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  #1  
Old 10-12-2017, 03:45 PM
Snowboarder Bo Snowboarder Bo is offline
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Trump's Executive Order on Health Care: what's the deal?

Trump signed a health care order today.
Quote:
Frustrated by health care failures in Congress, President Donald Trump directed his administration Thursday to rewrite some federal insurance rules as a beginning of renewed efforts to undermine “Obamacare,” the program he’s promised to kill.

“With these actions, we are moving toward lower costs and more options in the health care market,” Trump said before signing his directive in the Oval Office. Trump said he will continue to pressure Congress to repeal and replace former President Barack Obama’s Affordable Care Act.
The effects of the new policies are debatable, apparently:
Quote:
Some experts said the White House plan could undermine coverage on the ACA’s insurance marketplaces, particularly for people with health problems. That would happen if healthy people flock to lower-cost plans with limited benefits.

Other experts said Trump’s proposals appear to be modest and would have limited impact.
But no one seems to think anything is going to change anytime soon due to this EO.
Quote:
The steps the president outlined Thursday will take months for the federal bureaucracy to finalize in regulations. Experts said consumers should not expect changes for next year.
The AP story mentions several points of the plan:
Quote:
—Easing current restrictions on short-term policies that last less than a year, an option for people making a life transition, from recent college graduates to early retirees. Those policies are not subject to current federal and state rules that require standard benefits and other consumer protections.

—Allowing employers to set aside pre-tax dollars so workers can use the money to buy an individual health policy.
I'm not sure what I think about those things.

Two characterizations:
Quote:
On Capitol Hill, House Democratic Leader Nancy Pelosi said Trump “knows very little” about health care policy or legislation. She said she was unfamiliar with the details of the executive order, “but I do know it’s a sabotage of the Affordable Care Act.”
Quote:
But Sen. John Barrasso, R-Wyo, said Trump is taking “bold action” to give patients “the freedom and flexibility to choose the health care plan that works best for them.”
Which is it? Is it both? Is it neither?

What's the deal?
  #2  
Old 10-12-2017, 04:03 PM
bobot bobot is online now
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I'm no expert on this, but I did read a little about it on my lunch break. The short version is that people who are likely not to need insurance soon will find it easier to get bare bones plans, and those who will actually need to use insurance soon are about to be price gouged and fucked. How unexpected.
  #3  
Old 10-12-2017, 04:04 PM
Aufgeblassen Aufgeblassen is offline
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The deal is that it is better than nothing!
  #4  
Old 10-12-2017, 04:19 PM
enipla enipla is online now
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Trump is just screwing people that have health problems. And those that think they are healthy, but BOOM along comes the big 'C' or something and they will be screwed too. Trump knows NOTHING about any type of insurance.

He's just showing once again what a racist idiot he is. All he wants to do is sabotage the ACA because Obama put it in place.
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Last edited by enipla; 10-12-2017 at 04:20 PM.
  #5  
Old 10-12-2017, 04:23 PM
RickG RickG is offline
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My go-to on healthcare policy is Vox.com.

That link has a good explainer on association plans and the potential effect of putting them under the rules of large businesses (as opposed to small), and also letting self-employed people (some of the biggest users of the individual markets) into those association plans.

The upshot is a potential death-spiral in the individual markets, which would effectively end that part of the ACA without congress needing to explicitly repeal it.
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Last edited by RickG; 10-12-2017 at 04:25 PM.
  #6  
Old 10-12-2017, 07:38 PM
Iggy Iggy is offline
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Quote:
The AP story mentions several points of the plan:
Quote:
...—Allowing employers to set aside pre-tax dollars so workers can use the money to buy an individual health policy.
This point is appealing to that very small business sector that does not have enough employees to be required to provide coverage per the ACA. Larger businesses effectively get to provide employee benefits with pre-tax dollars. This proposal would allow those very small businesses to do the same without incurring some of the issues related to section 105 plans which is how they would have to do this now. Actually a reasonable idea.
  #7  
Old 10-12-2017, 10:51 PM
WillFarnaby WillFarnaby is online now
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This is the only way health care policy should be reformed. Incremental steps toward capitalism. A master stroke by Rand Paul.
  #8  
Old 10-13-2017, 12:43 AM
GIGObuster GIGObuster is offline
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Originally Posted by WillFarnaby View Post
This is the only way health care policy should be reformed. Incremental steps toward capitalism. A master stroke by Rand Paul.
With a system that the home market of 2008 would be proud of.
  #9  
Old 10-13-2017, 08:09 AM
Czarcasm Czarcasm is online now
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Those that have, live.
Those that don't, die.

