# So, what is the way forward on the Health Care front in the US? **URL:** \ **Category:** Great Debates\ **Tags:** trump\ **Created:** [November 7, 2024, 5:57pm UTC](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874 "2024-11-07T17:57:30Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![RickJay](https://avatars.discourse-cdn.com/v4/letter/r/bb73d2/32.png) [@RickJay](https://boards.straightdope.com/u/RickJay)\ **Post date:** [December 11, 2024, 7:13pm UTC](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874/21 "2024-12-11T19:13:06Z")
> [@Hari\_Seldon](#): > > Yeah, you made my point with much more detail. But it’s still going strong. That’s why all the opposition to food stamps and Medicaid. Medicaid is very popular and broadly supported in the USA. > **[5 Charts About Public Opinion on Medicaid | KFF](https://www.kff.org/medicaid/poll-finding/5-charts-about-public-opinion-on-medicaid/)** > > A quick look at the public’s view of Medicaid, the government health insurance and long-term care program for low-income adults and children, from recent KFF polling. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [December 13, 2024, 5:34am UTC](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874/22 "2024-12-13T05:34:07Z")
> [@DSeid](#): > > In practice I actually have seen Medicare Advantage plans work as they should from the large health care providers side anyway. There are “quality” goal targets set with decent pots of money contingent on hitting certain targets. Investing in _prevention_, keeping your panel of patients as healthy as possible, pays in these cases. This is especially the case for identifying those most likely to get sickest in the near term and aggressively preemptively providing the resources to prevent that. Under a system like that, how do they prevent doctors from dropping all their unhealthy patients or patients who are not responding to treatment though? Refusing to see unhealthy patients seems like a good way to improve metrics under that system, so I assume some methods are put in place to prevent that from happening. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [December 13, 2024, 3:15pm UTC](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874/23 "2024-12-13T15:15:21Z")
First to be clear the incentives from the insurer (and to them from the government) are at the group level, and normed to coding of how “sick” the baseline of that panel is, which is based on doctors having fully entered accurate specific diagnosis condition codes that fully capture all the co-morbidities. Generally speaking that is a lot of work and many groups are shortchanging themselves by not getting credit for how sick their panel is; some are accused of inflating codes to make their panel seem sicker than they are. My guess is that entering inaccurate or exaggerated inflated diagnoses codes, that did not have adequate documentation, is the basis of allegations made against groups earlier in this thread. Individual physicians’ compensations in these groups are often based on a hybrid of the “work” they do, based on things like the quantity and sort of office visits and procedures, and the quality measures, such as fraction of those in their specific panel with diabetes who have had eye screening done or achieved hypertension control targets, or those of certain age groups that have had various cancer screenings. The group is paid, based on that sickness level norm, some fixed amount per member per month and “bonuses” for defined population “quality” targets. Individual physicians and the group can’t just drop a patient because they are sicker; pretty much if they signed up with the group they are your responsibility, barring dismissal for defined causes, like being abusive to staff. There _were_ some early cases of groups getting in trouble by trying to set up enrollment sites at places that would select for a healthier group. Like up a set of stairs or such. Or otherwise marketing in ways that encouraged “favorable selection”. My understanding is that was successfully remediated. Not an expert on it though. ETA. There is some hope among some groups that use of AI will help with adequate documentation and coding of diagnostic conditions. That’s one of the big motivations for medical groups to innovate with AI assisted documentation. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [December 13, 2024, 5:54pm UTC](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874/24 "2024-12-13T17:54:03Z")
I only know one person who was ever dropped by a doctor for anything that wasn’t very explicit (like the patient missing appointments, or the doctor moving out of town). She was kind of a hypochondriac, but she was also a really bad fit for the doctor philosophically, and they discussed it and she agreed to find a different primary physician. ---
