Current Events > Republican senators answer questions about their healthcare bill

(+) Yeah! (+)

https://www.vox.com/policy-and-politics/2017/9/20/16333876/republican-senators-graham-cassidy

Jeff Stein
Senator, I wanted to ask you for a policy-based explanation for why you’re moving forward with the Graham-Cassidy proposal. What problems will this solve in the health care system?

Pat Roberts
That — that is the last stage out of Dodge City.

Jeff Stein
I’m just trying to explain to our readers what the policy —

Pat Roberts
What readers? Who do you represent?

Jeff Stein
It’s a website called Vox.

Pat Roberts
... [Graham-Cassidy] is the last stage out of Dodge City. I’m from Dodge City. So it’s the last stage out to do anything. Restoring decision-making back to the states is always a good idea, but this is not the best possible bill — this is the best bill possible under the circumstances.

If we do nothing, I think it has a tremendous impact on the 2018 elections. And whether or not Republicans still maintain control and we have the gavel.

Jeff Stein
But why does this bill make things better for Americans? How does it help?

Pat Roberts
Pardon me?

Jeff Stein
Why does this make things better? What is this doing?

Pat Roberts
Look, we’re in the back seat of a convertible being driven by Thelma and Louise, and we’re headed toward the canyon. That’s a movie that you’ve probably never seen —

Jeff Stein
I do know Thelma and Louise, sir.

Pat Roberts
So we have to get out of the car, and you have to have a car to get into, and this is the only car there is.
...
Jeff Stein
What are the main policy explanations for getting behind this bill? What does this bill do right, policy-wise?

John Kennedy
I think it’s an improvement over Obamacare.

Jeff Stein
Why?

John Kennedy
My position has always been that, number one, I think Obamacare has been a failure.

Number two: First chance I get to vote for repeal it, I’ll do it.

And number three: If it’s replacement, if replacement is better than Obamacare, I will vote for it.

Glad that's cleared up
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reminds me of that time elizabeth warren refused to answer any questions

Sounds about right.
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Remember how the ACA wasn't a tax until it was when Schumer was asked if Congress had the authority to charge a penalty for non-compliance? Politics are stupid. Anyone who chooses either of these parties is just a pawn.
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republican voters: i don't have pre-existing conditions yet so repeal is good for me, and repeal with something that replaces it is great for me!

democrat voters: u srs

this is what happens when elections are not competitive.

roberts' last election was won by 10.6% (53.5/42.1) against an independent.
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FLUFFYGERM posted...

reminds me of that time elizabeth warren refused to answer any questions

I applaud your commitment.
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Antifar posted...

If we do nothing, I think it has a tremendous impact on the 2018 elections. And whether or not Republicans still maintain control and we have the gavel.

I can't imagine taking healthcare away from millions of Americans will go over that well either
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Coffeebeanz posted...

Remember how the ACA wasn't a tax until it was when Schumer was asked if Congress had the authority to charge a penalty for non-compliance? Politics are stupid. Anyone who chooses either of these parties is just a pawn.

I remember when the ACA was a public option, and two senate democrats fucked it all up for everyone (Mary Landrieu and Ben Nelson, by name)

Doom_Art posted...

I can't imagine taking healthcare away from millions of Americans will go over that well either

millions of americans who were never going to vote for him
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Doom_Art posted...

Antifar posted...

If we do nothing, I think it has a tremendous impact on the 2018 elections. And whether or not Republicans still maintain control and we have the gavel.

I can't imagine taking healthcare away from millions of Americans will go over that well either

It's not like the ACA actually improved access to healthcare for anyone. Insurance coverage doesn't mean a hill of beans if you're deductibles are higher than what your previous premiums used to be.

Look, I know you have the GOP (who doesn't?) But the ACA is a total shitshow that somehow made healthcare even less affordable and accessible than before.
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Coffeebeanz posted...

