NMR: State of the Union Address - thoughts?

catsareniice1

I didn't catch it and was wondering what everyone thinks of Obama's SOTUA.

Posting here because the other boards are dead.

vlagrl29

I didn't hear much of it honestly except for the rundown afterwards.  sounds like he said the economy is better, more government expansion with free child care and 2 years of community college for free.  Something about raising minimum wage.  I think the repubs wanted him to talk more about the terrorism.

DH is watching fox news meghan kelley right now - honestly I can't take all the shit talk anymore. I'm over it.  The repubs don't want the rich to be taxed and the dems want "free stuff" - how about a middle ground.  I know that will never happen. lol

ETA - I think he also mentioned some vetoes he would do like immigration and keystone.  It should be interesting to see how the next 2 years will go with Republican controlled senate.

CuriousKiddosMama

I didn't watch either. I'm going to catch recaps this morning hopefully on the local news.
Vlagrl29- my BMB was talking about the 'free college' yesterday. Apparently he is proposing to pay for it by taxing 529 accounts- which is people saving- for college...... Does this get any more insane?
I agree with you about a middle ground. Can we all work, pay for ourselves, and forget the government even exists? I think one of the main problems is that Democrats get elected by promising free stuff, and republicans by promising tax cuts. Those are their horses that the are willing to die on. And until we get a legitimate 3rd party in this country to shake things up, we are all screwed.
Wow- I'm just a burst of sunshine this morning, aren't I? No sleep 3 nights in a row will do that to you I guess.

CuriousKiddosMama

OMG guys, I just saw my ticker..... I'm always mobile these days. How is it possible that in 5 months, I will have a 2 year old?!?!?!

hoffse

Yeah I didn't watch it either.  It sounds like he discussed a bunch of stuff that has virtually no chance of getting passed.  The free community college thing riles me up.  Community college is not the problem - in fact, it's one of the better aspects of the entire higher education system.  I think the bigger problem is the federal government being willing to loan tens or even hundreds of thousands of dollars to 18-22 year olds with no credit check who have no assets to secure a loan that big.  No private bank would ever do such a thing, because the notion is ludicrous.  And because there's really no cap to how much the gov will loan, 4-year schools and universities keep raising their prices, and students keep borrowing more.  It's crazy.  So yeah, two years of free community college is not going to solve the problem.  

Xstatic3333

hoffse said:

Yeah I didn't watch it either.  It sounds like he discussed a bunch of stuff that has virtually no chance of getting passed.  The free community college thing riles me up.  Community college is not the problem - in fact, it's one of the better aspects of the entire higher education system.  I think the bigger problem is the federal government being willing to loan tens or even hundreds of thousands of dollars to 18-22 year olds with no credit check who have no assets to secure a loan that big.  No private bank would ever do such a thing, because the notion is ludicrous.  And because there's really no cap to how much the gov will loan, 4-year schools and universities keep raising their prices, and students keep borrowing more.  It's crazy.  So yeah, two years of free community college is not going to solve the problem.  

I agree with this, even though I like the idea in theory. If it's going to be paid for by taxing 529s then I definitely don't support that. That's punishing families for planning ahead.

I can't sit through the SOTU but I try to read about all of these issues. I do agree about a middle ground. Though I agree with the president on many of his policies, I am starting to see some entitledness among my generation that is bugging the heck out of me. From the little I have read I'm intruiged by the middle class tax breaks he is proposing. I just wish it could be covered by closing tax loopholes for large corporations who pay very little in tax nationally instead of tinkering with estate taxes. It's complicated stuff though and I definitely don't have the full background.

als1982

We were at the gym during the SOTU, but were home by the Republican rebuttal, which my H was insistent on watching. I about lost it when Joni Earnst called the affordable care act a failed policy. And then when she spoke about Keystone never once mentioning the words pipeline, drilling or oil, I finally just had to put in my headphones. Ridiculous.

hoffse

AprilH81 said:

I didn't watch last night, I can't stand to listen to Obama talk anymore...

I read an article over the weekend that he wanted to propose to tax the 529s to pay for two free years of community college (as others mentioned this would be punishing those who planned ahead), increase the capital gains tax (punishing those who wanted to invest in good ideas that boost the economy) and the inheritance "death" tax (taxing money that had ALREADY been taxed as income, capitol gains, etc just because the government "needs" it), AND he wants to cap the amount of money you can save in retirement accounts because you know, it wouldn't be fair for someone to have more in retirement than someone else.  X(

It boils my blood.  The money I earn is MINE not the government's.  They shouldn't be able to decide someone else needs it more, raise my taxes and then give it to whatever special interest group they deem worthy.  

The government should not be able to to essentially confiscate a person's estate when they die, it should be distributed according to a will or given to the next of kin in absence of a will.  If their argument is that "the heir didn't earn it" then that applies to the government too, the government didn't earn that money either.

Yeah I agree with all of this.  The good news is that most of this will never get past a Republican Congress.  Heck it wouldn't get past most Democrats either, because they will be thinking to themselves, "Well shit that might affect me personally."  

