Repealing ACA

pmabraham, BSN, RN · Jul 7, 2017

"1. How would you fix the ACA?"

By repealing it completely; government should have minimal involvement in health care.

"2. What is the perfect healthcare system for the U.S?"

EMBRACE Single System (not Single Payer) Healthcare System- An Introduction - YouTube might good if it grabs traction.

LovingLife123 · Jul 10, 2017

I'm just wondering this, why are people against paying for healthcare? They have no problems paying for the latest iPhone, Michael Kors purses, retro Jordan sneakers..... But the thought of paying for life saving medications or appts to see a doctor is completely unreasonable? Do we as nurses not deserve to be paid for how hard we work? Because that's basically what the current attitude here in the US says to me.

Plus, everyone still wants top of the line healthcare for no cost. I've been reading up on how it's done in Europe. Did you know they have public and private hospitals? That the private hospitals require insurance?

Single payer systems do not work. I agree the costs need to come down but that is a complex cycle we have going on. Insurance companies control stuff right now and that needs to stop. We also need to figure out how to get people to pay for their services. Hospitals lose tons of money a year on people that have no insurance.

Bottom line for me is we need to change the mentality here in the US that healthcare is free and nobody should be paying a dime. Maintaining your body is no different than maintaining a car or house. And if it ends up with socialized medicine here, the expectations will have to come down drastically. There cannot be any more patient satisfaction. Because there will not be anymore private rooms, the food will go downhill big time. Not everybody will be seen by a doctor right away. Patients won't be able to demand a litney of testing and we will no longer pull out all the high end stops to save their loved ones.

The government will decide every aspect of their healthcare. I don't think the people here are ready for that. Because as it stands right now, those on Medicaid get the same exact access that those with private healthcare get. No money is ever asked for upfront.

allnurses Guide · Jul 15, 2017

"1. How would you fix the ACA?"
By repealing it completely; government should have minimal involvement in health care.
"2. What is the perfect healthcare system for the U.S?"
EMBRACE Single System (not Single Payer) Healthcare System- An Introduction - YouTube might good if it grabs traction.

Very interesting.

I would have lots of questions if there were a chance this could happen in the near future.

Is there a thread to discuss this?

Perhaps if there is not you would like to start one.

Kooky Korky, BSN, RN · Jul 16, 2017

I think a combination of catastrophic care plus health savings account would be the way to go. A catastrophic policy is usually pretty inexpensive but takes away the financial worry if something major happens. A health savings account would pay for the routine stuff and you would be using the money you otherwise would for high premiums.
I have noticed that people absolutely hate the idea of using their own money for health care. I don't know why that is. We use our own money for everything else.

Care is terribly expensive. Most people just don't have that amount of money. A single dose of some meds can cost hundreds, thousands of dollars. Epi Pens, Nursing homes, an operation - who makes

that kind of money? Not your average wage slave. Maybe Gates, Trump, Clintons. Even our

elected officials don't make enough to pay for very much health care.

Also, we are used to employers providing coverage.

Cure: Do what the rest of the world does. Get rid of insurers in medical coverage. Yes, that's

higher taxes. Can't help it. Something's got to give.

Kooky Korky, BSN, RN · Jul 16, 2017

How large would an hsa have to be in order to pay for routine care for an insulin-dependent diabetic? Hint: lantus now retails for around $300 per 10ml vial (a 28 day supply). Then there's test strips (about a dollar apiece), labs, work-ups and meds to manage related health issues and pcp visits to direct it all.
Hsa's sound good on paper, but with the cost of living nowadays, they make sense only if you're young and completely healthy.

A vial of Lantus or anything else will last for varying lengths of time, depending on the dose a patient is on.

heron, ASN, RN · Jul 16, 2017

A vial of Lantus or anything else will last for varying lengths of time, depending on the dose a patient is on.

Yes, but 28 days is the max even if refrigerated. Unless, of course, it is used past the expiration date. Do you have info on the possible consequences of doing that? I don't.

