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House Republicans preparing health care bill
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georgia_tech_swagger Offline
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Post: #41
RE: House Republicans preparing health care bill
(03-25-2020 03:52 PM)b0ndsj0ns Wrote:  
(03-25-2020 03:29 PM)UofMstateU Wrote:  
(03-25-2020 03:26 PM)b0ndsj0ns Wrote:  
(03-25-2020 03:04 PM)georgia_tech_swagger Wrote:  
(03-25-2020 02:56 PM)Owl 69/70/75 Wrote:  I would allow the option of substituting a high deductible with a HSA for the basic plan. All that could be worked out actuarially.

This is what health insurance should have always been.... like your car insurance: It doesn't cover oil changes, tires, brake pads, windshield wipers, or any other basic good. But it does present you with a tiny bill when something major happens. How tiny depends upon how much you are willing to pay per month.

The problem with high deductible + HSA is it now flies in the face of the mountain of lies we have erected in the healthcare industry. It will act like a beacon sucking away all the healthy people who will leave the government run pools in increasingly sicker and sicker condition leading to a death spiral in the insurance market. This has been going on since the beginning of Obamacare and that's why in like 1/3 to 1/4 of the country there's only one insurer to choose from on the Obamacare exchange. This is why with the sole exception of temporary insurance high deductible plans have been outlawed since Obamacare's passage.

I'm not a great fan of this Republican proposal from what I've read. But I far more hate those who champion Obamacare while standing atop the ashes of what use to be the health insurance industry.

I'm not champion of Obamacare, but there's little I'd love more than to be standing atop the ashes of the for profit health insurance industry.

Without foor profit health insurance, you wouldnt be standing on the ashes. You would be the ashes.

Or we could have non-profit heath insurance industries like Bismarck countries have. There is zero value added by those companies being for profit. They aren't doing research, they aren't developing drugs, they are literally just profiting off of human suffering.

Do you sit around plotting to pass laws to make car insurance, pet insurance, event insurance, homeowner's insurance, and literally several trillions of dollars worth of other insurance industries illegal?

One person's "profit off suffering" is another person's "thanks for replacing my house after it burned down from a lightning strike for the low cost of $800/yr."
03-25-2020 03:56 PM
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UofMstateU Offline
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Post: #42
RE: House Republicans preparing health care bill
(03-25-2020 03:52 PM)b0ndsj0ns Wrote:  
(03-25-2020 03:29 PM)UofMstateU Wrote:  
(03-25-2020 03:26 PM)b0ndsj0ns Wrote:  
(03-25-2020 03:04 PM)georgia_tech_swagger Wrote:  
(03-25-2020 02:56 PM)Owl 69/70/75 Wrote:  I would allow the option of substituting a high deductible with a HSA for the basic plan. All that could be worked out actuarially.

This is what health insurance should have always been.... like your car insurance: It doesn't cover oil changes, tires, brake pads, windshield wipers, or any other basic good. But it does present you with a tiny bill when something major happens. How tiny depends upon how much you are willing to pay per month.

The problem with high deductible + HSA is it now flies in the face of the mountain of lies we have erected in the healthcare industry. It will act like a beacon sucking away all the healthy people who will leave the government run pools in increasingly sicker and sicker condition leading to a death spiral in the insurance market. This has been going on since the beginning of Obamacare and that's why in like 1/3 to 1/4 of the country there's only one insurer to choose from on the Obamacare exchange. This is why with the sole exception of temporary insurance high deductible plans have been outlawed since Obamacare's passage.

I'm not a great fan of this Republican proposal from what I've read. But I far more hate those who champion Obamacare while standing atop the ashes of what use to be the health insurance industry.

I'm not champion of Obamacare, but there's little I'd love more than to be standing atop the ashes of the for profit health insurance industry.

Without foor profit health insurance, you wouldnt be standing on the ashes. You would be the ashes.

Or we could have non-profit heath insurance industries like Bismarck countries have. There is zero value added by those companies being for profit. They aren't doing research, they aren't developing drugs, they are literally just profiting off of human suffering.

We sure do have some of the most fantastic drugs in the world for noone to be doing development. If it werent for our drugs, the Bismark countries would be sh*t. All we need to do is to change the law that ANOTHER country isnt allowed to purchase OUR drugs for anything less than a 5 year rolling average of our price. Thats one reason other countries healthcare systems arent even worse than they are, they write their own laws to limit the price on drugs, and the pharmaceuticals either dont sell them, or sell them at their prices. We write our own law,and they either pay the fair market price, or they dont get the drugs. Problem solved.
03-25-2020 03:57 PM
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georgia_tech_swagger Offline
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Post: #43
RE: House Republicans preparing health care bill
(03-25-2020 03:52 PM)b0ndsj0ns Wrote:  Or we could have non-profit heath insurance industries like Bismarck countries have. There is zero value added by those companies being for profit. They aren't doing research, they aren't developing drugs, they are literally just profiting off of human suffering.


