Bitter Pill Reconciliation Act of 2017

Capture88(aka Senate version of American Health Care Act)

The Senate health bill has some good things and some not-so-good things. It largely keeps too much of Obamacare, except the individual and employer mandates, and repeals most of Obamacare taxes but allow almost no additional health plan flexibility. Oh, it’s pretty good on Medicaid.

Here’s quick rundown of major elements in the bill:
• Subsidies phase out at 350% (not ACA’s 400%)

• Subsidies a function of both age and income
• Changing Silver etc to “median benchmark plan”
• Repeal individual and employer mandate
• No abortion coverage
• States get a boatload of money
• Repeal most taxes
• Use your HSA/FSA on OTC drugs
• Higher HSA contribution limits
• Medicaid expansion phased out
• States can impose work requirements
• Per capita block grant
• Association Health Plans for small biz
• Opioid assistant to states
• Medical loss ratio state regulated
• Cost sharing reduction payments phased out
• NO increased state flexibility health plan regs

• States can adjust age bands

• Sunsets so-called Essential Health Benefits (yeah!!!)

• State have additional rights to seek waivers (not sure how this helps)
https://www.budget.senate.gov/imo/media/doc/SENATEHEALTHCARE.pdf

Comments (101)

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  1. Bart I says:

    It sounds like the age-based tax credits are dead. Just as well. They were arbitrary and poorly-designed.

    • Ron Greiner says:

      Bart, the age-based tax credits for a 30-year-old couple and 2 children is $9,000. Why don’t you tell us the credits for this family under Obamacare.

      Don’t we want something simple for the consumer to understand? You know, bring a little simplicity to complexity.

      Do you have a solution Bart or only complaints.

      • Bob Hertz says:

        Ron, I am not sure that the Senate bill is so straightforward as to give a $9000 credit to that family.

        What I have read so far is a more complex scheme regarding income and the cost of a bronze plan. Let’s see what surfaces.

        • Ron Greiner says:

          What we know for sure is if your income is over 350% of poverty you are going to pay through the nose for over-priced guaranteed issue insurance with high deductibles and skinny provider networks unless you are on employer-based insurance.

          Notice how employees can’t even deduct the cost of Individual Medical (IM) insurance and must purchase with after tax dollars to keep Blue Cross competition to a minimum. What a country.

    • Bart I says:

      Do you have a solution Bart or only complaints.

      I said “just as well,” not “better than” or “worse than.”

      Ron, I proposed my solution to the tax treatment question years ago, well before Obamacare.

      Tax credits should be only be for community-rated policies (to the extent that they exist), and should be designed to offset most of the additional cost of C.R. over underwritten rates, in order to shift this hidden tax to the general fund where it belongs.

      People should be free to choose STM or permanent underwritten insurance if they want, but without the fixed tax credit. They may or may not be slightly better off by doing so.

      I’m not philosophically opposed to additional income-based assistance beyond what I just proposed, but my priority is a functioning system. Income-based assistance should be kept separate from the above tax credits.

      • Ron Greiner says:

        You are a nice guy Bart. Employees who don’t have employer-based health insurance can’t even deduct their premiums so they pay taxes on theirs which makes their insurance much more expensive than yours. But you don’t care and they should get no tax relief.

        Just sounds like you are treating them like second class citizens. But, all politicians in this country think like you. Now Union employees are special and we pay for their insurance if they retire young because they are not used to paying anything.

        How do you decide that some pay taxes and some people don’t Bart? Shouldn’t we be fair?

        • Bart I says:

          ESI is more similar to Obamacare coverage than to STM, in that healthy employees are paying more to subsidize high-cost employees.

          Tax breaks offset the cost of ESI so the net cost is on a par with STM and other underwritten coverage. The same goes for tax credits to offset the excess cost of O-care and similar coverage.

          Tax credits for STM will not make anything “more fair”. STM customers are already paying about the same as the others’ after-tax cost.

          • Ron Greiner says:

            Bart, you are clueless. Employees are buying over-priced guaranteed issue Obamacare plans with after tax dollars. Employees don’t know about STM which has almost no market share.

            YOU think it’s perfect these poor employees don’t get any tax relief yet multi-millionaires don’t pay taxes on their ESI.

            YOU are twisted Bart and add NO value to the NCPA blog because you are a Socialist with no heart. A lot of people have died because you want to treat anybody without ESI as 2nd class citizens.

            • Bart I says:

              Employees are buying over-priced guaranteed issue Obamacare plans with after tax dollars. Employees don’t know about STM which has almost no market share.YOU think it’s perfect these poor employees don’t get any tax relief yet multi-millionaires don’t pay taxes on their ESI.

              That’s a lie, Ron. In the above comments I clearly said people with community-rated policies such as Obamacare should have tax relief.

              It’s unfortunate that a one-interesting blog and forum is losing its value by being flooded by your incessant garbage posts.

              • Ron Greiner says:

                Bart, YOU wrote, “Tax breaks offset the cost of ESI so the net cost is on a par with STM and other underwritten coverage. The same goes for tax credits to offset the excess cost of O-care and similar coverage.”

                Employees with Obamacare’s “Family Glitch” get no tax credits and that is what we were talking about. YOU say you “CLEARLY” stated they should get tax relief and that is the LIE.

                Self-employed people can deduct their STM and it seems that you think they should lose that right. Really Bart, YOU are the only person who I have ever heard that says medically underwritten insurance should get no tax relief. So that makes YOU a very special person.

                Granted, I do catch you in your LIES and that makes this blog different than any other blog for YOU. TRUST ME, you have no value to the NCPA blog who came up with the idea of HSAs and I enrolled the 1st one in the USA and have been here a lot longer than YOU. YOU are a new guy here Bart.

                Bart, you are a new guy here and think you can come in and tell the old timers that they have no value. Name another person who wants to start taxing the self-employed with their STM. YOU are kinda lonely Bart.

              • Bart I says:

                Ron, here is what I said:

                Tax credits should be only be for community-rated policies (to the extent that they exist), and should be designed to offset most of the additional cost of C.R. over underwritten rates, in order to shift this hidden tax to the general fund where it belongs.

                I suppose my later statement would have been clearer if I had said, “The same SHOULD GO for tax credits to offset the excess cost of O-care and similar coverage.”

                I suppose I am the new guy, as I have only been commenting here for the last decade or so. Most or all of the other four or five commenters were already here.

                Makes one wonder about the reach of a forum like this when there are only a half-dozen participants, with 95 percent of the comments coming from one person. This really should be renamed,

                The Ron Greiner Insurance Agency Blog
                Hosted by: N.C.P.A.
                Moderator: Devon Herrick

                • Ron Greiner says:

                  Bart, like I said, you think self-employed people should start being taxed on their medically underwritten health insurance which makes you a very lonely guy, sorry.

                  Stop whining you big baby. YOU are the one who loves ESI that consumers lose when they get too sick to work. YOU don’t understand exactly how deadly that is. That is why I’m here, to remind you.

                • Bart I says:

                  Ron, I didn’t say anything about the self-employed deduction and you know it. They are a small percentage of the population, so I have no problem with them being grandfathered as the “special case” they’ve always been. A few people receiving a windfall is not worth being distracted from the big picture.

