regulation a practical myth?

Perhaps, but just because something has been really screwed up for a long time doesn't mean you have to go on making the same mistakes just because that's what you are used to.

Usually, that's the kind of thinking that causes entire societies to collapse. We're probably nearly there with debt, and all of these unfunded liabilities (promises) made by government move us in that direction.

quote:

Originally posted by Redford1970:
Pre-Existing Conditions PRE ACA

If you bought INDIVIDUAL insurance and liked changing carriers periodically, you had a big problem.

If you were in a GROUP PLAN, you generally were in good shape, even if your Employer moved his coverage periodically. MOST group plans in my State did not have a Pre-Ex clause. Some of those who did still paid on Pre Ex Conditions but only up to $5000 in the first year, after being in a premium paying status for 12 months, there were no exclusions, 18 months for dependents.

As an aside, NONE of our HMO plans have had Pre Ex in decades, thanks to the marketplace (union demands).

Before ACA, 80% of insured Americans were in GROUP PLANS, the Rest in Individual plans. The group plans I am speaking of were at least 50 employees in size.

We started in a Group plan and were allowed to convert to a portable individual plan with no preexisting conditions exclusion. A lot of people made choices as the years rolled by.

Insurance companies aren't gonna' let people have another cut at that ball.

quote:

Insurance companies aren't gonna' let people have another cut at that ball.

I really don't care about insurance companies... I care about people and about treatment.
Insurance companies that don't offer what people want to buy go bankrupt. Who cares? Let them.

Some of you just don't seem to have much faith in your fellow man. You seem to think that unless forced, no one will do the right thing or show compassion. Doing the right thing means doing it when you are not forced and when no one is looking over your shoulder.

Another thing that would go a long way would be pricing. At least to the extent that a person seeking treatment knows what that is.

What other business are you aware of that can't give you any pricing until you receive the bill in the mail?

As a consumer, I want to be able to compare prices between providers. This would also force providers to compete with one another on price.

quote:

This would also force providers to compete with one another on price.

Ahem, "force" is what government uses.
Competition is based on voluntary agreement, a meeting of the minds, between willing participants.
But other than the word 'force', exactly so.

quote:

Originally posted by chellim1:

quote:

What did people do before and would again? Bankruptcy

See above. I would carry a high-deductible catastrophic plan at a reasonable cost and cover my high deductible with my HSA. I don't buy car insurance for oil changes, nor would I want a third party payer for most of my routine doctor bills.
Yes, some people would "fall between the cracks" either due to their own incompetence or some disaster beyond their control.
See charity above.

That's it then? Charity? Too bad for those who may get sick during whatever transition period there may be?

Anyway, your proposition was that Obamacare should be immediately repealed without putting anything in its place for a transition. Your proposition is that something would be figured out during the two years.

If you are in the industry, then what would happen the next day? A given person in Obamacare would have no insurance after the monthly premium period lapsed or on whatever phase out schedule, leaving the consumer on his/her own?

Insurance companies would then scramble to create and market new contracts to consumers? How long would that take? And, if the transition was still being considered over two years, how could a company or person make an informed decision on how to proceed?

Hospitals would provide surgery to those signing away everything to get emergency care and the consumer would file bankruptcy, resulting in none of the doctors or hospitals and other incidental creditors being paid.

Negotiated rates to keep the cost of hospital care would not be of effect so consumers would receive impossibly inflated bills even if they could pay?

It seems to me that the system has a lot of moving parts. Do you not think your approach would create personal distress and economic chaos?

After all was said and done, why would rates necessarily go down? It is not as though the federal legislation will control what sovereign states may legislate into existence/perpetuation.

quote:

Hospitals would provide surgery to those signing away everything to get emergency care and the consumer would file bankruptcy, resulting in none of the doctors or hospitals and other incidental creditors being paid.

The wild, wild west. Blood in the streets everywhere. No one would get paid, all hospitals would close. Everyone would starve too because the government hasn't set up 'food exchanges' and 'minimum standards' on what you can put in your grocery cart.

quote:

Do you not think your approach would create personal distress and economic chaos?

No. I think the personal distress and economic chaos has already been caused by too much government intervention.
A phase out period would give most people time to negotiate something better than Obamacare.

quote:

After all was said and done, why would rates necessarily go down? It is not as though the federal legislation will control what sovereign states may legislate into existence/perpetuation.

