Avik Roy, a conservative health policy specialist, has published an article in Forbes on the Senate bill:

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The hotly-anticipated Senate Republican health care bill came out on Thursday morning. The airwaves quickly filled up with predictable talking points from both sides. But once the dust settles, it will emerge that the Senate bill will have far-reaching effects on American health care: for the better.

Link

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Addressing right-wing complaints

Some on the right are complaining that the Better Care Reconciliation Act doesn’t do enough to repeal Obamacare, echoing those on the left in 2010 who complained that Obamacare wasn’t a single-payer bill.

Full repeal was never going to be possible in a Senate where Republicans did not control 60 votes. And furthermore, we have learned that moderate Republicans in both the House and the Senate have no appetite to fully deregulate Obamacare at the federal level.

But any Republican conservative in the Senate who is thinking of voting “no” on this bill: how many times in your life will you have the opportunity to vote for a bill that fundamentally transforms two entitlement programs? How often will you get to vote for a bill that cuts spending by hundreds of billions of dollars? How often will you get a chance to make a difference for millions of your constituents who are struggling under the weight of rising premiums and exploding deductibles?

As Sen. John Cornyn (R., Tex.) put it on Thursday, “it’s time to put up or shut up.”

I know most of here are aware of this, but the Congress is approaching from the wrong premise. The repeal bill should be presented from the premise that government has no place in health care or health insurance.

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Originally posted by bcereuss:
I know most of here are aware of this, but the Congress is approaching from the wrong premise. The repeal bill should be presented from the premise that government has no place in health care or health insurance.

Unfortunately that ship has sailed. I think even with 60 votes, the GOP would not do a clean repeal of Obamacare. It is now established that the federal government must regulate health insurance and provide subsidies for people to buy it. As with all entitlement programs, we now have the party of big government and party of slightly less big government. The program will be expanded and trimmed around the edges depending on who is in power, but the basic framework is a permanent feature now unless there is a tectonic shift in the political culture.

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The Senate bill contrasts with the House-passed bill on several key planks. The Senate bill would cut Medicaid at a slower rate compared to the House’s American Health Care Act (AHCA) and offer more generous tax credits for older Americans. The Senate’s proposal would not allow insurers to set higher prices for people with pre-existing conditions compared to healthy people.

If those conditions stay in the bill it should be voted down. That's the exact type of meddling in the insurance market that got us where we are today.

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According to the Congressional Budget Office (CBO), the House’s AHCA would save $834 billion over the next ten years by cutting Obamacare’s Medicaid expansion.

When has the damn CBO ever been even in the same universe with the term 'accuracy' on anything they've scored. And even if by some stretch of the imagination they did get it right, color me totally unimpressed with those numbers.

Remember when we heard the lie "You can keep your doctor and plan if you like them" from the worst president in American history. Well, now we're being introduced to the GOP's version called "Repeal and Replace".

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Originally posted by bigdeal:

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The Senate’s proposal would not allow insurers to set higher prices for people with pre-existing conditions compared to healthy people.

If those conditions stay in the bill it should be voted down. That's the exact type of meddling in the insurance market that got us where we are today.

Conceptually I agree, but we need to be dang careful what we wish for. The criteria for "pre-existing" should at least be defined. A few decades ago, someone might be denied coverage or charged a higher rate because they had actually suffered a heart attack. Now, the same could happen because someone's cholesterol is high(with thresholds being ratcheted down with every new study). In the future, a DNA test might identify potential risks that would be used to justify high premiums for a person's entire life.

Of course, they may just set the standard premium very high and then offer "discounts" based on the level of hoops you are willing to jump through. How many meds are you willing to be on to get your cholesterol and BP down to some ridiculously low level? Are you willing to undergo an angiogram to prove you don't have pre-existing blockages? It goes on and on and is much more complex than the obvious abuse of someone buying insurance in the ambulance on their way to the ER.

Remember, the insurance companies have absolutely NOTHING to do with your health. They are in it to maximize profits and that is unlikely to align with what is in your best interest.

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Remember, the insurance companies have absolutely NOTHING to do with your health. They are in it to maximize profits and that is unlikely to align with what is in your best interest.

Few people are able to conceptualize the difference between health CARE and health INSURANCE. We are getting to the point where it's not really insurance.

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The Senate’s proposal would not allow insurers to set higher prices for people with pre-existing conditions compared to healthy people.

