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ArtBest23
Joined: 02 Jul 2013 Posts: 14550
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Posted: 03/16/17 1:53 pm ::: |
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justintyme wrote: |
the ACA is the basic framework which offers a market based system to achieve universal coverage. There are tweaks that can make it better and actually universal if both sides are willing to commit to it, but outside of that frame work I don't know of an actual market solution (mostly because health care is nore of a public service than it is a market commodity, and thus "free markets" will never achieve that goal alone without major government involvement).
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I completely disagree with all of this.
The ACA isn't a decent framework for anything. It's a cribbed together mess by people who didn't believe in what they were doing and actually just wanted a huge government social program. It's a mess and a bad joke and was doomed to be an expensive, unsatisfactory mess, which it is.
The starting problem in your response is failing to acknowledge that delivery of health care and payment for health care are two different things.
Health insurance is certainly not a "public service" and most definitely is amenable to market solutions based on sound actuarial principals just like every other type of insurance.
The delivery of healthcare services is a separate issue that requires some degree of regulation, as it always has.
It's just not that difficult if you let the experts instead of the politicians design it.
You want to see what a mess a single payer government system looks like? There is no more wasteful, inefficient, expensive system, than the Tricare program.
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justintyme
Joined: 08 Jul 2012 Posts: 8407 Location: Northfield, MN
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Posted: 03/16/17 2:30 pm ::: |
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ArtBest23 wrote: |
The starting problem in your response is failing to acknowledge that delivery of health care and payment for health care are two different things.
Health insurance is certainly not a "public service" and most definitely is amenable to market solutions based on sound actuarial principals just like every other type of insurance. |
Not really. Health insurance is all about risk. In order to keep premiums down the insurance companies either need to be able to cap what pay out, exclude people that pose to much risk for them (or else be able to charge them insane amounts like auto "risk" insurance), and simply deny coverage to people that will cost them too much money (pre-existing conditions). If the government is going to stop them from being able to do these things it is going to raise the costs for everyone, because the market demand for this insurance will always be significantly higher from people who feel they are at risk. Healthy people, when left to their own devices will mostly opt to do without.
The first way you counter this is by the government forcing low risk people to also purchase insurance to balance out the demand from high risk. Thus you have the individual mandate.
The second way is to offer risk corridors in which the government compensates insurers for taking on high risk individuals.
This is the basic principle behind the ACA.
But I am confused on how you think we achieve universal health care without universal insurance coverage? Left to its own devices, a free market healthcare system would only provide its service to what people could afford. It would prioritize the wealthy and give better service to those who can pay for it.
The answer to this is government mandated equitable service from health care providers. But if you mandate this, you need to be able to make sure the providers are compensated, which is where insurance becomes a factor.
The way our healthcate system works, if we want to ensure that everyone has full access to comprehensive, quality healthcare we need to make sure everyone has access to affordable comprehensive health insurance. Otherwise seeing a doctor, having non life or death surgery, preventative care, and managing cetain chronic conditions becomes a financial decision rather than a health decision and that is what needs to be stopped.
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ArtBest23
Joined: 02 Jul 2013 Posts: 14550
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Posted: 03/16/17 3:19 pm ::: |
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justintyme wrote: |
Not really. Health insurance is all about risk. In order to keep premiums down the insurance companies either need to be able to cap what pay out, exclude people that pose to much risk for them (or else be able to charge them insane amounts like auto "risk" insurance), and simply deny coverage to people that will cost them too much money (pre-existing conditions). If the government is going to stop them from being able to do these things it is going to raise the costs for everyone, because the market demand for this insurance will always be significantly higher from people who feel they are at risk. Healthy people, when left to their own devices will mostly opt to do without.
The first way you counter this is by the government forcing low risk people to also purchase insurance to balance out the demand from high risk. Thus you have the individual mandate.
The second way is to offer risk corridors in which the government compensates insurers for taking on high risk individuals.
This is the basic principle behind the ACA.