And, more seriously, failure to understand the importance of the profit motive means you cannot be trusted with economic policy. That's how you end up with workers sabotaging their own manufacturing plant to get the paid time off while waiting for the gov't to fix the assembly line. You can wave your magic wand and declare health insurance for profit to be illegal. It will not change the salary of one single worker there. It will send private capital fleeing for the hills though as it seeks a place to sink capital that will actually have a ROI. I wonder if health insurance companies view operating capital as important when deciding premiums or breadth of coverage....
(This post was last modified: 03-25-2020 04:00 PM by georgia_tech_swagger.)
03-25-2020 03:58 PM
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Owl 69/70/75 Offline
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Post: #44
RE: House Republicans preparing health care bill
(03-25-2020 03:52 PM)b0ndsj0ns Wrote:  Or we could have non-profit heath insurance industries like Bismarck countries have. There is zero value added by those companies being for profit. They aren't doing research, they aren't developing drugs, they are literally just profiting off of human suffering.

But that's not necessarily the case. The Dutch system (generally regarded as the best in the world) is almost all for-profit. The German lander insurers are technically non-profit, but they operate as profit-seeking companies and then bonus out all the profits to top executives. The French is a mix of non-profit (the basic plans) and for profit (the "pay" side).

Bismarck defines a number of approaches where there is one level of care that is universal, and supplemental care can be purchased. 99+% of the French are in the basic plan (only those transitioning in or out of the country are temporarily excluded) and 90% purchase supplemental (employers can and do provide it as a benefit). That means they have a higher percentage on supplemental insurance than we do on insurance, period.
03-25-2020 04:06 PM
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DavidSt Offline
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Post: #45
RE: House Republicans preparing health care bill
(03-25-2020 03:50 PM)Hambone10 Wrote:  
(03-25-2020 03:42 PM)DavidSt Wrote:  Another words, Republicans are forcing ration cure and death panels.
2.Blue Cross/Blue Shields is becoming a monopoly in the state of Arkansas because clinics, doctors and hospitals are slowly rejecting other insurances because for not paying.

Did you miss the part about buying across state lines?

What you mean is BCBS is paying providers more than others are. Why is the quickest/highest paying service who is obviously price competitive with/cheaper than everyone else (else everyone would buy their policy and doctors would be forced to take it) a 'bad' thing in your world?



You did not read what I said. The doctors and nurses told us that they are refusing to take the other insurance companies because they refused to pay. There have been lawsuits against the health insurance companies because for not paying. This bill would be forcing the doctors, clinics, hospitals and pharmacies to accept them when medical industry drop those insurance companies.
03-25-2020 04:08 PM
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Hambone10 Offline
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Post: #46
RE: House Republicans preparing health care bill
(03-25-2020 03:30 PM)georgia_tech_swagger Wrote:  If you can not have insurance and then simply pick up coverage when you get sick that's not insurance: that's a bailout.

I was speaking of a different aspect of the issue... that nobody (especially the poor, this is the left's lie about the issue) is currently uninsured. I get what you're saying.

You actually can though as it's just math... but everyone else picks up the cost for you. The poor would always be covered because the government pays it... It's the middle class or even the wealthy who would benefit from this.


(03-25-2020 03:52 PM)b0ndsj0ns Wrote:  Or we could have non-profit heath insurance industries like Bismarck countries have. There is zero value added by those companies being for profit. They aren't doing research, they aren't developing drugs, they are literally just profiting off of human suffering.

another thing that sounds good but isn't true, unless you think your nurse is profiting off of your suffering.

That said, here's a list of MAJOR Non-Profit health Insurance Companies. There are plenty of minor ones as well.

