The strange greatness of Donald Trump

[oxmixmudd]

So what you're saying is that it's a perpetuation of the Obamacare lie that health insurance is synonymous with healthcare (a lot of people who were forced to sign up for the "free" Obamacare were often shocked to discover that it cost more and covered less than their previous insurance, including, in some cases, lifesaving treatments).

But here's the thing: why are we looking to government to fix a problem that is largely of their own making? As Ronald Reagan famously said, "Among the most frightening words in the English language are 'I'm from the government, and I'm here to help.'"

No, that's not the issue at all.

The issue is that prior to ACA people could lose coverage they would normally have just because they changed jobs or lost their job and had to move to another job because insurance companies would refuse to take on a new client IF they were already sick with a disease they normally WOULD pay for. That is what coverage of pre-existing conditions is all about. And now, with ACA insurance companies are no longer allowed to refuse coverage to someone who, say, already has cancer when they buy the coverage. Specifically say when they change jobs and go from one provider to another.

The reason Tillis's bill is a lie is because they are using the terminology which is used to define this provision of the ACA, but the reality is they mean something very different. They just mean you'll get a policy- not a continuation of coverage. And the reality is they are allowing the insurance companies to do the same thing they were dong before, they are just calling it a different name. But they are using the terminology that implies that implies the opposite.

So it's a lie. They are not keeping the provision that makes it so insurance companies can't refuse to cover you if you have to switch providers during an illness.


Jim

[NorrinRadd]

Ever notice how old people die at a higher rate than young people? I wonder why that might be...?

Probably because they go to doctors too damned often.

[NorrinRadd]

You didn't eat with your fingers again, did you?

Probably much less messy than trying to eat without them.

[Mountain Man]

The issue is that prior to ACA people could lose coverage they would normally have just because they changed jobs or lost their job and had to move to another job because insurance companies would refuse to take on a new client IF they were already sick with a disease they normally WOULD pay for. That is what coverage of pre-existing conditions is all about. And now, with ACA insurance companies are no longer allowed to refuse coverage to someone who, say, already has cancer when they buy the coverage. Specifically say when they change jobs and go from one provider to another.

You didn't follow my links, did you? A lot of people who signed up for Obamacare, either willingly or were forced to by the government, found that lifesaving treatments were being denied under their new plan.

https://nypost.com/2013/11/12/death-...ncer-patients/

So, no, Obamacare didn't fix that one, either.

[oxmixmudd]

You didn't follow my links, did you? A lot of people who signed up for Obamacare, either willingly or were forced to by the government, found that lifesaving treatments were being denied under their new plan.

https://nypost.com/2013/11/12/death-...ncer-patients/

So, no, Obamacare didn't fix that one, either.

Yiu still are not getting the point mm. You are jusr covering for people that are kying abiut what they are doing.

The differences are (1) the difference between not covering a treatment for ANYONE and (2) being covered and then later denied when one otherwise would not be on the new plan solely because you didnt gain access to the new plan as a well person. And (3), lying about what is being proposed, pretending a provision exests when it does not.

Jim

[carpedm9587]

You didn't follow my links, did you? A lot of people who signed up for Obamacare, either willingly or were forced to by the government, found that lifesaving treatments were being denied under their new plan.

https://nypost.com/2013/11/12/death-...ncer-patients/

So, no, Obamacare didn't fix that one, either.

So first - 2013?

Second, the article is full of anecdotes, which are poor evidence.

Third, where it does cite "studies" it leaves major question marks that require answers. For example, it cites:

A study by Avalere Health found that up to 90 percent of ObamaCare plans will force cancer patients to cover half the cost of new drugs until they hit the out-of-pocket maximum. By comparison, only 29 percent of non-ObamaCare employer-based plans do so.

This paragraph has at least the potential to be "fun with statistics." It compages "Obamacare plans" generally, with non-Obamacare plans - but limits the latter to "employer-based." SO right away we have apples/oranges that raises all sorts of questions.

1) For those securing the Obamacare plans, what kind of insurance did they have BEFORE Obamacare. If most of them had no insurance at all, then the plan is an improvement for those people - even with its flaws.

2) What percentage of the non-Obamacare employer plans with these coverages continued unchanged (or improved?) under Obamacare? If this percentage is high, the impact of the 90% in the first line is negligible.

So this paragraph could reflect something truly horrible (an enormous percentage of people seeing diminished coverage for cancer) or it could reflect a trivial reality (many uninsured now have insurance, but not as good as it could be, and employees are largely unaffected by the change). Without more data, we cannot tell.

This is the kind of game both sides play with "statistics." It takes careful reading to spot it.