But I am confused on how you think we achieve universal health care without universal insurance coverage? Left to its own devices, a free market healthcare system would only provide its service to what people could afford. It would prioritize the wealthy and give better service to those who can pay for it.
The answer to this is government mandated equitable service from health care providers. But if you mandate this, you need to be able to make sure the providers are compensated, which is where insurance becomes a factor.
The way our healthcate system works, if we want to ensure that everyone has full access to comprehensive, quality healthcare we need to make sure everyone has access to affordable comprehensive health insurance. Otherwise seeing a doctor, having non life or death surgery, preventative care, and managing cetain chronic conditions becomes a financial decision rather than a health decision and that is what needs to be stopped. |
You're missing so much of the picture regarding management of utilization. This is why they need the pros because lay people and politicians just don't understand.
And the reason they're separate is because anyone is free to get any care from any doctor they choose. They just can't always expect someone else to pay for it. No different than saying anyone can buy any car, but not everyone can afford any car.
Basic healthcare should be available to all. That doesn't mean everyone is entitled to Cadillac health care. Everyone's entitled to food and clothing too, but that doesn't mean everyone's entitled to lobster and Jimmy Choo shoes. Everyone should get cancer treatment, but maybe everyone can't get a private room at Mayo.
You know, everyone pays the same thing for each of the 100+ plans provided by the FEHBA program regardless of age, sex, health or other actuarial factors. There are no "risk corridors" or other rubbish. Yet there are no shortage of companies eager to participate.
The left wants to pretend it's far more complicated than it is as their excuse for saying creating the world's biggest social welfare program and government control of peoples' lives is the only choice. It's bullshit.
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justintyme
Joined: 08 Jul 2012 Posts: 8407 Location: Northfield, MN
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Posted: 03/16/17 4:04 pm ::: |
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ArtBest23 wrote: |
Basic healthcare should be available to all. That doesn't mean everyone is entitled to Cadillac health care. Everyone's entitled to food and clothing too, but that doesn't mean everyone's entitled to lobster and Jimmy Choo shoes. Everyone should get cancer treatment, but maybe everyone can't get a private room at Mayo. |
People should be entitled to what their health dictates they need. If their health issue requires a Mayo specialist, then they should have access to it. I doubt health would dictate the need of a "private room".
Not everyone should be entitled to a Cadillac, but they definitely are entited to a car with brakes, airbag, and the like.
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ArtBest23
Joined: 02 Jul 2013 Posts: 14550
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Posted: 03/16/17 4:18 pm ::: |
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justintyme wrote: |
ArtBest23 wrote: |
Basic healthcare should be available to all. That doesn't mean everyone is entitled to Cadillac health care. Everyone's entitled to food and clothing too, but that doesn't mean everyone's entitled to lobster and Jimmy Choo shoes. Everyone should get cancer treatment, but maybe everyone can't get a private room at Mayo. |
People should be entitled to what their health dictates they need. If their health issue requires a Mayo specialist, then they should have access to it. I doubt health would dictate the need of a "private room".
Not everyone should be entitled to a Cadillac, but they definitely are entited to a car with brakes, airbag, and the like. |
No, everyone is NOT "entitled" to the #1 specialist in the world for whatever ails them. That's absurd dreamland stuff.
Everyone should receive mainstream, medically accepted course of treatment by competent and qualified health care personnel.
If they want more than that, they can pay for it themselves. Just like they can buy their own Jimmy Choos.
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justintyme
Joined: 08 Jul 2012 Posts: 8407 Location: Northfield, MN
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Posted: 03/16/17 4:27 pm ::: |
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ArtBest23 wrote: |
No, everyone is NOT "entitled" to the #1 specialist in the world for whatever ails them. That's absurd dreamland stuff.
Everyone should receive mainstream, medically accepted course of treatment by competent and qualified health care personnel.