                  I understand perfectly about the problems with ESI and would love to see a usable and viable alternative, both for myself and for everyone else. Unfortunately the House and Senate bills don’t provide one. Nor have you proposed anything that would solve the problem.

  2. Bob Hertz says:

    Medica’s rates in Iowa for a 55 year old for a $2500-deductible plan will be $1,100 a month when their 2018 rate increase goes through.

    And Medica will likely be the only carrier in the state.

    If the 55 year old is single and earns more than about $39,000 a year, he or she will get no subsidies under the Republican plan or so it seems.

    (because subsidies stop at 350% of poverty)

    Maybe there is some assistance in another part of the bill for this not so tiny group of people.

    Otherwise, I am shaking my head at the Republican willingness to throw a lot of likely Trump supporters under the bus. The more rural states have the highest health insurance premiums.

    One has to conclude that the pressure to cut taxes and please the 5,000 wealthiest Republican donors has drowned out any populism whatsoever.

    • Ron Greiner says:

      Bob, Obamacare was going to start a civil war in Iowa and the Republican bill just throws fuel on the fire.

      It’s not just Iowa either.

  3. Lee Benham says:

    Neither ACA nor this bill give subsidies to illegal immigrants. ACA extended it to “alien legally present in the US”, this bill restricts it to “Qualified Alien” (a legally present alien who also works).

    The $10-15B pool is for CMS to distribute to all the states, it’s not a per-state fund, and it only lasts from 2018-2021

    No coverage for abortion clinics is half the story, any plan that covers abortion can’t be a QHP (page 8, (d)(1)). Among other things, that means no subsidies.

    Medicaid is block granted. (sec 134) That’s a big deal. Don’t let the “Medicaid Flexibility Program” title fool you.

    The block grant has a population growth limit, if a state expands too fast, the extra eligibles aren’t funded. (page 92, (c)(2)(C))

    Medicaid expansion is repealed. (sec 126)

    States have an option to require Medicaid recipients to work in order to remain eligible, effective Oct 1, 2017 (sec 131). Being unable to find or keep a job means they’d lose their Medicaid coverage too.

    Subsidies no longer based on SLCS, it’s now “applicable median cost benchmark plan”, which is a bare-minimum 58% AV plan (AV’s down to 58% are now permitted, so we finally have the “lead tier” plans with $10,000 deductibles that we’ve joked about). FPL limit lowered from 400% to 350%.

    They also age-banded the allowable percentages and raised them across the board. (Refer to chart on page 6). Allowable percentage increases with age, so older people are going to have to cover a larger portion of their premium, which is already higher to begin with. Maxes out over 16% of income…

    Effectively, they’re going to cut subsidies in half, or more, and put those people into plans with deductibles so high they can’t actually use it (remember, CSR is gone under this bill).

    States that exceed the average Medicaid per-capita spending will be penalized. This doesn’t compensate for the difference in cost of care from state to state, and will disproportionally impact high-cost states.

    No new funding proposed to cover all the removed taxes, they’re relying on “monies in the Treasury not otherwise obligated”. The Treasury may not have sufficient un-obligated capital, which means the money just isn’t available. We’ll likely wind up with a situations similar to the 87.3% Risk Corridor shortfall.

    The cons may outweight the pros on this one. It’s a “discussion draft”, so there will likely be changes, but some of this stuff is going to piss off a lot of people.

    • Ron Greiner says:

      Blue Cross Association and employer-based health insurance came out of this smelling like a rose. To hell with the American citizen and what would be best for the consumer.

      Blue Cross owns both political parties. I’m impressed.

    • Bob Hertz says:

      I wonder if the requirement that subsidized plans exclude abortion goes into effect right away, for 2018 enrollments.

      If it does, will there be some mad scrambling on the state exchanges? Liberal consumers in a state like California will face some hard choices potentially.

  4. Lee Benham says:

    on a side note I like the chocolate ice cream emoji . seems fitting 🙂

  5. Lee Benham says:

    It appears to me they are trying to get rid of the individual market all together and let individuals and small business join associations that have been certified by the government to offer health insurance in specific states.

    Guess that’s one way to protect the Cash Cow of ESI. Kill off all competition once and for all.

    • Ron Greiner says:

      17 Senators last week asked Dr. Tom Price to rescind the unconstitutional ban on Short Term Medical (STM) which will take the consumer from Open Enrollment to the next.

      Sir, you can get Medica for $40,000 with a $6,500 per person deductible or this low cost STM with a $5,000 deductible for $12,000 a year. Which seems lower priced to you? Is saving $28,000 a year important to you?

  6. Ron Greiner says:

    I’m sorry, NCPA blog readers deserve real numbers instead of me just taking numbers off of the top of my head. So lets look at the real numbers for my little brother in Ames, Iowa (zip code 50010). He is 60-years-old and has a wife and 2 sons and the youngest is 12-years-old and his name is Blake. I don’t know his income so I’m going to say it is $101,000 a year. He earns too much for 2018 Obamacare/Trumpcare tax credits.

    In 2018 the Medica premium for the $6,400 per person deductible Bronze HSA plan is $36,104 a year. The only other HSA plan is the Silver plan with $5,500 Out-Of-Pocket per person for $41,166 a year.

    I am told that our Short Term Medical (STM) plan is adapting and will soon have a Conversion Privilege (CP) that the consumer may continue to purchase additional 3 month policies without medical underwriting until the next Open Enrollment or January 1st of the following year. The quarterly cost for my brother would be $3,491 or annually the cost would be $13,964. This STM has a $5,000 per person deductible then 100% coverage. The PPO network is Aetna Open Choice PPO with 850,000 participating
    providers.

    Closing Question 1: Do you prefer Medica’s $6,400 deductible for $36,104 per year or the STM with a smaller $5,000 deductible with the $13,984 premium?

    Closing Question 2: Does it make sense to you to save $23,000 a year?

    Closing Question 3: This is like an IQ test, don’t you agree?

    To give you an HSA magic twist: If my little brother deposits $15,000 into his own tax-free HSA, which he can with the new maximum, his Modified Adjusted Gross Income (MAGI) drops to $86,000 and under the new Senate bill his Obamacare/Trumpcare tax credits to purchase insurance would be $22,344.

    This is all pretty simple for the highly educated American consumer to understand and all of America should be able to enroll in 1 month over 2017 Thanksgiving. I just hope they don’t ask an HSA question because who has the TIME to explain things to a consumer when you have to do a years worth of enrollments over the holiday? Who thought this up anyway?

  7. Devon Herrick says:

    The problem with health reform is that the GOP (and the Democrats) face an impossible task. They all want to give subsidized medical care to sick people, but that costs way more than taxpayers can afford. With the help of people like Gruber, Democrats devised a plan to shift costs of covering sick people from everyone else.

    Insurance is designed to pool risk. But Obamacare went farther. So-called “garbage” insurance wasn’t a problem for most people; their expected costs were covered. But for a few the costs were not. Without forcing everyone to have comprehensive insurance with no benefit caps there could be no multi-million dollar coverage for those with extremely high costs. The trade-off of that strategy has been high costs on taxpayers and high-deductibles for everyone else.

    If you ask poor people what they want in coverage, they don’t tend to say they want a HD plan that will cover them for a $10 million claim. They say they want a plan that will let them see a doctor for a cold or flu without missing a car payment.