It's not like the ACA actually improved access to healthcare for anyone. Insurance coverage doesn't mean a hill of beans if you're deductibles are higher than what your previous premiums used to be.

it absolutely did for high risk pool participants
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Darkman124 posted...

Coffeebeanz posted...

It's not like the ACA actually improved access to healthcare for anyone. Insurance coverage doesn't mean a hill of beans if you're deductibles are higher than what your previous premiums used to be.

it absolutely did for high risk pool participants

For roughly 1/2 of 1%. It only benefits those who grossly overuse healthcare resources for usually preventable chronic diseases like COPD and congestive heart failure. These conditions take up a grotesquely disproportionate amount of healthcare dollars.

For every one person with some super rare vasculitis, there's hundreds of COPD patients having exacerbations and getting hospitalized for 5 days just because they won't quit smoking or use their meds.
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Let them take away people's healthcare. :u That'll make sure they don't get reelected.
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OpheliaAdenade posted...

Let them take away people's healthcare. :u That'll make sure they don't get reelected.

My premiums went from $150/month to $400/month, and my deductibles actually went up in the process. How did that improve my access to healthcare?
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Coffeebeanz posted...

For roughly 1/2 of 1%. It only benefits those who grossly overuse healthcare resources for usually preventable chronic diseases like COPD and congestive heart failure. These conditions take up a grotesquely disproportionate amount of healthcare dollars.

http://www.kff.org/health-reform/issue-brief/pre-existing-conditions-and-medical-underwriting-in-the-individual-insurance-market-prior-to-the-aca/

um, try 27%

not all of that 27% are at-risk because they presently have group coverage

but all it takes is losing your job and dropping your group coverage once to discover you're in the high risk pool now

ACA changed that.

Coffeebeanz posted...

My premiums went from $150/month to $400/month, and my deductibles actually went up in the process. How did that improve my access to healthcare?

you already had access to healthcare and you still do

the way merging risk pools works is that things get harder for the people who had it too easy

and things get easier for the people who had it too hard
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you already had access to healthcare

the way merging risk pools works is that things get harder for the people who had things too easy

and things get easier for the people who had things too hard

You have no clue what you're talking about.
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Coffeebeanz posted...

You have no clue what you're talking about.

i'm trying real hard to not be a dick to you but your status as a doctor does not confer knowledge of insurance economics

stick to content of posts

i want to emphasize my earlier post:

Darkman124 posted...

republican voters: i don't have pre-existing conditions yet so repeal is good for me, and repeal with something that replaces it is great for me!

the nature of the system pre-ACA was that people who might be impacted at some point in the future were not yet being impacted as they held their group policy

also i'm relying on Kaiser for my data. you're making up numbers. please don't do that.
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OpheliaAdenade posted...

Let them take away people's healthcare. :u That'll make sure they don't get reelected.

It' cute you believe this, I remember

Let them hold the government hostage over stupid shit, they'll just lose harder
Let them have Trump as their challenger to the democrats, make the election easy

It's been shown time and time again that it doesn't matter what the Republicans do, they will not lose power, in fact, they keep getting rewarded with more power when they do something dirty as fuck because people either don't vote or hate the Dems and liberals just that much more.
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tremain07 posted...

OpheliaAdenade posted...

Let them take away people's healthcare. :u That'll make sure they don't get reelected.

It' cute you believe this, I remember

Let them hold the government hostage over stupid shit, they'll just lose harder
Let them have Trump as their challenger to the democrats, make the election easy

It's been shown time and time again that it doesn't matter what the Republicans do, they will not lose power, in fact, they keep getting rewarded with more power when they do something dirty as fuck because people either don't vote or hate the Dems and liberals just that much more.

Yea buddy, sure :u
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A personal example - I have a COPD patient who gets hospitalized monthly for exacerbations because his medication copays shot through the roof after the ACA. Now he can't afford his inhaled long acting steroids, so he simply racks up $100k/month in medical bills instead. He hates it, and it literally benefits no one. Medicaid will pay for these hospitalizations before they'd give him a discount on meds that would prevent them. These costs are shifted to the"healthy people who have it easy".