If they want more than that, they can pay for it themselves. Just like they can buy their own Jimmy Choos. |
Then this is where we fundementally disagree. Rich and poor alike have the same value to their lives. If someone's condition cannot be adequately treated by the local doctor and they require a specialist to tackle their extremely rare form of cancer, or incredibly complicated heart condition, then they should have access to that person. It should be the health needs of the individual to see that specialist, not the individual's wealth.
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ArtBest23
Joined: 02 Jul 2013 Posts: 14550
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Posted: 03/16/17 4:45 pm ::: |
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justintyme wrote: |
ArtBest23 wrote: |
No, everyone is NOT "entitled" to the #1 specialist in the world for whatever ails them. That's absurd dreamland stuff.
Everyone should receive mainstream, medically accepted course of treatment by competent and qualified health care personnel.
If they want more than that, they can pay for it themselves. Just like they can buy their own Jimmy Choos. |
Then this is where we fundementally disagree. Rich and poor alike have the same value to their lives. If someone's condition cannot be adequately treated by the local doctor and they require a specialist to tackle their extremely rare form of cancer, or incredibly complicated heart condition, then they should have access to that person. It should be the health needs of the individual to see that specialist, not the individual's wealth. |
A specialist doesn't mean "world renowned specialist".
Just because you need an orthopedist doesn't mean insurance needs to pay for you to be treated by Dr James Andrews.
If you need to mischaracterize what I said in order to make your argument work, maybe it's because your position is indefensible.
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cthskzfn
Joined: 21 Nov 2004 Posts: 12851 Location: In a world where a PSYCHOpath like Trump isn't potus.
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Posted: 03/16/17 4:47 pm ::: |
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ArtBest23 wrote: |
justintyme wrote: |
the ACA is the basic framework which offers a market based system to achieve universal coverage. There are tweaks that can make it better and actually universal if both sides are willing to commit to it, but outside of that frame work I don't know of an actual market solution (mostly because health care is nore of a public service than it is a market commodity, and thus "free markets" will never achieve that goal alone without major government involvement).
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I completely disagree with all of this.
The ACA isn't a decent framework for anything. It's a cribbed together mess by people who didn't believe in what they were doing and actually just wanted a huge government social program. It's a mess and a bad joke and was doomed to be an expensive, unsatisfactory mess, which it is.
The starting problem in your response is failing to acknowledge that delivery of health care and payment for health care are two different things.
Health insurance is certainly not a "public service" and most definitely is amenable to market solutions based on sound actuarial principals just like every other type of insurance.
The delivery of healthcare services is a separate issue that requires some degree of regulation, as it always has.
It's just not that difficult if you let the experts instead of the politicians design it.
You want to see what a mess a single payer government system looks like? There is no more wasteful, inefficient, expensive system, than the Tricare program. |
A one page bill: The age requirement for Medicare is birth.
Medicare for all.
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justintyme
Joined: 08 Jul 2012 Posts: 8407 Location: Northfield, MN
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Posted: 03/16/17 5:02 pm ::: |
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ArtBest23 wrote: |
justintyme wrote: |
ArtBest23 wrote: |
No, everyone is NOT "entitled" to the #1 specialist in the world for whatever ails them. That's absurd dreamland stuff.
Everyone should receive mainstream, medically accepted course of treatment by competent and qualified health care personnel.
If they want more than that, they can pay for it themselves. Just like they can buy their own Jimmy Choos. |
Then this is where we fundementally disagree. Rich and poor alike have the same value to their lives. If someone's condition cannot be adequately treated by the local doctor and they require a specialist to tackle their extremely rare form of cancer, or incredibly complicated heart condition, then they should have access to that person. It should be the health needs of the individual to see that specialist, not the individual's wealth. |
A specialist doesn't mean "world renowned specialist".
Just because you need an orthopedist doesn't mean insurance needs to pay for you to be treated by Dr James Andrews.
If you need to mischaracterize what I said in order to make your argument work, maybe it's because your position is indefensible. |
Except that I have never argued to that specific of a case. Itam only saying that health should dictate, not finances. If a local doctor or a local specialist can take care of your health issue there is no reason to go to the #1 doctor. If your case can only be solved by that #1 doctor than you should have the ability to see that doctor. That is as far as I am going with my argument. Which is actually the way that the Mayo currently takes on clients.
