Honest question: Why repeal AND replace?

[Ahhdurr]

Obama is a Kenyan muslim so we have to destroy it.
Edit: Forgot my /sarcasm.

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The real reason is that health care IS NOT and CAN NEVER be a free market economy. The best way to handle it is through a socialist construct, but OH NO!! commies.

[drakensoul]

But we need to solve the underlying problem, which is not "how do we pay for it?" it's "why does it cost so much to begin with?" when most countries have similar quality of care at a fraction of the price.

What you perhaps fail to understand is that the ACA is the first step in fixing that problem. There might be other ways to start, but this is definitely one of them. Our healthcare system is broken and there is no one-button magic fix. It's going to be a process, and it's going to take time. The ACA is quite literally in its infancy, and people with no foresight are unfortunately jumping at the chance to kill it.

Healthcare is extremely expensive right now because the few people who actually pay are subsidizing those who don't pay. If a CBC really costs $50 but 95% of the people who go to a hospital are uninsured, the one insured person who goes in and gets a CBC will pay the cost for the other 95% of the population that didn't. Otherwise hospitals would not be able to operate. They have to get the money somehow, and this is how they get it. So now they charge everyone $250 for a $50 test knowing that only 5% of the tests will be reimbursed. If you've gotten an ER-visit bill you know how insane the prices are.

There are obviously other factors to pricing -- competition, the amount of money spent on futile end-of-life care, the amount of preventable admissions avoidable with appropriate primary care access, etc. But the number of uninsured people is a huge driving factor.

The first step to correcting this inequality is to increase access to health care so that prices can equilibrate under the assumption and fact that, ideally, everyone has health insurance and everyone pays for their own CBC.

Politicizing this into a "Your premiums went up! Obama and the dems lied! They're stealing your money! Vote for me and I'll repeal this disaster!" nonsense fest is unfortunate. It doesn't matter what you do, how much competition you have, how great you are at negotiating prices -- as long as healthcare institutions are treating a population that is largely under/uninsured and thus not being reimbursed for it, prices will stay high.

[Ahhdurr]

The first step to correcting this inequality is to increase access to health care so that prices can equilibrate under the assumption and fact that, ideally, everyone has health insurance and everyone pays for their own CBC.

Sounds like one of those commie universal health care plans.

[Zan15]

What you perhaps fail to understand is that the ACA is the first step in fixing that problem. There might be other ways to start, but this is definitely one of them. Our healthcare system is broken and there is no one-button magic fix. It's going to be a process, and it's going to take time. The ACA is quite literally in its infancy, and people with no foresight are unfortunately jumping at the chance to kill it.

Healthcare is extremely expensive right now because the few people who actually pay are subsidizing those who don't pay. If a CBC really costs $50 but 95% of the people who go to a hospital are uninsured, the one insured person who goes in and gets a CBC will pay the cost for the other 95% of the population that didn't. Otherwise hospitals would not be able to operate. They have to get the money somehow, and this is how they get it. So now they charge everyone $250 for a $50 test knowing that only 5% of the tests will be reimbursed. If you've gotten an ER-visit bill you know how insane the prices are.

There are obviously other factors to pricing -- competition, the amount of money spent on futile end-of-life care, the amount of preventable admissions avoidable with appropriate primary care access, etc. But the number of uninsured people is a huge driving factor.

The first step to correcting this inequality is to increase access to health care so that prices can equilibrate under the assumption and fact that, ideally, everyone has health insurance and everyone pays for their own CBC.

Politicizing this into a "Your premiums went up! Obama and the dems lied! They're stealing your money! Vote for me and I'll repeal this disaster!" nonsense fest is unfortunate. It doesn't matter what you do, how much competition you have, how great you are at negotiating prices -- as long as healthcare institutions are treating a population that is largely under/uninsured and thus not being reimbursed for it, prices will stay high.

and the biggest reason....why its so damn expensive...is....

US

we are fat, lazy, unhealthy, smokers, eaters, etc etc etc

[Jtbrig7390]

and the biggest reason....why its so damn expensive...is....

US

we are fat, lazy, unhealthy, smokers, eaters, etc etc etc

The funny part is......That's not true at all.

A box kleenex tissues in a hospital doesn't cost $47 because someone is Fat,Lazy,Smokers ect.....

That's one example on how much shit costs. Everything is expensive because we allow them to make it so fucken expensive, because its a free market.

[Ahhdurr]

and the biggest reason....why its so damn expensive...is....

US

we are fat, lazy, unhealthy, smokers, eaters, etc etc etc

As big of factors as those are... the profit driven motif is the real reason.

I had to see my personal doctor to get a TB test for school. Insurance wanted him to charge me $35 for a test that cost 25 cents. He said fuck paying for it and gave it to me for free. That's a 140000% mark up on one of the easiest tests. That's retardedly insane.