Capital gains taxes used to be insanely high.  And you know what?  People simply didn't invest back then.  I do a lot of M&A work, and as one of the partners I work for likes to say, "It's not about how much you can get for selling your company.  It's about how much you get to keep."  In other words, helping with the tax structuring of deals is a big part of my job, and it drives me crazy when people say things like, "Well you should tax corporations more."  It's so much more complicated than that, and the tax structures play a huge part in what businesses are able to afford to do to provide jobs, innovate, take risks, buy and sell, etc.  For closely held businesses, the estate tax rules and personal income tax rules come into play also, because usually the "family business" is that person's biggest asset.  It's all interconnected, and messing with one area of the tax code can have huge affects on another area.

The last thing I'll say about this is that there's this really false notion that American business=big money.  I sat in on an interesting presentation from an investment bank yesterday.  They were talking about valuing lower-middle market companies (those worth less than $25M) because selling those companies will become more and more common as the boomers start to retire and die.  They said that only 5% of American businesses are worth more than $10M.  Only 2% are worth more than $25M.  That poses a huge problem when it comes to buying and selling because smaller companies have a hard time affording the legal, accounting, and financial help they need to get through a buy/sell transaction, not to mention the taxes they may have to pay on that transaction if it's not structured correctly.  Just because Joe is a business owner does not mean he's Warren Buffet.

Xstatic3333

Just Googled about the 529 and retirement plan stuff and yikes, I don't like that at all.  Particularly the 529 part.  I doubt I'll ever personally bump up against those retirement limits, but not a fan there either.  It's like defaulting to the assumption that the "middle class" just won't invest and only the upper class will.  I'm pretty middle class here.  I've made poor decisions that I'm paying for and spend money irresponsibly sometimes, but I still find a way to stock money away and should have enough saved to retire.  I don't think we should punish people who want to save; I'd rather see us educate so that more are able to do it.  

I think getting into MM stuff is turning me into a fiscal conservative in some ways, though not all.  The ACA has been life changing for so many people I care about that I would hate to see it repealed or weakened, though I know it is far from perfect.  

vlagrl29

I didn't know about the 529 tax - wow!  We don't do that but save in other ways for DD.  I just don't want to save in a 529 if she would happen not to go to college.  I just assumed they would just tax the 1% which is totally fine with me.  

I don't think the govt should mess too much with peoples money.  They should never tax life insurance.  If it wasn't for that I wouldn't have known what to do when my first H passed away.  I worry sometimes about retirement accounts.  We are assuming that social security will be long gone by the time its our turn and I would hate if the govt messed with the only way we could afford to live.

I have somewhat stepped away from the repub party and am more in the center these days.  I understand that each party does whats good for the benefit of them.  One of the reasons I stepped away from the repubs a bit was because of the ACA.  All the horror stories they put out - I fell into believe some of them.  I waited about 4 months and called coventry to get a quote and turns out it's the best insurance we have ever had.  Not to mention pre existing is gone so we don't have to worry about our next pregnancy not being covered.  So I'm a fan of it for sure and hope it never goes away. DH said it won't because it's such a huge bill you couldn't get it all out.

I also wish the repubs would find better people to do their rebuttal.  That lady was a joke and I couldn't stand her voice.

vlagrl29

vikingsfan711 said:

OMG guys, I just saw my ticker..... I'm always mobile these days. How is it possible that in 5 months, I will have a 2 year old?!?!?!

How is it possible I have an almost 4 year old that is 3 1/2 feet tall.  I wanna cry when I think about it. LOL

formerlyGDaisy09

I watched, I haven't taken any time to look into the details of what he is proposing, i.e. how he plans to get the money to pay for these things.  Sounds like I'm the minority here as an Obama supporter, the ideas are good, but I doubt any of them will make it through a republican congress. 

America is so far behind other countries as far as making sure our citizen are well educated, Obama is proposing making 2 years of Community College free for everyone, so we're not talking about handing out bachelors degrees, but setting people up with the skills that are needed.  We have a nursing shortage in this country, that could be addressed by this program. 

I'm a huge advocate of Obama's health care reform, as a public health professional (full disclosure: at an institution that was a close advisor to helping write the affordable care act) I've picked the affordable care act to pieces, as well as the medicare/medicaid fee-for service model, that was a situation where drastic change needed to be made, and I have along with collegues written our republican representatives to urge them not to repeal the affordable care act but rather to work to make changes that fix some of the flaws. 

He did breifly touch on the issue of student loan debt, which I think we all agree that the cost of higher education and the burden of student loan debt is a problem. 

He did make a point that part of his plan to pay for things was to close some of the loopholes that corporations use to avoid paying taxes...I'm not well educated in that subject area but it sounded like he had a plan to discourage corporations from keeping the assets off shore. 

I'm hoping to have more time to research next week.  

edited for words

vlagrl29

@gdaisy09 - I don't think they will make it thru a republican congress either.  I am kinda like you too where I can see how these programs will be good but someone has to pay for them.  I really hope they don't repeal the ACA - it has done a lot for our family and has actually made me think universal healthcare could be a good thing.  I can appreciate what he would like to happen but not sure how it all can happen here.

hoffse

We don't talk politics much around here.  I'll say that I'm a fiscal conservative because I'm cheap.   Socially, I'm fairly liberal - I don't care at all what people do in the privacy of their own homes, and I feel like judging people for personal choices they make is just being nosy.

