[ldrews]

Winstonm, on 2017-June-30, 11:24, said:

No, I'd rather hear facts than regurgitation of Trump talking points.

So you criticize but have nothing constructive to offer. Sounds about right.

I think the Republicans should just bag it. Not pass anything. Then when the situation becomes dire enough that the Representatives and Senators are getting heat from their constituents, then maybe they will work together and come up with something better. Until then, nothing much will probably happen.

[Winstonm]

ldrews, on 2017-June-30, 11:46, said:

So you criticize but have nothing constructive to offer. Sounds about right.

I think the Republicans should just bag it. Not pass anything. Then when the situation becomes dire enough that the Representatives and Senators are getting heat from their constituents, then maybe they will work together and come up with something better. Until then, nothing much will probably happen.

The Democrats already have a plan in place - it is imperfect and needs improvement. It is already much, much better than doing nothing.

Your solutions always seem to involve a fantasy portrayal of reality. There is no John Galt.

[jogs]

mike777, on 2008-February-13, 14:39, said:

I have tried to do a bit of research on what the costs are for the proposed Health care plans.

The best rough numbers I could come up with so far are:
1) 8-11,000$ per couple
2) plus copayments and deductibles.
3) These numbers are expected(guess) to increase 10-15% per year.

Hopefully someone can come up with better estimates than my rough numbers.

I get the impression alot of people are voting for this right and feel this is so important we should all have it regardless of costs.

Gov Jerry Brown has proposed single payer for all Californians. $400B a year for 39 million residents.
That translates to $3.4T for the entire USA. That would be about 80% of the US budget.
70% of Americans already has better health coverage than single payer. 30% have far better coverage.
There must be a better and cheaper way to provide health coverage for the 30% who do not have coverage from
their employer, medicare, or medicaid.

The individual insurance market makes no economic sense.
There are only two types of customers. Insurers love the healthy one who are over paying for services.
Insurers don't want those with pre-existing conditions. Insurers lose money with every customers.

Those with pre-existing conditions must be insured by the FED govt. Only the FED can afford to lose money.

[jogs]

Winstonm, on 2017-June-30, 13:29, said:

The Democrats already have a plan in place - it is imperfect and needs improvement. It is already much, much better than doing nothing.

This is a lie perpetuated by the Democrats. Obamacare is in total collapse. Doing nothing is better.

[mike777]

jogs, on 2017-July-01, 07:19, said:

Gov Jerry Brown has proposed single payer for all Californians. $400B a year for 39 million residents.
That translates to $3.4T for the entire USA. That would be about 80% of the US budget.
70% of Americans already has better health coverage than single payer. 30% have far better coverage.
There must be a better and cheaper way to provide health coverage for the 30% who do not have coverage from
their employer, medicare, or medicaid.

The individual insurance market makes no economic sense.
There are only two types of customers. Insurers love the healthy one who are over paying for services.
Insurers don't want those with pre-existing conditions. Insurers lose money with every customers.

Those with pre-existing conditions must be insured by the FED govt. Only the FED can afford to lose money.

OK but you seem unaware of the most important point.

the fed govt is YOU.

your post reflects the attitude of many posters here...the fed govt is someone else paying the bills...not you.

---------------

As for calif doing an experiment in single payer....it will be interesting.

I understand it is open to non legal residents as well

[Flem72]

No way I'm reading everything upthread, but wondering: Does it escape notice that this debate isn't about pricing health care, it is about pricing insurance? What if actual health care costs -- visits, procedures, tests, drugs -- were controlled, either by market forces, competition through advertising/cost comparison, or by some level of fiat (gulp -- not my cup of tea, really)? And if meaningful tort reform is part of the package, docs can use their common sense and medial experience in treatment and not have to fall back on the safest, by-the-numbers protocols -- OK, another MRI !! because if I don't do it, and the case falls into the small percentage where that could be made to look like it matters to a jury , I lose my shorts.

A friend who used to run hospitals tells me that in the 50s, 60s there was a book that priced procedures according to a regionally-based multiplier similar to a cost of living criterion. Base cost of an appendectomy = $X. In NYC, it's 1.9X, in Topeka, .7X. When was the last time any medical professional told you what something cost? when was the last time you asked?