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Everything is expensive because we allow them to make it so fucken expensive, because its a free market.

Which healthcare IS NOT and NEVER WILL BE a free market.

[schwarzkopf]

Why will be a question many rational people ask a lot over the coming 4 years.

The answer - 'because Trump' and 'because Republicans' and that's the best answer you will get.

The absolute stupidity of the whole health care mess in the US, is that a proper universal health care system would save the country over $1 trillion a year in health care costs.... yet they are asking who is going to fund it.

[Captain N]

Because repealing it without a replacement is indirectly killing thousands of people.

Considering the number of people who think those in low-income jobs who lacked insurance in the past should starve because having a social safety net is somehow supporting lazy people does this surprise you that those against wage increases are also the loudest voices in ACA repeals?

[Ahhdurr]

The absolute stupidity of the whole health care mess in the US, is that a proper universal health care system would save the country over $1 trillion a year in health care costs.... yet they are asking who is going to fund it.

Cheap medicine and surgery and preventative care? How are we supposed to pay for better everything at a third of the cost?

[schwarzkopf]

Cheap medicine and surgery and preventative care?

No - for those who can afford it, they will still have the option of the top of the line care.

For those who can't - they will get baseline treatment for free.

You get to keep your choice of insurer or provider if you can afford it, you only lose choice of provider if you can't afford insurance.

So you literally get to have your cake and eat it too - AND save over $1 trillion a year in health care costs.

Yet no-one wants to do it.

[Deleted]

But we need to solve the underlying problem, which is not "how do we pay for it?" it's "why does it cost so much to begin with?" when most countries have similar quality of care at a fraction of the price.

1. Your doctors will start practicing late in their life.
2. Big states brain-drain poor states.

[alexw]

What you perhaps fail to understand is that the ACA is the first step in fixing that problem. There might be other ways to start, but this is definitely one of them. Our healthcare system is broken and there is no one-button magic fix. It's going to be a process, and it's going to take time. The ACA is quite literally in its infancy, and people with no foresight are unfortunately jumping at the chance to kill it.

Healthcare is extremely expensive right now because the few people who actually pay are subsidizing those who don't pay. If a CBC really costs $50 but 95% of the people who go to a hospital are uninsured, the one insured person who goes in and gets a CBC will pay the cost for the other 95% of the population that didn't. Otherwise hospitals would not be able to operate. They have to get the money somehow, and this is how they get it. So now they charge everyone $250 for a $50 test knowing that only 5% of the tests will be reimbursed. If you've gotten an ER-visit bill you know how insane the prices are.

There are obviously other factors to pricing -- competition, the amount of money spent on futile end-of-life care, the amount of preventable admissions avoidable with appropriate primary care access, etc. But the number of uninsured people is a huge driving factor.

The first step to correcting this inequality is to increase access to health care so that prices can equilibrate under the assumption and fact that, ideally, everyone has health insurance and everyone pays for their own CBC.

Politicizing this into a "Your premiums went up! Obama and the dems lied! They're stealing your money! Vote for me and I'll repeal this disaster!" nonsense fest is unfortunate. It doesn't matter what you do, how much competition you have, how great you are at negotiating prices -- as long as healthcare institutions are treating a population that is largely under/uninsured and thus not being reimbursed for it, prices will stay high.

The reason it costs so much is because its wildly inefficient. In most markets competition drives out those inefficiencies but because of the way healthcare works those competitive pressures don't function. Other countries have got around this by having their government take the place of those nonfunctional market forces, and in various ways approximating their effects.

Would it be preferable to have a functional free market forcing costs down? Undoubtedly yes. But that isn't possible so we have to choose the closest thing we can get to it, and that means government involvement to provide the necessary incentives and pressures to approximate free market outcomes.

Obamacare is the first step in this, in turning the US system into what other countries do (though single payer would have been a faster way of doing it). This is why republicans hate it. They know there is no way to solve the cost problem in ways that meet their ideological preferences but know the problem of spiraling healthcare costs need to be fixed, and that that means government involvement.

So what we can expect is alternating hatred and grudging acceptance by republicans (hatred when out of power grudging acceptance when in), while democrats slowly but irrevocably reshape the system over a decade or two.

[kail]

and the biggest reason....why its so damn expensive...is....

US

we are fat, lazy, unhealthy, smokers, eaters, etc etc etc

No, problem is we turned healthcare to some profitable industry. The result: hospitals, pharmaceuticals, and insurance companies want to make a profit. Our costs for the same procedures in other countries is crazy high.

[Blur4stuff]

Before the ACA insurers would routinely look for reasons to dump people that needed care. For example, you could get diagnosed with an expensive to treat cancer and your insurer would put extra effort into finding a loophole not to pay. Did you get a hangnail 15 years ago? Pre-existing condition goodbye coverage! And then when you get dumped their executives get a bonus.