[Mountain Man]

Yiu still are not getting the point mm. You are jusr covering for people that are kying abiut what they are doing.

The differences are (1) the difference between not covering a treatment for ANYONE and (2) being covered and then later denied when one otherwise would not be on the new plan solely because you didnt gain access to the new plan as a well person. And (3), lying about what is being proposed, pretending a provision exests when it does not.

Jim

I agree that if that's the case then the Republican politicians who proposed the measure are not being honest.

My point is that you're praising Obamacare for doing exactly what you accuse some Republican politicians of doing: promising one thing but delivering another.

[Mountain Man]

So first - 2013?

Second, the article is full of anecdotes, which are poor evidence.

Third, where it does cite "studies" it leaves major question marks that require answers. For example, it cites:

A study by Avalere Health found that up to 90 percent of ObamaCare plans will force cancer patients to cover half the cost of new drugs until they hit the out-of-pocket maximum. By comparison, only 29 percent of non-ObamaCare employer-based plans do so.

This paragraph has at least the potential to be "fun with statistics." It compages "Obamacare plans" generally, with non-Obamacare plans - but limits the latter to "employer-based." SO right away we have apples/oranges that raises all sorts of questions.

1) For those securing the Obamacare plans, what kind of insurance did they have BEFORE Obamacare. If most of them had no insurance at all, then the plan is an improvement for those people - even with its flaws.

2) What percentage of the non-Obamacare employer plans with these coverages continued unchanged (or improved?) under Obamacare? If this percentage is high, the impact of the 90% in the first line is negligible.

So this paragraph could reflect something truly horrible (an enormous percentage of people seeing diminished coverage for cancer) or it could reflect a trivial reality (many uninsured now have insurance, but not as good as it could be, and employees are largely unaffected by the change). Without more data, we cannot tell.

This is the kind of game both sides play with "statistics." It takes careful reading to spot it.

Sure, carpe, you can twist and turn and avoid the facts all you want, but it remains true that Obamacare made life worse for a lot of people. It's the exact same "bait and switch" you and ox are complaining about Republicans pulling.

And if you don't like an article from 2013 then how about one from 2017?

(Spoiler: things haven't gotten any better for cancer patients under Obamacare.)

And just for fun, here's a 2016 editorial titled "How My ObamaCare Coverage Is Almost Worse Than No Coverage".

[carpedm9587]

Sure, carpe, you can twist and turn and avoid the facts all you want, but it remains true that Obamacare made life worse for a lot of people. It's the exact same "bait and switch" you and ox are complaining about Republicans pulling.

Made it worse for some? Absolutely. Every change improves things in some ways, and makes them worse in another.
Made it worse for "a lot of people?" Well, that depends on what "a lot of people" means.
Made it worse for most? That case has not been made. All that has been done by the right is point to isolated locales/people where things got worse and relay those anecdotes. I have not seen broad-based and properly used statistics making this case.

And if you don't like an article from 2013 then how about one from 2017?

(Spoiler: things haven't gotten any better for cancer patients under Obamacare.)

I don't think I'll bother with the article, MM. I already agree with the title. I have no doubt that there are plans that don't include major cancer centers. Few things (on a policy basis) always achieve anything. When you frame things in absolutes, you can say horrible-sounding things that are actually not that bad when looked at closely. How about some numbers that show what percentage of plans include/exclude this coverage, what percentage of people are impacted, and how that changed before and after Obamacare for like populations? THOSE would be meaningful statistics.

And just for fun, here's a 2016 editorial titled "How My ObamaCare Coverage Is Almost Worse Than No Coverage".

Yeah...I'm sure an editorial will make your case for you.

Really, MM - your habit of cherry-picking quotes and articles and even fragments of data to hold your position is pretty well demonstrated, and largely a waste of time. When you have the data I asked for above, let me know. THEN I'll look at it and, if it says what you are claiming, agree with you that "Obamacare generally made things worse for cancer patients."

[Mountain Man]

I already gave you that information, but you dismissed it as "anecdotes" and "cherry picked" statistics.

You're the internet equivalent of the kid who sticks his fingers in his ears and yells, "La la la, I can't hear you!"

[carpedm9587]

I already gave you that information, but you dismissed it as "anecdotes" and "cherry picked" statistics.

You're the internet equivalent of the kid who sticks his fingers in his ears and yells, "La la la, I can't hear you!"

Sorry, MM. You haven't. And claiming you did doesn't make it so. As for sticking one's fingers in one's ears and chanting "la la la, I can't hear you," even if that were true (and it's not), it has no real impact if the other person isn't actually saying anything.

[oxmixmudd]

I agree that if that's the case then the Republican politicians who proposed the measure are not being honest.