MunoRN, RN · Jul 20, 2017

"1. How would you fix the ACA?"
By repealing it completely; government should have minimal involvement in health care.
"2. What is the perfect healthcare system for the U.S?"
EMBRACE Single System (not Single Payer) Healthcare System- An Introduction - YouTube might good if it grabs traction.

The "EMBRACE" proposal is essentially identical to a "medicare for all" single payer system, it's only the semantics that are different.

The EMBRACE proposal is a system overseen by a board that is subject to congressional oversight, just like medicare.

The EMBRACE system board sets best practice guidelines and encourages/enforces compliance with those guidelines, same as medicare for all.

The EMBRACE system funds healthcare with a dedicated tax revenue, same as medicare for all.

The EMBRACE system covers all acute treatment needs, coverage of "luxury" care can be purchased separately, same as medicare.

The EMBRACE system encourages a cross-compatible EMR system, same as medicare.

It's functionally no different than the single payer "medicare for all" proposal that's been around for a while, it's carefully explained in a way that makes it seem different, and if that's what it takes for people to get on board then that's fine with me.

allnurses Guide · Jul 22, 2017

The "EMBRACE" proposal is essentially identical to a "medicare for all" single payer system, it's only the semantics that are different.
The EMBRACE proposal is a system overseen by a board that is subject to congressional oversight, just like medicare.
The EMBRACE system board sets best practice guidelines and encourages/enforces compliance with those guidelines, same as medicare for all.
The EMBRACE system funds healthcare with a dedicated tax revenue, same as medicare for all.
The EMBRACE system covers all acute treatment needs, coverage of "luxury" care can be purchased separately, same as medicare.
The EMBRACE system encourages a cross-compatible EMR system, same as medicare.
It's functionally no different than the single payer "medicare for all" proposal that's been around for a while, it's carefully explained in a way that makes it seem different, and if that's what it takes for people to get on board then that's fine with me.

In the video chronic back pain and migraine headaches are given as examples of Tier Two.

How would the diagnosis be made?

I was able to work an additional 21 years as a full time hospital nurse because of being seen by a specialist for one of these conditions.

MunoRN, RN · Jul 29, 2017

But wouldn't costs over a certain dollar amount qualify as catastrophic?

Catastrophic plans usually refer to very high deductible plans, usually $30,000 or more, meaning you pay the first $30,000 in medical bills and then pay for insurance that would pay for costs above that. And while that certainly reduces your premiums, the $30,000 you're going to pay on your own only covers a small portion of major medical costs, so the premiums are still going to be a few thousand a year for a family for instance.

All insurance works based on this basic concept, just with varying deductible amounts. You pick a plan where everyone in that plan is committing to paying the first $3000, $5000, etc of their annual healthcare costs and then everyone in the plan is splitting costs only above that amount.

Jolie, BSN · Jul 29, 2017

Funny. As recently as 2013, before the full implementation of Obamacare, the family policy we purchased directly from BCBS (with a premium under $600/month for a family of 4) was considered "catastrophic" coverage. It had a family deductible of $5000. Care in our primary physician's office (regardless of the nature of that care) was covered from the first dollar without regard to deductible. We OPTED out of maternity coverage, fully aware of the ramifications of that choice. We had vision benefits, but no dental, and were able to utilize a pre-tax spending account to meet non-covered expenses. A

We currently pay over $18,000 per year in premiums for 3 family members. One child is now on her own. We have a $15,000 deductible that is STANDARD for many individual family policies, and NOT considered catastrophic. Our plan is not eligible for coordination with a healthcare spending account. Other than the Obamacare mandated "essential benefits" most of which we have no use for, we must pay $33,000 out of pocket per year before our coverage begins. But that is no longer considered high deductible or catastrophic. Go figure...

We recently attended a meeting held by our state insurance commissioner who predicts that next year our premiums will be over $30,000 due to loss of competition in the individual marketplace. He was outlining a proposal he is making the federal government that would keep premiums "more affordable" at about $24,000, because he accurately predicts that premiums as high as they are otherwise projected to be, will collapse the individual market altogether in our state. He's right. But there is no guarantee that the feds will approve his plan, or that it will sustain individual insurance here beyond one more year.

