RebKell's Junkie Boards

[GlennMacGrady]

[mercfan3]

[jammerbirdi]

I guess you're taking something I said in another thread and maybe remembering someone's dishonest trolling misrepresentation of it. Or you're clairvoyant and just reading my thoughts. Because yeah, me and justin are on the same page.

I don't really want to write things like, this is how politics works, but in some people's case it seems almost necessary.

Years before we can or will EVER get universal health care coverage established in this country, that much-demogogued proposition will have to be brought seriously into the public discussion. It will have to be brought into the mainstream of public discourse. Notice my repeated use of the verb brought. And then it's going to have to marinate in the hearts and minds of the American people for a long time. It will have to be taken and treated seriously by the political elites of this country and by the chattering classes of the establishment media. And, to get even to that point, much will have to be done to break down all the many barriers to it ever actually being treated as a serious proposition, the seen and the many that are unseen, the tentacles that have wrapped themselves around the profits and the rewards of the system as it exists today.

We are not anywhere near there. Universal health care has had its ass kicked so many times in the past few decades that it has seemed since the passage of Obamacare that it would now be considered permanently off of the table. So in that context, and in the dangerous atmosphere of a Republican president and Republican congress circling the ACA with an eye to repealing it without providing anything that's even equal to it, let alone better, here we have single payer health care once again thrown into the discussion.

By a lone congressman? A controversial documentary filmmaker? No. Not this time. This time it is being put forth by a GROUP of mother fucking United States Senators. One thing that is always made painfully evident here, is that you can't count on people understanding politics. But the United States Senate is, as much as anything in this country, a bought and paid for representation of the sold out thing we call the American political system. But not Bernie Sanders. Not Al Franken. Not Elizabeth Warren. Not Kamila Harris. Not Kirstin Gillibrand. And not quite a few other United States Senators who have decided that the time has come not only to BRING this idea up to the highest levels of the US government, but to legitimize it by giving an actual bill their endorsement and support.

The reason YOU don't like any of this, mercfan3, is because you suffer as much from a hatred for Bernie Sanders as your political hero does. Let's call it what it truly is. Bernie Derangement Syndrome. And right at the moment Bernie Sanders and a dozen or more other Democratic US senators have put forward this unprecedented bill offering up single payer for all healthcare in America, it happened to inconveniently coincide with Hillary's book tour and her scorn for Bernie Sanders and all the inflammatory reasoning behind it coming into public view. And so POOF!, you're incensed at Bernie Sanders all over again. Her pain is still fresh and, of course, we all have to feel her pain and so now your pain is fresh again also. Such is the danger and damage of Hillary Clinton rearing up and trying to settle scores when the rest of us would like to move on to something that looks like actual progress.

And so this effort by a heroic group of progressive US senators gets no support and instead nothing but scorn from progressive you. And doubtless the repulsion you feel at seeing Bernie Sanders netting all this attention at this moment will have been replicated in the hearts and minds of so much of Hillary Clinton's fan base. It's damaging. You are living proof. That's what I said, that's what I meant, and that's what a resident troll here dishonestly misrepresented.

You pull up a piece in the Washington Post by an absolutely junior pundit who never in her legacy student at Princeton short life has ever had to worry about where her health care coverage was going to come from. A piece that is as superficial a treatment of the merits of any policy as I've ever seen. But you linked to it! lol. And added, Typical of Sanders.

I say typical of Bernie Derangement Syndrome.

[GlennMacGrady]

[PUmatty]

[ArtBest23]

[Howee]

[PUmatty]

[ArtBest23]

[GlennMacGrady]

I didn't say the teacher's virtually unlimited healthcare coverage was "free"; I said it was an example of the kind of social program "free lunch" mentality that ends up bankrupting. That's because it's of course NOT FREE, but is paid for by present and future taxpayer money other than the teacher's.

Which brings up the whole subject of public unions, a concept that is a contradiction in terms -- an oxymoron -- which should be illegal. How can public employees "bargain" on economically rational terms with themselves? There is no management vs. employees in public employment. Everyone's a public employee, so there's little incentive to contain pension and healthcare costs.

Many of the highest paying jobs are now in the public sector, as are the highest pensions, and as are richest healthcare plans. Federal and some state employees have the closest thing to the idealized no-pay health plans we are discussing. Congress even exempts themselves and other federal employees from the taxes, restrictions, rationing and other utilization tools in Obamacare.

Providing reasonable health care for all will have to address the Kryptonite plans that many public employees have, mostly paid for by other taxpayer's money. That political reality will create substantial resistance by the public employees, including virtually all politicians themselves, to any national health plan that they perceive to be a "take away".

Hartford, Connecticut, may be one of the next to go bankrupt. In that process, the federal court system will likely end up taking away public employee pension and retirement benefits.

_________________
http://www.youtube.com/MagicBusBasketball

[ArtBest23]

[GlennMacGrady]

"Free" is being ambiguously used in two ways: the underlying funding mechanism, which of course is never free; and the out-of-pocket costs for medical services under various plans, which is what we are mostly talking about.

Out-of-pocket costs include the premiums + the deductibles + the copay percentages or amounts. Closely connected, and also affecting out-of-pocket costs, are the geographic scope of the network and how many doctors and hospitals are in it, and also the number of medical procedures that are excluded or rationed.

(I'd be curious to know the annual deductible for federal plans.)

Let's put aside the comparable salary issue for private vs. public employees. Let's even put aside the pensions. And I'll put aside my strong feeling against public unionization. Let's just focus on the healthcare plans available to pre-Medicare public vs. private employees who are both working and retired.