Affinity
American Postal Workers Union Health Plans
AmeriHealth Mercy/Independent Blue Cross
Arkansas BlueCross BlueShield
AultCare Health Plans
AvMed, Inc
Blue Cross & Blue Shield of Mississippi
Blue Cross & Blue Shield of Rhode Island
Blue Cross and Blue Shield of Alabama
Blue Cross and Blue Shield of Florida, Inc.
Blue Cross and Blue Shield of Kansas
Blue Cross and Blue Shield of Kansas City
Blue Cross and Blue Shield of Louisiana
Blue Cross and Blue Shield of Minnesota
Blue Cross and Blue Shield of Montana
Blue Cross and Blue Shield of Nebraska
Blue Cross and Blue Shield of North Carolina
Blue Cross and Blue Shield of Vermont
Blue Cross Blue Shield of Arizona
Blue Cross Blue Shield of Delaware
Blue Cross Blue Shield of Massachusetts
Blue Cross Blue Shield of Michigan
Blue Cross Blue Shield of North Dakota
Blue Cross of Idaho Health Service, Inc.
Blue Cross of Northeastern Pennsylvania
Blue Shield of California
BlueCross BlueShield of South Carolina
BlueCross BlueShield of Tennessee
BlueCross BlueShield of Western New York and BlueCross BlueShield of Northeastern New York
Bluegrass Family Health, Inc.
Boston Medical Center HealthNet Plan
Capital Blue Cross
Capital District Physicians Health Plan, Inc.
CareFirst Blue Cross Blue Shield
CareOregon
CareSource, Inc.
Community Health Group
Community Health Network of Connecticut, Inc. (CHNCT)
Community Health Plan of Washington
Cook Children's Health Plan (CCHP)
EmblemHealth, Inc.
Fallon Community Health Plan
Family Health Partners
Fidelis Care, Inc.
Geisinger Health Plan
Government Employees Health Association (GEHA)
Group Health Cooperative
Harvard Pilgrim Health Care, Inc.
Hawaii Medical Service Association
Health Alliance Plan of Michigan
Health Care Service Corporation
Health Partners of Philadelphia
Health Plus (PHSP), Inc.
Healthfirst
HealthPartners, Inc.
HealthPlus of Michigan, Inc.
Highmark, Inc.
Hometown Health Plan, Inc.
Horizon Blue Cross Blue Shield
Hudson Health Plan
Independent Health Association, Inc.
Inland Empire Health Plan
Kaiser Permanente
Kern Health Systems, Inc.
Lifetime Healthcare Companies
Maryland Physicians Care (MPC)
McLaren Health Plan
MDWise
Medica Health Plans
Medical Mutual of Ohio
MVP Health Care Preferred Care
Neighborhood Health Plan, Inc.
Paramount Care, Inc. (ProMedica Health System)
Parkland Community Health Plan
Partnership Health Plan of California
Phoenix Health Plan/Abrazo Advantage
Premera, Inc.
Priority Health
Priority Partners
Providence Health Plan
Rocky Mountain Health Plans
SCAN Health Plan
Scott and White Health Plan
Security Health Plan of Wisconsin, Inc.
SelectHealth
Sentara Health Plans, Inc.
Texas Children's Health Plan
The Chartered Health Plan Inc.
The Regence Group
Trustmark Companies
Tufts Associated Health Plans, Inc.
UAW Retiree Medical Benefit Trust
UCare
University Health Care Health Plans
UPMC Health Plan, Inc.
Virginia Premier Health Plan, Inc.
Wellmark, Inc.

You've got David bitching about BCBS becoming a monopoly and you bitching that it's not.
03-25-2020 04:10 PM
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Hambone10 Offline
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Post: #47
RE: House Republicans preparing health care bill
(03-25-2020 04:08 PM)DavidSt Wrote:  You did not read what I said. The doctors and nurses told us that they are refusing to take the other insurance companies because they refused to pay. There have been lawsuits against the health insurance companies because for not paying. This bill would be forcing the doctors, clinics, hospitals and pharmacies to accept them when medical industry drop those insurance companies.

Your comment makes no sense, David. Who is 'the medical industry' that is dropping the companies if it isn't Doctors, Clinics, Hospitals and Pharmacies whom you say are being forced to accept them? If they're dropping companies who don't pay (though insurance is a simple legal process... they can't just 'not pay' unless you're breaking the contract, which is generally Federally mandated/described.

I think what you mean is they don't pay ENOUGH or that they are slower than BCBS... if that is the case, then why is it a problem that 'the best company' is getting all the business?

And your fears about monopoly are mitigated because being able to buy across state lines means that there will be competition from SOMEWHERE which doesn't exist now.

If it turns out that BCBS universally delivers the best product and reimbursement for the best price, so long as competition/barriers to entry aren't made illegal, why would providers (or members) care that they win all the business?