    • Lee Benham says:

      So you are saying the politicians have no concept of what insurance is or what it’s for?

      • Ron Greiner says:

        Devon, you and Lee are way too nice. It doesn’t cost much to make my $8 million maximum benefit go to unlimited. I say they knew EXACTLY what they were doing because this is trillions of dollars. They insisted on the destruction of the Individual market so employer-based insurance would have no competition.

        With no competition employees have no choice but to pay $600 a month for a child and now have high deductibles. There is nothing anybody can do.

        An added benefit is all sick people are switched off the group plans for payment of very expensive treatment when they are too sick to work.

        It is not that they were stupid it is that they are genius and POWERFUL enough to own both political parties. Like I said, I’m impressed.

  8. Bob Hertz says:

    Good for you! I have been saying for some time that the ACA promise of “unlimited lifetime benefits” is not a major asset, but is in fact a snare and delusion.

    But you are pessimistic as to a solution, and there is at least one way out, as follows:

    a. Analyze the multimillion dollar claims. It is my belief that most of them will involve very long hospital stays and very expensive drugs.

    b. Some of the very long hospital stays (i.e. Terri Schaivo) could go into VA hospitals. The gov’t is already paying for those.

    c. We need price controls on the most expensive drugs that have no substitutes.

    d. We could place other expensive claims into Medicare, the way we handle kidney dialysis. The expense never disappears, but the cost is spread over 150 million taxpayers rather than hammering just those in the individual market.

    • Ron Greiner says:

      Bob, why do we have to take the liabilities away from the employer-based plans? Anthems stock has went from $30 a share when Obama was elected to $191.

      Bob, do you think it should be higher and they are not making enough money?

      You are correct that the things people do talk about are “in fact a snare and delusion.”

    • Devon Herrick says:

      Ron and Bob,

      Yes I’ve heard from actuaries that unlimited lifetime benefits are really not that costly. My concern is that without limits, the sky becomes the limit of what the Medical Industrial Complex can charge. The mere presence of no limits today virtually guarantees there will be many more people tomorrow who experience $1 million dollar therapies. Or in the supposed case of Iowa, $1 million per month therapies.

      A regulatory blank check will cause spending to grow for a variety of reasons: 1) some people will have coverage for a costly illness they otherwise would not have had (they probably would have been treated but now the hospital gets paid for the service); 2) new technology will emerge to treat once untreatable conditions (whether effective or not); 3) higher prices for care since there is coverage to pay them.

      Granted, the ban on lifetime limit that big a deal, but to me it’s just another example of how Obamacare sought to redistribute more societal (and private) resources to hard cases and the medical industrial complex.

      • allan says:

        Devon, I think what you might be saying is that we need liquidity constraint.

        Bob Hertz’s answers are to shift the costs to other entities that are already spending way too much. His ideas do not constrain cost. Instead he helps to bankrupt other programs

        The Republican plan in part is to permit everyone to have membership in third party payer which again doesn’t restrain costs.

        We have to stop shifting the chairs on the Titanic and recognize that healthcare could consume more than the GDP if their were not constraint.

        To constrain healthcare costs in the long term we have to let the consumer determine what is or isn’t needed while at the same time eliminate the unnecessary middlemen and bureaucracy that eat up a lot of our healthcare dollar.

        So that Ron doesn’t explode, that means if the insurance salesman provides a benefit to the individual he should exist, but that is something determined by the marketplace. Insurance is very complex so at least in the present I believe insurance salesmen are needed for the market to function in an efficient manner when the consumer is calling more of the shots.

        For the insurance companies, they should be permitted to innovate and restrictions from innovating should be removed. They should be able to provide the type of insurance their clients want. But, along with permitting them room for innovation we should be permitting more competition and hold the insurers responsible for unclear contracts.

        For those socialists, that does not mean the government isn’t involved. It means it takes a step back from making insurance companies and hospital systems into near monopolies. It doesn’t mean the poor die in the streets. Along with other entities government can help proven needy folk from funds taken from general revenue instead of increasing premiums. However, that doesn’t mean that government guarantees the country club person’t social status. Before paying golf fees pay your healthcare premium or be prepared to be sued for medical bills.

        • Ron Greiner says:

          Allan, Our standard of living is high because of the free enterprise system, and the salesman is the heart and soul of that system.
          Several years ago the secretary of Commerce of the United States said that what we need in this country is one million more professional salespeople. The reason he made the statement is obvious. When the salesman sells the wheels of industry turn. OK, I plead guilty to being prejudiced about this magnificent profession of selling, but let me give you some historical data.
          When Castro took over, nothing was rationed, nothing was in short supply, salesmen were all over the island, and Cuba was completely self-sufficient as a nation. Today, no salesmen are there. Virtually everything is rationed and many things cannot be bought at any price. To my observation there are very few salesmen on the island, some people might say, “Well Ron, if you don’t have surplus you certainly don’t need salesmen.” Interesting enough, however, when they had the salesmen they had the surplus. The reason is simple. Salespeople create jobs and opportunity. They build industry and prosperity.
          America was settled by salesmen. If the salesman wasn’t there to sell picks and shovels when the pioneers went West the great migration could not have happened.
          YOU probably think that salespeople only care about commission, not true. Us tax-free MSA and HSA salespeople NEVER were paid a commission because they are free. Like I have always said, that is salesman abuse. We did it to save our great country and today tax-free HSAs are available to all Americans, even though we were never paid and one million health insurance salespeople were run out of business.
          I’m worse than a salesman, I’m a sales trainer. Sales is a transference of perceptive. When the dust settles the health insurance salesperson will find that his license is his ticket to success when 157 million employees abandon their non-licensed employers’ HR bozo and seek the guidance of a trained insurance agent.

          Allan, have you sold yourself yet, or need I say more?

          • allan says:

            Ron, read what I wrote.

            “if the insurance salesman provides a benefit to the individual he should exist, but that is something determined by the marketplace.”

            • Ron Greiner says:

              Allan, even suggesting if salespeople should exist seemed odd to me. Everybody knows that America was discovered by a salesman. Christopher Columbus was a salesman to get the Queen of Spain to cough up those 4 ships. Some people think there were only 3 but one actually did fall off the edge of the world.

              It was salesmen that inspired Americans to give up their lives to fight for our freedom against King George.

              • allan says:

                Ron, read my statement again.

                “if the insurance salesman provides a benefit to the individual he should exist, but that is something determined by the marketplace.”

                You wrote, “It was salesmen that inspired Americans to give up their lives to fight for our freedom against King George.”

                Our founders were not health insurance salesmen.

                • Ron Greiner says:

                  Allan, us tax-free HSA salespeople are not health insurance salespeople either, although I happen to be.

                  Christopher Columbus wasn’t a “health” insurance salesman either but he was a salesman. Christopher Columbus was looking for India and missed it by about 10,000 miles. Fortunately, he was a better salesman than he was a navigator!

                  If you question his sales credentials, consider this: He was an Italian in Spain with only one prospect to call on. If he missed the sale, he would have to swim home. That’s pressure selling. Once aboard ship, he really had to “sell” in order to sail. Those sailors were going to throw him overboard and he kept saying, “It’s just around the corner or over the horizon, let’s sail one more day!” Then came that exciting call from the lookout, “Land ho!” and the most profitable sales call in history came to a close.

