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jammerbirdi



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PostPosted: 09/14/17 3:48 am    ::: Dems Push for Single Payer Reply Reply with quote

It's really HARD Shocked to find articles in the major papers that just REPORTS on the fact that Bernie Sanders and a handful of high-profile Senators are pushing for Medicare-for-all. I can't IMAGINE why that would be. Wink

Pretty much every one I've found is really a push back on the idea to varying degrees. This is about the mildest I've found. Well, I personally love the idea. I have NO doubt that most of America would be behind this and that most of the public criticism of Obamacare and even early efforts was due to the proposed plans not going far enough towards universal single-payer health coverage.

I don't have any doubt that the lower economic wing of Trump supporters would also be for this. And if there was ever anything approaching a plan that has come out of Trump's own mouth and personal thought process over the years and during the campaign, it WAS, if you all remember, something about Medicare for all, universal coverage, etc. So you just never can tell with this guy.

Who ISN'T on board? Chuck and Nancy and, oh, of course, the Granny Starving Republican establishment.

What say y'all?


cthskzfn



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PostPosted: 09/14/17 7:34 am    ::: Reply Reply with quote

I say Harry Truman had the right idea in 1945.

The most controversial aspect of the plan was the proposed national health insurance plan. In his November 19, 1945 address, President Truman called for the creation of a national health insurance fund to be run by the federal government. This fund would be open to all Americans, but would remain optional. Participants would pay monthly fees into the plan, which would cover the cost of any and all medical expenses that arose in a time of need. The government would pay for the cost of services rendered by any doctor who chose to join the program. In addition, the insurance plan would give a cash balance to the policy holder to replace wages lost due to illness or injury.

What did opponents say? Why this, of course. Sound familiar?

The American Medical Association (AMA) launched a spirited attack against the bill, capitalizing on fears of Communism in the public mind. The AMA characterized the bill as "socialized medicine", and in a forerunner to the rhetoric of the McCarthy era, called Truman White House staffers "followers of the Moscow party line".*

I say the people who say it can't work, that it's preposterous, that it will bankrupt the country, etc, are full of hooey.



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mercfan3



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PostPosted: 09/14/17 1:56 pm    ::: Reply Reply with quote

My opinion, for the past ten years (and only because that's when I began to get educated on Human Rights)..has been that Health Care is a human right. So that's where I stand. (Although, I'm not sure single payer is where we should go, but I wouldn't be opposed of it either)

If Bernie and co are serious about this, they need to come up with a serious bill. The one presented is pathetic, and clearly just a litmus test. Details matter. And if you propose a bad plan that means Dems take a loss, and we move a step further away from universal healthcare.

I'm interested in reading Murphy's bill.

Nancy is worried about protecting Obamacare. Which is legitimate considering Republicans control everything.



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GlennMacGrady



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PostPosted: 09/15/17 12:45 pm    ::: Reply Reply with quote

Whether health care is a human "right" is an interesting philosophical question that could not even have arisen until very modern times. In most societies throughout history, qualified medicine men were in very short supply and it was more of a luxury of wealth to be able to afford quality medical care.

Whatever health care is, it is not being provided by Obamacare. Obamacare does not provide health care. To some people, it provides health insurance policies, but the deductibles and premiums are so high as to render actual medical care back to the luxury status. To others, Obamacare provides a rationed and spotty medical care system (Medicaid) paid for by a bureaucratically circuitous redistribution of taxpayer wealth.

My own view is that insurance companies, and their state law protected profit margins, must be eliminated from any national health care scheme.

That leaves government funded, single payer health care a la Medicare. My own view is that this makes sense in many aspects.

EXCEPT:

And unfortunately, I have never seen any evidence that a "Medicare for all" plan would be remotely affordable to the nation -- unless there are substantial exceptions, limitations, rationings, and a host of other significant coverage holes.
justintyme



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PostPosted: 09/15/17 4:24 pm    ::: Reply Reply with quote

GlennMacGrady wrote:

EXCEPT:

And unfortunately, I have never seen any evidence that a "Medicare for all" plan would be remotely affordable to the nation -- unless there are substantial exceptions, limitations, rationings, and a host of other significant coverage holes.

Except all of that money is already being spent in the private insurance industry.

Single payer does a few things that make it much more cost effective per individual:

1) It mandates universal coverage. Since all people, young or old, sick or healthy, are paying on it diminishes the "risk pool". And it is that risk pool that makes health insurance premiums jump like crazy at certain times.

2) It eliminates a lot of the overhead that is invloved in the insurance industry and normalizes costs across the country.

3) The government run monopsony is able to dictate prices.