Right now the biggest issue would be that (as an example) New York Medicaid won't pay for services delivered in New Jersey (because they get some of that money back vicariously through taxes, research grants etc)... but since that's 'free', there really isn't an issue of unfairness
(This post was last modified: 03-25-2020 04:22 PM by Hambone10.)
03-25-2020 04:20 PM
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Eagleaidaholic Offline
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Post: #48
RE: House Republicans preparing health care bill
(03-25-2020 04:08 PM)DavidSt Wrote:  
(03-25-2020 03:50 PM)Hambone10 Wrote:  
(03-25-2020 03:42 PM)DavidSt Wrote:  Another words, Republicans are forcing ration cure and death panels.
2.Blue Cross/Blue Shields is becoming a monopoly in the state of Arkansas because clinics, doctors and hospitals are slowly rejecting other insurances because for not paying.

Did you miss the part about buying across state lines?

What you mean is BCBS is paying providers more than others are. Why is the quickest/highest paying service who is obviously price competitive with/cheaper than everyone else (else everyone would buy their policy and doctors would be forced to take it) a 'bad' thing in your world?



You did not read what I said. The doctors and nurses told us that they are refusing to take the other insurance companies because they refused to pay. There have been lawsuits against the health insurance companies because for not paying. This bill would be forcing the doctors, clinics, hospitals and pharmacies to accept them when medical industry drop those insurance companies.
Who is the Obamacare provider in Arkansas? That may answer your question and have nothing to do with "Republicans".
03-25-2020 04:21 PM
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DavidSt Offline
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Post: #49
RE: House Republicans preparing health care bill
(03-25-2020 04:20 PM)Hambone10 Wrote:  
(03-25-2020 04:08 PM)DavidSt Wrote:  You did not read what I said. The doctors and nurses told us that they are refusing to take the other insurance companies because they refused to pay. There have been lawsuits against the health insurance companies because for not paying. This bill would be forcing the doctors, clinics, hospitals and pharmacies to accept them when medical industry drop those insurance companies.

Your comment makes no sense, David. Who is 'the medical industry' that is dropping the companies if it isn't Doctors, Clinics, Hospitals and Pharmacies whom you say are being forced to accept them? If they're dropping companies who don't pay (though insurance is a simple legal process... they can't just 'not pay' unless you're breaking the contract, which is generally Federally mandated/described.

I think what you mean is they don't pay ENOUGH or that they are slower than BCBS... if that is the case, then why is it a problem that 'the best company' is getting all the business?

And your fears about monopoly are mitigated because being able to buy across state lines means that there will be competition from SOMEWHERE which doesn't exist now.

If it turns out that BCBS universally delivers the best product and reimbursement for the best price, so long as competition/barriers to entry aren't made illegal, why would providers (or members) care that they win all the business?


Right now the biggest issue would be that (as an example) New York Medicaid won't pay for services delivered in New Jersey (because they get some of that money back vicariously through taxes, research grants etc)... but since that's 'free', there really isn't an issue of unfairness


What I am saying that the doctors, hospitals, clinics and pharmacies dropped those companies. The states, the doctors, the clinics and the pharmacies with the clients of those health insurance companies brought class action lawsuits against these health insurance companies. I am saying that Blue Cross/Blue Shields becoming a monopoly in Arkansas because of the actions of the other insurance companies.
03-25-2020 04:28 PM
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georgia_tech_swagger Offline
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Post: #50
RE: House Republicans preparing health care bill
(03-25-2020 04:28 PM)DavidSt Wrote:  What I am saying that the doctors, hospitals, clinics and pharmacies dropped those companies. The states, the doctors, the clinics and the pharmacies with the clients of those health insurance companies brought class action lawsuits against these health insurance companies. I am saying that Blue Cross/Blue Shields becoming a monopoly in Arkansas because of the actions of the other insurance companies.

BCBS is a monopoly in Arkansas for three reasons:
1) Obamacare decimating the market of insurers
2) Existing government regulation which prevents people outside of Arkansas offering health insurance services inside Arkansas
3) BCBS is very good and nickel and diming claims and quietly denying and hoping you pay anyway. I've never had a problem with claims from any insurer I've used other than BCBS, and that includes AETNA, CIGNA, UnitedOne, and Humana. None of those last four ever denied a claim I made. BCBS denied five claims I've made. After playing the waiting game on phone for hours they picked 2 of the 5 up. The other 3 QuestDiagnostics ate the cost of. It was all blood work ... and it was all preventative in nature blood work. And I couldn't find anybody at the doc, Quest, or BCBS that would dare say out loud they were refusing to cover preventative care. But they had no problems sending bills to me.
03-25-2020 04:34 PM
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Hambone10 Offline
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Post: #51
RE: House Republicans preparing health care bill
(03-25-2020 04:34 PM)georgia_tech_swagger Wrote:  
(03-25-2020 04:28 PM)DavidSt Wrote:  What I am saying that the doctors, hospitals, clinics and pharmacies dropped those companies. The states, the doctors, the clinics and the pharmacies with the clients of those health insurance companies brought class action lawsuits against these health insurance companies. I am saying that Blue Cross/Blue Shields becoming a monopoly in Arkansas because of the actions of the other insurance companies.

