[no_such_reality]

Currently Medicaid costs are $552 Billion for ACA.

At the propose income limits for the tax credit per filer, 90% of return have AGI that qualify. Assuming married filing jointly get two and singles get one tax credit that averages $3000, we’re over $500 billion in tax credit.

Seems like they just proposed a trillion dollar program. Which afaict, is close to $400 billion more than current.

The cost of he U.K. System for our population size at he same expenditure per capita is $1.1 trillion.

[no_such_reality]

I read through the highlights last night. I’ll need to read the whole thing.

What I read was Obamacare with a 5x spread instead off 3x allowing insurers to make it cheaper for younger groups and a shift of financial aid to go more to their constituent base.

Nutshell, 20& 30s insurance cheaper that under ACA, 40 about the same. 50 and 60 more. Those 50&60s will pick up a $3500-$4500 tax credit (credit not deduction) up to $150k per couple and phase out incrementally over that. Everyone else gets a tax credit too.

They shell gamed the cost and credits otherwise it’s Obamacare. Can’t imagine this isn’t massively more expensive since it’s pork for all.

[no_such_reality]

I’m curious what you think that article is telling us?

[no_such_reality]

Again, I’m not saying ACA should be repealed. I’m saying why the current congress won’t be able to fix it.

AKA, they’ve glue their nuts to the third rail.

We as a people want Caesar’s Bacchanal Buffet, but we want to pay the Port O’ Call price.

So your statement [quote]In order to make make the math work, we need a good mechanism to ration care, administratively or market wise. That’s the way it is with everything.[/quote] is correct.

And that is what will make people scream bloody murder.

If we don’t do that, and we keep the stuff people want, guaranteed coverage, no gouging sickies, your ‘kid’ can ride your plan until they’re 26, its costs $$$$. Oh wait people don’t like it costing $$$$.

Anecdotally, I know people in Canada that were very happy with their health care, the they weren’t. The reason is simple, they hit one of the gaps.

For years I’ve been saying we ration healthcare, we’ve just been choosing to let for profit insurance do it under the guise of low cost insurance.

Again, we need to focus on the cost bending part of the equation. Government entering as an insurance provider is one way to do and leverage medicare and VA buying to drive costs down.

Changing laws to prevent Epi-pen gouging is another. Changing others to prevent Shrkeli is more.

Simplifying the administrative burden is a third.

And making people pay, is the forth.

And finally, change the law so the the providers need to publish a cash up front price and frankly, that price needs to be lower than insurance provided rate (which conflicts with laws on Medicare and other things). What we have today is backwards. You want outpatient surgery? The hospital charges are $30,000. It’s $20,000 if you pay cash up front. And if you have insurance, the insurance will pay $15,000 and you have $1500 co-pay… Broken.

[no_such_reality]

[quote=FlyerInHi]The equation should be solved for maximum aggregate health in a cost effective manner, not some technologies and drugs that we can point to and say “ah ha, we are the best.”

[/quote]

Those are death panels, LOL. JK, I agree with your sentiment, but that highlights the problem. Aggregate effectiveness is great until you’re on the secret VA patient waiting list or your kid is on the 4 year wait list in the Canadian Province for early childhood intervention.

The masses don’t like that because they’re *sure* it means they’ll get denied the treatment they need by Big Brother.

[quote]
NSR, you said earlier that the buffet should not be unlimited. The Japanese all-you-can-eat places make you eat everything you order so you don’t waste food. It’s all you can eat, but you’re not allowed to waste.

As Obama said, if we were to start from scratch we would do it differently. We would decide what % of GDP to spend and how to most effectively allocate the resources.[/quote]

My buffet analogy was poorly worded, I did say pile it on, what I really was thinking was pile on whatever I want. Which then of course gives of the Doctor, Patient, Insurance game of ‘justifying’ medical necessity.

And we have our 1 in basically 2 people with chronic conditions ranging from hypertension to diabetes. Unfortunately our system has made those incredibly expensive. Our insurers are paying out $10,000 more per person with diabetes compared to one without.

The UK spends about $4000…

Hence we expect the buffet to take those chronic conditions and pay for them, because we’ve made them too expensive to pay for ourselves.

[no_such_reality]

Yes, they balance the equation. NHS in the UK is planning on having their first two proton therapy centers in operation by 2018. Conversely, California at half the population has 3, err maybe 2 since one just filed for bankruptcy. The USA has 22 in operation and 18 under construction.

