Obamacare

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Hey, at least I've never hidden who I was or what I believed, or acted insulted when called on it. But I guess now I won't be surprised when a whole lot of liberals start coming out of the "I hate America" closet. Bully on being able to be yourself out loud, I guess, Blots.
I didn't feel this way until November 8th 2016.
 
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America started to go down the toilet in November of 2010.

As for the ACA - and I refuse to call it "Obamacare" - it may be the only way I have health insurance after January 6.
 

GasBandit

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Lot in this comment. I do agree that during Obama's presidency too much power was invested in the executive. Congress won't move on allowing military power in Syria? Keep on bombing. No movement on illegal immigration? Well we'll set up DACA. I agree with some of his actions (DACA not Syria) but he did overplay his powers very often when he needed to kick it to congress and let them get yelled at .

But I think right now there is too much inertia and rot too really have much hope for even the long game.

Problem 1 is gerrymandering Republicans have so many "safe" seats where the only challenge is the primary that even actions that will help the country can't be allowed because a harder right candidate will then take their seat during a primary. So voting to enshrine birth control as a right isn't going to happen until we do the census and redraw the voting maps. Which might happen after the 2020 census or the gerrymandering might keep on paying off getting the people who drew the maps reelected to draw the maps again at which point 2030 is the next best bet for breaking out of that shitty feedback loop.

Then of course we have the problem that our institutions are not actually all that great as it turns out. The State department is a skeleton crew right now ICE has started becoming the fucking jackbooted thugs we were always warned about and the education department is going to be paying huge chunks of money for Betsy's security detail. I for one thought that the Trump people would be forced to fit into the system but so far it seems like our institutions can be controlled by people who actively despise them and that the career civil servants aren't able to defend them nor do we know what kind of shape they will be in after this.

And then we have fucking Russia. This one is by far the most shocking to me cause I'm an 80's kid so growing up there was one thing I knew deep in my DNA and that was not one single American would ever side with Russia over even their most hated America enemy. But at this point we have an attorney general who committed perjury in order to cover up his Russian contacts and a president who gave out classified information to the Russians in the god damned Oval Office. And this is a problem that I have no idea how you even get started on fixing. The official report might come out detailing the Russia influence but in this age where our president claims every article he doesn't like even the ones that just quote him as "fake news" I have no idea how the voting public will break.

I have felt unmoored ever since Trump was elected. I see the way back but I don't know if America will go that way.
Believe it or not, I commiserate with you on all counts there.

Yes, but I was quoted. ;)
The first couple sentences were to address what you'd said, the last one I specifically said "Blots" because it was for him.


America started to go down the toilet in November of 2010.
Oh it started down this path a lot earlier than that.
 
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A not-so-friendly comment for the "you can afford" crowd.

The federal minimum wage is still $7.25 an hour. Two weeks at full time is $580 BEFORE taxes.

Many ambulance services charge for their services, even in an emergency. Charges can run as high as $800 per trip or more. It's not always covered by insurance.

Need to go to the hospital NOW? Bye bye at least one entire paycheck.

So what'll it be? Your life or your wife or kids vs food or your home? Choose wisely. And quickly, they're bleeding out all over the floor.
 

GasBandit

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That's some excellent fallacious appeal to emotion and false dichotomy work you got there, Lou. Throw in some Cherry Picked "as much as" figures, and you should be working in Fox News in no time.

Oh wait, you did that too.
 
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Ehh... it's not that far off, fallacious appeal to emotion not withstanding. There are things that can skyrocket the cost of an ambulance ride, such as being from a service not in network. Distance is also a factor; you get charged a flat fee for the ambulance and then per a mile. You can't forget extra things like oxygen and life saving triage along the ride. God forbid you need to be airlifted to somewhere.

Strictly speaking, proper healthcare is out of the hands off the nation's actual working class unless they are willing to mortgage their futures. That's inappropriate and a great ill in our society.
 
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That's some excellent fallacious appeal to emotion and false dichotomy work you got there, Lou. Throw in some Cherry Picked "as much as" figures, and you should be working in Fox News in no time.

Oh wait, you did that too.
Better check that privilege there, bub. It's easy to sit there and pontificate when you've never been faced with that choice.
 
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That's some excellent fallacious appeal to emotion and false dichotomy work you got there, Lou. Throw in some Cherry Picked "as much as" figures, and you should be working in Fox News in no time.
"It's ok, you guys, you only have to make that choice sometimes, not every time..."