Most plans I have seen are funded through an increase in payroll taxes with matching amounts payed by both employee and employer. For people who make under a certain amount (basically the people currently on Medicaid or who receive subsidies) would receive all or some part of that back in tax credits.

As for current Medicaid? It is far superior insurance coverage than anything but the most elite of plans. No copays, no deductibles, conplete coverage of just about all non-cosmetic surgeries. Very few limitations on doctors or procedures.

My brother is in Medicaid due to being unable to work due to severe and repreated back issues that began for him while in college. He just had back surgery with one of the top local spine surgeons at an elite surgery center. Before that he had 3 seperate MRIs and extensive physocal therapy. For the surgery itself he was able to get two full disk replacements with the newest technology even though a two-level fusion is the old less expensive standard.

Total cost to him? Absolutely nothing. All covered by Medicaid. So I am not sure where this idea of Medicaid coverage being substandard comes from.



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GlennMacGrady



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PostPosted: 09/15/17 5:42 pm    ::: Reply Reply with quote

Even if Medicare-for-all were remotely financially feasible, people have to understand that "Original" Medicare today is hardly free. (The other types, Medicare "Advantage" plans, are already being phased out, significantly due to money taken out of them and put into Obamacare.)

First, you have to pay a payroll tax for Medicare for your entire working life.

At 65 you go on Medicare Part A (hospital & nursing home care), which has no premium. However, it does have an annual deductible of about $1,300 and pretty hefty daily co-insurance payments after 60 days in a hospital or 20 days in a nursing home.

Part B (doctor & lab services) has a monthly premium at least $109 and an annual deductible of $183. While some preventive services have no coinsurance, all other services and procedures have a 20% coinsurance.

Part D (drug plans) all have monthly premiums and various co-payments for different types of medications. I'm on the cheapest Part D plan in Connecticut, which is about $18 per month. There are holes in all these plans if you use a lot of medications -- i.e., big extra payments.

To fill some of the gaps, holes and deductibles in Parts A & B, companies (most famously AARP) sell Medicare Supplemental Insurance (or "Medigap") policies. There are about eight types of policies, providing different levels of coverage, and the price of them varies quite widely from state to state. I have a medium coverage policy that costs me about $150 per month.

Therefore, for "free" Medicare, for Parts B, D and a Medigap Plan, I pay about $3,520 per year plus whatever I have to pay in co-pays for doctor services and medications.

Other things: Medicare won't cover you in a foreign country. Medicare won't cover certain procedures.

As to availability, many doctor offices in my part of CT have signs saying "No Medicaid Accepted", which is because the state reimbursement rates are so low. Less frequently, some busy physicians with top reputations won't take Medicare patients either, again because the reimbursement rates are too low for them. The Mayo Clinic and other famous medical centers won't accept the Medicare reimbursement rates and demand a significant upcharge, which patients must pay out of their own pockets unless they've paid for the most expensive Medigap policy, which covers such upcharges.

This is all very expensive for old people on fixed incomes.

I used to pay ZERO for all medical care when I worked for a large corporation, which self-funded all their employees' medical costs. No insurance companies or government involved at all. That corporation no longer offers free medical coverage, and the rates for retirees spiked tremendously due to Obamacare.

Summary: Even if the USA could afford Medicare-for-all, which I seriously doubt -- with a $20 trillion deficit and $150 trillion in unfunded liabilities -- it will still be rather expensive for individuals if the rates are anything like what they are for seniors on Original Medicare right now.
justintyme



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PostPosted: 09/15/17 6:46 pm    ::: Reply Reply with quote

But that's the thing, "Medicare-for-all" is a misnomer. Medicare is popular so they use the name. Really it is just a single payer system where all the money is paid up front through payroll taxes. Medicare requires additional funding because it is just the highest risk people. Once you auto-enroll all the healthy young people at a significantly higher rate (akin to what they would have to pay for insurance coverage) costs drop significantly.

There would be no co-pays or deductibles (the big selling point), and places like the Mayo would have to accept people because that would be all there is (BTW, Mayo accepts Medicaid and Medicare patients right now, it just might take awhile to get an appointment unless your case is critical).

Again, people are already paying for inefficient insurance with out of control health care costs. Single payer creates an efficent monopsany to reign in those costs and shifts the money paid to private for-profit insurance companies to the government. And because of the auto-enroll young, healthy people pay in and don't take out.



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GlennMacGrady



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PostPosted: 09/15/17 10:21 pm    ::: Reply Reply with quote

Well, I hope you could be right, but I remain very financially skeptical.

No one has introduced a single-payer bill that has gone anywhere, even the Dems when they controlled everything in 2009-10. Bernie's home state, Vermont, completely gave up on a state single-payer plan when the preliminary costs rolled in.

Now we have something called the Graham-Cassidy bill floating around the swamp, which no one yet understands.