Has Rand Paul ever been poor enough not to be able to afford his own health care?
  #10  
Old 10-13-2017, 08:23 AM
Dereknocue67 Dereknocue67 is offline
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Trump has adopted the herd mentality on health care. If a member of an animal herd is sick or injured, the herd abandons it and leaves it behind, usually to die.

Trump is using the same approach to health care and is culling the population of what he may believe is excess weight.

He can do this because after all, in his mind, he’s the smartest guy on the planet.
  #11  
Old 10-13-2017, 08:54 AM
BobLibDem BobLibDem is online now
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Originally Posted by WillFarnaby View Post
This is the only way health care policy should be reformed. Incremental steps toward capitalism. A master stroke by Rand Paul.
And having thousands of people die as a result is a feature, not a bug. Rand Paul doesn't give a damn about anything but his morally bankrupt libertarian philosophy. He must have a strong stomach, standing next to Dumb Donald who proudly holds up a signed order with the same expression as a two year old who just went on the potty by himself. This is a sickening day, literally, for the US.
  #12  
Old 10-13-2017, 09:38 AM
Doctor Jackson Doctor Jackson is offline
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The main pushback I've heard so far is that this EO will drive the young and healthy out of the exchanges and into these new, cheaper (with less coverage) plans and, thereby, raise rates for the older, sicker segment of the population. The fact is that the young and healthy never signed up for ACA in any significant numbers. A large percentage decided to do without insurance all together.
Quote:
The most significant factor behind next year's sharply rising prices, experts say, is that millions of “young invincibles,” who represent a large segment of the uninsured pool, have so far not signed up for Obamacare.
and
Quote:
Indeed, only 28% of exchange members in 2014 were in the coveted 18-34 age range, and that percentage stayed level for 2016. It's below the 40% level many actuaries say is needed to create a more stable rate environment. The insurance industry has a name for that condition, which Obamacare was designed to fight. It's called adverse selection. And so far, the ACA's medicine isn't working.
In my mind, it's the young & healthy who are currently uninsured who will go for the proposed plans. ACA may lose a few of that demographic, but there really aren't enough out there to make the numbers work anyway. Only 45% of the total US population is under age 35 (age 0-34), yet actuaries say the ACA pool needs to have 40% of participants be in that age group. In reality, that 40% would come mostly from those in the 26-35 age bracket, which is only 12% of the US population. ACA, as implemented, is unsustainable.

Where the ACA pool may be (I have seen no numbers one way or the other yet) affected most is by the association insurance provision. This will let small businesses band together to offer insurance to their employees at group prices, which are most often lower than exchange prices. This will no doubt draw people away from the exchanges, but the mix of healthy vs not healthy is unclear.

I'm going to wait until I see more data before I decide whether this is good, bad or indifferent.
  #13  
Old 10-13-2017, 09:49 AM
asahi asahi is offline
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The problem is, if you're an insurance company, how do you price your premiums for ACA recipients? Sure, the law still exists on paper, but you also have a president who is eliminating requirements that encourage (or push, depending on your leanings) people to participate in the marketplace. Meanwhile, he's removing subsidies to help people who fall into more expensive care brackets. In effect, Obamacare's red tape, though complicated, was actually getting people to sign up for that care. But Trump has signed Obamare's death warrant and it's probably irreversible.

What this means is that we'll probably go back to the way it was in 2008. A bunch of cheap skate policies that pay absolutely nothing if you actually do end up getting sick, and nothing to control the costs of healthcare or health insurance. The people who get real medical insurance will probably get it through their employer, but if they're disabled and can't work....
  #14  
Old 10-13-2017, 02:23 PM
SingleMalt SingleMalt is offline
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Originally Posted by Doctor Jackson View Post
The main pushback I've heard so far is that this EO will drive the young and healthy out of the exchanges and into these new, cheaper (with less coverage) plans and, thereby, raise rates for the older, sicker segment of the population. The fact is that the young and healthy never signed up for ACA in any significant numbers. A large percentage decided to do without insurance all together.

...