**Author:** ![DeadTreasSecretaries](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/deadtreassecretaries/32/4817_2.png) [@DeadTreasSecretaries](https://boards.straightdope.com/u/DeadTreasSecretaries)\ **Post date:** [December 13, 2024, 6:12pm UTC](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874/25 "2024-12-13T18:12:15Z")
> [@Sage\_Rat](#): > > Realistically, the Supreme Court has largely ruled that ACA is unconstitutional and that health care should be run by the states. This isn’t even close to true. They essentially ruled that federal programs where taxes and services are used as soft mandates are constitutional and that forcing the states to spend their own money isn’t. ---
**Author:** ![Sage\_Rat](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/sage_rat/32/399_2.png) [@Sage\_Rat](https://boards.straightdope.com/u/Sage_Rat)\ **Post date:** [December 13, 2024, 8:32pm UTC](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874/26 "2024-12-13T20:32:22Z")
So, I can let the horse freely choose to drink (or not drink) on its own, but I can’t forcibly pump water into its stomach. Sounds like I’m not allowed to force the horse to drink. ---
**Author:** ![DeadTreasSecretaries](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/deadtreassecretaries/32/4817_2.png) [@DeadTreasSecretaries](https://boards.straightdope.com/u/DeadTreasSecretaries)\ **Post date:** [December 13, 2024, 8:48pm UTC](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874/27 "2024-12-13T20:48:11Z")
And obamacare mandating health insurance by tax penalty is constitutional because it had horse drinking incentives without forcing the horse to drink, and further horse drinking reform could do the same. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [December 14, 2024, 1:14pm UTC](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874/28 "2024-12-14T13:14:38Z")
Here’s a good link with some public views on the various types of insurance in America. The people who have insurance, which is about 92%, tend to view their own insurance favorably. They do complain about battling with insurers over claims or the co-pays, etc, particularly if they’re in more poor health. > **[KFF Survey of Consumer Experiences with Health Insurance | KFF](https://www.kff.org/private-insurance/poll-finding/kff-survey-of-consumer-experiences-with-health-insurance/)** > > The survey finds nearly six in 10 people with health insurance experienced a problem using their insurance in the past year, with even larger shares reporting problems among people who are sick or who have mental health needs. It includes data for... Of interest, among other things, is that 81% of people view their own insurance favorably. This includes 91% of medicare recipients, 82% of Medicaid, 80% of Employer-Sponsored Insureds, 72% of Marketplace ACA recipients. The number that sticks out to me is the 91% for Medicare. This type of coverage seems to consistently poll higher than other types. If we expand or do further reforms in the future, the path forward might be a Medicare expansion. In the short-term, the best outcome might be just limiting the damage from whatever Trump tries to sabotage in any of the different types of coverage. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [January 5, 2025, 2:48am UTC](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874/29 "2025-01-05T02:48:39Z")
I was thinking of starting an ACA Deathwatch thread. It’s possible that the attacks on Obamacare are more serious this time, as MAGAts try and have an offset for the tax cuts that we all know are coming. They still hate the ACA - even though it was originally designed around a conservative thinktank’s ideas. So, it’s possible that in the near term, something bad is coming…more work requirements for Medicaid, or maybe Medicaid block grants. Or maybe the end of the 2021 Biden expanded ACA premium tax credits. They expire in 2026 unless Congress extends them. Or maybe an all out repeal will happen this time. However, in the darkest times, occasionally a flower will bloom. Let’s hope there are enough GOP folks that agree with Murkowski. One GOP Senator isn’t enough. But it’s a start. See the link: > **[Alaska: GOP Sen. Murkowski says she supports extending IRA subsidies!](https://acasignups.net/25/01/03/alaska-gop-sen-murkowski-says-she-supports-extending-ira-subsidies)** > > I don't want to get out over my skis here; a single Senator saying that she supports something in an interview is a far cry from them actually voting to do so, especially when you'd need several more members of both the House and Senate (including... ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [January 5, 2025, 3:55am UTC](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874/30 "2025-01-05T03:55:24Z")