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ArtBest23
Joined: 02 Jul 2013 Posts: 14550
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Posted: 03/16/17 5:43 pm ::: |
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cthskzfn wrote: |
ArtBest23 wrote: |
justintyme wrote: |
the ACA is the basic framework which offers a market based system to achieve universal coverage. There are tweaks that can make it better and actually universal if both sides are willing to commit to it, but outside of that frame work I don't know of an actual market solution (mostly because health care is nore of a public service than it is a market commodity, and thus "free markets" will never achieve that goal alone without major government involvement).
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I completely disagree with all of this.
The ACA isn't a decent framework for anything. It's a cribbed together mess by people who didn't believe in what they were doing and actually just wanted a huge government social program. It's a mess and a bad joke and was doomed to be an expensive, unsatisfactory mess, which it is.
The starting problem in your response is failing to acknowledge that delivery of health care and payment for health care are two different things.
Health insurance is certainly not a "public service" and most definitely is amenable to market solutions based on sound actuarial principals just like every other type of insurance.
The delivery of healthcare services is a separate issue that requires some degree of regulation, as it always has.
It's just not that difficult if you let the experts instead of the politicians design it.
You want to see what a mess a single payer government system looks like? There is no more wasteful, inefficient, expensive system, than the Tricare program. |
A one page bill: The age requirement for Medicare is birth.
Medicare for all. |
You left out line three.
Every morning the Secretary of the Treasury will pick the necessary dollars off the money tree growing on the White House South lawn. If on any morning there aren't enough ripe dollars on the money tree, the Secretary will gather an egg from the Golden Goose.
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justintyme
Joined: 08 Jul 2012 Posts: 8407 Location: Northfield, MN
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Posted: 03/16/17 6:47 pm ::: |
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Single payer has its issues, but one of them is not government expense. Empirically, costs come down and because it gets paid out of payroll taxes everyone is included in the risk pool. No longer is the government paying to subsidize which eliminates the need for Medicaid spending and it basically collects its premiums from the public. For the most part people just pay what they would have to a private insurer to the government instead. With the elimination of much of the administration costs and the ability to dictate prices, people actually pay less in the long run. It also eliminates administration costs of businesses, especially medium sized businesses, by getting them out of the health insurance game.
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ArtBest23
Joined: 02 Jul 2013 Posts: 14550
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Posted: 03/16/17 7:04 pm ::: |
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justintyme wrote: |
No longer is the government paying to subsidize which eliminates the need for Medicaid spending and it basically collects its premiums from the public. For the most part people just pay what they would have to a private insurer to the government instead. With the elimination of much of the administration costs and the ability to dictate prices, people actually pay less in the long run. It also eliminates administration costs of businesses, especially medium sized businesses, by getting them out of the health insurance game. |
No subsidies. Really? So you're not planning on covering un- or under-employed? Interesting.
Eliminates much of the administrative costs - Really? Because government run programs like Medicare, Medicaid, VA, are so efficient and devoid of waste and fraud. Gee I must have forgotten that.
I guarantee you it will cost the government at least double what it costs private industry to provide the same care.
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justintyme
Joined: 08 Jul 2012 Posts: 8407 Location: Northfield, MN
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Posted: 03/16/17 7:51 pm ::: |
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ArtBest23 wrote: |
justintyme wrote: |
No longer is the government paying to subsidize which eliminates the need for Medicaid spending and it basically collects its premiums from the public. For the most part people just pay what they would have to a private insurer to the government instead. With the elimination of much of the administration costs and the ability to dictate prices, people actually pay less in the long run. It also eliminates administration costs of businesses, especially medium sized businesses, by getting them out of the health insurance game. |
No subsidies. Really? So you're not planning on covering un- or under-employed? Interesting.