Just one reason out of many why US healthcare was shit. The number one goal is profit, not keeping people healthy or making them well.

[Xar226]

Honest question -- why is Obamacare discussed in the context of repeal AND replace? It is framed as if there must be a replacement. Why not just repeal?

Two reasons.

#1: Remember waaaay back before Obamacare got passed? There was a reason health care reform was on the docket and a reason Obama basically used every bit of political capital the election afforded him on it. Costs were soaring out of control, way faster than inflation, and it was a major national issue. If you've just spent the last eight years campaigning on how awful a healthcare reform act was you'd best bring a better idea to the table, especially if step #1 of your plan is "dump insurance for 20 million people who didn't have it before."

#2: The second you stop calling it "Obamacare" and start asking about the specific components of the law, it suddenly becomes popular. According to a poll by the Kaiser Foundation in November 2016, 85% of Americans (82% of Republicans) approve of the provision allowing people to stay on their parents' plan until they are 26; 83% (77% R) approve of eliminating out-of-pocket expenses for many preventative services; 80% (67% R) support providing subsidies to afford health insurance; 60% (45% R) support forcing employers with over 50 employees to provide health coverage or pay a fine; and 80% (67% R) support allowing states to increase Medicare coverage to more low-income people. The only provision of the act that is universally disliked is the individual mandate, which only 35% support (21% R). This for an act that has a 45% favorable rating overall. In other words people love all the things that drive the price of health insurance up and not the ones that drive it down. All of these provisions evaporate with the repeal of the ACA.

Now that the Republicans have to actually govern instead of just obstruct, they're realizing good policy isn't quite simple enough to fit into 140 characters. Personally I hope Democrats just fold their arms, lean back and watch bemusedly. Republicans had eight years to come up with an alternative, and now not only are they caught flat-footed but they want to try to keep half the law too? Ell-oh-ell.

[Azadina]

As big of factors as those are... the profit driven motif is the real reason.

I had to see my personal doctor to get a TB test for school. Insurance wanted him to charge me $35 for a test that cost 25 cents. He said fuck paying for it and gave it to me for free. That's a 875% mark up on one of the easiest tests. That's retardedly insane.

Sorry for nitpicking, but 25 cents into 35 dollars is 14000% increase, or in other words, 140 times the amount. Not 875%.

[Ahhdurr]

Sorry for nitpicking, but 25 cents into 35 dollars is 14000% increase, or in other words, 140 times the amount. Not 875%.

You're right. Must have been tired or something.

[Heladys]

Because they want to get rid of it, but know the people would oppose it. So by promising to replace it with something "better", they get to kill it, and then run away without ever fulfilling the other half of the promise.

And the same blithering morons that elected them will wonder what happened.

[javen]

Honest question -- why is Obamacare discussed in the context of repeal AND replace? It is framed as if there must be a replacement. Why not just repeal?

Because the entire reason healthcare reform was a major policy plank in 08 is because premiums were rising way too fast, substantially outpacing wages and accounting for a higher percentage of total income year over year. The ACA was created to try and curb this by such measures as limiting how much of ones premiums could be spent on nebulous "administrative costs", and made sure that money collected from consumers was actually spent on care. Now that it's gone, there's no reason not to believe that healthcare costs will continue to outpaces wages as they used to, so some type of replacement should be considered to dilute that effect.

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Because politicians will never learn, lol. Health care is a monumentally difficult problem to solve, and now three separate administrations have or are going to try to "fix it" as one of their first acts in office before they have a clue how hard it it.

Bill and Hillary tried to do it and crashed and burned.
Obama did it but gave us an impossibly convoluted thing that isn't much of an improvement.
Trump is coming basically like the first two saying "oh, well, we'll just fix it, how hard can it be?" and I guarantee he's not going to have any more luck at it.

Health Care should be something you spend at least three years working on as a new president before you try to cram a quick-fix down the country's throat.

But we need to solve the underlying problem, which is not "how do we pay for it?" it's "why does it cost so much to begin with?" when most countries have similar quality of care at a fraction of the price.

Having healthcare be a for-profit driven enterprise was always going to run into problems, because healthcare realistically isn't an option for anyone. If you're sick, you HAVE to get medical attention. There's no choice involved. You get help, or you die.

Capitalism really only works in enterprises where the consumer has a realistic choice not to buy into a product if they don't deem it worth the price. That's the ideal give and take: businesses try to maximize profits by determining the threshold for which consumers will pay the most money for the least product. That doesn't really work for healthcare, because the product is the very life of the consumer, which means in a capitalist market, health insurance providers can name their price. What are you going to do, not pay?

[melodramocracy]

Repealing it without replacing it will cause many folks to realize that giving for-profit insurance companies the power to determine your well-being is about the dumbest fucking idea ever created.

So the replacement still allows insurance company and their investors to flourish (at your expense) while still tricking people into thinking their part of a progressive system.

Ta-da!