Also, it's not a fallacy if something does actually hurt people and the argument is about that in the first place.
 

GasBandit

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More fallacies - mostly ad hominems to boot. I knew it's what I'd come back to, this morning.

Let me point this out - the REAL false dichotomy we're talking about here is the ever-present one in this debate - that the only choices are to accept what we have now, or go fully socialized medicine. "An Ambulance ride costs a mortgage payment, so the government (read: your middle class neighbors with a gun held to their head) should pay for it!" This ignores the real underlying issue - why does an ambulance ride cost so much? And the answer is the same as why everything else in American medicine costs so much - because administrators and insurance companies have been doing everything in their power to undermine the capitalistic forces that are supposed to keep such things in check, for as long as any of us has been alive.

Let me just throw this idea out there, off the top of my head.
The primary problem, as you point out in an extremely emotional way, is that when a loved one is turning blue or bleeding out, you don't have time to comparison shop. But when you call 911, you aren't calling a specific ambulance or hospital or emergicare company, you're calling a government switchboard. They are the ones who decide which ambulance comes to pick you up. What if they started using a technology that has been around for at least 20 years - the electronic auction? The healthcare providers (or rather their administrators) can submit "bids" as often as they like for the all-inclusive cost of an ambulance trip to the emergency room, and when a call comes in, the dispatcher has an easy interface showing the least expensive bids and their locations. There's no time delay involved because the ambulances were bidding on responding to your emergency, days, even weeks, before your emergency even took place. As companies fail to win bids realize that slightly less money is better than no money, they'll lower their bids for the next emergencies, which will cause the other companies to do the same when they see they're not winning bids, and over a relatively short amount of time, there's a very palpable shrinking effect on the cost of an ambulance ride. This is the kicker - for capitalism to work, there has to be competition. Most of the problems with the price of our medical care has come about as a result of collusion aimed to undermine competition.

Is this idea perfect? No. Is it better than what we have? I think so. Are there even more options, that were not thought of by a layman over the course of a weeknight's sleep? Wouldn't be surprised at all.

But those aren't the debates we're having, either here, or on a national scale. It's locked into "status quo vs single payer," because the people at the top level of this debate have their own axes to grind, and that trickles down through the tribalism. Big Medicine has deep pockets, so they buy one side, and their street-level minions follow along because the OTHER side are headed up by the Ruinous Powers - the socialists, and their every-man-on-the-street followers are just as rabid because not accepting socialism means you want families to die horribly in squalid and abject poverty, you privileged scum.

But the truth is there's more than one way to skin a cat, and it doesn't take much looking at the underlying causes of the problem to find those other ways.
 
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I advise people to make that decision (and many more decisions) long before you end up in that situation.

Then when you're in it, you don't have to "think" about it, you act based on the path you've decided to take earlier. This is the primary purpose of a DNR, for instance - and the reasoning is similar. Only most people don't think about pre-planning emergencies until near the end of their lives. Do it now. Revisit it frequently. Determine the risks you have in your life and plan for each possibility.

As far as finances, you have to weigh your costs - do you pay more for insurance now, or do you pay for medical care out of pocket at time of service, or do you use payment plans after the care? If you can't afford insurance, and you can't afford the ambulance ride, then you're going to be dealing with medical expenses for a long time. You may have to take a second or third job to pay them off and avoid collections.

My experience with medical expenses, particularly emergency expenses, is that you can work out a payment plan and often get 0 interest, and maintain a reasonable standard of living while you pay them off.

If they go to collections you can often get the bills cut nearly in half, and then work out a payment plan (and in fact one technique some use is to let them got to collections then work out a deal - though it hurts your credit to do so).

So do the math. Are you reasonably healthy? Do you avoid risky activities? Are you at low risk for serious disease - diabetes, cancer, etc? Chances are good you could get away without insurance, and instead save up 10% of your paychecks for emergencies - medical or otherwise - and then use payment plans to cover really big emergencies.

If you aren't in good health, or participate in risky activities, or are at risk for serious disease, you may want to pay up front. Even if you can't afford conventional insurance, you may be able to afford catastrophic insurance. If something goes really wrong and you're in the hospital for weeks fighting a blood infection, they won't take care of all costs, but they'll bring them down to the point where you don't need to go bankrupt to keep up with the monthly payments you arrange with the hospital.

Further, learn some basic first aid and CPR and you and your family stand a much better chance of surviving an emergency situation. Certainly where I'm living it could take more than 5 minutes for an ambulance to arrive, so even if cost wasn't an issue (and even with insurance it can be) someone could easily die if we didn't prepare for basic medical care.