Eliminates much of the administrative costs - Really? Because government run programs like Medicare, Medicaid, VA, are so efficient and devoid of waste and fraud. Gee I must have forgotten that.
I guarantee you it will cost the government at least double what it costs private industry to provide the same care. |
Then why is it much more efficient in every other country that has it?
There will be waste and fraud, but there is in the current system as well. But you get rid of advertising, executive pay and other labor costs, redundant positions, sales people, etc. And the government struggles with half in and half out programs. Going all in on healthcare would actually help programs like the VA.
As far as subsidies, it would be the government paying itself. In other words there would be no increase in cost from what they currently pay out in healthcare. Yet they would take in more money since it will not be paid out to insurance companies by the people, but be paid to the gov.
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ArtBest23
Joined: 02 Jul 2013 Posts: 14550
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Posted: 03/16/17 9:13 pm ::: |
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It's the Democrats' wet dream. The biggest, most expensive, most wasteful, most bureaucratic, most intrusive social welfare program in the history of mankind.
Hundreds of thousands of government jobs. Hundreds of billions of dollars in new taxes and new debt. A massive government database of every personal detail about every single American. And once created and with its tenacles deeply imbedded into every person in the country, no way to ever undo it. Every American completely dependant on the Government for their very survival. And no one with any personal choice or control.
It would be the destruction of the America that two hundred years of Americans intended to exist.
I'm not some nutjob right wing zealot and even I can see this for the disaster it would be.
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justintyme
Joined: 08 Jul 2012 Posts: 8407 Location: Northfield, MN
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Posted: 03/16/17 9:52 pm ::: |
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Why would the US face something that no other country has faced? This is not what has happened elsewhere. Lower costs, more people covered. I don't know why it is assumed that it would be different here. The track record is just about universally positive.
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Howee
Joined: 27 Nov 2009 Posts: 15755 Location: OREGON (in my heart)
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Posted: 03/16/17 11:24 pm ::: |
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I have always conceded my inability to comprehend the complex economics of something like this, but....like Justin....I look to the examples of countries where single payer operates just fine. I have 20+ Canadian friends (with various health concerns) who vouch for that. They can't all be mistaken. I only know one German, who says their system is great.
Yes, we have many more citizens than either one of those places, but....we're also a wealthier nation than either, no? Why can't the model operate here, too?
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justintyme
Joined: 08 Jul 2012 Posts: 8407 Location: Northfield, MN
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Posted: 03/17/17 12:52 am ::: |
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To be fair, the German system is not actually true single payer. There are about 200 odd insurance companies that compete, though they are all heavily regulated (no deductibles or copays allowed). They also auto enroll all their citizens in a predetermined plan if they fail to find one themselves. But the premiums are paid to the government by a straight 8% tax on everyone, who then pays the insurers based on the number they cover.
http://m.startribune.com/want-a-new-health-care-model-the-germans-do-it-right/411702466/
IMO, it was the ACA principles done right.
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pilight
Joined: 23 Sep 2004 Posts: 67058 Location: Where the action is
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Posted: 03/17/17 7:09 am ::: |
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FWIW, at least one prominent Republican agrees with Justintyme...
http://www.advocate.com/election/2015/9/28/read-donald-trumps-advocate-interview-where-he-defends-gays-mexicans
Donald Trump wrote: |
I would press for universal health care. It’s ridiculous that the richest country on Earth can’t provide first-rate health care for our people. I would put forward a comprehensive health care program and fund it with an increase in corporate taxes. I’d strictly regulate the pharmaceutical firms to end these 500% profits on drugs that are cheap to produce. I like the Canadian system, although their health care is not the best. If you combine their system with the quality of our health care, we could provide cradle-to-grave health care for everyone. |
_________________ I'm a lonely frog
I ain't got a home
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ArtBest23
Joined: 02 Jul 2013 Posts: 14550
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Posted: 03/17/17 11:01 am ::: |
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justintyme wrote: |
Why would the US face something that no other country has faced? This is not what has happened elsewhere. Lower costs, more people covered. I don't know why it is assumed that it would be different here. The track record is just about universally positive. |
I always love it when people say "well X program seems to work in a much smaller, more homogenous country with an entirely different history regarding the structure, utilization, expectations, and costs of healthcare, so why wouldn't the same thing automatically work here? "
Ohhhhhhh, I don't know. . . . .