Nancy Pelosi was only partially right about these proposed national health care plans: No one indeed understands them before they vote on them . . . and, in addition, no one understands them even after they've long been passed and been to the Supreme Court 47 times.
justintyme



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PostPosted: 09/15/17 10:44 pm    ::: Reply Reply with quote

Yeah the state-by-state plans don't work. There is just not enough people for the pool, the buying power of the single payer isn't strong enough to limit costs, and the federal regulations get in the way. It really isn't feasible. Maybe, and that is a huuuuge maybe California could pull it off due to its size and the economic strength of Hollywood and Silicon Valley. But even then I wouldn't hold my breath.

If the dems are serious about this they should be having serious discussions with other countries like Canada, Australia, Germany (though Germany isn't a true single payer), England, and the Scandinavian countries to see what worked for them and whay pitfalls they encountered. And then attempt to see how those would or would not extrapolate to the US. Also, get actual experts involved who know the health side, the business side, and the economic side of all these things. And for God's sake, keep the special interest groups out of it.

(Yeah, the odds of all that happening....)



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PUmatty



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PostPosted: 09/16/17 12:45 pm    ::: Reply Reply with quote

John Conyers has been introducing a single payer bill every year since 2003.


cthskzfn



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PostPosted: 09/16/17 1:43 pm    ::: Reply Reply with quote

PUmatty wrote:
John Conyers has been introducing a single payer bill every year since 2003.


Indeed. But, he's only a Rep. And, a black one at that so, you know, it doesn't count.



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PUmatty



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PostPosted: 09/16/17 3:55 pm    ::: Reply Reply with quote

cthskzfn wrote:
PUmatty wrote:
John Conyers has been introducing a single payer bill every year since 2003.


Indeed. But, he's only a Rep. And, a black one at that so, you know, it doesn't count.


BERNIE! BERNIE! BERNIE!


mercfan3



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PostPosted: 09/16/17 4:21 pm    ::: Reply Reply with quote

https://www.washingtonpost.com/opinions/sanderscare-is-all-cheap-politics-and-magic-math/2017/09/14/d8db627c-998a-11e7-b569-3360011663b4_story.html?utm_term=.23459e825762

Typical of Sanders.

I'm interested in hearing Murphy's plan. From what I understand, he wants to improve the ACA and use it as a bridge for Universal Health Care. I expect the actual policy details will be significantly better.



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tfan



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PostPosted: 09/16/17 5:01 pm    ::: Reply Reply with quote

I wish Ross Perot had been elected. He had a line in a Presidential debate about if we couldn't figure out how to do health care, he'd go ask Europe how they do it. But I suppose the same problem would exist - getting the American rich to accept the Euopean model.


GlennMacGrady



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PostPosted: 09/16/17 7:27 pm    ::: Reply Reply with quote

justintyme



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PostPosted: 09/16/17 10:38 pm    ::: Reply Reply with quote

mercfan3 wrote:
https://www.washingtonpost.com/opinions/sanderscare-is-all-cheap-politics-and-magic-math/2017/09/14/d8db627c-998a-11e7-b569-3360011663b4_story.html?utm_term=.23459e825762

Typical of Sanders.

I'm interested in hearing Murphy's plan. From what I understand, he wants to improve the ACA and use it as a bridge for Universal Health Care. I expect the actual policy details will be significantly better.

This article was basically trash.

Of course this single payer bill is politics. It is meant to be. It is just like all the ACA repeal votes that the Republicans knew would be vetoed. This is about getting the Dems to commit to a much better health care system. One that finally realizes that health care cannot be treated as a free market commodity. I mean, lets be truthful here, Obamacare is not good. Oh, it is not terrible like the dumpster fire we had before the ACA, and it definitely was a move in the right direction with its essential heal services, but it is still fundamentally flawed and is going to need to be seriously fixed. And I would rather we fix it by going to a system that has proven to help keep costs in check rather than just throw more money at our out of control health industry.

But the author here makes a lot of claims without backing it up. Why does she think Americans would have an issue with increased payroll taxes, when their paychecks will be about the same? I know my health insurance premiums come out of my check before I see it. Whether it goes to a private insurer or the government, it is really inconsequential. And they definitely would love the idea of not having to worry about deductibles and co-pays. The people who will have a problem with this is the very wealthy, who will end up paying substantially more than they currently do, for an inferior product to their platinum executive plans. But the vast, vast majority of Americans will pay significantly less. Heck, she pointed out just how popular single-payer is, and everyone knows that means a shift to paying the government rather than insurance companies.

And where is her evidence that hospitals are suddenly going to go out of business? There doesn't seem to be that issue anywhere else in the world. Hospitals adjust to the new costs.