[mike777]

Flem72, on 2017-July-01, 10:08, said:

No way I'm reading everything upthread, but wondering: Does it escape notice that this debate isn't about pricing health care, it is about pricing insurance? What if actual health care costs -- visits, procedures, tests, drugs -- were controlled, either by market forces, competition through advertising/cost comparison, or by some level of fiat (gulp -- not my cup of tea, really)? And if meaningful tort reform is part of the package, docs can use their common sense and medial experience in treatment and not have to fall back on the safest, by-the-numbers protocols -- OK, another MRI !! because if I don't do it, and the case falls into the small percentage where that could be made to look like it matters to a jury , I lose my shorts.

A friend who used to run hospitals tells me that in the 50s, 60s there was a book that priced procedures according to a regionally-based multiplier similar to a cost of living criterion. Base cost of an appendectomy = $X. In NYC, it's 1.9X, in Topeka, .7X. When was the last time any medical professional told you what something cost? when was the last time you asked?

The points you make are very important ones.
1) yes docs are deathly afraid of being sued. Even if they win the case it is a horrible and expensive experience.
2) So they order test after test after test
3) We the patient don't ask the cost. We do ask about the pain or hassle the test puts us through but not the cost.

[Winstonm]

Flem72, on 2017-July-01, 10:08, said:

No way I'm reading everything upthread, but wondering: Does it escape notice that this debate isn't about pricing health care, it is about pricing insurance? What if actual health care costs -- visits, procedures, tests, drugs -- were controlled, either by market forces, competition through advertising/cost comparison, or by some level of fiat (gulp -- not my cup of tea, really)? And if meaningful tort reform is part of the package, docs can use their common sense and medial experience in treatment and not have to fall back on the safest, by-the-numbers protocols -- OK, another MRI !! because if I don't do it, and the case falls into the small percentage where that could be made to look like it matters to a jury , I lose my shorts.

A friend who used to run hospitals tells me that in the 50s, 60s there was a book that priced procedures according to a regionally-based multiplier similar to a cost of living criterion. Base cost of an appendectomy = $X. In NYC, it's 1.9X, in Topeka, .7X. When was the last time any medical professional told you what something cost? when was the last time you asked?

The problem with market=based approach is that when you are vomiting and doubled over in pain from appendicitis, asking how much it will cost to make the pain stop is not going to be a consideration - considering your options prior to occurrence of a problem is iffy, too, as you don't know where you will be when a health emergency occurs or if you will be able to answer questions at that time.

The basic question is actually simple: should some minimum standard of healthcare be provided for everyone or should healthcare be treated like a commodity, bought and sold to the highest bidders through a market-based approach.

An argument I have read for market-based is that a single payer system will devastate innovation and research, that the rest of the world is saved that cost by U.S. capitalism spending on development - the rest of the world gets to benefit from that research and thus can afford universal healthcare.

That, to me, seems a hollow argument as I lived during the time of "Ma Bell" and Bell Labs. The U.S. government made a deal with AT&T for them to monopolize telephone service but they had to forego all other business. This did not prevent them from spending millions on Bell Labs, although they could not benefit directly from the discoveries.

Even today, research and development is in a quest to find new drugs from chronic diseases - the most profitable drugs - and the development of new antibiotics is virtually non-existent. The market looks for profits - it is not equipped to care if most of the entire planet's inhabitants die off from a bacteria that is resistant to all treatment options.

Perhaps the best idea is a single payer system run by each state.

[mike777]

OK Winston you are against the markets making the decisions and prefer a King to make the decisions. However you are also in favor of crony capitalism working for the King to at least pay for health care.

[awm]

Obamacare has been pretty successful at what it sought to do, which is to reduce the number of uninsured and reduce the number of medical-related bankruptcies. The number of Americans with no insurance has gone down approximately by half (and it would be even better if Republican-run states had expanded medicaid). Of course, the cost of medical care has continued to increase, but the projections for Obamacare were that it would reduce the cost when compared to the prior status quo -- in other words, by reducing the rate of increase, not by causing an absolute decrease. This has happened! To the degree that exchanges are "collapsing" and insurers pulling out, there are a lot of reasons for this:

1. Uncertainty as to whether the premium support payments for low-income people will actually be paid by the feds. This uncertainty was created by the Trump administration, which has threatened multiple times to pull the payments.
2. Attempts to pressure the federal government to allow mergers of large insurance providers (for example Aetna has pulled out of several profitable markets for this reason).
3. Lack of young healthy people signing up for insurance (this would be helped by strengthening the individual mandate, rather than eliminating it as Republicans plan to do).