> [@survinga](#): > > “Medicare for All” died on the Cross when Bernie lost the primaries in 2016 and 2020. Bernies crazy and misnamed plan had absolutely nothing whatsoever to do with Medicare. And even if Sanders had won, it never would have passed. Not even with a Dem supermajority in both houses. It was a terrible plan. Now, real Medicare for all- that could work. > [@survinga](#): > > Also, I think the next time the Dems come into office, they need a sales pitch on expanding Medicare to people that want it. Not “Medicare for All”, but maybe “Medicare for Whoever Wants it”. Make is available to all children, if their parents sign them up. Make it available to anyone over 60. Yes, lower to 60 to start was my suggestion here. Then 55, etc. > [@DSeid](#): > > I’m not sure that that is necessarily bad, although in implementation it probably will be. It is bad, and it will never pass. Medicare and Social Security are the third rail of American politics. > [@Northern\_Piper](#): > > Yes, it started in Saskatchewan, Yay Sask! > [@survinga](#): > > I was thinking of starting an ACA Deathwatch thread. They dont have the votes in the House. The ACA is pretty popular in some of the poorer Red states. ---
**Author:** ![Zakalwe](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/zakalwe/32/270_2.png) [@Zakalwe](https://boards.straightdope.com/u/Zakalwe)\ **Post date:** [January 5, 2025, 4:30am UTC](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874/31 "2025-01-05T04:30:57Z")
> [@DrDeth](#): > > The ACA is pretty popular in some of the poorer Red states. As opposed to ObamaCare which is despised. > [@survinga](#): > > (the average US voter is a policy moron) QFT. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [January 5, 2025, 4:54am UTC](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874/32 "2025-01-05T04:54:10Z")
> [@DrDeth](#): > > it will never pass. Medicare and Social Security are the third rail of American politics [About accelerating the privatization of Medicare.] The privatization of Medicare is in progress and does not need anything to be passed. Medicare Advantage Plans are the government delegating private companies to provide the service. The issue is only how much the administration encourages those options, such as by making them the default choice. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [January 9, 2025, 2:07pm UTC](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874/33 "2025-01-09T14:07:20Z")
> [@survinga](#): > > I was thinking of starting an ACA Deathwatch thread. It’s possible that the attacks on Obamacare are more serious this time, as MAGAts try and have an offset for the tax cuts that we all know are coming. They still hate the ACA - even though it was originally designed around a conservative thinktank’s ideas. So, it’s possible that in the near term, something bad is coming…more work requirements for Medicaid, or maybe Medicaid block grants. Or maybe the end of the 2021 Biden expanded ACA premium tax credits. They expire in 2026 unless Congress extends them. Or maybe an all out repeal will happen this time. > > However, in the darkest times, occasionally a flower will bloom. Let’s hope there are enough GOP folks that agree with Murkowski. One GOP Senator isn’t enough. But it’s a start. See the link: > > [Alaska: GOP Sen. Murkowski says she supports extending IRA subsidies! | ACA Signups](https://acasignups.net/25/01/03/alaska-gop-sen-murkowski-says-she-supports-extending-ira-subsidies) My fear is they will enact work requirements for medicaid and end the inflation reduction act subsidies. But I think the ACA will stand. In my state they tried to do medicaid work requirements under the first Trump administration, but luckily it got tied up in court and was never enacted. By the time Biden came into power I think he revoked the requirement. When the GOP tried to repeal the ACA in 2017, they lost 21 votes. They still passed repeal but 21 GOP house members refused to support it. In 2025/2026 the GOP can only lose 1-2 votes and still pass a bill since their margin is so tiny. Hopefully this tiny margin helps protect the ACA. Also keep in mind that 10 republicans in the house voted to impeach Trump, several of them are still in office. So there is no guarantee that all 218-220 republicans in the house will fall in line. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [January 10, 2025, 1:43pm UTC](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874/34 "2025-01-10T13:43:56Z")