                  We were freed by a salesman. Think about it. Washington had to persuade the Colonists to leave their homes, farms, businesses, ship-building activities and fur trapping and go to war against the most powerful nation on earth. He had to be completely honest and tell them that if we won, he probably wouldn’t have any money to pay them, and if we lost, they would be hung. That’s selling!

                  • allan says:

                    Ron, your rhetoric doesn’t match the trend of the discussion and your attempt to elevate salesmen into the realm of the Gods doesn’t sell your point of view.

                    Be a salesman and learn when to be quiet. 🙂

                    • Ron Greiner says:

                      Allan, I find it interesting that Obamacare reduced our income to nothing running one million insurance agents out of business and YOU never said a word about that. Because us insurance agents don’t matter. I sold my wife on spending a couple million dollars advertising the tax-free MSA in selected markets in America, $1 million in Iowa, so every damn politician running for President who listened to Rush Limbaugh heard our ads over and over. Without that advertising I doubt the HSA would be available today. If you remember it was a TEST about to be sunset-ted.

                      Doctors on the other hand are big trouble makers compared to insurance agents. Doctors joined the Nazi Party in droves and were per capita the largest group supporting Hitler’s regime. They appreciated the Nazi Party’s “wellness” approach to health care, but they were also bribed by being paid for vaccinations and per capita patient care reimbursement.

                      At the Nuremberg doctor trials, a witness testified that there was no problem getting doctors for the euthanasia program – they volunteered.

                      I will make sure to tell my wife that you think her spending every dime she had plus having all of her customers cancelled was not noble. I will tell her this doctor named Allan says that her efforts were no more than any doc over-billing Medicare because their FRAUD is hard to detect.

                      Go ahead and look down your nose at salesman because you docs are so cool with your MONSTER-EGOS.

                    • Ron Greiner says:

                      Allan, I emailed you a couple radio spots from Detroit in 2005 that cost $400 a minute on Rush Limbaugh. YOU listen to my wife’s voice, the voice of the HSA, and you tell me if you have EVER heard a better tax-free HSA commercial.

                      OH, that’s right, YOU have NEVER heard an HSA commercial. Just the way my wife says, “If the POLITICIANS and the PRESS won’t tell YOU.”

                      My wife is a salesman and you can tell by the tenor of her voice she understands FREEDOM. She is DAR though.

                    • allan says:

                      “Allan, I find it interesting that Obamacare reduced our income to nothing running one million insurance agents out of business and YOU never said a word about that.”

                      Why should I? I opposed Obamacare and all its negative unintended consequences. If the law passed corrected the problems and the only problem was that insurance agents were no longer needed, though I would feel sorry for those people, I would be happy for the law. That is known as destructive innovation which makes a nation stronger. Think of how many people were put out of business when Eli Whitney invented the cotton gin. We haven’t heard or seen you burn Eli Whitney in effigy, have we? Healthcare reform is not supposed to be a jobs program.

                      “Doctors joined the Nazi Party in droves” I presume you mean in Germany.

                      You are going off the deep end Ron, but before you do consider this. Any believer in the free market system recognizes the willing buyer/ willing seller scenario doesn’t demand a salesman to be a part of the equation.

                    • Ron Greiner says:

                      Allan, salespeople are not buggy whips. U R A hoot. A wrong hoot I might add. I know that “doctor” means teacher. I know that there is a fine line between teaching and selling.

                      In the Bible it says, “Teach a man to “sell” a fish and he will feed the world.” I know that doctors are salespeople – just untrained. That’s an understatement. We have all of these doctor (MD) politicians all over DC and not one of them can sell the “Ownership Society” (OS) with any power at all.

                      I was TRAINED by the best. R.A. Torrey’s Grandson who said, “Your prayers can do anything God can do and GOD can do anything so your prayers are OMNIPOTENT!”

                      ha ha, get rid of salespeople.

                      YOU ask if “Nuremberg doctor trials”, “NAZI PARTY” and “euthanasia program” is – how did you say it, “I presume you mean in Germany?” To answer your question: YES YES YES – Now, can you see why I think some doctors are a little slow?

                      Should I slow down for you Allan?

                    • allan says:

                      “Should I slow down for you Allan?”

                      Ron, you run so dazzlingly fast that you remain put in place. Your rhetoric hasn’t moved. It is stuck much like a toilet gets stuck. I’ll get a plunger.

                      “doctors are salespeople – just untrained.”

                      Doctors aren’t supposed to be trained in sales. They are trained in knowledge, knowledge of the human body and those things that can help or hurt it. We can’t just rely upon our mouths. We have to depend upon our abilities to learn and retain a lot of information and then be able to use reason and logic in order to act in the appropriate manner.

                      Be a salesman and learn when to be quiet.

                    • Ron Greiner says:

                      I’m sorry Allan, I’m a salesperson and I don’t stop just because somebody asks me to. If I remember correctly the CONSTITUTION gives me the right to speak even if some MONSTER EGO guy says I don’t have that right.

                      Many times guys like you say, “Stop,” but many times you are just thinking out loud and after you think about it, roll it over in your mind, you realize just how wrong you are and “modifying your thinking” is exactly what the doctor ordered. Know what I mean?

                      Maybe you can explain when you say that doctors are “trained in knowledge” and I can only assume that you think salespeople are not “trained in knowledge.”

                      I think this thread would be perfect homework for the 1st day of training class. We could have a quiz on it at the beginning of the 2nd day.

                      Multiple choice questions like: Who discovered America?

                      1. A navigator

                      2. A salesman

                      3. A doctor

                      Being a sales trainer involves a little brainwashing to help control the self image of the field force if you are picking up what I’m laying down.

                      Question 2: Was George Washington

                      1. A navigator

                      2. A salesman

                      3. A doctor

                    • allan says:

                      “I’m sorry Allan, I’m a salesperson and I don’t stop just because somebody asks me to. If I remember correctly the CONSTITUTION gives me the right to speak even if some MONSTER EGO guy says I don’t have that right.”

                      No one has told you to stop being a salesman. I let the free market decide like it should in every market. I use insurance salesmen all the time because I spend a fortune on insurance for all different things and I need them to help me purchase the right things. I want a salesman to be knowledgeable and one that doesn’t over promote himself.

                      I also want a salesman that knows when to be quiet.

                    • Ron Greiner says:

                      Allan, lucky for all of us that we all don’t want the same thing. If we did then everybody would be married to my beautiful wife.

                    • allan says:

                      Ron, I am happy that you show such fondness for your wife. She must be a Saint.

  9. Lee Benham says:

    Would everyone agree that this bill kills the individual market? It’s on life support now.

    • Devon Herrick says:

      Maybe supporters believe the section 1332 waivers are a clandestine way to allow (i.e. force) states to deal with the problem of costly regulations. If so it’s too backhanded to actually work.

      You are correct — indeed it should be self-evident — that allowing people to wait until they are sick and still sign up without penalty will destroy the market for individual health insurance.

      Very few people have pre-existing conditions that would drive their premiums higher than Obamacare. Yet, Democrats have been able to use that topic to club Republicans.