If there's no reason to buy it before you are sick it's not insurance.
Why can't you buy fire insurance after your house is on fire, or car insurance after the wreck? It's because insurance insures against a risk, underwritten by it's probable likelihood to happen. If you already have a disease or an illness it is 100% likely to happen. Then it's cost sharing or cost shifting, or charity, but it's not insurance.

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Originally posted by chellim1: If you already have a disease or an illness it is 100% likely to happen. Then it's cost sharing or cost shifting, or charity, but it's not insurance.

Absolutely agree, but how do you define the onset? Many diseases are detectable/predictable years or even decades before any symptoms or clinical manifestations.

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how do you define the onset? Many diseases are detectable/predictable years or even decades before any symptoms or clinical manifestations.

I admit, it's a problem. You don't have that problem with auto or fire insurance.
I suppose you would have to have policy language that defined the coverage and the limitations. These are the sort of things that are typically written by the insurance company to limit the exposure, and no one reads before buying. These are the things that can piss people off and give insurance companies a bad name.

The best solution, IMO, is for insurance companies to get out of managing routine care. The small stuff shouldn't be paid for by insurance at all and it will become more competitive when people shop around because they are paying out of pocket. That's the only way to actually bring down cost.

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Originally posted by MNSIG:

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Originally posted by chellim1: If you already have a disease or an illness it is 100% likely to happen. Then it's cost sharing or cost shifting, or charity, but it's not insurance.

Absolutely agree, but how do you define the onset? Many diseases are detectable/predictable years or even decades before any symptoms or clinical manifestations.

Well that's the reality. We all apply for insurance after the house is on fire. None of us make it out of this alive. It's only a matter of time.

Insurance companies want to insure people who will pay premiums while paying out as little as possible.

There is no reason that insurance is the only way to pay for health care. There are some co-ops and concierge services, for instance, that seem to be doing well at a lower cost.

Why not spend money to encourage competition rather than to indefinitely subsidize insurance companies?

Since Obamacare has made such a coerced mess, it seems a transition period would help ease the process - the process of seeing how health care may be available to all Americans.

To say that such availability is laudable and a worthwhile question for any society is not to say that health care is an entitlement from government.

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Insurance companies want to insure people who will pay premiums while paying out as little as possible.

There is truth in this, however, if they never paid out a claim, who would buy the coverage, health, car, house, those premiums have loss experiences factored in by actuarial tables run now by computers with sophisticated logarithms.

All this discussion about pre-x and how many different pills you have to take to get to a good solution, or xrays, etc are driven by several things, but it's not insurance companies alone.

Lawyers have driven health care givers to force unnecessary or excessive testing on physicians and hospitals to insure nothing was missed in case something goes wrong during your treatment so that John Morgan et al doesn't take several million dollars out of the medical equation through a settlement for medical malpractice.

Legal tort reform is needed, as is changed to the way the FDA handles medication, example the epi pen, where Mylan charged us customers and insurance thousands per pen, but in Africa it was pennies... The USA patients/insurance fund low cost medical supplies overseas.

We can have all these discussions on pre-x, cobra, etc but the fact is, doesn't matter if it's single payer or private market, you will be restricted, monitored, managed, and decisions will be made that impact your health.

Who do you want making those decisions, you with your medical provider and private health Insurance, or some government agency and bureaucrat deciding on how the taxpayer money should be spent to care for you during stage 4 cancer treatment at age 60...

The questions and decisions have to be made either way

June 24, 2017
Health Care's Four Horsemen
By Eileen F. Toplansky

Should the Senate Republican health care reform legislation pass, it will usher in another house of horrors just like Obama's patently not affordable health care law.

In 2008, Drs. Mark Albanese, George Mejicano, and Larry Gruppen, concerned about "a looming shortage of physicians" wrote about the "four horsemen of the medical education apocalypse" which include

teaching patient shortages, teacher shortages, conflicting systems, and financial problems. Rapidly expanding class sizes and new medical schools are coming online as medical student access to teaching patients is becoming increasingly difficult because of the decreasing length and increasing intensity of hospital stays, concerns about patient safety, patients who are stressed for time, teaching physician shortages and needs for increasing productivity from those who remain [.] Further, medical education is facing reductions in funding from all sources, just as it is mounting its first major expansion in 40 years. The authors contend that medical education is on the verge of crisis and that little outside assistance is forthcoming.

Indeed, the GOP bill will bring us even closer to another crisis.