> [@Wesley\_Clark](#): > > My fear is they will enact work requirements for medicaid and end the inflation reduction act subsidies. But I think the ACA will stand. The bad thing about the end of the IRA enhanced subsidies is that Congress can effectively let that happen without taking action. The IRA was passed with an automatic sunset of the subsidies at the end of 2025. I hated it when that was passed. Somehow the Dems need to gain some leverage in a negotiation and get them extended again. Medicaid work requirements don’t work. They don’t encourage work or encourage people to get coverage. They don’t save money either. Very inefficient. ---
**Author:** ![StringsandHammers](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/stringsandhammers/32/17933_2.png) [@StringsandHammers](https://boards.straightdope.com/u/StringsandHammers)\ **Post date:** [January 10, 2025, 4:11pm UTC](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874/35 "2025-01-10T16:11:02Z")
Medical debt can no longer show up on a credit report, sounds like the problem has already been “fixed.” Just kidding, it’s a house of cards and will collapse if major changes aren’t made soon, which they won’t because Republicans aren’t into finding solutions when they can easily campaign against the problem. ---
**Author:** ![RickJay](https://avatars.discourse-cdn.com/v4/letter/r/bb73d2/32.png) [@RickJay](https://boards.straightdope.com/u/RickJay)\ **Post date:** [January 11, 2025, 10:18pm UTC](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874/36 "2025-01-11T22:18:35Z")
> [@survinga](#): > > Also, I think the next time the Dems come into office, they need a sales pitch on expanding Medicare to people that want it. You immediately crash headfirst into adverse selection. ---
**Author:** ![Aspenglow](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aspenglow/32/76_2.png) [@Aspenglow](https://boards.straightdope.com/u/Aspenglow)\ **Post date:** [January 11, 2025, 10:50pm UTC](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874/37 "2025-01-11T22:50:01Z")
Oh, they’re not wasting any time. (Gift link.) > **[Supreme Court to Hear New Affordable Care Act Case on Preventative Care](https://www.nytimes.com/2025/01/10/us/politics/supreme-court-affordable-care-act-obamacare.html?unlocked_article_code=1.oU4.V-4d.lqzwiL-AG52Z&smid=url-share)** > > Lower courts ruled that a task force that determines which treatments must be covered at no cost had not been validly appointed. From the article: > The new challenge is directed at a task force that decides which treatments are covered. It has determined that insurers must pay for, among other things, screenings to detect cancer and diabetes; statin medications to reduce the risk of heart disease and strokes; physical therapy for older adults to prevent falls; and eye ointment for newborns to prevent infections causing blindness. > > The law’s requirement of coverage for lung cancer screenings alone saves more than 10,000 lives each year, the Biden administration [told the justices](https://www.supremecourt.gov/DocketPDF/24/24-316/326373/20240919152821295_Becerra%20v%20Braidwood%20-%20Cert_Pet.pdf). > > Several Texas residents and two small Christian-affiliated businesses that provide health insurance to employees sued to contest the way the task force had been appointed, saying it violated the Constitution. The plaintiffs objected to the task force’s decision to cover medication preventing H.I.V. infection in some at-risk people, saying the drugs “encourage and facilitate homosexual behavior.” I wonder, I wonder, how the SCOTUS is going to rule. (Not.) ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [January 20, 2025, 5:31pm UTC](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874/38 "2025-01-20T17:31:07Z")
> [@survinga](#): > > Medicaid work requirements don’t work. They don’t encourage work or encourage people to get coverage. They don’t save money either. Very inefficient. It doesn’t matter if they work or not. The goal of medicaid work requirements is to punish people and harm people. The end goal is inflicting harm. Its not saving money or any of that bullshit. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [January 24, 2025, 1:24pm UTC](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874/39 "2025-01-24T13:24:22Z")
I agree with you. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [January 24, 2025, 1:25pm UTC](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874/40 "2025-01-24T13:25:16Z")
Here’s another ray of hope that the ACA might be saved from cuts. A tiny ray, but there is hope… [A bit of _positive_ news: Politico reports at-risk GOP House members sweating over ACA & Medicaid cuts | ACA Signups](https://acasignups.net/25/01/23/bit-positive-news-politico-reports-risk-gop-house-members-sweating-over-aca-medicaid-cuts) [Previous page](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874.md?page=1) [Next page](https://boards.straightdope.com/t/so-what-is-the-way-forward-on-the-health-care-front-in-the-us/1009874.md?page=3)