You can get proton therapy through NHS currently, certain patients deemed necessary are sent overseas for treatment.

The other half is simple too, take Mylan, one client in the UK, they don’t pay that. Mylan can choose, not sell it or take the lower rate. Guess which they do?

That’s the balance.

That’s the reality people don’t want to own up to on insurance and healthcare spending.

IMHO, insurance works best for those things that are rare (home fire, burglary, etc. i.e. your basic home insurance) or catastrophic.

They don’t work well for those things that are routine.

[no_such_reality]

Again, I’m not arguing for Trump.

And there is difference between getting a mortgage and using a credit card for monthly expenses.

Our deficit spending has been using a credit card and not getting a mortgage for a major investment like a house, IMHO.

That’s not paying the bills.

The people like Warren Buffett are few and far between that are saying ‘my taxes should be raised”. The bulk is someone else should be paying more taxes.

As for ACA, it may have serious flaws, but those flaws aren’t any worse than the flawed system we had before and it could be improved. IMHO, the current Repubs won’t do that, they can’t because they’ve been so busy screaming it’s a disaster that they chugged a gallon beer and then superglued their cocks to the new third rail of politics.

Some minor changes would make a lot of difference IMO. Add a high deductible option to the available plans for everyone. Change the law so companies like Mylan can’t sextuple price and the offer coupon to cover the co-pay. Change other laws so that people like Shkreli can’t acquire treatments and then increase their costs 10X. Let the insurance companies compete by having Medicare offer the option for under 65 to buy in at cost.

Those are starts.

The replacement won’t be anything like that though. They’ve painted themselves in a corner.

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No, at $19.8 Trillion in debt today and a debt increase of over $7 Trillion in the budgets Obama led and $9 Trillion since he took office, they really don’t.

It’s kind of like the complaints on the last tax cut proposal where Dems complain that the “rich” get 70% of the cuts.

Of course, that “rich” is people making over $100K. That same group pays 80% of the income tax.

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[quote=FlyerInHi]NSR, real quick here before I go back to home remodeling.
Your equation lacks the total amount of services. You focus on profit while aggregate health spending/revenue is much more important. Trump wants more services to cover everyone for less total spending. Let’s see how he solves the equation. He won’t.[/quote]

He won’t. Essentially, single payer is how to bend the cost curve, but that’s anathema to the GOP. I’m not emphasizing profit, I see it as an excess and questionable if necessary, cost. The main benefit of those profits is the innovation in services and treatments.

You bend the cost curve (in aggregate) in three simple ways:

A) You reduce the overhead (insurance companies, their required administrative burden and their profits).

B) You reduce the cost of services (either by reducing the cost of providing service or by limiting access to higher cost services [i.e. proton therapy]), or implementing price controls such that companies like Mylan can’t game the pricing market.

C) You reduce the demand for services.

“The People” are really clear, they don’t have an tolerance for C if it impacts them. Nor B, if it means they have to wait or can’t get their desired option. And if you really want to piss them off, tell them the cost benefit of treatment 2 doesn’t warrant the extra cost over treatment 1, that the specialist has told them is sooooo much better.

Which really just leaves A. And if you refuse to do “A” then the only option you really have to play a shell game of shuffling costs so that 60-80% are less impacted and the remainder is just short of porked.

Again, the math is really simple. If your family (and a bunch of others like it) uses on average X dollars of services, insurance (in aggregate) has to charge your family $X + administrative overhead + profit.

Or make the Doctors charge less (and make less), make the drug companies charge less, etc.

It’s a lot like the budget, after years of reduction in the deficit, we still have a deficit that is over 40% of the discretionary budget. Not counting defense spending which our President said he wants to increase spending on, it accounts for about 80% of the non-defense budget.

We want our cake, we want to eat it too, and we don’t want to pay the bill.

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[quote=FlyerInHi]So Obamacare repeal would most benefit middle to upper class, young, healthy individuals. The older sick, working class guys will get screwed because they won’t be able to afford health care, even with the tax credits. Sounds like Trump voters will get the hopey changey they clamored for.

https://www.washingtonpost.com/blogs/plum-line/wp/2017/03/02/republicans-already-think-obamacare-repeal-is-a-nightmare-its-about-to-get-worse/?hpid=hp_no-name_opinion-card-c%3Ahomepage%2Fstory&utm_term=.d5ec3cf8f219%5B/quote%5D

The math is really simple. It’s 7th grade algebra.