  10. Lee Benham says:

    I just tweeted my senator. I have been fighting for republican health care reform for 25 years. If he votes yes on this bill I voting democrat from now on. Might as well go out in a blaze of socialism.

    • Ron Greiner says:

      I’m with you Lee. These Republicans have the Family Glitch which makes poor children pay taxes on their health insurance and rich millionaires don’t. It’s not fair what Republicans are doing against poor uninsured children in America. The newspapers will go crazy and explain it day and night when it is the Republican’s fault.

      Vote Democrat because Republicans hate poor children.

      • allan says:

        I heard a good number of very conservative libertarians who were not voting or voting Democrat to spite the Republicans (who I agree are mostly trashy) and we got Obama along with Obamacare, Sotomayor and a policy of destroying America.

  11. Devon Herrick says:

    Ron you’ve been touting short-term medical coverage. In the event this passes and the individual mandate is gone, do you see short-term medical becoming the wave of the future, where everyone renews coverage every six months? A better way would be to have long-term medical, with risk-rated plans that have a two or three year duration.

    • Ron Greiner says:

      Devon, If the price for a 30-year-old couple and 2 children is $15,000 per year with a $7,150 deductible and STM is only $5,000 a year with a little deductible the consumer will go STM.

      Devon, there is no such plan that lasts only 3 years. What would be best is personal, portable and “permanent” Individual insurance which delivers the best security. Exactly like before 1/1/2014 and Obamacare.

      • Devon Herrick says:

        I believe some plans in Switzerland (which are portable) have durations that are longer than one year.

        • allan says:

          Devon, I think our rules and regulations are inhibiting innovation by the insurers. I think a several year duration for a plan would be a good idea to think about. But, even if it is a one year plan I don’t think a new deductible should start at the years end.

          • Ron Greiner says:

            Allan, there is no free lunch. If you have a per occurrence deductible the premium would change and restricting options and choices is not what a free people need from government bean counters and regulators.

            You are correct that in a free society the market will decide as long as there are salespeople to explain the options to the uninformed consumers.

            • allan says:

              I am recommending a very high deductible that lasts over several years. That helps to prevent gaming and is most helpful to those that need insurance the most.

              The market determines what salespeople are needed and how much they should be paid.

              • Ron Greiner says:

                Well, I have historical data to make an informed decision and 99% of my customers had the highest “Qualifying” deductible on the base plan but had a little-bitty deductible on ACCIDENTS of $250 then 100% coverage because it is called “Permitted Insurance”, under federal law, and it is so cheap. So you and I disagree there Allan. But, how could you know when you have NEVER sold ONE insurance policy in your life and I ran the largest agency in the United States for America’s oldest health insurance company that is in 44 states, more than any competitor, with 250,000 appointed agents.

                If I had a dime every time somebody said, “My doctor says I should have no problem getting insurance”, I would be a multi-millionaire. I just tell them, “I don’t care what your doctor says…”

                Also, the market doesn’t determine how much an insurance agent makes because I determine how much they make or a manager in their up-line. I thought everybody understood that.

                There is no such product that has a deductible that lasts for just several years, sorry. Lets make a deal Allan. YOU stop recommending non existing insurance products and I’ll stop doing surgery, OK? Remember, I’m licensed and you are not licensed.

                • allan says:

                  “Also, the market doesn’t determine how much an insurance agent makes because I determine how much they make or a manager in their up-line.”

                  Apparently you don’t recognize how a free market functions. The wage of your manager and the money available to spend are part of the determining factors of the wages paid down the line.

                  “There is no such product that has a deductible that lasts for just several years, sorry. Lets make a deal Allan. YOU stop recommending non existing insurance products and I’ll stop doing surgery, OK? Remember, I’m licensed and you are not licensed.”

                  Ron, you are licensed to sell insurance, not to think. Most of us can study to pass the licensure requirements and obtain that license. Your knowledge and experience stops at your mouth. You can’t do surgery because you don’t know how and you can’t get a license to practice medicine. You have no more knowledge to develop an insurance company than I and in fact I probably have more because of my combined medical and business experience along with the ownership of multiple businesses.

                  Everyone can suggest what they think is an insurance product to consider. I suggest that a multi year package with one deductible be a choice that is available. That doesn’t prevent other add-ons or subtractions. You are becoming annoying and are acting like a fool.

                  • Ron Greiner says:

                    Allan, you spew, “You have no more knowledge to develop an insurance company than I and in fact I probably have more because of my combined medical and business experience along with the ownership of multiple businesses.”

                    Really, why don’t you tell us the type of health insurance that you “sold” to your own employees. Of course I already know because I know the law but I think you telling us would be interesting.

                    • allan says:

                      Ron, you are pissing on your own shoes.

                      I’m not sure which employees you are talking about so I will limit the discussion to the employees in my own office.

                      I let them choose.

                    • Ron Greiner says:

                      Allan, you say, “I let them choose.” That means you don’t pay one penny of their premium.

                      Did you ever offer insurance to employees in all of these multiple businesses of yours? If so, tell us the type of insurance that you offered.

                      By the way, I was doing $5 million a year in premium in 1989, long before I ran the largest agency in the USA for America’s oldest insurance company. I have way over $100 million in written premium and you have $0. Your MONSTER EGO, because you are an MD, has you believing in pipe dreams to say about your skills, “I probably have more because of my combined medical and business experience along with the ownership of multiple businesses.”

                      $100 million VS $0

                      Come on Allan, tell us the type of insurance that you offered to your employees in the past. Grow a pair.

                    • allan says:

                      “Allan, you say, “I let them choose.” That means you don’t pay one penny of their premium.”

                      As I said you need remedial reading. I actually provided quite good insurance, but let them decide upon what they preferred. I even sometimes helped to cover the deductible and sometimes paid for sick time when there was a severe illness.

                      I earned good money so I didn’t mind spending a bit more on salaries and benefits.

                      “$100 million VS $0”
                      That would place you in a very good financial situation.

                      Since you force me to compare… I’m retired and could have done so at a much earlier date. I have more than one home, all of them premium properties, and plenty in the bank so I have no worries. Most of that money came from my own investments and ownership in businesses, one of them an insurance company. In other words I succeeded financially both in the medical field and multiple other fields.

                    • Ron Greiner says:

                      Allan, you wrote, “I earned good money so I didn’t mind spending a bit more on salaries and benefits.” There, you admit you were “SELLING” ESI to employees that they lose if they couldn’t fulfill their ELIGIBILITY REQUIREMENT if they became too sick to work.

                      You don’t know enough about insurance to tell us the type of insurance you offered, ha ha. YET, you say you would be smarter than me who has brought in billions in premium because you own a couple of houses, ha ha. In insurance Allan we discuss 1st year premium only. TRUST ME, with well over $100 million in 1st year we are talking BILLIONS with rate increases over 30 years.

                      Every single insurance program you have ever sold to an employee had eligibility requirements that they lose if the get too sick to work. Me on the other hand have NEVER sold ONE ESI and would walk away instead of putting people in danger. See the difference between you and me Allan?

                      I know it is legal in Florida for non-licensed MDs like you to sell insurance to employees and not provide Full and Proper disclosure.

                      I am licensed coast to coast and know the laws in all of the states and you don’t know the laws in your home state.