In my mind, it's the young & healthy who are currently uninsured who will go for the proposed plans. ACA may lose a few of that demographic, but there really aren't enough out there to make the numbers work anyway. Only 45% of the total US population is under age 35 (age 0-34), yet actuaries say the ACA pool needs to have 40% of participants be in that age group. In reality, that 40% would come mostly from those in the 26-35 age bracket, which is only 12% of the US population. ACA, as implemented, is unsustainable.

Where the ACA pool may be (I have seen no numbers one way or the other yet) affected most is by the association insurance provision. This will let small businesses band together to offer insurance to their employees at group prices, which are most often lower than exchange prices. This will no doubt draw people away from the exchanges, but the mix of healthy vs not healthy is unclear.

I'm going to wait until I see more data before I decide whether this is good, bad or indifferent.
This is a very interesting point, the consequences of which could backfire. These "less coverage" plans may actually encourage enrollment in the ACA by the young and healthy who would otherwise be non-enrollees. Thus, higher total participation in the ACA than previously.

Also, the subsidies for the lower-income participants are based on the participant's income, not the cost of the coverage (iirc). If the rates go up, the subsidies will also go up, meaning the taxpayers will be picking up the difference. The people who will be hurt are those above the subsidy line, who could end up paying substantially more for their coverage.

Who knew unintended consequences could be so complicated?
  #15  
Old 10-13-2017, 03:03 PM
Buck Godot Buck Godot is offline
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Originally Posted by asahi View Post
The problem is, if you're an insurance company, how do you price your premiums for ACA recipients? Sure, the law still exists on paper, but you also have a president who is eliminating requirements that encourage (or push, depending on your leanings) people to participate in the marketplace. Meanwhile, he's removing subsidies to help people who fall into more expensive care brackets. In effect, Obamacare's red tape, though complicated, was actually getting people to sign up for that care. But Trump has signed Obamare's death warrant and it's probably irreversible.

That is my thought exactly, even under the best scenario where none of his tweeted policy statements never go anywhere, the tweets raise uncertainty in the future of the health care markets, and the mere existence of this uncertainty may be sufficient to severely wound ACA.
  #16  
Old 10-13-2017, 04:42 PM
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"Severely wound"? Indeed, the point of the dagger is the point of the exercise.
  #17  
Old 10-13-2017, 05:27 PM
kanicbird kanicbird is offline
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Originally Posted by Dereknocue67 View Post
Trump has adopted the herd mentality on health care. If a member of an animal herd is sick or injured, the herd abandons it and leaves it behind, usually to die.....
No Trump has adopted the mentality of a toddler (actually it appears he has the mentality of a toddler), if he can't have it his way he will try to destroy it and make people miserable.

I wanted someone with a heart of a child to be the leader, not the mind of one
  #18  
Old 10-13-2017, 05:39 PM
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I don't have anything to add to what has already been said here. It seems Trump and his supporters are only interested in one thing, and one thing only - "do whatever it takes to make the lib'ruls mad". Roll back sound, bipartisan policy achievements from the prior administration, say and do things inconceivable for a leader, bully anyone who does not bow down to the Emperor. It does not matter if it is bad for the world, bad for the nation, or bad for them as individuals - if it makes liberals crazy mad, then they are all for it.
  #19  
Old 10-13-2017, 08:21 PM
asahi asahi is offline
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Originally Posted by kanicbird View Post
No Trump has adopted the mentality of a toddler (actually it appears he has the mentality of a toddler), if he can't have it his way he will try to destroy it and make people miserable.

I wanted someone with a heart of a child to be the leader, not the mind of one
Part of Trump just takes satisfaction in destroying Barack Obama's legacy. Trump made an ass of himself with his birth certificate conspiracies, and Obama went on to get re-elected and ended up having a little fun at his expense at the press corps roast or whatever it's called. Trump has been waiting to put 'uppity' Obama in his place for years, and this is his chance to do it. And he's doing it. He's not going to stop there either. Whatever Obama did, he will undo; whatever Obama didn't do, he will do. From free trade to nuclear weapons deals to criminal justice reform, Trump is the anti-Obama.

