The GOP Healthcare Bill

[NorseThing]

The only "Constitutional" challenge to the ACA was the provision compelling individuals to buy private health insurance.

There is nothing even remotely "unconstitutional" about universal health care. For instance if the government simply expanded Medicare to cover everyone. Nothing unconstitutional about that.

There were many challenges to the ACA. Only one was at the US Supreme Court level. The basic problem is if you start having subsidies and income constraints, you run afoul of many parts of the constitution.

Even Bernie's Medicare for All has problems with administrative costs plus fraud that exceed together the same costs in the private sector. People seem to argue efficiency of Medicare administrative costs without including the fraud as a part of administrative costs.

The Medicare under compensates providers and trusts the providers will still accept the Medicare patients since they are not the whole practice. That cost redistribution does not work if everybody is in the Medicare system. So prices will rise and the federal budget will balloon. To avoid this then, there will be restrictions that will probably run contrary to the constitution. I seem to be speaking in circular logic here, but the problem is Medicare has the same circular logic. Universal care cannot be constitutional unless everybody is covered and no differentiation on costs to income is made. The system cannot support itself financially without a huge increase beyond the proposed taxes. Of course once we implement the system, it would be too late to fix the tax problem. This seems to fit the logic of the failures we are seeing in the ACA.

[Elfdude]

Neither subsidies nor income constraints were challenged. The US constitution explicitly grants those permissions. The challenge was regarding whether the US can compel someone to purchase private insurance, a complaint which likely would not have existed if the US offered its own competing option.

Also as a doctor never heard really anyone who doesn't like medicare. Medicare is a rare opportunity for hospitals to recoup costs paying to save or treat people without any ability to pay for it. Generally speaking with few exceptions you'll find folks are contributing more money on medicare to coffers than they do if they're privately or uninsured.

[Love Mountain]

There were many challenges to the ACA. Only one was at the US Supreme Court level. The basic problem is if you start having subsidies and income constraints, you run afoul of many parts of the constitution.

Even Bernie's Medicare for All has problems with administrative costs plus fraud that exceed together the same costs in the private sector. People seem to argue efficiency of Medicare administrative costs without including the fraud as a part of administrative costs.

The Medicare under compensates providers and trusts the providers will still accept the Medicare patients since they are not the whole practice. That cost redistribution does not work if everybody is in the Medicare system. So prices will rise and the federal budget will balloon. To avoid this then, there will be restrictions that will probably run contrary to the constitution. I seem to be speaking in circular logic here, but the problem is Medicare has the same circular logic. Universal care cannot be constitutional unless everybody is covered and no differentiation on costs to income is made. The system cannot support itself financially without a huge increase beyond the proposed taxes. Of course once we implement the system, it would be too late to fix the tax problem. This seems to fit the logic of the failures we are seeing in the ACA.

1) Administration costs for Medicare as it is currently, are around 2%. Privately run Medicare Advantage plans (which is a perfect comparison) are 11%.

That's an Apples-to-Apples comparison. Medicare is cheaper. Administrative costs in the health industry vary between 10%-30% depending on what type of service they provide.

The costs of administering the Medicare program have remained low over the years – less than 2 percent of program expenditures. As such, program administration is not a contributing factor to Medicare’s expenditure growth. Administrative costs include all expenses by government agencies in administering the program (HHS, Treasury, the Social Security Administration, and the Medicare Payment Advisory Commission). Also included are the cost of claims contractors and other costs incurred in the payment of benefits, collection of Medicare taxes, fraud and abuse control activities, various demonstration projects, and building costs associated with program administration.

2) I've already addressed "cost-shifting" a billion times on this board. It's an implicit cost, which means it's hard to prove or its nonexistent. Hospitals benefit from additional Medicare and Medicaid revenues, otherwise, why would 93% of primary care physicians accept it? Cost-shifting is about as valid of an argument as "public investment crowding out private investment". It makes sense, it's alluring, but there's no conclusive evidence of it. Hospitals benefit from Medicare and Medicaid, they're just annoyed that they pay less than private insurers do. In other words, greed.

[NorseThing]

https://www.nytimes.com/2017/10/17/u...subsidies.html

Of course this is bipartisan. Neither party wants to fix anything nor be blamed for doing nothing. This kicks the can down the road past the next Congressional election cycle. If I were keeping score -- I would vote out of office any Congressional elected member voting for this. Fix it. Do not avoid fixing it. Throwing money at a problem does not fix the problem.

What is the problem? -- you might be asking. The problem is giving authority to the Executive Branch to meddle while the Legislature cannot make up their collective minds on whether to nationalize healthcare or let the make decide how to allocate resources. Spitting the difference is worse than either alternative. It is not efficient. It does an insufficient amount to help those least able while making it more expensive for those better off financially.

[JP226]

Neither subsidies nor income constraints were challenged. The US constitution explicitly grants those permissions. The challenge was regarding whether the US can compel someone to purchase private insurance, a complaint which likely would not have existed if the US offered its own competing option.