Good, but 'not being honest' is a gross understatement. They are not only lying, they are deceiving - they created something that looks like what people are getting in the ACA on the surface in the hopes they won't discover their lie until the deal is done, and they've left a trojan horse to allow the insurance companies to return to the previous practice, which is nothing less than sacrificing peoples lives on the alter of profit (more on that later).

My point is that you're praising Obamacare for doing exactly what you accuse some Republican politicians of doing: promising one thing but delivering another.

No. That is a significant oversimplification and a completely invalid equivalence (e.g. apples to oranges).

Insurance is a complicated business. Providing healthcare to everyone with any semblance of affordability is an exercise in compromise. There are limitations on what can be done, there are mistakes that can be made setting the system up and which would need to be worked out over time. Most of what you are trying to equate with what Tillis' bill does is simply the fact that ACA is imperfect, or a consequence of over promising in ignorance - it doesn't boil down to the sort of willful out and out deception that Tillis' plan is.

Tillis is pretending to get rid of one of the worst aspects of private insurance while, again, giving the insurance companies the trojan horse that will cause them to be able to return to those old policies.

Why is this so bad, compared to the former?

Because what happens with the 'not covering pre-existing conditions clause' is that insurance companies were leveraging it to provide themselves greater profit by terminating coverage that they are actually charging to cover.

How does that work?

Take two insurance providers A and B. When they sell a policy that covers disease X, they factor in the percentage of people that get disease X and how much it costs to treat disease X over that populations lifetime. then they spread that cost (as premiums) over the entire population they cover - well and sick. That then become a portion of the total premium cost. But these statistics are based on a normal population. If people don't buy insurance until they get sick, then that is a statistically skewed population and there just isn't enough income from the premiums to actually cover disease X at that premium cost. So that is where pre-existing conditions clauses come from - it keeps the insurance company from going bankrupt if large populations of people wait till the get sick to buy insurance. So normally when you get a policy, they want you to start the policy 'normal' so to speak. So far this is ok, it's just the cost of doing business and the realities of the limits of health insurance.

But over a persons lifetime, they may change jobs and go from insurance A -> B, and others may move from B->A. Now the reality is those movements tend to average out, and if a person (pAxB) starts with A and contracts disease X and then moves to B while he has disease X, there will be someone else (pBxA) that started with B and get disease X and moved to A while they had disease X*. And in that case, pAxB and pBxa are in fact part of the same 'normal' population the premiums where calculated against - the statistics they use to calculate the premiums are still valid. But what if both A and B leverage their abnormal population pre-existing conditions policy to exclude normal population members pAxB and pBxA so that when they make the transition, the lose their coverage for X? Now, A and B reduce the cost of treatment for people like pAxB and pBxA - they only pay out a portion of the treatment cost AND THEIR PROFITS GO UP based on the statistics they used to determine the premium prices.

It is inexcusable. But it is what the insurance companies almost universally did and what they want to be able to do again.

Now, there is a real problem if you take away ALL pre-existing conditions clauses across the entire insurance industry and allow anyone to join a policy at any time - i.e. when they get sick. The stats do change and the premiums must be higher - unless you require EVERYONE to buy into insurance. Which is why the ACA has penalties for not buying insurance. It only works if everyone participates.

Bottom line, trying to provide coverage for everyone - I don't know if that can ever be truly affordable, it's a difficult task.

But terminating people's coverage already paying premiums, already insured, because some life event makes them change policies is nothing but sacrificing the innocent on the alter of profit. And it is truly despicable to LIE (as the are in Tills' plan) to make people think you are NOT doing that all the while in the background you've been bought by the insurance industry and you have a back door in place to, in fact, allow it.



Jim

*there are diseases that are rare enough your client population isn't quite big enough to be moderated by the statistical average. Insurance companies sometimes solve this problem by buying their own insurance on their insurance from someone like Lloyd's of London. The cost of that insurance insurance is part of your premium too.

[carpedm9587]

Good, but 'not being honest' is a gross understatement. They are not only lying, they are deceiving - they created something that looks like what people are getting in the ACA on the surface in the hopes they won't discover their lie until the deal is done, and they've left a trojan horse to allow the insurance companies to return to the previous practice, which is nothing less than sacrificing peoples lives on the alter of profit (more on that later).



No. That is a significant oversimplification, so much so I will attribute it to ignorance rather than malice.

Insurance is a complicated business. Providing healthcare to everyone with any semblance of affordability is an exercise in compromise. There are limitations on what can be done, there are mistakes that can be made setting the system up and which would need to be worked out over time. Most of what you are trying to equate with what Tillis' bill does is simply the fact that ACA is imperfect, it doesn't boil down to the sort of willful out and out deception that Tillis' plan is.