But more to the point, it's worth repeating that Trump can't create anything. He can't develop anything. He can't produce. He can only destroy. He never built hotels; he just found ways to scam other people into doing it for him and then taking their money - why else would he need to scam contractors? Good businessmen don't do that - don't need to. Trump is just a destroyer. And he will continue to just walk in the shop and break stuff until he's either impeached or voted out of office. And the longer he stays, he's going to find more expensive stuff to break.

Last edited by asahi; 10-13-2017 at 08:24 PM.
  #20  
Old 10-13-2017, 10:34 PM
D'Anconia D'Anconia is online now
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Originally Posted by asahi View Post
The people who get real medical insurance will probably get it through their employer, but if they're disabled and can't work....
The disabled can get it through Medicare, right?

Last edited by D'Anconia; 10-13-2017 at 10:36 PM.
  #21  
Old 10-13-2017, 11:54 PM
E-DUB E-DUB is offline
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The thing to remember is that with these guys, first they decide what they're going to do, THEN they come up with the high sounding rhetoric to justify it.
  #22  
Old 10-14-2017, 12:43 AM
Ann Hedonia Ann Hedonia is offline
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The executive order itself is kind of funny.

https://www.whitehouse.gov/the-press...nd-competition

It reminds me of one of those pseudo-legal documents the sovereign citizen types are always trying to file in court. It looks kind of official on the surface but once you really read it you see how the whole thing is pretty much bullshit.

It says
It shall be the policy of this administration to facilitate the purchase of insurance across state lines and then it goes on for several paragraphs about how the Patient Protection and Affordable Care Act sucks. Since it's an official document he didn't say ObamaCare. Isn't that presidential?

It is sadly lacking in details about how it will facilitate the purchase of insurance across state lines or even a real explanation of what that even means. But they drop something about developing and operating a healthcare system that provides high quality care and affordable prices. But this phrase is just kind of dropped in the middle of the document without context.

Then they lay out a flawed theory about how association plans will save the day. Then they resolve to "expand access" to them but they don't say what that means and they seem unaware of the fact that insurers don't want to give associations access to the same plans as large businesses.

Then they go on some more about how much the PPACA sucks.

Then they explain what HRAs are

More about how much the PPACA sucks.

Then the actual action that they will be taking. Various cabinet secretaries are going to consider proposing some regulations or giving some guidance.

Looks like something they threw together because Trump "needed a win". And they hope it keeps him from going insane over the weekend, Thrn they'll worry about next week.

But now they own it. Big Miscalculation

Last edited by Ann Hedonia; 10-14-2017 at 12:46 AM.
  #23  
Old 10-14-2017, 03:48 AM
DWMarch DWMarch is offline
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Originally Posted by WillFarnaby View Post
This is the only way health care policy should be reformed. Incremental steps toward capitalism. A master stroke by Rand Paul.
Wow, you must have one great and rock-solid health care plan to make a statement like that.

So, that raises a couple of issues:

First, in a purely capitalist system your insurance provider will have the option to deny your insurance claims simply because they feel like it and you will have no recourse whatsoever. When you go to the government to say it's not fair they will come back and say no it is not fair but that's Rand Paul's master stroke of capitalist genius right there.

Second, there are all these angry working class whites across America who probably do not have health care plans similar to yours. What do you recommend so that they can get these health plans? Particularly if they already have some health issues and the capitalist market can completely deny them any coverage at all because of those issues? "Pull yourself up by your bootstraps" is great... if you have boots to begin with. But all these people in between Podunk and Lake Wobegon don't have boots or bootstraps or any means of procuring either. And these are white people we're talking about here! How can they attain the same level of privilege that you take for granted?
  #24  
Old 10-14-2017, 10:15 AM
asahi asahi is offline
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Originally Posted by D'Anconia View Post
The disabled can get it through Medicare, right?
If you *become* disabled through illness or injury it can take up to 2 or more years before you start receiving benefits. Meanwhile, medical bills due to hospital stays, follow-up visits, and medication do add up. All of this leads to a potential medical-related bankruptcy. Taxpayers end up paying somehow. Unless we bring back peonage and debtors prisons.
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Old 10-14-2017, 10:25 AM
asahi asahi is offline
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I don't have anything to add to what has already been said here. It seems Trump and his supporters are only interested in one thing, and one thing only - "do whatever it takes to make the lib'ruls mad". Roll back sound, bipartisan policy achievements from the prior administration, say and do things inconceivable for a leader, bully anyone who does not bow down to the Emperor. It does not matter if it is bad for the world, bad for the nation, or bad for them as individuals - if it makes liberals crazy mad, then they are all for it.
To be fair, Obamacare wasn't a bipartisan policy; it was passed over the objections of mostly rich white men who didn't want to pay for "those people's" medical care and "women's stuff." It's just that they've been waiting for 7 years to finally do something about it, and now they have the power to do something about it. And even though when it came down to the moment of truth they were confronted with their own lies and realized that ordinary people actually kinda liked Obamacare and didn't have the stomach to vote against it, they can just close their eyes and try to claim credit for it anyway.