That said, I dislike entitlement programs.  I would much rather we change some tax laws to incentivize more charitable giving.  Charities are the ones on the ground in communities, and they are the ones best able to assess who really needs help and who is just sitting around waiting for a handout.  Nobody can argue that some people simply fall on hard times, and they need a helping hand to get back on their feet.  However, collective action problems are a bedrock principal of economics, and government handouts/entitlements really incentivize a lot of people to just do nothing.

You want the 1% to hand their money out?  Then make it worth their time to support their favorite charitable groups.  If I had a choice to send $20,000 to the IRS or send $20,000 to the local food bank, I know who I would pick, and I know who would put that money to best use.

I also think the military is way over-funded, which isn't very conservative of me... but I mean, that's just a black hole of money.  If they took a year and evaluated their military contracts, I'm sure they could find millions if not billions where they could cut back.

So yeah, I'm cheap.  And I just want the government to leave me alone.  I don't want to be told what to do with my money, I don't want to be told what kind of insurance to buy, I don't want to be told who I can and can't marry, I don't want to be told what I can and can't do with my body.  I feel like all of these decisions are my business and nobody else's.   

formerlyGDaisy09

vlagrl29 said:

@gdaisy09 - I don't think they will make it thru a republican congress either.  I am kinda like you too where I can see how these programs will be good but someone has to pay for them.  I really hope they don't repeal the ACA - it has done a lot for our family and has actually made me think universal healthcare could be a good thing.  I can appreciate what he would like to happen but not sure how it all can happen here.

in addition to providing options for people who don't have health insurance through an employer, and getting rid of pre-existing conditions, and requiring maternity coverage the ACA has done a lot to take our health care model to a place where doctors and hospitals are reimbursed for providing the right care at the right time (ie. in some cases for doing nothing, or using less invasive interventions) rather than where we've been where hospitals and doctors got paid (incentivized) to do more, even if it isn't necessary.  repealing the ACA and going back to what we had before would be so many steps in the wrong direction.  

If anyone wants some interesting reading that give a nice prospective on the burden that overscreening puts on our health care system (both in increased costs and inflated disease burden) I highly recommend "overdiagnosed" by H. Gilbert Welch, he also writes a lot for the New York Times. 

hoffse

AprilH81 said:

hoffse said:

We don't talk politics much around here.  I'll say that I'm a fiscal conservative because I'm cheap.   Socially, I'm fairly liberal - I don't care at all what people do in the privacy of their own homes, and I feel like judging people for personal choices they make is just being nosy.

That said, I dislike entitlement programs.  I would much rather we change some tax laws to incentivize more charitable giving.  Charities are the ones on the ground in communities, and they are the ones best able to assess who really needs help and who is just sitting around waiting for a handout.  Nobody can argue that some people simply fall on hard times, and they need a helping hand to get back on their feet.  However, collective action problems are a bedrock principal of economics, and government handouts/entitlements really incentivize a lot of people to just do nothing.

You want the 1% to hand their money out?  Then make it worth their time to support their favorite charitable groups.  If I had a choice to send $20,000 to the IRS or send $20,000 to the local food bank, I know who I would pick, and I know who would put that money to best use.

I also think the military is way over-funded, which isn't very conservative of me... but I mean, that's just a black hole of money.  If they took a year and evaluated their military contracts, I'm sure they could find millions if not billions where they could cut back.

So yeah, I'm cheap.  And I just want the government to leave me alone.  I don't want to be told what to do with my money, I don't want to be told what kind of insurance to buy, I don't want to be told who I can and can't marry, I don't want to be told what I can and can't do with my body.  I feel like all of these decisions are my business and nobody else's.   

The whole "just leave me alone" and "I don't care what you do in your home" is actually more of a Libertarian thought than a liberal thought.  

It's true.  I would claim Libertarian if I could actually vote that way...

formerlyGDaisy09

AprilH81 said:

hoffse said:

 

The whole "just leave me alone" and "I don't care what you do in your home" is actually more of a Libertarian thought than a liberal thought.  

It's true.  I would claim Libertarian if I could actually vote that way...

I'm a fiscal conservative and a libertarian with just about everything else except national defense/security and then I lean Republican.

I tend to vote Republican because Libertarian/3rd party candidates are frequently either crazy or funded by the Democrats to draw away Republican votes.

I really think it is insane how much the government is trying to legislate, how much sytrofoam can be used, trying to tax what the government deems to be "unhealthy" behaviors, trying to legislate morality (abortion, gay marriage, etc.).  The government should stay out of all of that in my opinion.

If we expect the government to pay for health care (which is also what happens when people don't have insurance and don't pay their hospital bills...because otherwise hospitals close, and no one wants that to happen) I think it's fair for the government to tax activities that cause us to require more health care (I also think one of the smartest things to do is to figure out how to regulate canibis so that it can be sold legally and taxed like tabacco or alcohol).

vlagrl29

AprilH81 said:

Gdaisy09 said:

AprilH81 said:

hoffse said:

 

The whole "just leave me alone" and "I don't care what you do in your home" is actually more of a Libertarian thought than a liberal thought.  