Tillis is pretending to get rid of one of the worst aspects of private insurance while, again, giving the insurance companies the trojan horse that will cause them to be able to return to those old policies.

Why is this so bad, compared to the former?

Because what happens with the 'not covering pre-existing conditions clause' is that insurance companies were leveraging it to provide themselves greater profit by terminating coverage that they are actually charging to cover.

How does that work?

Take two insurance providers A and B. When they sell a policy that covers disease X, they factor in the percentage of people that get disease X and how much it costs to treat disease X over that populations lifetime. then they spread that cost (as premiums) over the entire population they cover - well and sick. That then become a portion of the total premium cost. But these statistics are based on a normal population. If people don't buy insurance until they get sick, then that is a statistically skewed population and there just isn't enough income from the premiums to actually cover disease X at that premium cost. So that is where pre-existing conditions clauses come from - it keeps the insurance company from going bankrupt if large populations of people wait till the get sick to buy insurance. So normally when you get a policy, they want you to start the policy 'normal' so to speak. So far this is ok, it's just the cost of doing business and the realities of the limits of health insurance.

But over a persons lifetime, they may change jobs and go from insurance A -> B, and others may move from B->A. Now the reality is those movements tend to average out, and if a person (pAxB) starts with A and contracts disease X and then moves to B while he has disease X, there will be someone else (pBxA) that started with B and get disease X and moved to A while they had disease X. And in that case, pAxB and pBxa are in fact part of the same 'normal' population the premiums where calculated against - the statistics they use to calculate the premiums are still valid. But what if both A and B leverage their abnormal population pre-existing conditions policy to exclude normal population members pAxB and pBxA so that when they make the transition, the lose their coverage for X? Now, A and B reduce the cost of treatment for people like pAxB and pBxA - they only pay out a portion of the treatment cost AND THEIR PROFITS GO UP based on the statistics they used to determine the premium prices.

It is inexcusable. But it is what the insurance companies almost universally did and what they want to be able to do again.

Now, there is a real problem if you take away ALL pre-existing conditions clauses across the entire insurance industry. That stats do change and the premiums must be higher. Unless you require EVERYONE to buy into insurance. Which is why the ACA has penalties for not buying insurance. It only works if everyone participates.

Bottom line, trying to provide coverage for everyone - I don't know if that can ever be truly affordable, it's a difficult task.

But terminating people's coverage already paying premiums, already insured, because some life event makes them change policies is nothing but sacrificing the innocent on the alter of profit. And LYING (as the are in Tills' plan) to make people think you are NOT doing that all the while in the background you've been bought by the insurance industry and you have a back door in place to in fact allow it is despicable.

Jim

Nice summary

This is a dynamic perpetually ignored. If you require insurance companies to cover pre-existing conditions and still let people only apply for coverage when they want to, you will get people putting off the purchase until they are sick. To maintain profitability, premiums will skyrocket for the insured.

And if you look at the patterns for whom that tends to happen, it is heavily skewed to young vs. old. The young tend to need less medical coverage, and tend to have other priorities. The old tend to have more need, and tend to have a more mature view of priorities. Meanwhile, the young tend to be employed and the elderly more on a fixed income. Longer lifespans means there are actually more OF them, exacerbating the problem.

The entire thing screams for a single-payer system that is funded by a tax (i.e., like the medicare/medicaid tax) and mandates universal coverage. For most of us, that tax could be fairly significant and it would still not equal what we are paying today in insurance premiums - so it's a net gain. It would primarily impact the very young, who would begin to pay a tax they don't currently pay, which is a net loss to them because they are not currently buying insurance. But correctly structured, they would benefit as they themselves get older, and suddenly find themselves a net drain on the system, rather than a net contributor to it.

The existing insurance companies don't have to go out of business. They can become private administrators and offer supplemental packages for things not covered (or, for some, not adequately covered) under the universal model.

[Mountain Man]

Sorry, MM. You haven't. And claiming you did doesn't make it so. As for sticking one's fingers in one's ears and chanting "la la la, I can't hear you," even if that were true (and it's not), it has no real impact if the other person isn't actually saying anything.

Oh, I know, any source that contests something you want to believe is dismissed with the wave of a hand.

It's OK, this is expected behavior from you.

[Mountain Man]

Tillis is pretending to get rid of one of the worst aspects of private insurance while, again, giving the insurance companies the trojan horse that will cause them to be able to return to those old policies.

Yes, which is to say that he's continuing something that was done under Obamacare which was sold on the lie that health insurance and healthcare are synonymous before pulling the rug out from under people who needed it most (cancer patients have been hit especially hard by Obama's "bait and switch").