Also as a doctor never heard really anyone who doesn't like medicare. Medicare is a rare opportunity for hospitals to recoup costs paying to save or treat people without any ability to pay for it. Generally speaking with few exceptions you'll find folks are contributing more money on medicare to coffers than they do if they're privately or uninsured.

Exhibit A of the alternate universe...

"The US constitution explicitly grants those permissions."

The definition of "explicitly" is "in a clear and detailed manner, leaving no room for confusion or doubt." And "detailed" meaning "describe item by item; give the full particulars of." This statement is a lie.

The challenge was regarding whether the US can compel someone to purchase private insurance, a complaint which likely would not have existed if the US offered its own competing option.

Note challenge is singular, meaning one. Completely disregards the challenge forcing states to expand medicaid which was struck down in the supreme court. Another lie. Rest of the sentence beginning with "a complaint" is pure baseless speculation and a waste of typing.

Also as a doctor never heard really anyone who doesn't like medicare.

Highly unlikely on both assertions made in this statement.

Medicare is a rare opportunity for hospitals to recoup costs paying to save or treat people without any ability to pay for it.

Evidence that the prior statement of "as a doctor" is most likely factually incorrect. Medicare is insurance for old people, you can't be uninsured if you have insurance. Similarly in the case for medicaid as it's insurance for poors. Low income pool funding, completely separate from the other two, is the hospitals' ancillary funding to cover "loss" from uninsured who are not old enough to have medicare, nor poor enough to be on medicaid. Another factually deceptive statement.

"Generally speaking with few exceptions you'll find folks are contributing more money on medicare to coffers than they do if they're privately or uninsured."

Again alternate universe poster is probably speaking towards medicaid as that is what PPACA s referring to... but speaking for "medicare" as well, PMPM rates are notoriously under funded even when Insurance companies can settle loss payments at 30 cents on the dollar on a good day.

[Love Mountain]

That's not the only definition of "explicit", especially when talking about law, code, or any form of legal language.

Insurance coverage in 1960s before Medicare and Medicaid wasn't great. Only about half of people aged over 65 had insurance, and a heavy bias towards married men and women vs unmarried. Today's technology skews costs ever more heavily in favor of Medicare and Medicaid. Hospitals simply did not have the level of sophistication they do today. Even then, extended hospital stays were prohibitively expensive, today? These costs are astronomical.

I suppose we should just let mother nature do her work, and let death and capitalism to ration out expensive care to those who need it the most. After all, a 70 year old billionaire is much more useful than a 65 year old virgin who achieved nothing in his life to afford expensive care. He might as well die and save society taxpayer money, useful members of society will inevitably be able to pay for their health bills.

[Elfdude]

Exhibit A of the alternate universe...

"The US constitution explicitly grants those permissions."

The definition of "explicitly" is "in a clear and detailed manner, leaving no room for confusion or doubt." And "detailed" meaning "describe item by item; give the full particulars of." This statement is a lie.

Sorry commerce clause grants explicit permission to regulate the sale of goods and services in and affecting the US. This has existed in US jurisprudence since the outset. I'm sorry but no supreme court challenge to the use of subsidies or in terms of income brackets for this law existed and none would rise to the level of the supreme court. The commerce clause is explicit within the US constitution and it alone is largely the powers by which ALL governance in the US rests. All draconic subordination of laws to the federal government (with the exception of the bill of rights) get their power through leveraging this particular provision.

The challenge was regarding whether the US can compel someone to purchase private insurance, a complaint which likely would not have existed if the US offered its own competing option.

Note challenge is singular, meaning one.

This is an irrelevant statement.

Completely disregards the challenge forcing states to expand medicaid which was struck down in the supreme court.

No this is the exact same challenge I mentioned. This was a surprise decision by the court unrelated to the main assertion of the case. Essentially it said that congress didn't have the ability to require states to expand their medicaid program or deny all government healthcare funding. States were allowed to opt out of medicaid expansion provisions however no majority decision from the court won out which resulted in the weird world in which all states were beholden under ACA with the exception of requiring medicaid expansion.

Another lie. Rest of the sentence beginning with "a complaint" is pure baseless speculation and a waste of typing.

The reasoning of appeal was that the government didn't have the ability to force someone to use private insurance or penalize them. This reasoning falls apart if a public option exists. Your attempt at expertise is laughable.

Also as a doctor never heard really anyone who doesn't like medicare.

Highly unlikely on both assertions made in this statement.

My bad, perhaps you misunderstood the intent of the statement, you won't find many medical professionals who complain about medicare, the biggest complaint about medicaid is the limitation of it.

Medicare is a rare opportunity for hospitals to recoup costs paying to save or treat people without any ability to pay for it.

Evidence that the prior statement of "as a doctor" is most likely factually incorrect. Medicare is insurance for old people, you can't be uninsured if you have insurance.

I made a statement that the uninsured are a direct cost to healthcare providers and medicare (government sponsored insurance) was a way for hospitals to recoup those costs. This is factually accurate. I never said that the people using medicare were uninsured. Strawman and poor reading comprehension for the win.