It's true.  I would claim Libertarian if I could actually vote that way...

I'm a fiscal conservative and a libertarian with just about everything else except national defense/security and then I lean Republican.

I tend to vote Republican because Libertarian/3rd party candidates are frequently either crazy or funded by the Democrats to draw away Republican votes.

I really think it is insane how much the government is trying to legislate, how much sytrofoam can be used, trying to tax what the government deems to be "unhealthy" behaviors, trying to legislate morality (abortion, gay marriage, etc.).  The government should stay out of all of that in my opinion.

If we expect the government to pay for health care (which is also what happens when people don't have insurance and don't pay their hospital bills...because otherwise hospitals close, and no one wants that to happen) I think it's fair for the government to tax activities that cause us to require more health care (I also think one of the smartest things to do is to figure out how to regulate canibis so that it can be sold legally and taxed like tabacco or alcohol).

But should the government BE paying for healthcare?  I personally do no think so, if you CHOOSE to smoke, do drugs, participating in unhealthy behaviors that make you sick then YOU (general you, not you specifically) should have to pay the consequences of your behaviors.

Health Insurance =/= Health Care.  Just because you have insurance doesn't mean that you have access to the doctors/care you need.  Doctors may not have availability in their schedules to see you, they may not have the specialties you need in your area etc or your coverage may not include what you need.

On the flip side, just because you don't have insurance does not mean you don't have access to health care.  You can still make an appointment, you just have to pay for it out of pocket instead of it being "free" (which we should all realize isn't free).

Health insurance was originally meant as a insurance policy against serious health issues like cancer, but as more and more stuff happened it has grown to be an all encompassing policy that will cover your birth control pills.  THAT is what is causing the cost of insurance (and then in turn medical care) to go up.  Forcing insurers to cover things they don't want to cover just makes the cost go up for everyone.

I will say that the end of the pre-existing condition is a positive outcome, there is nothing else in the ACA that I can stand behind.

but the cost to have medical procedures and visits is so out of control high - something needs to be done.

formerlyGDaisy09

AprilH81 said:

Gdaisy09 said:

AprilH81 said:

hoffse said:

 

The whole "just leave me alone" and "I don't care what you do in your home" is actually more of a Libertarian thought than a liberal thought.  

It's true.  I would claim Libertarian if I could actually vote that way...

I'm a fiscal conservative and a libertarian with just about everything else except national defense/security and then I lean Republican.

I tend to vote Republican because Libertarian/3rd party candidates are frequently either crazy or funded by the Democrats to draw away Republican votes.

I really think it is insane how much the government is trying to legislate, how much sytrofoam can be used, trying to tax what the government deems to be "unhealthy" behaviors, trying to legislate morality (abortion, gay marriage, etc.).  The government should stay out of all of that in my opinion.

If we expect the government to pay for health care (which is also what happens when people don't have insurance and don't pay their hospital bills...because otherwise hospitals close, and no one wants that to happen) I think it's fair for the government to tax activities that cause us to require more health care (I also think one of the smartest things to do is to figure out how to regulate canibis so that it can be sold legally and taxed like tabacco or alcohol).

But should the government BE paying for healthcare?  I personally do no think so, if you CHOOSE to smoke, do drugs, participating in unhealthy behaviors that make you sick then YOU (general you, not you specifically) should have to pay the consequences of your behaviors.

Health Insurance =/= Health Care.  Just because you have insurance doesn't mean that you have access to the doctors/care you need.  Doctors may not have availability in their schedules to see you, they may not have the specialties you need in your area etc or your coverage may not include what you need.

On the flip side, just because you don't have insurance does not mean you don't have access to health care.  You can still make an appointment, you just have to pay for it out of pocket instead of it being "free" (which we should all realize isn't free).

Health insurance was originally meant as a insurance policy against serious health issues like cancer, but as more and more stuff happened it has grown to be an all encompassing policy that will cover your birth control pills.  THAT is what is causing the cost of insurance (and then in turn medical care) to go up.  Forcing insurers to cover things they don't want to cover just makes the cost go up for everyone.

I will say that the end of the pre-existing condition is a positive outcome, there is nothing else in the ACA that I can stand behind.

I absolutely agree that the use of health insurance has balooned to something that is not sustainable. I attended a lecture by the CEO of a huge insurance company, and after that I totally agree that there is no reason for insurance to pay for things like birth control...when compaired to something like car insurance that sould be like your car insurance paying for an oil change, or other routine maintanence. 

Health care expenses are high because of how insurance companies, but even more so Medicare/medicaid, pay hospitals, which leads to people without insurance (at this point I'm talking about people who don't qualify for medicaid but don't have the money to buy their own insurance) using emergency rooms and urgent care for care inappropriately, where they rack up huge bills that they can't pay for... hospitals (the 90% that are non-profit, or critical access) operate at 1 or 2% margins or even at a loss.  

The majority of the people (not all, but many) who engage in those risky behaviors are the same people who can't pay their hospital bills and their care ends as charity care or bad-debt, or they're using medicaid. There is a direct correlation between income level and health status, the same correlation exists between education level and health status. So the people in this country with the lowest level of education and income is also the population that carries the highest disease burden. 

