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  1. #1
    Get Off My Lawn. Maynerd's Avatar
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    Healthcare

    We've spun off on a pretty significant tangent in the Trump thread. Let's move the discussion of the GOP health care plan here.


    I'll go first.


    ObamaCare is, in my opinion, an abject failure. It forced all Americans to purchase a commercial product, something our government has not previously done. The Supreme Court's decision to allow it was dubious, as the Court came up with its own language to interpret the word "fine" to really mean "tax" to keep the legislation within Constitutionally defined boundaries. And it did NOTHING to make health care more affordable.


    The GOP plan is NOT an abject failure. To call it this would do a disservice to other failures. It's a train wreck orders of magnitude worse than the ACA. It will take coverage away from those that need it most. By removing the individual mandate, it will make coverage more expensive for those who CAN afford it. And, like its predecessor, does NOTHING to make health care more affordable.


    What's the best way ahead? Don't just say "single payer," but add a discussion of how we might pay for a single payer system. Why is health care tied to employment? My employer doesn't pay anything besides my salary toward my home or my food. Why is he expected to pay for a chunk of my health care needs?


    I go to a barbershop, and there's a sign on the wall telling me what the various services cost. Why doesn't the healthcare industry publicize prices? No one cares about the bottom line; only about what their SHARE of that cost will be. And, those bottom line costs have nothing to do with the doctor's time, but have everything to do with the maximum allowable charge according to the insurance. It's a pricing system unlike anything else we do in the country. There HAS TO be a better way.


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  2. #2

    Re: Healthcare

    I liked the Medicare for All plan that Bernie presented but I don't have the expertise to say it's financially feasible. Here is the link to what he was proposing and how to pay for it. https://berniesanders.com/issues/medicare-for-all/

    For some reason the words "socialized medicine" have a negative connotation but it works in too much of the world to deny it's success. The government having the power to negotiate fees with providers would actually lower the cost of treatment and not just address insurance costs. Shared costs can also lower fees for in unexpected ways like universal coverage better prevents spread of infectious disease through more thorough regional epidemiological care. Optional supplemental insurance like with medicare could provide for things like dental and vision care. A system of universal care would be better equipped to "sell" preventative care since everyone would be subject to the same costs, rules and regulations. Ultimately, healthcare would become both more efficient, more effective and less expensive.

    In addition, you would see a reduction of economic poverty due to greater productivity from a healthier population. Which should lead to higher wages and a more effective workforce. We would no longer have the societal burden created by vulnerable, uninsured people being left destitute by medical expenses.

    I'm thinking while I type so I will probably have more to add or takeaway from this but wanted to get the ball rolling.

  3. #3
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    Re: Healthcare

    Quote Originally Posted by Maynerd View Post
    Why is health care tied to employment? My employer doesn't pay anything besides my salary toward my home or my food. Why is he expected to pay for a chunk of my health care needs?
    Why are you against employee benefits? 401k. Free meals. Free flights. Healthcare. Childcare. Ect...

  4. #4
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    Re: Healthcare

    Quote Originally Posted by ClownPickle View Post
    Why are you against employee benefits? 401k. Free meals. Healthcare. Childcare. Ect...
    A better question is why is someone who produces Widgets expected to be an expert in selecting a group health care policy for his employees?

    And why is health care tied to employment at all?
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  5. #5

    Re: Healthcare

    Quote Originally Posted by Yankee Tripper View Post

    And why is health care tied to employment at all?
    I think it was part of the New Deal.
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  6. #6

    Re: Healthcare

    Quote Originally Posted by NerfBall55 View Post
    I think it was part of the New Deal.
    Yep. Caps were placed on wages to limit inflation but insurance was excluded from the cap so it became a recruitment tool. Or something to that effect. I think it actually came a little after the New Deal but close enough.