Should the Senate GOP "repeal" bill pass, it will result in as Matthew Vadum illustrates "tinkering around the edges of the Obamacare system but leav[ing] the fundamentals of the failing program in place."

With only four courageous conservatives who have come out "against the language in the new draft bill" the American people must, yet again, rise up and demand a true repeal and replace bill. Sens. Mike Lee of Utah, Ted Cruz of Texas, Rand Paul of Kentucky, and Ron Johnson of Wisconsin are the only ones holding back the onslaught of what will eventually be a single-payer system in this country.

If Jonathan Gruber said that the Senate document is "no longer an Obamacare repeal bill [and] that's good" that should be more than sufficient evidence that this bill is not going to help Americans. Gruber, dubbed the "Obamacare architect was caught on tape admitting that Obamacare doesn’t provide subsidies for federally-run insurance exchanges [.]" In another video "Gruber said that 'the stupidity of the American voter' made it important for him and Democrats to hide Obamacare’s true costs from the public. 'That was really, really critical for the thing to pass,' said Gruber. 'But I’d rather have this law than not.' In other words, the ends -- imposing Obamacare upon the public -- justified the means."

Most Americans now understand that "Obamacare really is a huge redistribution of wealth from the young and healthy to the old and unhealthy" and Daniel Horowitz at Conservative Review explains that "everything [in the Senate bill] is working within the confines of the most extreme socialist baseline from the Obama era." Horowitz gets to the nub of the problem when he writes that to "avoid the endless semantics, lies, and perfidious distortions from GOP leadership on how they are 'repealing' Obamacare, let’s briefly describe the law."

Obamacare comprises five core elements related to health insurance (putting aside the burdens on health care itself): actuarially insolvent regulations; open-ended, means-tested subsidies; Medicaid expansion; the employer and individual mandates; and the tax increases.

Regulations: The foundation of Obamacare are the two dozen or so actuarially insolvent regulations designed to 'cover everyone' but that in turn have tripled premiums and are now destroying the entire individual market.

Subsidies: Because the regulations make insurance unaffordable, anyone below a certain income level is subsidized to purchase medical insurance. This, in turn, inflates the cost of insurance even more.

Medicaid expansion: In addition to subsidizing non-Medicaid patients to purchase unaffordable medical insurance (thanks to the regs), Obamacare dramatically expanded both the eligibility and the federal subsidy rate to the states for the program. The cost of covering an individual in the subpar Medicaid program was $3,247 per individual in 2011 before Obamacare was enacted. In 2015, according to data from the Department of Health and Human Services, the cost of enrolling an individual in Medicaid doubled, to $6,366 per individual. And that is only for the second year of implementation.

The funding mechanism of tax increases: In an attempt to make the government spending and the regulated private sector solvent, Obamacare levied over $1 trillion in tax hikes (over 10 years). Also, in order to ensure that younger individuals don’t game out the system by not purchasing insurance but then taking advantage of the new regulations forcing insurers to provide for those who already got sick, Obamacare enacted the individual mandate to force everyone to purchase insurance up front. It also forced all employers of large businesses to provide insurance plans so that more money would flow into the system. However, the regulations have been so insolvent that these mandates proved insufficient to fund the Ponzi scheme.

Horowitz asserts that the "Senate bill is essentially a more liberal version of the House bill, which, in itself, was a more insolvent version of Obamacare [.]" Thus, the market is not healed, "competition is not restored, and prices don't come down." Ergo, "nobody will be able to afford insurance, and everyone will need subsidies or Medicaid." In essence, "the GOP bill replaces Obamacare subsidies... with more subsidies."

In 2013 Sally Pipes wrote that "thanks to Obamacare a 20,000 doctor shortage is set to quintuple."

America is suffering from a doctor shortage. An influx of millions of new patients into the healthcare system will only exacerbate that shortage -- driving up the demand for care without doing anything about its supply. Those who get their coverage through Medicaid or the exchanges may feel the effects of the shortage even more acutely, as many providers are opting not to accept their insurance.

Right now, the United States is short some 20,000 doctors, according to the Association of American Medical Colleges. The shortage could quintuple over the next decade, thanks to the aging of the American population -- and the aging and consequent retirement of many physicians. Nearly half of the 800,000-plus doctors in the United States are over the age of 50.