Morally hospitals cannot turn those patients away, but the care they use is expensive, and the way they currently interact with the health care system is expensive, some how it has to get paid for. I'm not saying the ACA is perfect, far from it, but it is the best step we've taken towards correcting a broken system.

formerlyGDaisy09

Gdaisy09 said:

AprilH81 said:

Gdaisy09 said:

AprilH81 said:

hoffse said:

-SNIP-

If you have a way to access it, Steven Brill has a fantastic article in Time Magazine from February 2013 that does a great job outlining why the health care system is/was so broken and points out some of the weaknesses of the ACA that need fixing.  He has another article in Time from a couple weeks ago that I haven't worked all the way through. 

formerlyGDaisy09

AprilH81 said:

vlagrl29 said:

AprilH81 said:

Gdaisy09 said:

AprilH81 said:

hoffse said:

 

The whole "just leave me alone" and "I don't care what you do in your home" is actually more of a Libertarian thought than a liberal thought.  

It's true.  I would claim Libertarian if I could actually vote that way...

I'm a fiscal conservative and a libertarian with just about everything else except national defense/security and then I lean Republican.

I tend to vote Republican because Libertarian/3rd party candidates are frequently either crazy or funded by the Democrats to draw away Republican votes.

I really think it is insane how much the government is trying to legislate, how much sytrofoam can be used, trying to tax what the government deems to be "unhealthy" behaviors, trying to legislate morality (abortion, gay marriage, etc.).  The government should stay out of all of that in my opinion.

If we expect the government to pay for health care (which is also what happens when people don't have insurance and don't pay their hospital bills...because otherwise hospitals close, and no one wants that to happen) I think it's fair for the government to tax activities that cause us to require more health care (I also think one of the smartest things to do is to figure out how to regulate canibis so that it can be sold legally and taxed like tabacco or alcohol).

But should the government BE paying for healthcare?  I personally do no think so, if you CHOOSE to smoke, do drugs, participating in unhealthy behaviors that make you sick then YOU (general you, not you specifically) should have to pay the consequences of your behaviors.

Health Insurance =/= Health Care.  Just because you have insurance doesn't mean that you have access to the doctors/care you need.  Doctors may not have availability in their schedules to see you, they may not have the specialties you need in your area etc or your coverage may not include what you need.

On the flip side, just because you don't have insurance does not mean you don't have access to health care.  You can still make an appointment, you just have to pay for it out of pocket instead of it being "free" (which we should all realize isn't free).

Health insurance was originally meant as a insurance policy against serious health issues like cancer, but as more and more stuff happened it has grown to be an all encompassing policy that will cover your birth control pills.  THAT is what is causing the cost of insurance (and then in turn medical care) to go up.  Forcing insurers to cover things they don't want to cover just makes the cost go up for everyone.

I will say that the end of the pre-existing condition is a positive outcome, there is nothing else in the ACA that I can stand behind.

but the cost to have medical procedures and visits is so out of control high - something needs to be done.

I think that can at least partially be fixed by tort reform.  There are a lot of frivolous lawsuits out there for medical malpractice that cause doctors to pay high premiums for insurance AND cause a lot of unncessary tests/procedures to be done (defensive medicine) just to make sure they can say they ran the test if asked.

Example:  When I was 26 years old I had a breast reduction done as an out patient procedure.  Because the surgery was delayed several hours they kept me overnight for observation but I was in the hospital less than 24 hours.  

While I was trying to sleep they had my legs hooked up to compression boots to prevent blood clots, my bed kept shifting to prevent bed sores, and I was woken up around 3:00 in the morning by a respiratory therapist who made me blow in a plastic tube to make sure I didn't get pneumonia from weakened lungs.  I tried to deny the therapist because I knew I didn't need it, but in the middle of the night while I was half asleep and still on pain killers they wouldn't let me refuse.

As the bills started rolling in I was charged several hundred dollars for the respiratory therapy and the one-use breathing tube.  

I was a healthy 26 year old who only was in the hospital because the surgery I had was delayed to long and they wanted to keep me for observation.  I did not need ANY of those procedures, yet they were forced on me and then I was charged money for services I don't want.  Why?  Because the hospital and doctors needed to cover their asses.  What happens *if* I had developed a blood clot and I hadn't had the booties on?  What happens *if* I had gotten pneumonia and I hadn't received the therapy?

All of those unnecessary tests and procedures are what is driving up the cost of health care along with the malpractice insurance that doctors are forced to carry.

Limiting damages in malpractice suits (along with reforming what constitutes malpractice) would go a long way to bringing health care costs down.

And while I'm on my soap box.

Just because you have insurance doesn't mean you (again, general you) needs to run to the docor/urgent card/ER for every sniffle and sneeze because it is "free".  Antibiotics don't work for every illness and you take up a spot for someone who is truly sick, limiting someone else's access.

This is exactly the kind of care that hospitals will not be able to get paid for under the ACA.  We're still transitioning out of fee-for-service payment, but Hospitals will evenually get paid for the quality of the care they provide...the care you describe above would not be classified as quality care and the hospital would likely be denied payment for much of the care you received. 