                      Tell me one more TIME Allan how you would be so much better at running a health insurance company than me.

                      That is like me telling you I would be better at surgery than you even if I have never picked up a scalpel.

                      MDs and their MONSTER EGOs, I swear.

                    • allan says:

                      “There, you admit you were “SELLING” ESI to employees that they lose if they couldn’t fulfill their ELIGIBILITY REQUIREMENT if they became too sick to work.”

                      I would have preferred to pay dollar for dollar in salary, but that is not what they wanted.

                      You don’t believe in free choice do you Ron? You want to impose your decisions on everyone else. You are nothing more than a big mouthed petty dictator in waiting. That is not the type of insurance agent I would hire.

                    • Ron Greiner says:

                      Allan, calm down. YOU write, “I would have preferred to pay dollar for dollar in salary.” If your employees were my clients you would have made tax-free MSA deposits and both you and your employees would have had better, cheaper insurance and escaped taxation. Your salary option is taxed and was not the only option.

                      PLUS, your employees with children would have had a Dependent Conversion Privilege (DCP) so their children could keep the insurance at a majority age regardless of medical history. With your ESI the children lost the insurance even if they were diagnosed with MS like my daughter.

                      I would have taken care of the children of your employees and you say, “That is not the type of insurance agent I would hire.”

                      With me your employees would have had the security of personable, portable and permanent Individual Insurance and the money you were spending would have been redirected to your own employees’ MSA instead of the insurance company.

                      You admit you can’t sell and influence your employees so that is why you over paid with cheezy dangerous insurance. You just needed a professional insurance agent that empowered your employees with tax-free MSAs.

                      Allan, admit it, don’t you think your employees deserved a Dependent Conversion Privilege (DCP) on their children that they love?

                    • allan says:

                      “Allan, calm down. YOU write, “I would have preferred to pay dollar for dollar in salary.” If your employees were my clients you would have made tax-free MSA deposits and both you and your employees would have had better, cheaper insurance and escaped taxation. Your salary option is taxed and was not the only option.”

                      You or the way you picture yourself weren’t there. I used several insurance agents and had my employees search for the best insurance for themselves. We settled on a plan based upon employee consensus. I would have liked to pay simple salary and let them do their own thing basing the salary on the blues. The one criteria was that I would not pay for HMO insurance because I refused all HMO contracts at great cost. I could avoid HMO’s, but not ESI.

                      In this case you are right. I am not an insurance agent and therefore I have never felt it wise that the tax deduction only be given to the employee as health insurance. Third party payer sucks and just made my job more difficult.

    • Ron Greiner says:

      Devon, STM goes for 1 year from one Open Enrollment to the next.

  12. Lee benham says:

    Thank god John left the NCPA to go to Washington and help shape Health Care policy. Otherwise this could have been a really crapy bill !

  13. Ron Greiner says:

    A One-Sentence Bill To Force The Health-Care Issue
    [Comments enabled]

    Here it is:

    “Notwithstanding any other provision in state or federal law, a person who presents themselves while uninsured to any provider of a medical good or service shall not be charged a price greater than that which Medicare pays for the same drug, device, service or combination thereof.”

    http://market-ticker.org/akcs-www?post=232164

    • allan says:

      The blogger is ignorant of unintended consequences and some of the laws we live under.

      • Ron Greiner says:

        Allan, his thought is good. It should be illegal for a hospital to charge an uninsured child 10 times more than an insured child. Charging $100,000 for a stomach bug is completely out of hand and is destroying the lives of young American families.

        Lets face it, these hospitals terminate the insurance on their own employees when they get cancer and too sick to work. Obamacare rules just switch the sick employee, paid by the taxpayer, to Individual Medical (IM) and the self-employed find their premiums skyrocket to the moon and their coverage downgraded to dangerous HMOs with ultra-skinny provider networks.

        The self-employed don’t have the lobbyists and nobody cares about them. That is why the self-employed were chosen to test drive the tax-free MSA. Nobody wanted their insurance business.

        • allan says:

          Ron, of course the hospitals are playing predatory games and they have been given a legal license to do so. Price controls, however, are not the way to solve this problem. (The author doesn’t even understand tax deductions in his second statement)

          This is a matter of contract and the laws should reflect that. Judges can declare agreements to be unconscionable and they have, though in the healthcare system we seem to prefer dictatorial and socialistic price controls.

          We have set up such a complicated healthcare system, legal and otherwise, that it has become impossible for the individual to appropriately manage his own affairs. The individual is paying with his time, health and money while the money spins through the system enriching a lot of people who haven’t done a damn thing to deserve anything.

          • Bob Hertz says:

            Allan, you are correct that judges have declared some forms of hospital pricing to be unconscionable.

            However, to take advantage of that ruling, a patient must have courage and also have money for a good lawyer, in order to take on a hospital billing department.

            And then the patience to wait while their credit rating is trashed while the case moves through the courts.

            It should not be necessary to sue for fair treatment in what was originally a gift relationship. We need a federal law that limits charges in emergencies, and we need health courts that could provide binding arbitration in other cases.

            • allan says:

              Bob, nothing is perfect so it is best to change the atmosphere rather than change law after law. The country would do much better funding attorney’s and training judges for as soon as patient victories mount up change invariably follows and the charges stop.

              We saw that with HMO’s though because of intervention not completely. The suits against them made them more expensive and that is part of the reason that their rapid rise in market share declined.

              In the meantime a few people do get injured, but the entire country is being injured by your type of interventions and those interventions never subside. That is what your last paragraph advocates in part, more reliance upon changing the law over and over as soon as the situation changes which is what we have been doing for decades.

              What are healthcare courts other than judges more familiar with healthcare? Are you going to advocate that they try things differently or deal with current contract law?

              • Bob Hertz says:

                I agree with your main point — that there is plenty of case law on contracts, prices, et al so that new legislation is not needed.

                I am just looking for a solution to help the kind of patient who is damaged by an unconscionable medical bill, but does not have the money to pay a lawyer to challenge the bill. The lawyer cannot work on contingency, because even if he wins the case, the client gets no money, just a smaller bill.

                That is why I am interested in federally funded arbitration panels or health courts. Please correct me if I am in error here. Thank you.

                • allan says:

                  Bob I am not an expert. The health courts would be something to consider.

                  On the other hand a person doesn’t require a lawyer to go to court especially when a bill is unconscionable. He can go pro se. He shouldn’t really require a lawyer. The judges should require the hospitals to prove their case and the judge could have access to the fees paid by insurance companies as well. The hospital’s case should be proven by actual money collected on patients. I don’t believe this to be a difficult problem.

                  I do think, however, that since a hospital may not collect anything from an uninsured person that the uninsured person be charged significantly more than the calculated insured person’s fee. This incentivizes the individual to carry insurance.

                  The court would end up deciding the maximum fee that is “reasonable”. Now it is the job of the hospital to collect at which point a deal may or may not be made for a lower rate. This is done all the time with hospitals and they have to consider that in bankruptcy they may collect nothing so that stimulates them to make a deal on terms and price. It is actually a progressive way of thinking because those with lots of money who could easily have carried insurance don’t have the threat of bankruptcy and therefore might be forced to pay more. That is the group where Barry and I are constantly at odds. I don’t feel that society has to maintain that person’s standard of living. Before he pays his golf fees he should pay his insurance premiums or run the risk of having to resign from the golf club.