Perhaps it's true that no plan today truly has zero out-of-pocket costs. But it used to be the case in many plans not that long ago (last century).

As a general rule, I believe the medical plans that have the least out-of-pocket costs are: federal plans and some rich state plans; then most of the rest of the state plans; then the average private employer plans (skipping the Rolls Royce plans available to top execs); and lastly the unsubsidized Obamacare plans that are the primary subject of this topic. Of course, there may be a lot of various options within each of these categories, but my sense is that this is generally the current hierarchy of out-of-pocket cost tiers.

If healthcare is a human right, most people will interpret that to mean we all have the same rights. A human right to free speech, for example, can't mean speech is free for all words for federal employee but only for words beginning with consonants for private employees.

Thus, one of my political feasibility points is that a national healthcare system, which supersedes everything, should equalize benefits and out-of-pocket costs for everyone. But that will inevitably mean some sort of "take-away" from the people who currently are in the most favorable out-of-pocket cost tier. They will be strong opponents of an equalizing national system, and that tier includes all the federal legislators.

The only utopian way out of this kind of political opposition would be a national system that covers everything and which has no out-of-pocket costs, as JIT apparently thinks can be the case. I think that is completely impossible as a matter of national budget economics, and I bet Bernie Sanders would agree.

Medicare-for-all, if modeled on original Medicare or any of the alternative plans, will have plenty of deductibles, copays, coinsurances, non-coverages, rationings, and other utilization-deterring features.

_________________
http://www.youtube.com/MagicBusBasketball

[ArtBest23]

[ArtBest23]

[GlennMacGrady]

[GlennMacGrady]

[Howee]

I cannot wrap my head around all the technical layers of this debate, but:

To my earlier point re: who's getting rich? I'm currently touring Canada. My host utilizes the same form of insulin I do (Tujeo injectable pen). He picked his up today. Cost to his insurance: $91. The exact same product in my town: $1200 billed to my insurance. I know that's only a tiny facet on this disco ball of a debate, but again....why the diff?

_________________
Oregon: Go Ducks!
"Inévitablement, les canards voleront"

[mercfan3]

[ArtBest23]

Or, the number of doctors who opt out of the Government plan could well skyrocket, creating parallel govt/private healthcare systems based on ability to pay.

Illustrative is this passage from a recent Kaiser Foundation report:

"EFFECTS OF PRIVATE CONTRACTING ON MEDICARE BENEFICIARIES’ OUT-OF-POCKET COSTS

Under current law, when a patient sees a physician who is a “participating provider” and accepts assignment, as most do, Medicare pays 80 percent of the fee schedule amount and the patient is responsible for the remaining 20 percent. For example, for a colonoscopy with biopsy, which is about $500 on Medicare’s fee schedule, Medicare pays $400 and the patient is responsible for the remaining $100. If the physician is a “non-participating provider,” he or she is permitted to balance bill Medicare patients up to a maximum of 115 percent of a reduced fee schedule amount. In this example, the beneficiary’s liability would rise to $166, rather than $100 (Appendix Table 2).

However, if a physician opts out of Medicare and privately contracts with his or her Medicare patients, the amount that physician may charge is not limited by Medicare; the patient is responsible for whatever the physician charges for a given service, as specified in their contract. If, in the example above, that physician charges the average out-of-network charge among private insurers, about $1,200, rather than $500, the patient is responsible for the full $1,200—a substantially higher amount than otherwise required.4 It is important to note, however, that this example is illustrative and there is no cap on the amount physicians can charge their patients under private contracts."

The key phrase is "the average out-of-network charge among private insurers, about $1,200, rather than $500.". In other words, Medicare is paying far less than the going commercial rate. The doctor can accept the $500 for a limited number of Medicare patients because he is getting $1200 for other patients. So what happens when everybody is in the same government health plan which sets a fee of $500 or $250? How many doctors decline to participate completely, how many go work for drug companies or find something else to do with their time? What happens when the government plan no longer has commercially insured patients subsidizing its unrealistically low fee schedules? How high do the mandatory premiums go then? And how big a provider shortage results?

We would likely end up with a two tier system like much of Europe where people who can afford it can buy better private insurance or pay out of pocket for better or more comprehensive care or fewer delays, or for their choice of the best doctors and hospitals. What then happens politically when the majority of people realize they're being excluded from the best care and that the rich are getting better health care services?

[ArtBest23]

[ArtBest23]

I wish people would stop merging universal and single payer and using the terms as if they are equivalent or interchangeable. They're not.

The critical thing is to get mandatory universal healthcare coverage. Single payer is but one way to do that; in my view not even close to being the best or most desirable way.

The Supreme Court, btw, threw a big ( and in my view unnecessary and incorrect) monkey wrench into the process when they made up from nothing that simply mandating people's participation is unconstitutional. So we're left with having to structure it as a tax, which is far from ideal, particularly if you want to structure the system using commercial payers rather than a giant medicare program.

[GlennMacGrady]

[jammerbirdi]

It's hard arguing with you, mercfan3.



Here's why. Young senators. Said it three times so it must be true, right?

[pilight]

2/3 of the senate is 60 or older. None of them are under 40. The ones under 50 are overwhelmingly Republicans.

_________________
I'm a lonely frog
I ain't got a home

[justintyme]

Outstanding article in the LA Times.

There are 3 types of single-payer 'concern trolls' — and they all want to undermine universal healthcare