BCBS is a monopoly in Arkansas for three reasons:
1) Obamacare decimating the market of insurers
2) Existing government regulation which prevents people outside of Arkansas offering health insurance services inside Arkansas
3) BCBS is very good and nickel and diming claims and quietly denying and hoping you pay anyway. I've never had a problem with claims from any insurer I've used other than BCBS, and that includes AETNA, CIGNA, UnitedOne, and Humana. None of those last four ever denied a claim I made. BCBS denied five claims I've made. After playing the waiting game on phone for hours they picked 2 of the 5 up. The other 3 QuestDiagnostics ate the cost of. It was all blood work ... and it was all preventative in nature blood work. And I couldn't find anybody at the doc, Quest, or BCBS that would dare say out loud they were refusing to cover preventative care. But they had no problems sending bills to me.

This. If they have a case, they will win... because as I said, insurance is now a very straightforward thing. The ACA mandated coverage of specific things... and if the services provided meet that description (and there are specific codes that are included) then they cannot deny the claims. Period.

Now if there is something shady going on in Arkansas, the ability to purchase across state lines will resolve that as I've said.... but this makes no sense that Republicans in Arkansas would make health insurance non-competitive such that the 'big winner' in the state was the ACA Marketplace non-profit plan.

I suspect the reality is that Arkansas is a very poor state meaning the government the largest payer... whether it is Medicaid or Marketplace, thus they have the greatest economies of scale. Again, being able to buy across state lines eliminates this... but this isn't the fault of Republicans in the state (and certainly not Democrats)... it's how the math works. If you're insuring 70% of the population, you have very predictable cash flows.
03-25-2020 04:56 PM
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solohawks Offline
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Post: #52
RE: House Republicans preparing health care bill
Playing devils advoctae...If you're allowed to buy across state lines then what is to prevent say Anthem Blue Cross from accelerating buying out the local BCBS in the states they do not already own the franchise? Wouldnt buying across state lines accelerate consolidation and bankrupt the crummy BCBS plans that only exist due to monopoly protection?
03-25-2020 05:18 PM
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DavidSt Offline
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Post: #53
RE: House Republicans preparing health care bill
(03-25-2020 04:56 PM)Hambone10 Wrote:  
(03-25-2020 04:34 PM)georgia_tech_swagger Wrote:  
(03-25-2020 04:28 PM)DavidSt Wrote:  What I am saying that the doctors, hospitals, clinics and pharmacies dropped those companies. The states, the doctors, the clinics and the pharmacies with the clients of those health insurance companies brought class action lawsuits against these health insurance companies. I am saying that Blue Cross/Blue Shields becoming a monopoly in Arkansas because of the actions of the other insurance companies.

BCBS is a monopoly in Arkansas for three reasons:
1) Obamacare decimating the market of insurers
2) Existing government regulation which prevents people outside of Arkansas offering health insurance services inside Arkansas
3) BCBS is very good and nickel and diming claims and quietly denying and hoping you pay anyway. I've never had a problem with claims from any insurer I've used other than BCBS, and that includes AETNA, CIGNA, UnitedOne, and Humana. None of those last four ever denied a claim I made. BCBS denied five claims I've made. After playing the waiting game on phone for hours they picked 2 of the 5 up. The other 3 QuestDiagnostics ate the cost of. It was all blood work ... and it was all preventative in nature blood work. And I couldn't find anybody at the doc, Quest, or BCBS that would dare say out loud they were refusing to cover preventative care. But they had no problems sending bills to me.

This. If they have a case, they will win... because as I said, insurance is now a very straightforward thing. The ACA mandated coverage of specific things... and if the services provided meet that description (and there are specific codes that are included) then they cannot deny the claims. Period.

Now if there is something shady going on in Arkansas, the ability to purchase across state lines will resolve that as I've said.... but this makes no sense that Republicans in Arkansas would make health insurance non-competitive such that the 'big winner' in the state was the ACA Marketplace non-profit plan.