And don't even get me started on how insurance companies are allowed to not pay for sleep studies, but require them to qualify for CPAPs. It's absurd.
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Coffeebeanz posted...

Darkman124 posted...

Coffeebeanz posted...

It's not like the ACA actually improved access to healthcare for anyone. Insurance coverage doesn't mean a hill of beans if you're deductibles are higher than what your previous premiums used to be.

it absolutely did for high risk pool participants

For roughly 1/2 of 1%. It only benefits those who grossly overuse healthcare resources for usually preventable chronic diseases like COPD and congestive heart failure. These conditions take up a grotesquely disproportionate amount of healthcare dollars.

For every one person with some super rare vasculitis, there's hundreds of COPD patients having exacerbations and getting hospitalized for 5 days just because they won't quit smoking or use their meds.

Bullshit. There are hundreds of preexisting conditions.

This will kill people and bankrupt more.
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We need a single payer system with regulations for standards of care. This hybrid shit is making healthcare so expensive and emphasizes hospitalization over good primary care.
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Coffeebeanz posted...

We need a single payer system with regulations for standards of care. This hybrid s*** is making healthcare so expensive and emphasizes hospitalization over good primary care.

on this, we agree 100%.

if the ACA repeal were replacing it with sanders' medicare-for-all plan I would be good with it.

as to the specific situations you've observed, i don't doubt that there are repairable problems in the ACA (or medicaid). i do not think these problems are 'necessary evils' to allow for the end of high risk pooling, but mistakes in the policy that could be updated now that we've seen they are mistakes.

the fundamental goal of removing high-risk pools was a good one. that it would impact the costs of the healthy was a given. that it impacts the costs of the sick-and-covered is very unfortunate and ought to be fixed, but is not a driver for repeal.
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Just consider how ridiculous this is. 1/3rd of total Medicare expenditures are utilized for the sickest 10%. If we invested more money in primary care access and emphasized early treatment or prevention, we wouldn't have to do that.
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This bill makes it so Insurance companies reduce almost all risk. Insure healthy people for cheap and charge so much to the non healthy they can't afford it.

It will bring back the bullshit they were doing before when they voided policies for minor application errors on high cost patients. They literally gave bonuses to employees who found reasons to do this.

Plus, it'll be worse because Medicaid is being gutted.

If you get anything chronic and are not wealthy this will make you choose death or insurmountable debt.
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I like how that shit assumed the reporter didn't know what Thelma and Louise was but he himself has never heard of Vox.
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Coffeebeanz posted...

Just consider how ridiculous this is. 1/3rd of total Medicare expenditures are utilized for the sickest 10%. If we invested more money in primary care access and emphasized early treatment or prevention, we wouldn't have to do that.

that's somewhat consistent with the rest of the healthcare market (overall it actually appears to be somewhat better than the broad US market)

http://www.kff.org/health-reform/issue-brief/high-risk-pools-for-uninsurable-individuals/

In the U.S. and other developed nations, population health care spending is highly concentrated: in any given year, the healthiest 50% of the population accounts for less than 3% of total health care expenditures, while the sickest 10% account for nearly two-thirds of population health spending (Figure 1). Private health insurance pools risks so that premiums paid by most enrollees, who have low claims costs, help pay claims for the small share of enrollees with high costs.

kaiser is saying it happens even in other western nations, so i don't think single payer is gonna fix that either. possibly a psychological/public knowledge issue?

idk. if anything your link seems to show that medicare works better than the market on average.
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lilORANG posted...

I like how that shit assumed the reporter didn't know what Thelma and Louise was but he himself has never heard of Vox.

In fairness, the reporter is like, 30? at most.
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lilORANG posted...

I like how that shit assumed the reporter didn't know what Thelma and Louise was but he himself has never heard of Vox.