                  Bob, I am fortunate and can afford to pay cash even at the inflated rates of today. I carry insurance only to protect my assets and I believe anyone in my position that refuses to “share” or pool in advance shouldn’t have the advantage of pooling after their house burns down.

                  • Ron Greiner says:

                    Allan, you say, “I do think, however, that since a hospital may not collect anything from an uninsured person that the uninsured person be charged significantly more than the calculated insured person’s fee.”

                    The Orlando Weekly reported that uninsured children are charged 10 times more than an insured child. They reported that a simple stomach bug could cost $100,000.

                    To endorse that poor people be charged 10 times more than rich people like you seems a little mean. I guess you could care less when young families lives are ruined. In Florida it is illegal to charge more for gas during an emergency like a hurricane. But you think charging a poor uninsured child ten time more than you are charged is perfect.

                    Allan, your mind is warped. YOU my friend need a check-up from the neck-up.

                    • allan says:

                      Ron, you require remedial reading 100.1

                      I fully understand hospital accounting methods with regard to their charge master. My hospital charged 20 times more than the insurance paid for a simple procedure as an outpatient.

                      The question that might be beyond your ability to understand is what is the contract, what it says and whether or not is is legal or unconscionable. As I mentioned earlier in greater length the thinking processes of some judges have to be modified.

                      “In Florida it is illegal to charge more for gas during an emergency like a hurricane.”

                      Your ignorance makes you accuse all others of being mean, but you are being stupid and your stupidity cause injury to others. I think gas distribution in Florida today better takes into account hurricanes, but what really happens behind the anti gouging laws is that more people are hurt, not less.

                      When the hurricane hit before the gouging laws were passed prices went up and people were more reluctant to purchase gas they likely didn’t need. That left more gas for more people in need.

                      After gouging laws were passed we had a hurricane and a long weekend. Since prices couldn’t be raised no one could raise the amounts paid to the truckers and everyone else. None wanted to go through the trouble on a long weekend to bring gas when they aren’t being paid a higher sum of money.

                      Take the same argument to generators. Before the anti-gouging law people brought generators in because they could profit greatly. Those that felt the price of the generator worth it bought them and both parties were better off. That was not permitted after the anti gouging laws were passed.

                      Any benefits we have seen since the anti gouging laws were passed do not come from the laws rather they come from improvements in infrastructure and planning.

                      You really need a course in economics and a bit of behavior modification. You have gone off the wall.

                    • Ron Greiner says:

                      Allan, you wrote, “I do think, however, that since a hospital may not collect anything from an uninsured person that the uninsured person be charged significantly more than the calculated insured person’s fee.”

                      So you think an uninsured child should be charged 10 times more than you with insurance. Then you try and justify this insanity with your twisted economics.

                      Governor Rick Scott calls it “price gouging” but you defend this corruption. Go ahead and keep calling me stupid and keep telling us how smart you are because you are an MD.

                      Allan, these peoples lives are destroyed because you want to charge uninsured children 10 times more than a rich guy like you.

                    • allan says:

                      Ron,

                      “So you think an uninsured child should be charged 10 times more”

                      That would be unconscionable and shouldn’t be permitted, but you probably don’t understand how the law works and you probably don’t know what the meaning of the word ‘unconscionable’ is. You are a fool.

                    • Ron Greiner says:

                      Finally this FOOL, me, have got you, the smart MD, to admit that you wanting to charge uninsured children 10 times more is ‘unconscionable’.

                      So when you demand that the uninsured child be “charged significantly more” you must have meant only 9 times more.

                      Why do you call people FOOLS when they catch you promoting ideas that you yourself call ‘unconscionable’?

                    • allan says:

                      “Finally this FOOL, me, have got you, the smart MD, to admit that you wanting to charge uninsured children 10 times more is ‘unconscionable’.

                      You are right. I should have said fool and illiterate. What I said didn’t mean anyone had to pay 10 times more. The word was significantly more and in my mind that would require an actuary to figure out some good numbers. Are you an actuary as well as a fool?

                    • Ron Greiner says:

                      Allan, calm down. Many children have lost their insurance because their parents were sold dangerous ESI by non-licensed uninformed employers like you without a Dependent Conversion Privilege (DCP). Now these uninsured children you believe should be charged “significantly more” but now we need professionals in actuarial science, in your mind, or I’m “illiterate”.

                      I would think you might use reason and logic to debate instead of just calling people names. I hope you were a better MD than you are a debater because if you weren’t I know exactly who not to call with a medical problem – YOU!

                    • allan says:

                      “Many children have lost their insurance because their parents were sold dangerous ESI by non-licensed uninformed employers…”

                      I calculate a total package, salary and benefits. Anything within that package is good to me so I let my employees make decisions. I don’t believe in excessive paternalism so I have nothing to do with their dependents.

                      As far as name calling, I am not gratuitously calling you ignorant and illiterate. I am doing so because your replies indicate you are unable to understand the written word. Additionally you say things demonstrating an ignorance of basic economics. You have been acting this way for a long time, but I didn’t mention anything until you stupidly and repetitively started to misstate what I said while trying to elevate your fictional position in life at my expense.

                      Then you started to talk about the millions and millions of dollars you were involved with pointing to the fact that you are an expert, but I find you an idiot for have such earning capacity and not using it widely to protect you from an uncertain future. I don’t like saying these things, but who can help it faced with the constant barrage of idiotic personal implications being thrown on a non ending
                      basis.

                      You should really stop blogging so much and spend that time working to give your wife some relief.

                    • Ron Greiner says:

                      Allan, sorry I was busy. I just got off the phone and I have changed the world one more TIME starting July 3rd 2017. But not in all 44 states, just 33 states.

                      A lot of people are going to save a lot of money because of me and one more TIME I wasn’t paid a dime to purchase expensive homes like you.

                      But, when a 30-year-old couple with 2 children can drop their premiums from $1,234 a month in Phoenix with Centene, with a $6,500 deductible, to $317 a month with a deductible that is only $2,500, they will be able to purchase some Christmas presents this year for those kids.

                      I’m sure they would send me a Christmas card but they won’t know my name. Maybe they should just address the card to: The ignorant and illiterate FOOL.

                    • allan says:

                      “I’m sure they would send me a Christmas card but they won’t know my name. Maybe they should just address the card to: The ignorant and illiterate FOOL.”

                      Ron, I hear a lot of big talk but what is really missing is results. I don’t know how they should address you, but certainly the above address seems promising based on how you have been acting.

                    • Ron Greiner says:

                      Allan, I did get results today. It starts July 3rd, 2017 from an email I sent on 5/12/17 with an idea based on the Dependent Conversion Privilege (DCP) that I told you about. This is called STM-CP available in 33 states starting 7/3/2017.

                      I know when I do something historical like enrolling the 1st tax-free MSA in the USA. This is historical and Dr. Tom Price can kiss my ass. Now healthy people can get STM that lasts until the Open Enrollment of Jan 1st for Obamacare and the sick can enroll into Obamacare and pay 4 times more.

                      Did you do anything historical today Allan?

                      Calling me names doesn’t count.