Obamacare is further thinning the doctor corps. A Physicians Foundation survey of 13,000 doctors found that 60 percent of doctors would retire today if they could, up from 45 percent before the law passed. Doctors are also becoming choosier about whom they’ll see.

They’ve long limited the number of Medicaid patients they’ll treat, thanks to the program’s low reimbursement rates. According to a study published in Health Affairs, only 69 percent of doctors accepted new Medicaid patients in 2011. In Florida, just 59 percent do so. And a survey by the Texas Medical Association of doctors in the Lone Star State found that 68 percent either limit or refuse to take new Medicaid patients. Medicaid pays about 60 percent as much as private insurance. For many doctors, the costs of treating someone on Medicaid are higher than what the government will pay them.

As Pipes asserts, "[t]he first step in addressing America’s shortage of doctors is full repeal of Obamacare. And the second is the installation of market-based reforms in its place. That’s the best way to ensure that Americans can actually get care when they need it."

The Four Horsemen of the Apocalypse generally refer to the tribulations that will befall mankind. How wonderful it would be if the four congressmen who see through the myth-making of the GOP "repeal" plan would actually be victorious, for then the American people will reap the rewards and the devastating government overreach will be diminished. If the subsidies remain, that will "further distort the market and... in fact, after 2020 the subsidies are made even worse and go into the middle class."

Thus, the system will be completely insolvent and this time "the Republicans will actually own it."

http://www.americanthinker.com..._four_horsemen_.html

Much of the above article comes from here:

Senate GOP Launches Obamacare “Repeal” Bill
Is Obamacare here to stay if it passes?
http://www.frontpagemag.com/fp...l-bill-matthew-vadum

It's almost funny, the number of people who now accept that we just can't possibly repeal Obamacare without replacing it. We can't possibly expect people to pay for thier own shit.

All the talk is about how complex the issue is, so complex that it's gonna be so hard to fix. Congress is trying so hard to come up with a replacement that is workable. I think it's all a bunch of bullshit.

To elaborate: It's bullshit because it doesn't matter whether they get some Obamacare lite bill passed or not. It'll fail. Maybe it'll last a year or maybe a hundred, but it's doomed from the start.

It's a really, really simple problem with a really simple solution. It all boils down to a few fundamental truths.

When there are people who need it and can't pay for it, you gotta make the people who don't need it, pay for it. The problem is, there are so many in the first group, that the second group can't afford it.

So, simply put, they're spinning thier wheels. There's no way to create a workable socialist utopian healthcare system that works in the United States. As the comparative sizes of the two aforementioned groups continues to shift in favor of the first group, socialist healthcare becomes even less feasable.

To be workable, socialist healthcare requires a big productive class and a comparitively small non-productive class. Places where socialist healthcare appears to be, on some level, working are places that have a much higher number of productive than non-productive.

But even in those places, it's doomed in the long term. In the end, the socialist government destroys the productive class in favor of the non-productive, creating the very environment that is so destructive to socialism.

Can anyone point out a case where a non-socialist system turned socialist and afterward succeeded? It appears to me that in most cases of non-socialist systems turning more socialist, there was/is a decline and in most cases of socialist countries abandoning socialism, there is success.

My opinion, all attempts by the government to tweak Obamacare, are doomed in the long term.

Maybe they can tweak it so that it'll last 500 more years. Unlikely, but even then, it's still doomed. All socialist programs depend on the ratio of non-productive to productive, and serve to grow the non-productive class while shrinking the productive class.

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All socialist programs depend on the ratio of non-productive to productive, and serve to grow the non-productive class while shrinking the productive class.

Which is why they all collapse.
It's also why charity is the best way to care for those who cannot care for themselves. People are generous to those who are truly in need, whereas those who are capable are forced to provide for themselves.

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Originally posted by chellim1:

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All socialist programs depend on the ratio of non-productive to productive, and serve to grow the non-productive class while shrinking the productive class.

Which is why they all collapse.
It's also why charity is the best way to care for those who cannot care for themselves. People are generous to those who are truly in need, whereas those who are capable are forced to provide for themselves.