I suspect the reality is that Arkansas is a very poor state meaning the government the largest payer... whether it is Medicaid or Marketplace, thus they have the greatest economies of scale. Again, being able to buy across state lines eliminates this... but this isn't the fault of Republicans in the state (and certainly not Democrats)... it's how the math works. If you're insuring 70% of the population, you have very predictable cash flows.


Republicans here in Arkansas for a long time. As it is, BC/BSs have been used by Arkansas state for the ACA for the extended Medicaid program since there is a need in this state where most of the residents do not have money to afford health insurance or go to see a doctor. What the ACA did was brought more jobs in the medical field with new doctors, nurses, and staff to run the offices, clinics and hospital. BC/BS under the extended Medicaid that I was under, they paid all the bills without me paying a penny.
03-25-2020 05:57 PM
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georgia_tech_swagger Offline
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Post: #54
RE: House Republicans preparing health care bill
(03-25-2020 05:18 PM)solohawks Wrote:  Playing devils advoctae...If you're allowed to buy across state lines then what is to prevent say Anthem Blue Cross from accelerating buying out the local BCBS in the states they do not already own the franchise? Wouldnt buying across state lines accelerate consolidation and bankrupt the crummy BCBS plans that only exist due to monopoly protection?


BCBS' plans would overnight have to simultaneously contract enormously (they largely offer a spread of different premium/deductible/copy/ER combo garbage plans in the marketplace), and then diversify enormously. They would need to be competing with HMOs like Kaiser. They would need to be competing Humana and AETNA and CIGNA and United. And all of them would have to compete against a slew of new telemedicine-first online based insurance companies. I imagine over time it would consolidate to what is fundamentally a half dozen or so major national players just like in the cellular space. But also just like the cellular space, people will collectively bargain and companies will exist purely as resellers that collectively bargain on their customer's behalf just like MVNOs (Cricket, SimpleTalk, Mint, etc) do. So while it would lead to ultimate coverage coming out of a half dozen places for most people, at the interface point with the consumer that becomes hundreds of companies with dizzying amounts of choice. This is no different than what you see in tons of industries .... cars, cellular, power tools, even frozen pizzas.
03-25-2020 06:14 PM
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Post: #55
RE: House Republicans preparing health care bill
(03-25-2020 05:57 PM)DavidSt Wrote:  Republicans here in Arkansas for a long time. As it is, BC/BSs have been used by Arkansas state for the ACA for the extended Medicaid program since there is a need in this state where most of the residents do not have money to afford health insurance or go to see a doctor. What the ACA did was brought more jobs in the medical field with new doctors, nurses, and staff to run the offices, clinics and hospital. BC/BS under the extended Medicaid that I was under, they paid all the bills without me paying a penny.

It's illegal to charge anyone on Medicaid (although some states have minor copays, like $2). There are no medicaid supplements because they argue if you can afford the supplement, you don't need as much support.

It seems that you're describing my suspicion.... That BCBS dominates the market because of the ACA and that others trying to enter the market are being priced out because of the relatively small numbers. Much of this is due to regulations... i.e. you need 'x' employees per plan per state. If the overhead for those people is $1mm, then you need to earn the cost of insurance plus $1mm to break even, which is impossible if you only have say 1,000 members... which is pretty common in small states.

My point was simply that Republicans sure didn't create extended Medicaid. The COULD provide supports to prop up smaller companies, but that's not very 'Republican'. Buying across state lines makes this easier because the overhead can be consolidated.

(03-25-2020 06:14 PM)georgia_tech_swagger Wrote:  
(03-25-2020 05:18 PM)solohawks Wrote:  Playing devils advoctae...If you're allowed to buy across state lines then what is to prevent say Anthem Blue Cross from accelerating buying out the local BCBS in the states they do not already own the franchise? Wouldnt buying across state lines accelerate consolidation and bankrupt the crummy BCBS plans that only exist due to monopoly protection?


BCBS' plans would overnight have to simultaneously contract enormously (they largely offer a spread of different premium/deductible/copy/ER combo garbage plans in the marketplace), and then diversify enormously. They would need to be competing with HMOs like Kaiser. They would need to be competing Humana and AETNA and CIGNA and United. And all of them would have to compete against a slew of new telemedicine-first online based insurance companies. I imagine over time it would consolidate to what is fundamentally a half dozen or so major national players just like in the cellular space. But also just like the cellular space, people will collectively bargain and companies will exist purely as resellers that collectively bargain on their customer's behalf just like MVNOs (Cricket, SimpleTalk, Mint, etc) do. So while it would lead to ultimate coverage coming out of a half dozen places for most people, at the interface point with the consumer that becomes hundreds of companies with dizzying amounts of choice. This is no different than what you see in tons of industries .... cars, cellular, power tools, even frozen pizzas.