Xstatic3333

AprilH81 said:

vlagrl29 said:

AprilH81 said:

Gdaisy09 said:

AprilH81 said:

hoffse said:

 

The whole "just leave me alone" and "I don't care what you do in your home" is actually more of a Libertarian thought than a liberal thought.  

It's true.  I would claim Libertarian if I could actually vote that way...

I'm a fiscal conservative and a libertarian with just about everything else except national defense/security and then I lean Republican.

I tend to vote Republican because Libertarian/3rd party candidates are frequently either crazy or funded by the Democrats to draw away Republican votes.

I really think it is insane how much the government is trying to legislate, how much sytrofoam can be used, trying to tax what the government deems to be "unhealthy" behaviors, trying to legislate morality (abortion, gay marriage, etc.).  The government should stay out of all of that in my opinion.

If we expect the government to pay for health care (which is also what happens when people don't have insurance and don't pay their hospital bills...because otherwise hospitals close, and no one wants that to happen) I think it's fair for the government to tax activities that cause us to require more health care (I also think one of the smartest things to do is to figure out how to regulate canibis so that it can be sold legally and taxed like tabacco or alcohol).


But should the government BE paying for healthcare?  I personally do no think so, if you CHOOSE to smoke, do drugs, participating in unhealthy behaviors that make you sick then YOU (general you, not you specifically) should have to pay the consequences of your behaviors.

Health Insurance =/= Health Care.  Just because you have insurance doesn't mean that you have access to the doctors/care you need.  Doctors may not have availability in their schedules to see you, they may not have the specialties you need in your area etc or your coverage may not include what you need.

On the flip side, just because you don't have insurance does not mean you don't have access to health care.  You can still make an appointment, you just have to pay for it out of pocket instead of it being "free" (which we should all realize isn't free).

Health insurance was originally meant as a insurance policy against serious health issues like cancer, but as more and more stuff happened it has grown to be an all encompassing policy that will cover your birth control pills.  THAT is what is causing the cost of insurance (and then in turn medical care) to go up.  Forcing insurers to cover things they don't want to cover just makes the cost go up for everyone.

I will say that the end of the pre-existing condition is a positive outcome, there is nothing else in the ACA that I can stand behind.

but the cost to have medical procedures and visits is so out of control high - something needs to be done.



I think that can at least partially be fixed by tort reform.  There are a lot of frivolous lawsuits out there for medical malpractice that cause doctors to pay high premiums for insurance AND cause a lot of unncessary tests/procedures to be done (defensive medicine) just to make sure they can say they ran the test if asked.

Example:  When I was 26 years old I had a breast reduction done as an out patient procedure.  Because the surgery was delayed several hours they kept me overnight for observation but I was in the hospital less than 24 hours.  

While I was trying to sleep they had my legs hooked up to compression boots to prevent blood clots, my bed kept shifting to prevent bed sores, and I was woken up around 3:00 in the morning by a respiratory therapist who made me blow in a plastic tube to make sure I didn't get pneumonia from weakened lungs.  I tried to deny the therapist because I knew I didn't need it, but in the middle of the night while I was half asleep and still on pain killers they wouldn't let me refuse.

As the bills started rolling in I was charged several hundred dollars for the respiratory therapy and the one-use breathing tube.  

I was a healthy 26 year old who only was in the hospital because the surgery I had was delayed to long and they wanted to keep me for observation.  I did not need ANY of those procedures, yet they were forced on me and then I was charged money for services I don't want.  Why?  Because the hospital and doctors needed to cover their asses.  What happens *if* I had developed a blood clot and I hadn't had the booties on?  What happens *if* I had gotten pneumonia and I hadn't received the therapy?

All of those unnecessary tests and procedures are what is driving up the cost of health care along with the malpractice insurance that doctors are forced to carry.

Limiting damages in malpractice suits (along with reforming what constitutes malpractice) would go a long way to bringing health care costs down.

And while I'm on my soap box.

Just because you have insurance doesn't mean you (again, general you) needs to run to the docor/urgent card/ER for every sniffle and sneeze because it is "free".  Antibiotics don't work for every illness and you take up a spot for someone who is truly sick, limiting someone else's access.

You make some great points here that I agree with, while still supporting the ACA for a lot of the reasons @Gdaisy09‌ mentioned above.

I agree that people shouldn't go in for every little sniffle just because it's "free." However, I'm also a believer that responsible preventative care will save us all money by preventing expenses ER visits. I'm even supportive of some birth control being free (ducks to hide from flames).