Similarly in the case for medicaid as it's insurance for poors. Low income pool funding, completely separate from the other two, is the hospitals' ancillary funding to cover "loss" from uninsured who are not old enough to have medicare, nor poor enough to be on medicaid. Another factually deceptive statement.

Low income pool funding does not represent a complete recovery of the costs of treatment. The costs which are not covered by government action (which is the majority of it) are passed on to others who have insurance, medicare or medicaid. Nothing I said was factually deceptive. Your attempt to read my statements as all or nothing is humorous but hardly anything more than your own failure at understanding or attempting to understand the statement before you offhandedly reject it.

"Generally speaking with few exceptions you'll find folks are contributing more money on medicare to coffers than they do if they're privately or uninsured."

Again alternate universe poster is probably speaking towards medicaid as that is what PPACA s referring to... but speaking for "medicare" as well, PMPM rates are notoriously under funded even when Insurance companies can settle loss payments at 30 cents on the dollar on a good day.

I'm not speaking about medicaid. I was responding to Norse about medicare. Try to keep up. Furthermore it's an undeniable fact that the 19 million patients covered under medicare contribute more per patient to the overall funds of most hospitals. I'm not saying the private insurance industry is smaller, I'm saying that those who have it utilize less, or less expensive healthcare than those covered by medicare.



Good job failing to respond to my post.

http://www.healthbeatblog.com/2009/0...pay-hospitals/ A fairly good breakdown of how medicare is profitable. Furthermore I think a large portion of the medicare is underpaying us argument is savvy administrators doing their best to get even more and an attempt by insurance agencies to kill public sector insurance options.

[JP226]

Sorry commerce clause grants explicit permission to regulate the sale of goods and services in and affecting the US. This has existed in US jurisprudence since the outset. I'm sorry but no supreme court challenge to the use of subsidies or in terms of income brackets for this law existed and none would rise to the level of the supreme court. The commerce clause is explicit within the US constitution and it alone is largely the powers by which ALL governance in the US rests. All draconic subordination of laws to the federal government (with the exception of the bill of rights) get their power through leveraging this particular provision.



This is an irrelevant statement.



No this is the exact same challenge I mentioned. This was a surprise decision by the court unrelated to the main assertion of the case. Essentially it said that congress didn't have the ability to require states to expand their medicaid program or deny all government healthcare funding. States were allowed to opt out of medicaid expansion provisions however no majority decision from the court won out which resulted in the weird world in which all states were beholden under ACA with the exception of requiring medicaid expansion.



The reasoning of appeal was that the government didn't have the ability to force someone to use private insurance or penalize them. This reasoning falls apart if a public option exists. Your attempt at expertise is laughable.



My bad, perhaps you misunderstood the intent of the statement, you won't find many medical professionals who complain about medicare, the biggest complaint about medicaid is the limitation of it.



I made a statement that the uninsured are a direct cost to healthcare providers and medicare (government sponsored insurance) was a way for hospitals to recoup those costs. This is factually accurate. I never said that the people using medicare were uninsured. Strawman and poor reading comprehension for the win.



Low income pool funding does not represent a complete recovery of the costs of treatment. The costs which are not covered by government action (which is the majority of it) are passed on to others who have insurance, medicare or medicaid. Nothing I said was factually deceptive. Your attempt to read my statements as all or nothing is humorous but hardly anything more than your own failure at understanding or attempting to understand the statement before you offhandedly reject it.



I'm not speaking about medicaid. I was responding to Norse about medicare. Try to keep up. Furthermore it's an undeniable fact that the 19 million patients covered under medicare contribute more per patient to the overall funds of most hospitals. I'm not saying the private insurance industry is smaller, I'm saying that those who have it utilize less, or less expensive healthcare than those covered by medicare.



Good job failing to respond to my post.

http://www.healthbeatblog.com/2009/0...pay-hospitals/ A fairly good breakdown of how medicare is profitable. Furthermore I think a large portion of the medicare is underpaying us argument is savvy administrators doing their best to get even more and an attempt by insurance agencies to kill public sector insurance options.

Somthing I tell my employees, that will very well help you in life, be concise and to the point. Nobody wants to read this .

[Gaidin]

Somthing I tell my employees, that will very well help you in life, be concise and to the point. Nobody wants to read this .

So that's why you totally strawman and red herring his points? You don't even read it? Good to know.

[Elfdude]

Somthing I tell my employees, that will very well help you in life, be concise and to the point. Nobody wants to read this .

If you can't read less than a page of information I seriously question your claim of having employees.

[NorseThing]

For those who want to read more than a page of stuff:
https://randomcriticalanalysis.wordp...pectancy-gaps/

I have only briefly scanned and have not yet dived into the nuts and bolts. I suspect that much of the mainstream media angst on healthcare costs may be a bit exaggerated though not surprising. I do wonder about the per family unit expenditures changing over time though. It seems that housing and food are a bigger problem -- I do not buy into that. So I wonder what else I should doubt here.