This.

The bigger issue to me would be pricing and networks. Not that it can't be done, but that it would be highly complex.

A network serving NY and NJ would be great for those people, but horrible for people in Arkansas and vice versa. A network priced for Arkansas would be a steal in NY/NJ.

I'm not going to guess at and certainly not address the thousands of variables and possibilities on ways to address this, but like the ACA, you're not going to be able to pass this without some serious control, because even within the party, there would be some reasonable differences of opinion as to the 'perfect' solution.

One thing I know, I don't see Republicans voting to have citizens of Arkansas supplement the healthcare for citizens of NY. SOme solutions that come to mind are regional networks, population density networks, healthcare proximity networks... It would be like drawing redistricting maps.... MAJOR fights.... or most likely... just let insurers create the networks they want with the providers they want... and make people make informed decisions. Democrats would lose their minds over that idea
03-26-2020 09:14 AM
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b0ndsj0ns Offline
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Post: #56
RE: House Republicans preparing health care bill
(03-25-2020 03:57 PM)UofMstateU Wrote:  
(03-25-2020 03:52 PM)b0ndsj0ns Wrote:  
(03-25-2020 03:29 PM)UofMstateU Wrote:  
(03-25-2020 03:26 PM)b0ndsj0ns Wrote:  
(03-25-2020 03:04 PM)georgia_tech_swagger Wrote:  This is what health insurance should have always been.... like your car insurance: It doesn't cover oil changes, tires, brake pads, windshield wipers, or any other basic good. But it does present you with a tiny bill when something major happens. How tiny depends upon how much you are willing to pay per month.

The problem with high deductible + HSA is it now flies in the face of the mountain of lies we have erected in the healthcare industry. It will act like a beacon sucking away all the healthy people who will leave the government run pools in increasingly sicker and sicker condition leading to a death spiral in the insurance market. This has been going on since the beginning of Obamacare and that's why in like 1/3 to 1/4 of the country there's only one insurer to choose from on the Obamacare exchange. This is why with the sole exception of temporary insurance high deductible plans have been outlawed since Obamacare's passage.

I'm not a great fan of this Republican proposal from what I've read. But I far more hate those who champion Obamacare while standing atop the ashes of what use to be the health insurance industry.

I'm not champion of Obamacare, but there's little I'd love more than to be standing atop the ashes of the for profit health insurance industry.

Without foor profit health insurance, you wouldnt be standing on the ashes. You would be the ashes.

Or we could have non-profit heath insurance industries like Bismarck countries have. There is zero value added by those companies being for profit. They aren't doing research, they aren't developing drugs, they are literally just profiting off of human suffering.

We sure do have some of the most fantastic drugs in the world for noone to be doing development. If it werent for our drugs, the Bismark countries would be sh*t. All we need to do is to change the law that ANOTHER country isnt allowed to purchase OUR drugs for anything less than a 5 year rolling average of our price. Thats one reason other countries healthcare systems arent even worse than they are, they write their own laws to limit the price on drugs, and the pharmaceuticals either dont sell them, or sell them at their prices. We write our own law,and they either pay the fair market price, or they dont get the drugs. Problem solved.

When in the hell has Aetna or BCBS developed a single drug? I'll answer that for you, never.
03-26-2020 09:31 AM
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b0ndsj0ns Offline
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Post: #57
RE: House Republicans preparing health care bill
(03-25-2020 04:34 PM)georgia_tech_swagger Wrote:  
(03-25-2020 04:28 PM)DavidSt Wrote:  What I am saying that the doctors, hospitals, clinics and pharmacies dropped those companies. The states, the doctors, the clinics and the pharmacies with the clients of those health insurance companies brought class action lawsuits against these health insurance companies. I am saying that Blue Cross/Blue Shields becoming a monopoly in Arkansas because of the actions of the other insurance companies.

BCBS is a monopoly in Arkansas for three reasons:
1) Obamacare decimating the market of insurers
2) Existing government regulation which prevents people outside of Arkansas offering health insurance services inside Arkansas
3) BCBS is very good and nickel and diming claims and quietly denying and hoping you pay anyway. I've never had a problem with claims from any insurer I've used other than BCBS, and that includes AETNA, CIGNA, UnitedOne, and Humana. None of those last four ever denied a claim I made. BCBS denied five claims I've made. After playing the waiting game on phone for hours they picked 2 of the 5 up. The other 3 QuestDiagnostics ate the cost of. It was all blood work ... and it was all preventative in nature blood work. And I couldn't find anybody at the doc, Quest, or BCBS that would dare say out loud they were refusing to cover preventative care. But they had no problems sending bills to me.