If, however, your plan is to not prepare, and not plan ahead, and instead blame society for not taking care of you when you became ill, and demand that others take care of your medical expense then I'd suggest that's a poor plan, and you may be disappointed with your decision should you become seriously ill.

Besides, even people with good insurance can find themselves in a bad situation. Check your insurance carefully and make sure you understand what coverage you have when going out of state, for instance. Having a heart attack and a triple bypass on vacation isn't fun - and it gets worse when you find out your insurance only covers a fraction of your hundreds of thousands of dollars of emergency treatment.

So this isn't something that's limited to the poor.
 
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Your example works...IF everyone accepts everyone's insurance coverage. Which they don't.
So then we have an extra step during that electronic auction where the person who takes the call has to ask, "Now which insurance do you carry?" in order to filter out all the ambulance rides that are out-of-network and so not covered/too expensive.
But then the solution to that brings us back to single payer again.

--Patrick
 
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If you'd had insurance, maybe they could've saved it instead of being forced to amputate.

--Patrick
I knew I should've signed up for air ambulance insurance from one of the 18,000 mailers we've received since moving to rural SW Oregon.
 

GasBandit

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Your example works...IF everyone accepts everyone's insurance coverage. Which they don't.
So then we have an extra step during that electronic auction where the person who takes the call has to ask, "Now which insurance do you carry?" in order to filter out all the ambulance rides that are out-of-network and so not covered/too expensive.
But then the solution to that brings us back to single payer again.

--Patrick
Or a simple stipulation that the price of emergency services provided in this manner must be for all insurance companies. That's not single payer, and it addresses another underlying problem - that insurance is no longer insurance, but rather viewed as a "pay in advance" medical payment plan, and so long as your premiums are paid up the bill is "somebody else's problem." Remember what happens when, in a non-emergency situation, you DO shop around and tell the providers you're paying cash? Suddenly prices plummet. What if the model for insurance was reimbursement to the patient instead of directly paying the hospital (which, as it stands, cuts the patient out from any price negotiations and divorces them from the concept that they're actually paying for something)?

See, this is what I'm talking about... there are other avenues to debate and work out, not just a simple "Love Obamacare or you're Satan" false dichotomy.
 
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Your example works...IF everyone accepts everyone's insurance coverage. Which they don't.
So then we have an extra step during that electronic auction where the person who takes the call has to ask, "Now which insurance do you carry?" in order to filter out all the ambulance rides that are out-of-network and so not covered/too expensive.
But then the solution to that brings us back to single payer again.

--Patrick
For the ambulance company to be able to bid for these contracts, they'd have to accept enough insurance carriers to cover at least, say, 95% of the population. For insurance companies to sell in the area they'd have to have basic ambulance coverage that provided at least some coverage even for ambulance companies that they don't cover.

So even if you do happen to get an ambulance that isn't covered, you will still have a small bill. Further, the ambulance would be the cheapest option, so even if they didn't accept your insurance it should be half the cost of what it is today.
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@stienman I don't get what was so funny about my post but please elaborate.
Mostly because of the pretense that you care about the rural voter.

But your comment is too limited because the reality is that the majority of the United States only have one ambulance provider, not just rural, and they are operated by the government, or area hospitals, or non profit associations working with the hospitals. Only in densely urban areas do you find private ambulance companies (and most often those are non-emergency transport). If you look at the New York situation, 67% of all ambulances are owned and operated by the new york fire department. Most of the remainder are operated by hospitals. While there are private companies, and while the city can call on them for emergencies, there's a strict hierarchy to their operation, and if you started an ambulance service within NYC you would rarely see emergency calls except during mass casualty incidents.

So honestly, this whole discussion, while an entertaining and thoughtful example of how a service could be capitalized for the benefit of the consumer, would simply not work.

Further, privatizing emergency services is nice in theory, but the high costs are largely due to oversubscription because no one wants to be told their father is dead because they city had n-1 ambulances on call, and your father needed that nth ambulance. Usually, they work out deals with neighboring cities so when one reaches a certain point of usage, the other shifts units into the first's area and they share the load, so it's manageable with some planning and preparation. But they have to have vehicles in top working order, trained responders who act exactly as their process and procedure dictates (so they reduce liability for lawsuits), and they have to have more than they need, 24/7 on call, for their population. They'll be paying for the vehicles, fuel, and responders 100% of the time, even though a significant amount of time they are idle. Even if they have responders on call, they still have to have a certain number of working, stocked vehicles for them for when things get busy.

