robin1234

The CBO have done their analysis of the TrumpCare act, and it's pretty damning; they estimate that 14 million will lose their current healthcare.

Trump healthcare plan 'will strip insurance from 14 million' - BBC News

So how will the advocates of the proposed legislation react? Attack the credentials of the CBO? No doubt, but this is one argument they are using (quoted from the BBC article)

Health and Human Services Secretary Tom Price said the administration "strenuously disagreed" with the report's findings on the number of people who would lose coverage.
"Right now, current law, we've got individuals who have health coverage but no healthcare," he said after the assessment was released.

"Individuals who have health coverage but no healthcare..." So people who have a plan under ACA, but in practice can't use it because they can't afford the copays? Presumably even poor quality coverage like this becomes valuable in catastrophic circumstances, serious car crash etc?

Giantaxe

24m in ten years time.

It's a disingenuous point anyway given that this bill pushes high deductible insurance with HSAs, something available under the ACA anyway.

Additionally:

"House Republicans would allow insurers to sell health plans covering a smaller share of consumers’ medical costs, and cost-sharing subsidies for low-income people would be repealed in 2020. As a result, the budget office said, deductibles and other out-of-pocket costs for many consumers would be substantially higher than under the Affordable Care Act."

https://www.nytimes.com/2017/03/13/u...T.nav=top-news

And Trump's view?

"Mr. Trump predicted that if the Republican plan is enacted, “you’ll see rates go down, down, down, and you’ll see plans go up, up, up.” He said it would be “a thing of beauty.”

nun

Reducing healthcare costs is vital, however, I'm convinced that market economics simply don't work in healthcare. The biggest evidence of that is the current state of US healthcare. The ACA attempted to cub costs through the mandate and the AHA does it through cross border competition (and simply cutting Medicaid). Neither approach will solve the systemic problem that the US spends twice as much per capita as it's peer countries, insures fewer of it's citizens who then have a shorter average life span than the British, French, Japanese etc etc

The US health system does perform well for many and I'm gratefully one of the ones that gets inexpensive high quality healthcare because I'm on state retiree insurance. But there are millions under the ACA that have ridiculous costs and the AHA seems to give people the choice to either pay even more for insurance or simply go without it. Both solutions are simply not solutions.

scrubbedexpat099

What has the mandate got to do with curbing costs?

Pulaski

On the contrary, market economics seems to describe healthcare fairly well. Pre ACA the cost of healthcare was rising as demand rose. The ACA caused a further increase in demand, and exactly as economics would predict, the costs continued to rise.

Anian

If people who don't use much healthcare (and who previously went without paying for insurance because it wasn't worth it to them) are forced to pay into the system, they subsidise it for those whose premium is way less than their costs. Premiums are then lower overall because they are more people paying extra so there is a lower average amount needed per person to cancel out all the underpaying people.

This is all in a vacuum though, since the ACA added a load of underpaying people who were previously denied, plus a load of people who have endured all their long term problems and could suddenly afford insurance to get them all fixed.

scrubbedexpat099

The question related to healthcare costs not premiums. If someone is charged too much somebody else can be charged less but that has no impact on costs.

Pulaski

I think Boiler was talking about the cost of medical services, not the premiums. ..... You are correct about the premiums, but the ACA did little if anything to reduce the cost of medical services, I am not even sure whether the ACA did much to reduce the rate at which the cost of healthcare services is increasing.

[ETA I see Boiler has confirmed my understanding.]

scrubbedexpat099

Taxed platinum plans? Would be a ghard push, on balance I would say it increased costs to others, ACA plans have low reimbursement rates and would be made up by charging others more.

mrken30

One of the big factors is that healthcare is getting less in reimbursements. Also the money that used to cover uninsured ER patients is now down by a big margin because more people have access to regular doctors.
Many health providers are losing money or profits are down. Some of this is also to do with new healthcare models trying to cover preventative care and remote/video technology.

Anian

Ah, I was thinking about the costs for the consumer. Then I agree, I don't see how the mandate would reduce the costs charged by the care provider.

dc koop

You cannot have a working health care system that benefits everyone if there is a profit motive involved. The GOP may not like it but a government has to be involved and sooner or later the American taxpayer has to realize that a good healthcare system means higher taxes.

Trying to wing it is a waste of time. They need to look at Britain, the Scandinavian countries and Canada if they're really serious about providing a system to cover everyone

Trump's first priority should be to bring the costs of drugs down. The US companies have been fleecing the medical profession for years and paying huge contributions to both parties to keep it that way. I think it's time that drugs imported from Canada and Europe (as safe as any produced in the US) should be offered as an alternative and a way to end the monopoly once and for all.

Pulaski

If you want Americans to look at Britain, they'd better look quickly as there is an impending crisis for the NHS. The cost of operating the NHS has risen from about 10% of government revenue to over 30% of government revenge, and it can't keep increasing indefinitely as there isn't much other government spending to be cut to find money for the NHS, and there isn't an appetite for increased taxes either.

In the Canadian system health care is even more tightly controlled than in the UK and "going private" isn't an option, which is why Canadians come to the US for private treatment if they can afford to pay for it, and I can't see America ever outlawing private treatment.

From the perspective of most (but not all) Americans they have good health care and don't want the government sticking their oar in.

Rete

Please do not tell people to look to Canada. Having a Canadian husband, now a citizen of the US, and in-laws who still live in Quebec, Ontario and Nova Scotia provinces, their healthcare is not all you think it is. You also require private healthcare policies in some provinces in order to meet the high cost of healthcare. NS, for instance, does not cover prescriptions and it is all out of pocket, i.e. as per my stepson and grandson who live in Halifax. My in-laws in Montreal had to wait 2 months for a hospital bed and a surgeon when brother-in-law had lung cancer. Canada suffers from a severe shortage of qualified doctors which means many people have great difficulty in obtaining a primary doctor, as they are full up and not taking on her patients.

There are very few ideal healthcare systems worldwide and we, Americans can only hope that we would be able to install the same system in the US. The mindset, unfortunately, is that these programs are socialistic and that it undermines the American principle of furthering one's ability to elevate themselves by accumulation of wealth.

We are, at times, our own worse enemy.

scrubbedexpat099

I am not aware of any ideal system, why should there be an ideal system?