I agree. The ACA needs to be completely repealed. Patients should go back to paying doctors directly for day to day needs, and insurance should return to its original form of just covering expensive care. Indigent persons might suffer for a while, but I believe that charities would step up to provide care for them--Americans are very generous when they perceive a real need. There are at least 2 major children's hospitals at this time that run entirely on contributions--Shriner's and St. Jude's--so the idea can work. Of course, insurance companies would be free to provide policies providing a range of coverages, and the more affluent might purchase plans that cover more situations. I would not have a problem with a government plan similar to the basic Medicare (which one does pay premiums for).

flashguy

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Originally posted by flashguy:

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Originally posted by chellim1:

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All socialist programs depend on the ratio of non-productive to productive, and serve to grow the non-productive class while shrinking the productive class.

Which is why they all collapse.
It's also why charity is the best way to care for those who cannot care for themselves. People are generous to those who are truly in need, whereas those who are capable are forced to provide for themselves.

I agree. The ACA needs to be completely repealed. Patients should go back to paying doctors directly for day to day needs, and insurance should return to its original form of just covering expensive care. Indigent persons might suffer for a while, but I believe that charities would step up to provide care for them--Americans are very generous when they perceive a real need. There are at least 2 major children's hospitals at this time that run entirely on contributions--Shriner's and St. Jude's--so the idea can work. Of course, insurance companies would be free to provide policies providing a range of coverages, and the more affluent might purchase plans that cover more situations. I would not have a problem with a government plan similar to the basic Medicare (which one does pay premiums for).

flashguy

Get rid of it completely. No other answer in my mind. Get the GD government out of my health care. There is no constitutional basis for the government to mandate coverage or specify benefits.

Any other argument is pointless. This Robin hood bullshit from our government is immoral and anti-American.

Keep your laws of my body!

I agree, get out of it. Congress should stop wasting time on it and just let it be as is, individual mandate and all, until it fails under it's own weight. All the insurers will eventually pull out of the exchanges. Then, those who can obtain insurance will, and those who can't, for whatever reason, won't. Things will be back to the way they were.

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Originally posted by MNSIG:....Remember, the insurance companies have absolutely NOTHING to do with your health. They are in it to maximize profits and that is unlikely to align with what is in your best interest.

So you must believe that socialism will provide higher quality healthcare, make healthcare available to more people, all at a lower cost, than capitalism. Maybe socialist healthcare in Venezuela could provide a useful comparison.

Reality is that socialism encourages sloth, promotes waste, and empowers a self-serving government.

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Originally posted by chellim1:

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Remember, the insurance companies have absolutely NOTHING to do with your health. They are in it to maximize profits and that is unlikely to align with what is in your best interest.

Few people are able to conceptualize the difference between health CARE and health INSURANCE. We are getting to the point where it's not really insurance.

That has been the case for decades. It is pre paid health care, not health insurance.

But the manipulators know that "insurance" has a positive ring, or had anyway, sound, wise, prudent.

As Ambrose Bierce points out, "INSURANCE, n. An ingenious modern game of chance in which the player is permitted to enjoy the comfortable conviction that he is beating the man who keeps the table."

Paying for health care is onerous, burdensome. Why pay for health care when someone else will pay for you?

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Originally posted by Scoutmaster:

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Originally posted by MNSIG:....Remember, the insurance companies have absolutely NOTHING to do with your health. They are in it to maximize profits and that is unlikely to align with what is in your best interest.

So you must believe that socialism will provide higher quality healthcare, make healthcare available to more people, all at a lower cost, than capitalism.

Not at all, but we sure as heck need to keep our eyes on the insurance companies as well. They are not on our side.

For decades, about 80% of working-age people IIRC had their health insurance paid by their employer, or spouse's employer. This had its problems, but it was a stable system that served the great majority of people pretty well, particularly as employers became more cost-conscious rather than just paying the full bill through indemnity insurance.

ACA ruined that. Supposedly just planning to provide coverage to the uninsured, it made it so that employers dumped coverage for dependents; laid people off or cut them back to below the hourly level where they would be required to buy insurance; because now ACA would provide.

Medicaid was greatly expanded, at least in theory; but the majority of physicians will not accept new Medicaid patients so although insured, access to care did not improve correspondingly.

Now most of us would likely prefer that we return to something like the status quo ante, but that was already unsustainable due to increasing public costs of Medicare and Medicaid. Also, GOP officeholders did not run on "repeal", they ran on "repeal and replace", indicating they wanted to put in place a better system, market-oriented, less costly, less intrusive. Those of us who are conservatives and who have worked in the health policy area (see my post on Avik Roy above) would be delighted to see something like the Senate bill, hopefully nudged in a more free-market direction as per Cruz, Paul, and Lee.

Politics is the art of the possible.