So I don't think to privatize ambulance service and doing instant bidding is something that would work without changing what people expect from emergency services. You could do this in stable communities with an education campaign, but it would really only work in densely packed urban areas (as you rightly point out), and even then you'd suffer significant issues and lawsuits if people didn't understand what services are provided and what level of care and service they can expect.

And the same is true for many emergency services.

So I laughed because
1) I have a hard time believing you care about the rural voters you heap scorn upon for putting Trump in the White House
2) you are probably only covered by one ambulance service no matter where you live, so you're actually asking about your own situation unknowingly

But mostly 1. You're trying to use people you don't actually care about to support an argument they likely would disagree with.
 
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figmentPez

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What about in rural areas with only one hospital or only one ambulance provider?
If Gas's plan were in place, it woudln't be just rural areas. Every area that currently only has one cable provider would probably also have one ambulance provider. Which would include many major suburbs.
 

GasBandit

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If Gas's plan were in place, it woudln't be just rural areas. Every area that currently only has one cable provider would probably also have one ambulance provider. Which would include many major suburbs.
I don't think that's an accurate assessment. Here in BCS, we only have one cable provider, but we have three hospitals, additional urgentcare facilities (such as CaprockER and Physicians Premier) and even independent ambulance companies. There's just too much money in medicine for there to not be multiple companies trying to get in on the action.

In fact, the cost of the freestanding ERs is part of another debate currently going on in Texas, because they're overcharging, too.

Edit - in fact, you could even say this one-cable-network town is oversaturated with emergency care options.
 
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ITT: smart people deliberately issuing logical fallacies.
Gas, you are the one who brought up the Satanic False Dichotomy. There are plenty of other options, but they all het pushed away as impossible, socialist, or too expensive.
Stien: saying blots doesn't care about rural people because they voted for Trump is bonkers. I can must certainly think my neighbors are dickheads for playing loud music at night, and still hope an ambulance will come save them if they have a great attack.
Gas: your bidding system would mean everyone gets the cheapest option by default, which has been proven a million times over by governments all around the world, is a horrible system which means crappy service for all and a war to get as cheap as possible to the legal lower limits. Yes, I can think of better systems - about 20 of them being used in the EU right this instant. And yes, that means I put Bulgarian and Polish health care above the US system - because they won't let poor people die for lack of insurance.
 

GasBandit

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And yes, that means I put Bulgarian and Polish health care above the US system - because they won't let poor people die for lack of insurance.
Fun fact - American emergency services aren't actually allowed to turn people away for lack of ability to pay. They HAVE to accept them and treat them. They don't keep you sitting in the lobby until your check clears.

If it ends up to where you can't/don't pay, that impacts your credit rating, yes, but as Steinman referenced, there are other options at that point, too - all, of course, long AFTER the gushing blood has been stanched.
 
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1) I have a hard time believing you care about the rural voters you heap scorn upon for putting Trump in the White House
Not everyone in rural areas voted for trump. Conversely, there are people in cities that voted for him. Obviously yes I have no problems when trump voters die, especially at the hands of policies that they vote for, but I can't say we should just have a blanket "let them all die" attitude because I care about the good people there.
 

figmentPez

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I don't think that's an accurate assessment. Here in BCS, we only have one cable provider, but we have three hospitals, additional urgentcare facilities (such as CaprockER and Physicians Premier) and even independent ambulance companies. There's just too much money in medicine for there to not be multiple companies trying to get in on the action.

In fact, the cost of the freestanding ERs is part of another debate currently going on in Texas, because they're overcharging, too.

Edit - in fact, you could even say this one-cable-network town is oversaturated with emergency care options.
Yes, and you're advocating a system that would drastically cut how much money they can make. What do you think happens when that cut happens? There won't be 3 providers anymore. They'll probably merge, and/or carve things up with non-compete agreements, or whatever cable companies do to decide who serves which area.
 

GasBandit

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Yes, and you're advocating a system that would drastically cut how much money they can make. What do you think happens when that cut happens? There won't be 3 providers anymore. They'll probably merge, and/or carve things up with non-compete agreements, or whatever cable companies do to decide who serves which area.
There's a difference between what makes a cable company a geographic monopoly and what determines how many hospitals there are in an area. It would only be an apt comparison if the hospitals had to build their own roads, and only their own ambulances could use the roads they built.

B/CS had 3 hospitals even before all the extra emergency rooms started popping up in 2016.
 
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