Anyway, Obamacare is basically working. What we need is some approach to actually lowering medical costs now that everyone has insurance. Some thoughts on this:

1. Get Republican states to accept medicaid expansion, so we don't all have to subsidize uninsured people getting medical care through the emergency room!
2. Demand more visibility into how hospitals price procedures.
3. Allow Medicare to negotiate directly with drug companies.
4. Some sort of price controls as a part of the deal when companies use the patent process to enforce a monopoly on a life-saving drug or procedure.
5. Some reworking of the medical lawsuit system.
6. Add a public option (medicare/medicaid buy-in)?

Thing is, the Republican bill is not really doing those things. They are just chopping money from premium supports and medicaid in order to give a big tax cut (mostly to the wealthy). There is no world where cutting federal spending on medical care reduces premiums or deductables!

[Winstonm]

mike777, on 2017-July-01, 15:01, said:

OK Winston you are against the markets making the decisions and prefer a King to make the decisions. However you are also in favor of crony capitalism working for the King to at least pay for health care.

No, Mike. You are dead wrong.

I am arguing that a basic level of healthcare is not a commodity and therefore should not be bought and sold as if it were.

I am arguing that in a representative democracy - a republic, which, oh, by the way, is what we in the U.S. live in - that our representatives have been empowered to make decisions on our behalf.

There is only a king in your fantasies.

[Winstonm]

For the anti-ACA crowd consider this from 1993 in response to Clinton's working on a healthcare bill.

Quote

Republican Sen. John Chafee of Rhode Island introduced, Health Equity and Access Reform Today, had a list of 20 co-sponsors that was a who’s who of Republican leadership. There was Minority Leader Bob Dole, R- Kan., Sens. Orrin Hatch, R-Utah, Charles Grassley, R-Iowa, Richard Lugar, R-Ind., and many others. There also were two Democratic co-sponsors.

Among other features, the Chafee bill included:

An individual mandate;

Creation of purchasing pools;

Standardized benefits;

Vouchers for the poor to buy insurance;

A ban on denying coverage based on a pre-existing condition.

[ldrews]

awm, on 2017-July-01, 15:10, said:

Obamacare has been pretty successful at what it sought to do, which is to reduce the number of uninsured and reduce the number of medical-related bankruptcies. The number of Americans with no insurance has gone down approximately by half (and it would be even better if Republican-run states had expanded medicaid). Of course, the cost of medical care has continued to increase, but the projections for Obamacare were that it would reduce the cost when compared to the prior status quo -- in other words, by reducing the rate of increase, not by causing an absolute decrease. This has happened! To the degree that exchanges are "collapsing" and insurers pulling out, there are a lot of reasons for this:

1. Uncertainty as to whether the premium support payments for low-income people will actually be paid by the feds. This uncertainty was created by the Trump administration, which has threatened multiple times to pull the payments.
2. Attempts to pressure the federal government to allow mergers of large insurance providers (for example Aetna has pulled out of several profitable markets for this reason).
3. Lack of young healthy people signing up for insurance (this would be helped by strengthening the individual mandate, rather than eliminating it as Republicans plan to do).

Anyway, Obamacare is basically working. What we need is some approach to actually lowering medical costs now that everyone has insurance. Some thoughts on this:

1. Get Republican states to accept medicaid expansion, so we don't all have to subsidize uninsured people getting medical care through the emergency room!
2. Demand more visibility into how hospitals price procedures.
3. Allow Medicare to negotiate directly with drug companies.
4. Some sort of price controls as a part of the deal when companies use the patent process to enforce a monopoly on a life-saving drug or procedure.
5. Some reworking of the medical lawsuit system.
6. Add a public option (medicare/medicaid buy-in)?

Thing is, the Republican bill is not really doing those things. They are just chopping money from premium supports and medicaid in order to give a big tax cut (mostly to the wealthy). There is no world where cutting federal spending on medical care reduces premiums or deductables!