We've been talking a lot about Trump's inability to do anything, which is angering his base of supporters. Well, in a way, Trump just scored his first political victory with his extreme base, and he did it completely without help from Congress. He can unilaterally destroy Obamacare, which, in the eyes of "suck it up, butter cup" Republican voters, is a crowning achievement, politically. It's entirely possible that he can use this as leverage against McConnell and Ryan. True, it's wildly unpopular and potentially very risky what he's doing, but to the political activists in the deep red districts, Trump is clean-up hitter who just went deep. This might start a brutal civil war within the Republican party, and while some pundits might be cheering that prospect, I for one dread it. Because the extremists can win. And they can wreak hell on earth if they do.
  #26  
Old 10-14-2017, 12:04 PM
Snowboarder Bo Snowboarder Bo is offline
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I just saw this on the AP:
Quote:
President Donald Trump’s decision to end a provision of the Affordable Care Act that was benefiting roughly 6 million Americans helps fulfill a campaign promise, but it also risks harming some of the very people who helped him win the presidency.

Nearly 70 percent of those benefiting from the so-called cost-sharing subsidies live in states Trump won last November, according to an analysis by The Associated Press. The number underscores the political risk for Trump and his party, which could end up owning the blame for increased costs and chaos in the insurance marketplace.
(bolding mine)

We'll have to see how it all plays out, but that could be a significant "oops" factor.
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Old 10-14-2017, 01:12 PM
k9bfriender k9bfriender is online now
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Unless we bring back peonage and debtors prisons.
I think that EO is scheduled for next week.
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Old 10-14-2017, 04:18 PM
asahi asahi is offline
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I just saw this on the APbolding mine)

We'll have to see how it all plays out, but that could be a significant "oops" factor.
Potentially more problematic over the longer term is that many of those who benefit from the subsidies are working, and probably many of those are middle class whites. It's not like cutting off Medicaid and knowing that they weren't going to vote for you anyway. I'd guess that at least a fairly significant portion of those taking the subsidies liked the subsidies but that fact didn't necessarily buy them allegiance to the Democratic party. They're probably more likely to be politically active, too.

Even so, for many people on the right, this was a policy "win" for Trump, and I expect him to act more and more unilaterally from now on. He's going to put pressure on the Senate to end the filibuster, too. Trump doesn't want to be out-Trumped by Steve Bannon. He's already been embarrassed once and he's probably terrified that it could happen again.

Trump is going to be an extremist president, and this is just the beginning. I don't think people understand just how extremist he will become. It'll be up to moderate - hell not even moderates, just merely establishment Republicans, to stop Trump. Somehow, though, I doubt they have the courage to do it. As I've said before, the establishment GOP members invited the Tea Party, the Freedom Caucus, and the White Nationalists into their party because they believed that they could use them to their advantage and then dump them once they won their elections. It is no different than how the German conservatives believed that they could control the Nazis in the 1930s.
  #29  
Old 10-15-2017, 07:58 PM
Saint Cad Saint Cad is offline
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Originally Posted by enipla View Post
Trump is just screwing people that have health problems.
You mean like all of those on the exchange losing coverage due to pricing or the companies simply pulling out of poor areas via the exchange under Obamacare?
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Old 10-15-2017, 08:04 PM
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You mean like all of those on the exchange losing coverage due to pricing or the companies simply pulling out of poor areas via the exchange under Obamacare?
And how is this supposed to make it better?
  #31  
Old 10-15-2017, 08:53 PM
Euphonious Polemic Euphonious Polemic is offline
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Originally Posted by Snowboarder Bo View Post
I just saw this on the APbolding mine)

We'll have to see how it all plays out, but that could be a significant "oops" factor.
Not likely. Next election, the Russian social media machine will just "Blame democrats" for these people's loss of healthcare. And they will eat it up, and obediently follow Putin's order to vote Republican.
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Old 10-15-2017, 09:17 PM
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Insurers and insurees need to plan ahead. In that sense, any change, especially one by this erratic President, will be disruptive in the short-term.