True... I believe in federalism but I also believe in the interstate commerce clause of the Constitution. State regulation of insurance has to be limited to encourage nationwide competition, like auto insurance.

quote:

Originally posted by Tubetone:
A given person in Obamacare would have no insurance after the monthly premium period lapsed or on whatever phase out schedule, leaving the consumer on his/her own?

Can we get real for a moment. Millions of people have insurance 'cards' thanks to BarryCare. They do not however have healthcare because 1) they can't begin to afford the deductibles and co-pays, and 2) Many doctors simply won't see people in BarryCare plans. So many low income folks (just like illegals) are still hitting the ER when they turn up sick.

quote:

Insurance companies would then scramble to create and market new contracts to consumers? How long would that take?

All I know is that private industry will adapt and overcome far faster and efficiently than government to any given issue, so long as government butts out of the equation.

quote:

It seems to me that the system has a lot of moving parts. Do you not think your approach would create personal distress and economic chaos?

And what are we seeing with the current BarryCare system beyond massive personal stress and economic chaos. Welfare freeloaders don't care about any of this as they will simply transition back to emergency room care (assuming they ever made a change in the first place). The folks who were forced from their plans by BarryCare and made to endure massive cost hikes and deductible and co-pay increases would likely welcome any form of relief to get out from under their current plans they can't afford to pay for or use.

Knock down as many barriers to competition as possible and let market forces drive the solution(s).

Welcome, bigdeal. I think the underlying problem is:

quote:

Underlying most arguments against the free market is a lack of belief in freedom itself. - Milton Friedman

and...

quote:

The first lesson of economics is scarcity: there is never enough of anything to fully satisfy all those who want it. The first lesson of politics is to disregard the first lesson of economics.
- Thomas Sowell

quote:

Originally posted by chellim1:

quote:

Insurance companies aren't gonna' let people have another cut at that ball.

I really don't care about insurance companies... I care about people and about treatment.
Insurance companies that don't offer what people want to buy go bankrupt. Who cares? Let them.

Some of you just don't seem to have much faith in your fellow man. You seem to think that unless forced, no one will do the right thing or show compassion. Doing the right thing means doing it when you are not forced and when no one is looking over your shoulder.

I don't care about insurance companies as much as I care the benefit they provide to the consumer.

The bankruptcies to which I referred were the consumers. Shouldn't that be a concern as you refer to the impact on patients?

Ha. That hospitals and doctors and medical providers will not destroy a sick person with their billing practices does not comport with many clients over many years. Idealism about what happens is no substitute for consumers suffering under such experiences.

I have seen some wonderful kindnesses, too, but I see a lot of the other.

I already expressed an appreciation for co-ops, for instance. There are many market based solutions but I was referring to your proposition that Obamacare should be repealed immediately while hoping something will be worked out during the next two years.

Republicans have had decades to educate the public about a better way but have failed to do so. For the last eight years the Republicans, including conservatives, have had the chance to work out some solution but couldn't get it done - so far.

No. This doesn't need another two years. It needs to be fleshed out now. Well, at least that is the way it seems to me.

I, too, want Obamacare fully repealed but to get more than 17% of the people behind it, I think it will need more clarity among the patients and work among the legislators.

quote:

I don't care about insurance companies as much as I care the benefit they provide to the consumer.
The bankruptcies to which I referred were the consumers. Shouldn't that be a concern

If they don't provide a benefit to the consumer people won't buy the product and they go out of business. Someone else will provide something that people want to buy.
Yes... to prevent personal bankruptcy see catastrophic coverage, etc... above.

quote:

I, too, want Obamacare fully repealed

Alrighty, then. Welcome aboard!

quote:

Originally posted by chellim1:
Welcome, bigdeal. I think the underlying problem is:

quote:

Underlying most arguments against the free market is a lack of belief in freedom itself. - Milton Friedman

and...

quote:

The first lesson of economics is scarcity: there is never enough of anything to fully satisfy all those who want it. The first lesson of politics is to disregard the first lesson of economics.
- Thomas Sowell

Nice fluffy quotes but philosophy is one thing and practical reality is another.

Please talk of practical solutions if you might. Trust busting resulted from increased prices brought about by monopolistic pure market activities. Many interventions in free market philosophy were and are needed for practical reasons.

Referring to a high priest is the kind of thing that distances people from embracing purely philosophical appeals.

My view is that if a man is desperately treading water, he does not seek philosophy.

quote:

Originally posted by chellim1:

quote:

The bankruptcies to which I referred were the consumers. Shouldn't that be a concern

Yes... see catastrophic coverage, etc... above.

quote:

I, too, want Obamacare fully repealed

Alrighty, then. Welcome aboard!