Thank you for a thoughtful, substantive post.

Indeed, Obamacare has been successful in increasing the percentage of the public that have health insurance. Unfortunately it is becoming an empty success for many. The premium and deductible increases have essentially made many families self insured. I assume this was not the intent.

I recently read an article that indicated that 60% of Obamacare hospitial charges of <$500 in 2016 are still unpaid, 85% of charges >$1000. The families/individuals simply don't have the money.

[Winstonm]

ldrews, on 2017-July-01, 15:53, said:

Thank you for a thoughtful, substantive post.

Indeed, Obamacare has been successful in increasing the percentage of the public that have health insurance. Unfortunately it is becoming an empty success for many. The premium and deductible increases have essentially made many families self insured. I assume this was not the intent.

I recently read an article that indicated that 60% of Obamacare hospitial charges of <$500 in 2016 are still unpaid, 85% of charges >$1000. The families/individuals simply don't have the money.

From Money:

Quote

Health Department officials acknowledge that Obamacare premiums and deductibles can be pricey, especially for those who don't qualify for subsidies.
"These costs are largely a symptom of the fact that medical costs in this country are extraordinarily high," said Kevin Counihan, CEO of the federal exchange, healthcare.gov. "We have an 800-lb gorilla here, which is exploding health care costs."

This is a huge problem with no easy or quick solutions.

[barmar]

ldrews, on 2017-July-01, 15:53, said:

I recently read an article that indicated that 60% of Obamacare hospitial charges of <$500 in 2016 are still unpaid, 85% of charges >$1000. The families/individuals simply don't have the money.

And the solution is to reduce subsidies for the poor and reduce taxes for the rich? The people who can't afford their medical bills under Obamacare still won't be able to afford them under Trumpcare.

[ldrews]

barmar, on 2017-July-01, 20:09, said:

And the solution is to reduce subsidies for the poor and reduce taxes for the rich? The people who can't afford their medical bills under Obamacare still won't be able to afford them under Trumpcare.

So you are saying there is no downside to Trumpcare?

[mike777]

barmar, on 2017-July-01, 20:09, said:

And the solution is to reduce subsidies for the poor and reduce taxes for the rich? The people who can't afford their medical bills under Obamacare still won't be able to afford them under Trumpcare.

Barmar you seem to miss the big main point of your own post. People cannot afford their medical bills under Obamacare.


Posters in this forum seem to have just given up on asking the big main question...what can we as a nation do to get people to afford their own medical bills, posters just give up.


Look at Winston who always answers we need a KIng to pay for their bills, citizens will never be able to pay on their own.


The big really big success of Obama was to change the discussion from not how can citizens pay for care but how can we get DC to pay for it. He was successful in changing the discussion from how can the individual pay for it to how can the collective pay for it.

[Winstonm]

mike777, on 2017-July-01, 23:14, said:

Barmar you seem to miss the big main point of your own post. People cannot afford their medical bills under Obamacare.unless they are wealthy.

FYP


Posters in this forum seem to have just given up on asking the big main question...what can we as a nation do to get people to afford their own medical bills, posters just give up. so healthcare is affordable for all?
FYP

Look at Winston who always answers we need a KIng to pay for their bills, citizens will never be able to pay on their own.
Look at me - I think the market is a god!
FYP

The big really big success of Obama was to change the discussion from not how can citizens pay for care but how can we get DC to pay for it. He was successful in changing the discussion from how can the individual pay for it to how can the collective pay for it.

FYP

You're welcome.

[jogs]

mike777, on 2017-July-01, 08:03, said:

OK but you seem unaware of the most important point.

the fed govt is YOU.

your post reflects the attitude of many posters here...the fed govt is someone else paying the bills...not you.

The fed govt is someone else as long as you don't pay taxes.

[jogs]

ldrews, on 2017-July-01, 15:53, said:

I recently read an article that indicated that 60% of Obamacare hospitial charges of <$500 in 2016 are still unpaid, 85% of charges >$1000. The families/individuals simply don't have the money.

I favor freezing out the health insurers. The GOP plan was to give insurers $100B. Give them nothing.
The working poor should be subsidized. They would only be required to pay a portion of the bill. Each must submit their finances to the agency in charge of the program. Give the $100B to this program.