  7. #7
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    Re: Healthcare

    Quote Originally Posted by Texsahara View Post
    Yep. Caps were placed on wages to limit inflation but insurance was excluded from the cap so it became a recruitment tool. Or something to that effect. I think it actually came a little after the New Deal but close enough.
    As situations change I think this can change. Insurance should be tied to being a human being.
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  8. #8
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    Re: Healthcare

    Quote Originally Posted by NerfBall55 View Post
    I think it was part of the New Deal.
    Yes I'm aware. It was the 1942 Stabilization Act.

    The question is why is it still linked and should it be?
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  9. #9
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    Re: Healthcare

    Quote Originally Posted by Maynerd View Post
    Why is health care tied to employment? My employer doesn't pay anything besides my salary toward my home or my food. Why is he expected to pay for a chunk of my health care needs?
    I think I can answer this one.

    It's tied to wage caps in the 1940s and was a way to provide additional compensation.

    That it how now morphed into the primary means of access to healthcare for most Americans is one of the problems with the system.
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  10. #10
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    Re: Healthcare

    Quote Originally Posted by Maynerd View Post
    What's the best way ahead? Don't just say "single payer," but add a discussion of how we might pay for a single payer system.
    Single Payer.

    The obvious solution for payment is to institute a tax. A bulk of the tax could be on employers as they would see a complete reduction in premiums under a single payer system with the remainder payed by some combination or taxes on wages and passive income.

    Employers who currently offer generous health care packages would likely come out ahead as the tax would likely be lower than the current premiums they pay while companies that don't currently offer health would see costs go up. This might cause them to raise the price of their goods and services.

    I imagine something along the framework of Bernie's plan linked in a post above might be a starting point.
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  11. #11

    Re: Healthcare

    Quote Originally Posted by Maynerd View Post
    We've spun off on a pretty significant tangent in the Trump thread. Let's move the discussion of the GOP health care plan here.

    Why is health care tied to employment? My employer doesn't pay anything besides my salary toward my home or my food. Why is he expected to pay for a chunk of my health care needs?
    You were okay with health benefits while in the USAF? Yes? For your wife and kids?

    In this day and age salary isn't always the only drawing card. Health benefits, 401K's, stable company, stock dividends, retirement package, etc. are now considered as important as salary. It was for me anyway.
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  12. #12

    Re: Healthcare

    Quote Originally Posted by BRenninger View Post
    You were okay with health benefits while in the USAF? Yes? For your wife and kids?
    You seem to get agitated by this frequently. What's the story here?
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  13. #13
    Released Outright awy's Avatar
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    Re: Healthcare

    whether private insurances or a single payer pays for healthcare isn't that important for any of the meaningful desirable healthcare objectives you want to achieve.

  14. #14
    Tends to be difficult JL25and3's Avatar
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    Re: Healthcare

    Here's a good recap of how we got to employer-based insurance as the standard: http://www.npr.org/templates/story/s...ryId=114045132. It stays in place because, well, it's in place. Among other things, it enables us to buy insurance as part of a group rather than individually.

    As awy suggested, the single biggest problem I see with the system is not who pays for it, but what's being paid for. Reimbursement for procedures rather than outcomes is just a terrible, terrible model. It drives costs higher all the time by providing incentives for doctors to perform lots of procedures, lots of expensive procedures. Meanwhile it's actually destructive to the quality of health care, because it discourages things that take time but aren't directly billable. Doctors don't get paid for sitting with you for a half hour taking a detailed history and listening to you carefully. Instead they rely on a checklist that you fill out in the waiting room, let the nurse take your vitals, then spend five or ten minutes with you to prescribe lab tests, procedures and meds. Coordination of care is practically nonexistent. If there's anything complex or subtle going on, you go from one doctor to another; each symptom and each system gets looked at more or less independently, each through a separate set of eyes, and there's no one who gets paid for gathering all the different reports together and synthesizing them. It's a system that works well for the insurance companies - because it makes billing and reimbursement (or denial) so much easier - but not for anyone else.