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ArtBest23
Joined: 02 Jul 2013 Posts: 14550
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Posted: 03/17/17 11:05 am ::: |
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pilight wrote: |
FWIW, at least one prominent Republican agrees with Justintyme...
http://www.advocate.com/election/2015/9/28/read-donald-trumps-advocate-interview-where-he-defends-gays-mexicans
Donald Trump wrote: |
I would press for universal health care. It’s ridiculous that the richest country on Earth can’t provide first-rate health care for our people. I would put forward a comprehensive health care program and fund it with an increase in corporate taxes. I’d strictly regulate the pharmaceutical firms to end these 500% profits on drugs that are cheap to produce. I like the Canadian system, although their health care is not the best. If you combine their system with the quality of our health care, we could provide cradle-to-grave health care for everyone. |
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And I don't think anyone here is questioning universal healthcare.
That doesn't remotely mean single payer, or government controlled or provided.
Basically Trump is saying "the Canadian system delivers shitty healthcare, but we should do it great here, like everything I do, it'll be fabulous, best ever."
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GlennMacGrady
Joined: 03 Jan 2005 Posts: 8254 Location: Heisenberg
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Posted: 03/24/17 12:28 pm ::: |
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I have no firm idea why Trump is pushing for a vote today on this horrible health care bill, appropriately nicknamed RINO-Care.
Superficially, he perhaps just wants a first legislative victory out of the chute of his campaign promises, no matter what's in it.
Alternatively, perhaps he really doesn't care too much what's in it because he knows the Senate will significantly change it.
Finally, and most cynically, he perhaps hopes the bill goes down in flames and that Paul Ryan gets smothered with the blame. Ryan is a singularly ineffective Congressman and leader, an 18 year member of the House who reportedly has passed THREE pieces of legislation in his entire career. He's exactly the kind of untrustworthy corporatist, globalist and infinite immigrationist -- unflaggingly disloyal to Trump during the campaign -- whom Trump should want to kill in the swamp.
Here's hoping that RINO-Care goes down in nuclear flames today and incinerates the feckless Ryan and the entire Republican "leadership" in the House. |
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pilight
Joined: 23 Sep 2004 Posts: 67058 Location: Where the action is
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Posted: 03/24/17 12:41 pm ::: |
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GlennMacGrady wrote: |
Superficially, he perhaps just wants a first legislative victory out of the chute of his campaign promises, no matter what's in it. |
This plan is absolutely nothing like what he was promising during the campaign
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GlennMacGrady
Joined: 03 Jan 2005 Posts: 8254 Location: Heisenberg
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Posted: 03/24/17 12:46 pm ::: |
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pilight wrote: |
GlennMacGrady wrote: |
Superficially, he perhaps just wants a first legislative victory out of the chute of his campaign promises, no matter what's in it. |
This plan is absolutely nothing like what he was promising during the campaign |
Absolutely correct . . . and why I'm hoping that possibility is just a "superficial" hypothesis by me. |
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ArtBest23
Joined: 02 Jul 2013 Posts: 14550
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Posted: 03/24/17 3:51 pm ::: |
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Well that's a hoot. Trump blaming the Democrats, that none of them would support his bill.
That's hardly a shock.
This bill was junk, and got worse when they sold out to the right wing by removing the minimum coverages and the like.
He isn't saying a word about the Koch Bros and other groups on the extreme right that threatened conservatives who voted yes.
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ArtBest23
Joined: 02 Jul 2013 Posts: 14550
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Posted: 03/24/17 3:53 pm ::: |
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Trump's theory is that Obamacare will collapse, and then some Democrats will want to work out a bipartisan bill. And then they can all put together a better bill.
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