We can definitely all agree it's a broken system. Philosophically, I'm comfortable with the government having some role in providing affordable insurance a) for moral reasons and b) to hopefully throw fewer people into medical debt, which isn't good for anybody. We always had it that way in MA and everything worked great. I do worry for people who fell into the "gap" in states that didn't accept the Medicaid expansion. They are truly without a safety net.

formerlyGDaisy09

the ER visits are one of the biggest things. People, generally, who don't have insurance do not seek care until their condition becomes some kind of emergency.  providing affordable ways for people to access outpatient (not even primary care becase there are so many conditions that a GP is not adequately prepared to manage) care is key to keeping uninsured, or underinsured from clogging up EDs.  In addition to creating a huge cost burden for themselves or the institution where they are seeking care, they are also using up valuable resources that might prevent someone experiencing a true emergency (like a stroke or heart attack) from receiving the care that they urgently need. 

hopefully switching to the Accountable Care Organization model will help with both costs and appropriate use of care, but like all other insurance, the key is getting the right mix of healthy people in the pool.

smerka

Here are my thoughts if anyone cares. First the government makes you takes RMDs from 401ks and traditional IRAS, because they are tax deferred, not because they want to tell you when to take out your money. Second, I think a lot of people are going to be upset when they see how the ACA affects their taxes if they bought insurance through the exchanges. I like the ACA, but they have done a horrible job of explaining it. Third, instead of taxing the rich more, I would really like to see the tax code overhauled so that more people are paying income taxes. We currently fall into the 47% who don't because we have ridiculous property taxes, two kids, and education and medical expenses (yes we paid over $8,000 out of pocket last year and that's with pretty good insurance. Autism is effing expensive). It's insanity that we pay nothing in federal taxes on $65,000 of income. I face our tax liability is negative. The government pays us about $300 every year. But this year may be more. But no one will get elected on a platform where people in the middle and lower classes actual start paying taxes.

noffgurl

At what point do you consider something an emergency? With or without insurance? My H has a couple of medical bills from when he had excruciating pain in his scrotum that he waited a good month before finally going to the ER and unfortunately they couldn't find anything and referred him to a specialist that he still refuses to go to now that we have insurance because he knows the cost will still probably not be covered nearly enough for us to be able to afford it. On the flip side my medical bills are when I had insurance that we were paying a lot of money for. I went for a preventative check up and am being charged $1,200 for after what insurance covered. We now have insurance that costs H $150 per week out of his paycheck and we are afraid to even try and use it. Honestly, I would love to go the doctor right now because for the past couple of years I may have 2-3 periods in a year and now, since November, I have bled heavy (with some really big clots that I have never had this big before) for 36 of the 58 days. I am also getting covered head to toe in these weird painful sores. So, ya, I am pretty sure there is something really wrong, but since I'm not dying right this second its really not an emergency. If I go to the doctor I will come out judged for using facilities and supplies for non-emergency and probably another $1,200+ bill that I can't pay.

hoffse

smerka said:

Here are my thoughts if anyone cares. First the government makes you takes RMDs from 401ks and traditional IRAS, because they are tax deferred, not because they want to tell you when to take out your money. Second, I think a lot of people are going to be upset when they see how the ACA affects their taxes if they bought insurance through the exchanges. I like the ACA, but they have done a horrible job of explaining it. Third, instead of taxing the rich more, I would really like to see the tax code overhauled so that more people are paying income taxes. We currently fall into the 47% who don't because we have ridiculous property taxes, two kids, and education and medical expenses (yes we paid over $8,000 out of pocket last year and that's with pretty good insurance. Autism is effing expensive). It's insanity that we pay nothing in federal taxes on $65,000 of income. I face our tax liability is negative. The government pays us about $300 every year. But this year may be more. But no one will get elected on a platform where people in the middle and lower classes actual start paying taxes.

That's interesting.

I have been looking at 2015 for us, and we are slated to pay somewhere around $42K in federal taxes this year.  Then state and local income taxes are on top of that.  Plus property taxes.  Joy.  A lot of breaks we would otherwise qualify for we can't take because our joint income is going to be too high this year.  A lot of tax breaks start phasing out around $130-$150K for married couples.

We can afford to pay those taxes, but it's not always easy.  I got a big raise this year, but I won't be seeing much of it because it bumps us up to a higher tax bracket.  Our student loan payments are twice as much as our mortgage.  Yet, we can deduct our mortgage interest but we make too much to deduct our student loan interest.  

Again, if I could take that $42K and aim it somewhere else, it could do a lot of good.  As it is, we don't make as many charitable contributions as we would like because we have to pay our bills, our loans, our retirement, and our taxes first.

vlagrl29

we try to avoid ER's at all cost and only go if it's truly an emergency.  We have taken DD to urgent care in the past because it's so much cheaper than an ER but I know urgent care can only do so much.

Xstatic3333

noffgurl said:

At what point do you consider something an emergency? With or without insurance? My H has a couple of medical bills from when he had excruciating pain in his scrotum that he waited a good month before finally going to the ER and unfortunately they couldn't find anything and referred him to a specialist that he still refuses to go to now that we have insurance because he knows the cost will still probably not be covered nearly enough for us to be able to afford it. On the flip side my medical bills are when I had insurance that we were paying a lot of money for. I went for a preventative check up and am being charged $1,200 for after what insurance covered. We now have insurance that costs H $150 per week out of his paycheck and we are afraid to even try and use it. Honestly, I would love to go the doctor right now because for the past couple of years I may have 2-3 periods in a year and now, since November, I have bled heavy (with some really big clots that I have never had this big before) for 36 of the 58 days. I am also getting covered head to toe in these weird painful sores. So, ya, I am pretty sure there is something really wrong, but since I'm not dying right this second its really not an emergency. If I go to the doctor I will come out judged for using facilities and supplies for non-emergency and probably another $1,200+ bill that I can't pay.