    In fact, the ACA included various programs to try to change that model. Unfortunately, because it still left insurance companies in charge, its scope was mostly limited to Medicare, Medicaid and the VA. And there it's actually had an effect: https://www.nytimes.com/2014/09/24/o...ess-story.html. Maynerd, I know your complaints about the VA, and I know about all the things that have gone wrong over the past ten years (I suspect that the sudden impact of two protracted wars overburdened the system significantly), but coordination of care (once someone gets care) is something they do exceptionally well.

    I don't know the best way to encourage more of this, short of single-payer. I don't know what the Republican plan does with the initiatives from the ACA, but I'd guess it guts them pretty completely.

    Best source on this stuff - both on the models, and on the ACA's efforts to change them - is Atul Gawande, who's written extensively about it in the New Yorker for years. Google him, and you'll find plenty to read about it.
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  15. #15

    Re: Healthcare

    Quote Originally Posted by JL25and3 View Post

    As awy suggested, the single biggest problem I see with the system is not who pays for it, but what's being paid for. Reimbursement for procedures rather than outcomes is just a terrible, terrible model. It drives costs higher all the time by providing incentives for doctors to perform lots of procedures, lots of expensive procedures. Meanwhile it's actually destructive to the quality of health care, because it discourages things that take time but aren't directly billable. Doctors don't get paid for sitting with you for a half hour taking a detailed history and listening to you carefully. Instead they rely on a checklist that you fill out in the waiting room, let the nurse take your vitals, then spend five or ten minutes with you to prescribe lab tests, procedures and meds. Coordination of care is practically nonexistent. If there's anything complex or subtle going on, you go from one doctor to another; each symptom and each system gets looked at more or less independently, each through a separate set of eyes, and there's no one who gets paid for gathering all the different reports together and synthesizing them. It's a system that works well for the insurance companies - because it makes billing and reimbursement (or denial) so much easier - but not for anyone else.
    My now retired primary care physician told me this exact thing. He felt he couldn't give the proper care because of time constraints.
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  16. #16

    Re: Healthcare

    Quote Originally Posted by awy View Post
    whether private insurances or a single payer pays for healthcare isn't that important for any of the meaningful desirable healthcare objectives you want to achieve.
    It does if you cut the insurance companies out.

  17. #17

    Re: Healthcare

    This is all interesting but I've quoted the part that is relevant to this thread.

    https://www.washingtonpost.com/natio...536c5#comments

    House Republicans are advancing a series of bills that would make changes to the civil justice system long sought by doctors and U.S. corporations, including a cap on some medical malpractice awards and new roadblocks for classes of people seeking to sue jointly to address harm.
    The fourth measure in the package has yet to be scheduled for a vote. The Protecting Access to Care Act would establish a three-year statute of limitations for filing civil lawsuits in most cases where patients and their families believe negligent health care caused injury or death.

    The bill would also set a $250,000 cap on compensation for “noneconomic damages,” which are separate from damages plaintiffs receive based on future economic losses. Noneconomic damages are meant to compensate victims for pain and suffering, as well as permanent disfigurement or other serious disabilities that may not interfere with their ability to work.

    Many states have already adopted caps on noneconomic damages, but some have declared such limits unconstitutional. The House proposal would override those decisions, prompting lawmakers in both parties to complain that the measure would trample states’ rights.

    The caps would apply broadly to all manner of medical malpractice, including errors in surgery, side effects from unsafe drugs, abuse and neglect in nursing homes, and sexual assault by doctors.

    When Rep. Steve King (R-Iowa), introduced the bill last month, he said the law was necessary to “preserve fiscal sanity and federal health policy … As more companies pay in health-care costs, the less they can pay in wages.”

  18. #18
    Released Outright awy's Avatar
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    Re: Healthcare

    Quote Originally Posted by Mr Coffee View Post
    It does if you cut the insurance companies out.
    yes, there will be some overhead with an insurance system. but some choice is meaningful here. you can regulate private insurances like utilities. insurances don't have leverage over providers and pharma etc. those supply side actors are really the problme in terms of cost.

    european countries are moving towards more private insurance but with high level of price and treatment regulation

  19. #19

    Re: Healthcare

    http://m.sfgate.com/news/article/Ver...k-11027365.php

    Members of Vermont's congressional delegation told hundreds of constituents at a rousing town hall meeting Saturday that the defeat of the Republican health plan was "a victory," with U.S. Sen. Bernie Sanders telling the cheering crowd that he plans to introduce a "Medicare for all" bill soon.