We’ve got two groups of people, basically healthy and those with chronic conditions. At present 45% of the adult population has a chronic condition (aside from just being fat).

Insurance is a the simple part. You take the amount they pay for services, you add a bunch of administrative costs at the provider for dealing with insurances, you add couple boatloads of inefficiency and admin costs at the insurance carrier and then you add profit. We’ll call that Z, of in the case of a single insurance company we can call it $184 Billion.

Now, the simple math.

0.55X+0.45Y=$184 Billion.

And if you want X to be lower then Y needs to be even higher.

Or you bend the cost curve.

Seems pretty obvious were to cut inefficiencies to me.

[no_such_reality]

Betting 00 on the roulette table has a 1 in 38 chance and is worth $3150 on a $90 bet.

[no_such_reality]

I see your reading comprehension hasn’t improved.

Again, the nut of the problem is somebody else is paying for it. Yes, the consumer is still paying for it, just four layers removed in a business with no prices published.

Again, it’s like a buffet in that they don’t have to think about what it is they’re getting. They don’t have to think about the price. They don’t have to think…

That’s the nut of the problem.

What’s the chief complaint people have? The part they actually have to pay for. Gnash teeth, the copay has gone up, OMG, the doctors are actually collecting co-pays.

It’s a broken system where the providers provide a service with no concern over the consumers actual ability to pay for it. What part do Doctors hate the most? The fact that they actually have to manage collecting co-pays now or the price sharing wrecks their income model.

Yea, so it’s a buffett where the casino boss is telling you don’t need the lobster…

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[quote=kev374]I got a checkup when I was in Bangalore, India a few months ago. State of the art hospital using the same million dollar machines (from GE, Seimens whatever) used in American hospitals. I paid $50 out of pocket for Ultrasound, Full bevy of comprehensive tests including Lipid profile, Pre/Post glucose, stress test, consult with nutritionist, Dental consult, consult with Doctor, EKG, X-Ray, Bone density test and more. Not only that they gave me a full folder containing all the results, images and plots in addition to a CD with all the test data.

Oh, not to mention a delicious breakfast was also included on the house. Somehow the economics work for this hospital that has also bought these same machines for millions of dollars.

The same tests in the US would’ve cost me $10,000 or 200 times more. I can understand 3X-4X the cost but 200X? I want to know why.

Healthcare in the US is nothing more than a money making racket.

I’ve said it before and I will say it again… no healthcare strategy will EVER WORK unless we get to the bottom of why costs are so ridiculously astronomical compared to everything else in our economy. We have to get costs to a more reasonable level or we are just going to go in circles without solving anything.[/quote]

Actually, nothing you listed is a million dollar machine (or tens of million dollar machines like proton therapy). Everything you listed is a pretty run of mill test using pretty reasonable equipment.

Comparatively, $50 is actually, quite a lot with $8000 putting you on the top of middle income and the Doctors serving you made around $12000.

It doesn’t explain the vast differences those boil down to a real simple problem. Somebody else is paying for it. American’s treat their insurance almost like an all you can eat buffet. You paid the entrance cost with your insurance now you just pile everything on your plate.

We’ve also created layers and layers of additional costs in administrative functions playing whackamolevtrying to get paid.

[no_such_reality]

That might not be that bad. Granted the picture doesn’t show a lot, but you may actually have caught it still early.

Time to rip the rest of the dry wall off to the right to see how extensive it it. However from the photo, the middle 2×4 doesn’t appear to have them in it, or doesn’t have them extensively.

The one on the right, looks like a piece of wafer cookie with the frosting sucked out, but wall stud next to it doesn’t look heavily infested. So you may just have the single window framing board hosting.

How’s the top piece that frames the window. It looks covered by the flashing, or is it completely gone?

[no_such_reality]

Not sure I’m following which layer you’re talking about. Usually you have the shingles, underlayment, then plywood nailed to the rafters.

If you have planks instead, I think the main problem is they gapped has they aged

For replacing versus selling a leak, its condition and be of the roof. Are you dealing with asphalt shingles, T&G, tiles?

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