This is what Obamacare has wrought (and what many of us here accurately predicted) in the individual market. Most people have no comprehension of the state of the individual market, because they continue to receive benefits from employers or other group sources. This situation hits small businesses, farmers and other self-employed individuals and families in a devastating way.

We just want government out of the way so we can take care of ourselves and our families.

SouthpawRN · Jul 29, 2017

Another part of the equation is why stuff has to be so expensive. Yes, R & D costs money, but there is a certain amount of gouging that happens. Other countries negotiate with big pharma.

In one word: Lawyers! 94% of the worlds lawsuits are filed in the USA. If you want to control healthcare costs, you have to control the lawsuits including the class action ones!

MunoRN, RN · Aug 3, 2017

Funny. As recently as 2013, before the full implementation of Obamacare, the family policy we purchased directly from BCBS (with a premium under $600/month for a family of 4) was considered "catastrophic" coverage. It had a family deductible of $5000. Care in our primary physician's office (regardless of the nature of that care) was covered from the first dollar without regard to deductible. We OPTED out of maternity coverage, fully aware of the ramifications of that choice. We had vision benefits, but no dental, and were able to utilize a pre-tax spending account to meet non-covered expenses. A
We currently pay over $18,000 per year in premiums for 3 family members. One child is now on her own. We have a $15,000 deductible that is STANDARD for many individual family policies, and NOT considered catastrophic. Our plan is not eligible for coordination with a healthcare spending account. Other than the Obamacare mandated "essential benefits" most of which we have no use for, we must pay $33,000 out of pocket per year before our coverage begins. But that is no longer considered high deductible or catastrophic. Go figure...
We recently attended a meeting held by our state insurance commissioner who predicts that next year our premiums will be over $30,000 due to loss of competition in the individual marketplace. He was outlining a proposal he is making the federal government that would keep premiums "more affordable" at about $24,000, because he accurately predicts that premiums as high as they are otherwise projected to be, will collapse the individual market altogether in our state. He's right. But there is no guarantee that the feds will approve his plan, or that it will sustain individual insurance here beyond one more year.
This is what Obamacare has wrought (and what many of us here accurately predicted) in the individual market. Most people have no comprehension of the state of the individual market, because they continue to receive benefits from employers or other group sources. This situation hits small businesses, farmers and other self-employed individuals and families in a devastating way.
We just want government out of the way so we can take care of ourselves and our families.

I get that it can be frustrating to think you're paying exponentially more for the same thing you were getting before, although the price those in the individual market were paying before wasn't really for true insurance, it was for what republicans are now calling "junk insurance".

The pre-ACA individual market was made up of plans that were basically at-will coverage, despite what the plans said they covered, they were free to refuse claims or just drop coverage all together when you incurred high costs. They typically paid about a third of the costs of it's customers, which kept the costs of premiums down, but didn't really reduce the number of people going into bankruptcy and just shifted these costs to those in the group market, which is why group market plans averaged more than $14,000 per year for a family prior to the ACA. The majority of those who went bankrupt due to medical bills had insurance, typically individual market insurance, so it wasn't serving much purpose.

Accounting for the increased overall costs of healthcare over that period of time (increased availability of advanced treatments increase costs), and that healthcare costs in rural areas like Iowa, Nebraska, Wyoming, and Kansas increases the cost of coverage, your $18,000 per year is about what the same coverage would cost now if the ACA never happened.

While maternity coverage is often blamed for increasing premiums for those not planning to get pregnant, removing maternity coverage or shifting it to specific plans would drastically raise premiums for those who don't want to be part of a plan that covers maternity. Those who would use maternity coverage generally pay far more into insurance than their maternity costs, which brings down the costs for others in the plan.

There are certainly ways to reduce the costs of healthcare, but until we do that the fact is that healthcare is really expensive, and as a result insurance is really expensive. We'd all like to pay less but the question is who should pay more so that you can pay less?