  20. #20
    Word of the Year is Complicit ojo's Avatar
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    Re: Healthcare

    Quote Originally Posted by Texsahara View Post
    http://m.sfgate.com/news/article/Ver...k-11027365.php

    Members of Vermont's congressional delegation told hundreds of constituents at a rousing town hall meeting Saturday that the defeat of the Republican health plan was "a victory," with U.S. Sen. Bernie Sanders telling the cheering crowd that he plans to introduce a "Medicare for all" bill soon.
    Was he speaking extemporaneously? Why isn't the bill ready now, considering timing can be everything?
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  21. #21

    Re: Healthcare

    This is the way Obamacare is supposed to work.


    More States To Expand Medicaid Now That Obamacare Remains Law

    Source: Forbes

    More states will pursue expansion of Medicaid health benefits for poor Americans under the Affordable Care Act after Republicans failed to repeal and replace the law.

    The American Health Care Act, also known as Trumpcare, would’ve rolled back the ACA’s Medicaid expansion and put restrictions on states that tried to expand such coverage. But Speaker of the U.S. House of Representatives Paul Ryan Friday pulled the ACHA legislation Friday, making, “Obamacare the law of the land” as he said.

    At least two states – Kansas and North Carolina – are already working toward becoming the 32nd and 33rd states to expand Medicaid under the ACA. They would join 31 states plus the District of Columbia that have taken advantage of generous federal funding available under the law, President Obama’s signature legislative achievement, according to the Advisory Board.

    And there may be even more states that will resurrect state legislative efforts to expand Medicaid. Before Trump was elected, Georgia, Idaho, Nebraska and South Dakota were considering Medicaid expansion . But Trump’s election, along with Republican control of Congress prompted these states to put on the breaks for Medicaid expansion when an ACA repeal looked likely. “The effort to expand Medicaid in Georgia just died,” the Atlanta Journal-Constitution said Nov. 9, 2016, the day after Trump won the electoral college.

    https://www.forbes.com/sites/bruceja.../#254b7d5419a6
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  22. #22
    Bernie showing 45* how it's done!

    BERNIE SANDERS TO SPONSOR SINGLE-PAYER HEALTHCARE BILL

    Source: Newsweek

    BY NICHOLAS LOFFREDO

    Bernie Sanders is returning to a key campaign promise and will introduce a single-payer healthcare bill in the wake of the Republicans' Obamacare replacement defeat.

    The Vermont senator said Sunday that he was willing to work with both Democrats and Republicans to provide "insurance for all," two days after the GOP leadership's American Health Care Act was pulled from the House floor to avoid a legislative defeat. Sanders' support for a single-payer system was a centerpiece of his unsuccessful run for the Democratic presidential nomination.

    "Where we should be going is to join the rest of the industrialized world and guarantee healthcare to all people as a right," he said on CNN's "State of the Union."

    Sanders' comments came a day after he told a crowd in Hardwick, Vermont, that Medicare-for-all is "a common sense proposal, and I think once the American people understand it, we can go forward with it,” according to Vermont Public Radio.



    http://www.newsweek.com/bernie-sande...re-bill-574403
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  23. #23
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    Re: Healthcare

    Love the idea. Will never happen.
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  24. #24
    Tends to be difficult JL25and3's Avatar
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    Re: Healthcare

    Canada's roughly 15% nonwhite, mostly East Asian, First Nations, and South Asian.

  25. #25

    Re: Healthcare

    It got a lot more play this morning on the news shows I think B is right tht it's getting some traction. Bernie was especially forceful. Pretty sure Rubio lied when he saying they weren't going to try to rush it through.

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