Pfft he's heard of Vox, he's just pretending not to as a power move
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I GET IT! He's from Dodge City so he's dodging all the questions!
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ayyyy
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Words can't describe how screwed up our healthcare expenditure priorities are.

That was 2006. It's even worse now. We can't keep blowing all our money on treating preventable chronic illness due to poor life choices.
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Coffeebeanz posted...

Just consider how ridiculous this is. 1/3rd of total Medicare expenditures are utilized for the sickest 10%.

I never understood how health insurance was supposed to work if this type of imbalance wasn't the case.
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COVxy posted...

Coffeebeanz posted...

Just consider how ridiculous this is. 1/3rd of total Medicare expenditures are utilized for the sickest 10%.

I never understood how health insurance was supposed to work if this type of imbalance wasn't the case.

It's the same in all insurance. I used to work for a major property insurer. The vast majority of people never file claims in a given year. Why is there no outrage at people with house fires driving up costs?
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KiwiTerraRizing posted...

COVxy posted...

Coffeebeanz posted...

Just consider how ridiculous this is. 1/3rd of total Medicare expenditures are utilized for the sickest 10%.

I never understood how health insurance was supposed to work if this type of imbalance wasn't the case.

It's the same in all insurance. I used to work for a major property insurer. The vast majority of people never file claims in a given year. Why is there no outrage at people with house fires driving up costs?

because home insurance is cheap due to how uncommon those events are

Coffeebeanz posted...

Words can't describe how screwed up our healthcare expenditure priorities are.

imo this doesnt really illustrate anything about our priorities, just about costs

i think what we'd need to see to illustrate priorities is a breakdown of what % medicare/medicaid pay of medicines/primary care/general prevention treatments vs what % they pay to keep someone alive who didn't get those treatments

i think it's a given that the latter costs an order of magnitude or two more than the former, but they could be paying for the former and still have that huge net cost of chronic treatments.
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Why is there no outrage at people with house fires driving up costs

Because they're not having house fires every month for years. CHF, COPD and CKD are preventable and treatable. Exacerbations shouldn't happen often - especially if they're compliant with their meds.

Again, it's like saying we should keep building houses for the guy who keeps making a bonfire in his living room.
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KiwiTerraRizing posted...

The vast majority of people never file claims in a given year. Why is there no outrage at people with house fires driving up costs?

i am not sure but i think coffee is kinda mad that the vast majority of people aren't filing claims for preventative care

and/or possibly that they can't because it's not well covered

Coffeebeanz posted...

Because they're not having house fires every month for years.

i mean, the appropriate solution certainly isn't "let 'em burn", not even for the worst GOMER
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FLUFFYGERM posted...

KiwiTerraRizing posted...

COVxy posted...

Coffeebeanz posted...

Just consider how ridiculous this is. 1/3rd of total Medicare expenditures are utilized for the sickest 10%.

I never understood how health insurance was supposed to work if this type of imbalance wasn't the case.

It's the same in all insurance. I used to work for a major property insurer. The vast majority of people never file claims in a given year. Why is there no outrage at people with house fires driving up costs?

because home insurance is cheap due to how uncommon those events are

But if everyone paid their fair share, wouldn't that just defeat the purpose of health insurance?
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COVxy posted...

But if everyone paid their fair share, wouldn't that just defeat the purpose of health insurance.

depends on whether 'fair share' is calculated based on participant wealth or participant cost to system. winky face.
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COVxy posted...

FLUFFYGERM posted...

KiwiTerraRizing posted...

COVxy posted...

Coffeebeanz posted...

Just consider how ridiculous this is. 1/3rd of total Medicare expenditures are utilized for the sickest 10%.

I never understood how health insurance was supposed to work if this type of imbalance wasn't the case.

It's the same in all insurance. I used to work for a major property insurer. The vast majority of people never file claims in a given year. Why is there no outrage at people with house fires driving up costs?

because home insurance is cheap due to how uncommon those events are

But if everyone paid their fair share, wouldn't that just defeat the purpose of health insurance.

yes, because it would mean forcing nonsmokers to pay more because of smokers. skinny people to pay more because of fat people. etc.