A feature of Obamacare is a form of "Marxism": Take from the healthy and give to the sick and injured. Delving into specific details is pointless until you, dear Doper, decide if you are for or against this form of "Marxism."

The following may be a slight Exczaggeration, but summarizes this point:
Quote:
Originally Posted by Czarcasm View Post
Those that have, live.
Those that don't, die.
Another, lesser, purpose of Obamacare is to take from the rent-seeking insurance industry and give to the public. Again, dear Doper, are you are for or against? Do you want to study your portfolio before you answer this question?

Quote:
Originally Posted by Snowboarder Bo View Post
Quote:
Two characterizations:
Democratic Leader Nancy Pelosi said Trump “knows very little” about health care policy or legislation. She said she was unfamiliar with the details of the executive order, “but I do know it’s a sabotage of the Affordable Care Act.”

But Sen. John Barrasso, R-Wyo, said Trump is taking “bold action” to give patients “the freedom and flexibility to choose the health care plan that works best for them.”
Two characterizations:Which is it? Is it both? Is it neither?
A (D) says something and an (R) says something else, and you have to ask who's truthful and who's lying? "You're not from around here, are you?"
  #33  
Old 10-16-2017, 02:16 AM
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Insurance is not Marxism. It's insurance. It's not taking from the rich and giving to the poor. It's spreading out risk. Sure, the system is priced in a socialistic way, but that doesn't make for Marxism.

Not that there is anything wrong with Marxism, other than the fact that humanity as a species is (currently) too evil to use it. It is a more fair system, but is open to huge abuse.
  #34  
Old 10-16-2017, 06:37 AM
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Originally Posted by BigT View Post
Insurance is not Marxism. It's insurance.
Obamacare DOES have features of Marxism and I'm tired of liberals muddying the "dialog" by pretending otherwise.

Obamacare transfers some money from taxpayers to insurance companies and low-income insurees. That's "Marxism." Obamacare, with rules about pre-existing conditions, transfers value from the healthy to the sickly. That's "Marxism."

Whether Americans have the humanitarian values to consider these features good is a separate question. But these features are essential to Obamacare, or any UHC plan.

(I put "dialog" in quotes since, as I noted in another thread, there is no longer such a thing. America has divided into camps which can only scream at — and tell lies to — each other.)
  #35  
Old 10-16-2017, 07:30 AM
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Not that there is anything wrong with Marxism, other than the fact that humanity as a species is (currently) too evil to use it. It is a more fair system, but is open to huge abuse.
The theory behind Marxism is wrong leaving aside the system of communism in general. Dialectic analysis is wrong, the sweeping arc of history is wrong (aside from the facile observation that history advances), and with the advent of automation, neither labor nor capital play as big a role in production as innovation. Neither capitalism nor communism reward inventors as much as the worth that they bring, unless you're the handful of inventors who are also capitalists.
  #36  
Old 10-16-2017, 07:37 AM
Aspidistra Aspidistra is offline
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Originally Posted by septimus View Post
Obamacare DOES have features of Marxism and I'm tired of liberals muddying the "dialog" by pretending otherwise.

Obamacare transfers some money from taxpayers to insurance companies and low-income insurees. That's "Marxism." Obamacare, with rules about pre-existing conditions, transfers value from the healthy to the sickly. That's "Marxism."

Whether Americans have the humanitarian values to consider these features good is a separate question. But these features are essential to Obamacare, or any UHC plan.

(I put "dialog" in quotes since, as I noted in another thread, there is no longer such a thing. America has divided into camps which can only scream at — and tell lies to — each other.)
So...Marxist like the public school system then?
  #37  
Old 10-16-2017, 08:37 AM
Gyrate Gyrate is online now
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How does transferring taxpayer money to wealthy insurance companies constitute "Marxism"?
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  #38  
Old 10-16-2017, 01:05 PM
Saint Cad Saint Cad is offline
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Quote:
Originally Posted by running coach View Post
And how is this supposed to make it better?
It doesn't but let's place the blame where it really belongs, on the health insurance companies.
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