                    • allan says:

                      “Allan, I did get results today. It starts July 3rd, 2017 from an email I sent on 5/12/17 with an idea based on the Dependent Conversion Privilege (DCP) that I told you about. This is called STM-CP available in 33 states starting 7/3/2017.”

                      I hope it works out for the people and for you.

                      “Did you do anything historical today Allan?”

                      No, but I have done my fair share on other days. Today I decided to play cat and mouse with you as the mouse.

                    • Ron Greiner says:

                      Allan, you say, “Today I decided to play cat and mouse with you as the mouse.” So now you are calling me a mouse. For an MD you sure have called me a lot of names instead of using reason and logic.

                      No need to HOPE Allan it is already done. Now millions of families will have a low-cost insurance option so medical providers like YOU can’t ruin their lives by charging them “significantly more.” All thanks to me I might add.

                      Allan, now you brag about doing something historical by saying, “I have done my fair share on other days.”

                      Please inform this lowly, ignorant and illiterate FOOLISH mouse what you have done that is truly historic.

                      This aught to be good.

                  • Bob Hertz says:

                    The need to collect on hospital bills is a source of anguish for some patients, and extra cost (plus in some cases I think anguish) for the hospitals themselves.

                    For this reason, I would entertain an auto-enrollment procedure involving Medicare Part A.

                    If a person has no health insurance, they would pay an extra 2 to 4 per cent in income taxes. That amount would enroll them in Medicare Part A, which pays room and board in hospitals with a deductible of about $1,500 and no coinsurance.

                    Any new tax like this has some deadweight cost of compliance, but my intuition is that the new result would be positive. Hospitals would get paid on every single patient, and a person who thinks that private insurance is overpriced could go without such coverage with far less risk of bankruptcy or disaster.

                    We would need a way to ‘find’ the uninsured who work for cash and/or do not file a tax return.

                    • allan says:

                      The free loader argument (which is where your logic eventually leads to) is a poor argument. That is not where the big problems lie.

                      Your strategy only moves bankruptcy from one program to another. The solution of the problem is not shifting the chairs on the Titanic. It is a genuine reduction in the rate of spending. Much of what we hear about are one time reductions based upon shifting the problem elsewhere.

                      But, if you draw a line representing a rate of growth higher than the cost of living, growth of wages or growth of GDP all that happens with an influx of money is that you take a few steps back on the line while bankruptcy continues to be the end product of that line.

                      Control the rate of growth enough and suddenly bankruptcy disappears.

                      After pondering that line think of the fact that every year the government has to spend a lot more on many programs. Looking at some of those programs today with the budgets they have we might think it was impossible to survive with the much lesser budget 5 years earlier.

  14. Bob Hertz says:

    Good for you, Ron, to link to Karl Denninger and Market Ticker.
    He is a real one man show, whose last two months of writing on health care reform have been terrific.

    I love the idea that the uninsured would only face Medicare rates. If they were hospitalized for heart tests, the charge would be about $2800 instead of whatever monstrous $58.000 chargemaster rate that the hospital dreams up.

    This would make people less terrified of health care and so less willing to pay extortionate insurance premiums. Why would I pay $1,000 a month for health insurance, if I will have no claims most years and even an ER episode will only cost me $2800.

    I do disagree with Karl’s statement that “any provider” would be unable to charge more than Medicare to any uninsured person.

    I do not think that Karl’s regulation should be binding on regular internists or personal physicians. An internist should not be forced to charge an uninsured person $55 (the Medicare fee) instead of $125 (the normal fee). That is just regulatry overkill.

    I want less involvement of Medicare with office visits altogether.

  15. Lee Benham says:

    the comments on this post are a fitting match to the senate Bill. Maybe it’s just the frustration we are having with the incompetence of our elected leaders . drain the swamp. #Nevervoteforincumbent

  16. Lee Benham says:

    The AMA says

    “Medicine has long operated under the precept of Primum non nocere, or ‘first, do no harm.’ The draft legislation violates that standard on many levels,” the nation’s largest doctor group said in strongly worded letter Monday to McConnell.

    With that philosophy then no medical bill should ever be turned over for collections.

  17. Lee Benham says:

    Just got my agent notice. Medica Rates will be a lot next year.

    NOTICE OF PROPOSED BASE PREMIUM RATE INCREASE
    AND PUBLIC HEARING
    Dear INSURED:
    Proposed Increase in Base Premium Rates
    Medica has asked permission to increase its base premium rates by 43.5%. The base premium rate is the rate prior to adding individual rating factors, which are described in more detail below. The Iowa Insurance Commissioner must decide to deny, approve, or negotiate a lower rate increase. If approved or a lower rate increase is negotiated, the increase would be effective January 1, 2018.
    Why Medica Is Asking for a Base Premium Rate Increase
    Medica has asked for a base rate increase because of higher costs by policyholders in your rating class.

  18. Bob Hertz says:

    Allan, here is where I was coming from on my proposal that
    Medicare Part A become a catastrophic, auto-enrollment plan for anyone who does not want ACA qualified insurance……….

    Let’s say that an ACA plan costs $1,000 a month (which it soon will, for a 53 year old in Iowa).

    But then, say that we allow once again an underwritten indemnity plan with a $25,000 annual maximum, that costs $100 a month.

    If one hundred people buy the indemnity plan, about 95 of them will be much better off financially over the course of a year. They will save over $10,000 in premiums.

    But 5 of them will lose the gamble. They will get an illness or have an accident, or have their insurance claims denied because the insurance companies in the indemnity market are sometimes pretty sleazy.

    These 5 persons were the focus of the drive for the ACA.
    We were going to solve their problems by making everybody buy $1,000-premium insurance.

    My proposal for Medicare fallback would let the 100 people keep their cheap indemnity insurance, but ask for a small tax to cover the occasions when the cheap insurance does not work.

    Seems like the least bad solution! Incidentally the columnist Megan McCardle has proposed this for years.

    • allan says:

      Without advocating this approach we could change your idea to a Medicaid fallback rather than Medicare fallback and charge the patient a fee for Medicaid. In a way that would become the public option talked about.

      However, your attempt, MacCardle’s attempt along with a Medicaid public option do little to reduce the global costs of healthcare (the Medicaid option might actually provide some relief). That is the problem with most suggestions. We don’t need to just move the money around, we need to decrease overall amounts spent.

      Someone has to say NO. If the government does it, it does it with rationing and all the costs associated with government control. If the patient does it he 1) tailors his care to what is best for him and not the guy next door 2) he doesn’t have so many rent seeking entities sucking up the money.

      This doesn’t mean that the patient is left alone in the cold world. He carries insurance and can still get further help, but right now we are delivering bloated healthcare to every American where that cost is markedly increased due to all the entities feeding off of the system.

      If you wish to continue shifting the chairs on the deck of the Titanic do so, but I really think we needed to prevent the hole in the ship so the water never came into the ship in the first place.

    • Z Woof says:

      A male 53-year-old in Iowa zip code 50010 with STM with a $5,000 deductible then 100% coverage is $296 per month. If he raises his deductible to $25,000 the premium is $167.11 per month.

      What are you giving this guy to get the premium to $100 a month, $100 a day in the hospital?

      No one recommends indemnity plans, get real Bob.

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