The plans keep dying because people like Obamacare. The Republicans should just admit it and fix it with the public option.
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The house fire analogy is like saying we should keep building houses for the guy who keeps making a bonfire in his living room

At some point we've got to find a different way than just shifting the cost to others. If you want to talk about fairness, tell the guy who can't afford a head CT because Joe Smoker over here racked up $2 Million in medical bills over the years.
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Coffeebeanz posted...

It's like saying we should keep building houses for the guy who keeps making a bonfire in his living room

At some point we've got to find a different way than just shifting the cost to others.

that analogy doesnt really work. the guy in question dies if you stop 'building houses' for him

fundamentally the conflict is between utilitarian economic policy and the hippocratic oath, no?
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fundamentally the conflict is between utilitarian economic policy and the hippocratic oath, no

It's a conflict between benefiscence and justice, both of which are important factors in medical decision making. It's why we don't give Linezolid to every skin infection we see.
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FLUFFYGERM posted...

COVxy posted...

FLUFFYGERM posted...

KiwiTerraRizing posted...

COVxy posted...

Coffeebeanz posted...

Just consider how ridiculous this is. 1/3rd of total Medicare expenditures are utilized for the sickest 10%.

I never understood how health insurance was supposed to work if this type of imbalance wasn't the case.

It's the same in all insurance. I used to work for a major property insurer. The vast majority of people never file claims in a given year. Why is there no outrage at people with house fires driving up costs?

because home insurance is cheap due to how uncommon those events are

But if everyone paid their fair share, wouldn't that just defeat the purpose of health insurance.

yes, because it would mean forcing nonsmokers to pay more because of smokers. skinny people to pay more because of fat people. etc.

No, it would be exactly like having no insurance at all and just tanking the medical costs. That is a completely fair insurance scheme. But it is the same as not having insurance at all.
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Coffeebeanz posted...

The house fire analogy is like saying we should keep building houses for the guy who keeps making a bonfire in his living room

At some point we've got to find a different way than just shifting the cost to others. If you want to talk about fairness, tell the guy who can't afford a head CT because Joe Smoker over here racked up $2 Million in medical bills over the years.

You're a pretty creepy person. I wouldn't want you to be my doctor.

Coffeebeanz posted...

The house fire analogy is like saying we should keep building houses for the guy who keeps making a bonfire in his living room

At some point we've got to find a different way than just shifting the cost to others. If you want to talk about fairness, tell the guy who can't afford a head CT because Joe Smoker over here racked up $2 Million in medical bills over the years.

You are overestimating the amount of conditions caused by purposeful actions.

My son has claims paid by insurance that exceed 10 million. If there was no Obamacare he would be dead, that's a fact. If this bill passes I'll be in so much debt my only way out will be a bullet.
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I'm pleasantly surprised: almost 50 posts and no "lol vox" post yet
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Coffeebeanz posted...

It's a conflict between benefiscence and justice, both of which are important factors in medical decision making. It's why we don't give Linezolid to every skin infection we see.

same thing, really.

i understand the frustration.
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Darkman124 posted...

Coffeebeanz posted...

It's like saying we should keep building houses for the guy who keeps making a bonfire in his living room

At some point we've got to find a different way than just shifting the cost to others.

that analogy doesnt really work. the guy in question dies if you stop 'building houses' for him

fundamentally the conflict is between utilitarian economic policy and the hippocratic oath, no?

I don't know. I'm not as medical professional or an expert on insurance policy by any means. However, if you have a guy who is racking up huge medical costs, but won't change aspects of his lifestyle that contribute to those medical costs (smoking, drinking, etc), then I'm kind of in the "Fuck it, just let him die." camp.

Yeah, it sucks, but he is actively making things worse for everyone else in the pool.

Assuming his surging medical costs does raise costs for everyone else in the pool.
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