I think those are both great reasons to see a doctor! I think the one that's frustrating is people demanding antibiotics every time they get a common cold (which is also creating scary antibiotic resistant viruses).

I encourage you to see a doctor for what you are facing now, especially the sores. Perhaps your H's HR could help you figure out how much will be covered?

noffgurl

AprilH81 said:

noffgurl said:

At what point do you consider something an emergency? With or without insurance? My H has a couple of medical bills from when he had excruciating pain in his scrotum that he waited a good month before finally going to the ER and unfortunately they couldn't find anything and referred him to a specialist that he still refuses to go to now that we have insurance because he knows the cost will still probably not be covered nearly enough for us to be able to afford it. On the flip side my medical bills are when I had insurance that we were paying a lot of money for. I went for a preventative check up and am being charged $1,200 for after what insurance covered. We now have insurance that costs H $150 per week out of his paycheck and we are afraid to even try and use it. Honestly, I would love to go the doctor right now because for the past couple of years I may have 2-3 periods in a year and now, since November, I have bled heavy (with some really big clots that I have never had this big before) for 36 of the 58 days. I am also getting covered head to toe in these weird painful sores. So, ya, I am pretty sure there is something really wrong, but since I'm not dying right this second its really not an emergency. If I go to the doctor I will come out judged for using facilities and supplies for non-emergency and probably another $1,200+ bill that I can't pay.

For me an emergency would be a really high fever, days of vomiting, blood in your vomit/stool, car accidents, possibly broken limbs, etc.

Sores?  Irregular cycles (which sounds a lot like what I went through in my 20s, not fun), etc. are not emergencies and I would make an appointment with your regular doctor/OB-GYN for those.  Unless they run a log of dignostic tests the cost shouldn't be more than a few hundred dollars if you have zero coverage.

Also, what kind of check up did you get that cost $1,200?  A general wellness visit shouldn't cost that much unless they ran a lot of blood work or other tests.

Another low cost health option is County/City Health Departments.  They can usually provide vaccinations and physicals and other "routine" stuff for a much lower cost than a doctor.

It was the Pap Smear with some blood work. I wouldn't go to the emergency room for what I have now, I'm scared to go the doctor at all for the reasons I listed above.


*Edit
I just don't understand why it all costs so much, but then we really aren't supposed to use it unless we ABSOLUTELY have to. So we throw $150 a week away. Or get fined. What an awesome system.

formerlyGDaisy09

noffgurl said:

At what point do you consider something an emergency? With or without insurance? My H has a couple of medical bills from when he had excruciating pain in his scrotum that he waited a good month before finally going to the ER and unfortunately they couldn't find anything and referred him to a specialist that he still refuses to go to now that we have insurance because he knows the cost will still probably not be covered nearly enough for us to be able to afford it. On the flip side my medical bills are when I had insurance that we were paying a lot of money for. I went for a preventative check up and am being charged $1,200 for after what insurance covered. We now have insurance that costs H $150 per week out of his paycheck and we are afraid to even try and use it. Honestly, I would love to go the doctor right now because for the past couple of years I may have 2-3 periods in a year and now, since November, I have bled heavy (with some really big clots that I have never had this big before) for 36 of the 58 days. I am also getting covered head to toe in these weird painful sores. So, ya, I am pretty sure there is something really wrong, but since I'm not dying right this second its really not an emergency. If I go to the doctor I will come out judged for using facilities and supplies for non-emergency and probably another $1,200+ bill that I can't pay.

generally ER visits should be reserved for chest pain, stroke-like symptoms, broken bones, possible traumatic brain injury, car accidents, lower right quadrant pain (possible appendicitis), intense abdominal pain, bloody stools/vomit, etc.   These are often (not always) things that happen suddenly and require immediate medical attention.  

Most other things should go through your GP, or potentially an urgent care center or minute clinic. for irregular menses I'd see your PCP. Maybe make sure that whoever you're seeing is in network for you (your insurance company should be able to tell you) I've started double checking that places take my insurance when I'm scheduling an appointment. 

ETA: I am not a medical professional and this is not medical advice

blondie42107

Health care will never be perfect.

My employer has to offer me insurance because I work over 30hrs/week however I'm not full time so I would be responsible for the full cost of the premium. I would pay $690/month for individual coverage. I would have a $2500 deductible followed by specific copays for office visits, specialists, urgent care and ER. (Just for comparison - the premium for two people is $1660/month, family coverage is $2030/month.)

And saying birth control shouldn't be covered... making changes to that now would open a huge can of worms. Not all birth control is "free," like many people think. Also it is frequently used for other medical issues other than preventing pregnancy. Then if we aren't willing to have that covered by insurance, why have Viagra and the like covered for men?

I'm glad immunization annual max has been removed. I know people who wanted to have their children vaccinated postponed because of the out of pocket cost.

It would be nice if our country could focus on how to live healthy lives and use preventative care to lower medical costs. However you can only prevent so much.