Uh. I have always been aboard.

I was hoping President Trump had a plan, at least, to gut it in pieces. I believed he had a strategy toward that end that he and a very knowledgeable Mr. Price had in mind.

President Trump made promises and I do expect him to work toward fulfilling them.

I've always thought of Milton Friedman as the most practical of economists since .... Mises, perhaps even Adam Smith. The problem with most 'experts' today is that they are too abstract and not nearly as practical.

quote:

Please talk of practical solutions if you might. Trust busting resulted from increased prices brought about by monopolistic pure market activities. Many interventions in free market philosophy were and are needed for practical reasons.

Standard Oil is the classic example given for anti-trust intervention. I just disagree. I think the market provides a solution to monopolies. They may set high prices but they never last long because they create the environment for some young entrepreneur to find a way to deliver the product at a better price.

quote:

Originally posted by chellim1:

quote:

I don't care about insurance companies as much as I care the benefit they provide to the consumer.
The bankruptcies to which I referred were the consumers. Shouldn't that be a concern

If they don't provide a benefit to the consumer people won't buy the product and they go out of business. Someone else will provide something that people want to buy.
Yes... to prevent personal bankruptcy see catastrophic coverage, etc... above.

Average people cannot afford catastrophic coverage already. What man or woman earning $50,000.00 per year can reasonably afford $1,500.00 per month for two people with a $10,000.00 per year per person deductible?

quote:

Originally posted by chellim1:
I've always thought of Milton Friedman as the most practical of economists since .... Mises, perhaps even Adam Smith. The problem with most 'experts' today is that they are too abstract and not nearly as practical.

If I haven't been speaking in practical terms, well... I give up.

To me, the Freedom Caucus and others wanting a straight forward "repeal and wait" strategy should give details to consumers.

Practical things like how long will it take to have the market process work itself through would be nice. Why not a test project to move things from philosophy to a concrete example?

Practical things as to how to keep someone from bankruptcy or charity during a transition would be nice.

Practical things like how and, more importantly, why things would be better than before under a repeal only approach. Who's to say that prices would go down? Test project not philosophy?

Practical things like saying why repeal is better than letting the Obamacare collapse unfold.

These are the types of practical answers that would help move things forward.

I love philosophy but that's not where patients find themselves.

If only they could mail a quote from Friedman to pay the bill.

quote:

Average people cannot afford catastrophic coverage already. What man or woman earning $50,000.00 per year can reasonably afford $1,500.00 per month for two people with a $10,000.00 per year per person deductible?

Is that due to too much competition, or too much government intervention?

quote:

Test project not philosophy?

~ sigh.... you've worn me out.

How about this?
The two areas that I can think of that have had the MOST government involvement and intervention are health care and education. Those are also the two areas that have had the MOST price inflation over the last 30-40 years.

quote:

Originally posted by chellim1:

quote:

Average people cannot afford catastrophic coverage already. What man or woman earning $50,000.00 per year can reasonably afford $1,500.00 per month for two people with a $10,000.00 per year per person deductible?

Is that due to too much competition, or too much government intervention?

That is unclear. It would sure be nice to have some facts on that.

The way you pose it, it seems to me to just lead to philosophy.

Maybe the answer is neither. Maybe it has to do with uncertainty.

Maybe it has to do with such unequal bargaining power that the everyman has no way to effectively scream "NO!!!" into the healthcare void?

quote:

Originally posted by chellim1:

quote:

Average people cannot afford catastrophic coverage already. What man or woman earning $50,000.00 per year can reasonably afford $1,500.00 per month for two people with a $10,000.00 per year per person deductible?

Is that due to too much competition, or too much government intervention?

quote:

~ sigh.... you've worn me out.

I appreciate all of your ideas and discussion in this matter. I gather this stuff is some part of your day gig so you deserve a break.

It seems to me that comparing tuition to life and death healthcare costs is not a good match up. The forces driving healthcare and tuition are not the same. But, if the government provided low interest loans and hardship forbearance for surgery, the costs may have risen even more.

Market forces seek profit. Once there is an open ended supply of money, the market would just as soon have it.

quote:

Education is a tax expenditure and health care is a private expenditure.

College.... we are talking college tuition. See the graph above. Education is heavily subsidized by government in the form of grants and student loans but most people pay tuition either directly or by borrowing money.
And what has all of that subsidy brought? Beautiful campuses but very high prices.