And you are defending the "profit motive" of health insurance companies why exactly? What's the value added to anyone for this nonsense? Also they all do that coworker has been in a months long fight over getting something that they initially said they'd cover and then now are trying to say they won't with Aetna.
(This post was last modified: 03-26-2020 09:35 AM by b0ndsj0ns.)
03-26-2020 09:33 AM
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georgia_tech_swagger Offline
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Post: #58
RE: House Republicans preparing health care bill
(03-26-2020 09:33 AM)b0ndsj0ns Wrote:  
(03-25-2020 04:34 PM)georgia_tech_swagger Wrote:  
(03-25-2020 04:28 PM)DavidSt Wrote:  What I am saying that the doctors, hospitals, clinics and pharmacies dropped those companies. The states, the doctors, the clinics and the pharmacies with the clients of those health insurance companies brought class action lawsuits against these health insurance companies. I am saying that Blue Cross/Blue Shields becoming a monopoly in Arkansas because of the actions of the other insurance companies.

BCBS is a monopoly in Arkansas for three reasons:
1) Obamacare decimating the market of insurers
2) Existing government regulation which prevents people outside of Arkansas offering health insurance services inside Arkansas
3) BCBS is very good and nickel and diming claims and quietly denying and hoping you pay anyway. I've never had a problem with claims from any insurer I've used other than BCBS, and that includes AETNA, CIGNA, UnitedOne, and Humana. None of those last four ever denied a claim I made. BCBS denied five claims I've made. After playing the waiting game on phone for hours they picked 2 of the 5 up. The other 3 QuestDiagnostics ate the cost of. It was all blood work ... and it was all preventative in nature blood work. And I couldn't find anybody at the doc, Quest, or BCBS that would dare say out loud they were refusing to cover preventative care. But they had no problems sending bills to me.

And you are defending the "profit motive" of health insurance companies why exactly? What's the value added to anyone for this nonsense? Also they all do that coworker has been in a months long fight over getting something that they initially said they'd cover and then now are trying to say they won't with Aetna.


Let me just zoom out one level and summarize:

I'm not happy that due to government heavy handed regulation I'm now left with only one provider to choose from on health insurance, and they're awful.

You propose to fix my government induced problem .... with a huge raft of new government regulation in the health care sector.
03-26-2020 09:41 AM
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Hambone10 Offline
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Post: #59
RE: House Republicans preparing health care bill
(03-26-2020 09:33 AM)b0ndsj0ns Wrote:  And you are defending the "profit motive" of health insurance companies why exactly? What's the value added to anyone for this nonsense? Also they all do that coworker has been in a months long fight over getting something that they initially said they'd cover and then now are trying to say they won't with Aetna.

You're misrepresenting the facts

1) they would never tell you something even remotely debatable is covered in a hypothetical. Never. They would say, refer to your policy. The most they would tell you is that 'this group of services is covered for this group of providers', and if you meet those criteria, you will be covered. If you don't, you don't. Maybe your provider miscoded? Maybe your provider sent you to an out-of-network provider. All sorts of possibilities not related to Aetna... and also things that would absolutely be true under 'government' healthcare. Try taking NY Medicaid to NJ. Try taking Medicare to a doctor that doesn't take it.

2) what is the value added? mandated covered services helps keep plans comparable.... Competition for your dollar helps keep prices down... so that the provider with the lowest profit margin is the 'plan to beat'. Providers similarly have the ability to decline to accept a reimbursement level that is not competitive.... so by far the best/easiest way to generate a profit is to control non-healthcare related/administrative costs.

Please tell me what the motivation to control administrative costs is in a NFP or government program? Please tell me what competition the government has to help contain its costs. Please tell me what negotiating power a provider has with a single payer?
(This post was last modified: 03-26-2020 10:22 AM by Hambone10.)
03-26-2020 10:13 AM
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Post: #60
RE: House Republicans preparing health care bill
(03-26-2020 10:13 AM)Hambone10 Wrote:  Please tell me what the motivation to control administrative costs is in a NFP or government program?

None, unless you work like the German lander insurers. They operate as a profit-seeking entity, and then bonus out all profits to senior management.

Quote:Please tell me what competition the government has to help contain its costs.

None, which is why government-run entities always overspend their budgets.

Quote:Please tell me what negotiating power a provider has with a single payer?

None, which is why lots of providers move or shut down whenever single-payer (or single-provider) is implemented.
03-26-2020 10:27 AM
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