But anyways, this piece has very little substance other than to rant.



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mercfan3



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PostPosted: 09/17/17 9:32 am    ::: Reply Reply with quote

justintyme wrote:


Of course this single payer bill is politics. It is meant to be. It is just like all the ACA repeal votes that the Republicans knew would be vetoed. This is about getting the Dems to commit to a much better health care system. One that finally realizes that health care cannot be treated as a free market commodity. I mean, lets be truthful here, Obamacare is not good. Oh, it is not terrible like the dumpster fire we had before the ACA, and it definitely was a move in the right direction with its essential heal services, but it is still fundamentally flawed and is going to need to be seriously fixed. And I would rather we fix it by going to a system that has proven to help keep costs in check rather than just throw more money at our out of control health industry.


So it's a litmus test. Which is the article's point. Democrats believe in Universal Healthcare. There's no reason to do this. So, if you want to make a push for Single Payer..even if it's not a plan you can run right away, make it a serious one. The plan Sanders is advocating for is pathetic. Republicans are using it as a tool to back their plan too.

Obamacare does need fixing, no one would argue that. However, it also needs to be guarded and protected every few months so that people get to keep their healthcare.

Of course, Democrats have all been distracted by the litmus test hanging over their heads.

And again, I'm willing to bet that Senator Murphy's plan will be an actual serious attempt at improving healthcare. Why is that asking to much of Sanders? He's no longer a protest Senator.

justintyme wrote:

But the author here makes a lot of claims without backing it up. Why does she think Americans would have an issue with increased payroll taxes,
when their paychecks will be about the same? I know my health insurance premiums come out of my check before I see it. Whether it goes to a private insurer or the government, it is really inconsequential.


With no actual math involved, people actually don't know that they would be paying the same.

I can't find it quickly, but I've seen several polls that suggest that Americans seem to like the idea of Single Payer, but then when asked if they wanted their taxes raised, they no longer wanted it.

justintyme wrote:

And they definitely would love the idea of not having to worry about deductibles and co-pays. The people who will have a problem with this is the very wealthy, who will end up paying substantially more than they currently do, for an inferior product to their platinum executive plans. But the vast, vast majority of Americans will pay significantly less. Heck, she pointed out just how popular single-payer is, and everyone knows that means a shift to paying the government rather than insurance companies.


This is why I'm critical of Sanders lack of worked out details.

This all sounds wonderful. But, unless Sanders can tell me HOW we're going to do it, it's just magic land bullshit.

justintyme wrote:

And where is her evidence that hospitals are suddenly going to go out of business? There doesn't seem to be that issue anywhere else in the world. Hospitals adjust to the new costs.


See above. What you are claiming is the best things that can happen, what she is mentioning is the potential worst.

And given so many medical industries are dependent on health insurance, I wouldn't be surprised if some major economic issues did arise..which is why you need well thought out plans.

Personally, I'd be more concerned with CT, MA, and NJ's economy than hospitals in general.

I'm in favor of Universal Health Care. I really am. If Bernie was doing anything here but another one of his purity tests I could support it.



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justintyme



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PostPosted: 09/17/17 10:22 am    ::: Reply Reply with quote

mercfan3 wrote:
which is why you need well thought out plans.

I agree with this 100%, which is why I I wrote what I did above: the need to take it seriously and get input from other single-payer countries and health experts.

But they honestly aren't there yet. This bill doesn’t have a prayer of passing. Its goal is to get Democrats to stop treating it like a dirty word and to continue to grow support for it amongst the populace. The idea is to get it out of people's heads that going to single payer would turn us into Venezuela or the second coming of Soviet Russia. That is why it is being called "Medicare-for-all" even though it likely would be quite different from Medicare. But we don't actually need a well hashed out plan, nor do the supporters have the means to actually form the committees to get the research and expertise needed to form a solid bill. For where we are in the process what they are doing is adequate.

And we can see how it has worked elsewhere to know that going to a system of no co-pay or deductible would be feasible. The trade off is just longer wait times for non essential tests and surgeries. But the truth is we already have this. Yes, we can get tests relatively quickly once we make an appointment, but how many people put off these surgeries and tests because they can't afford them at the moment? That is also a "wait" that we just ignore.



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jammerbirdi



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PostPosted: 09/17/17 9:40 pm    ::: Reply Reply with quote

mercfan3 wrote:
https://www.washingtonpost.com/opinions/sanderscare-is-all-cheap-politics-and-magic-math/2017/09/14/d8db627c-998a-11e7-b569-3360011663b4_story.html?utm_term=.23459e825762

Typical of Sanders.

I'm interested in hearing Murphy's plan. From what I understand, he wants to improve the ACA and use it as a bridge for Universal Health Care. I expect the actual policy details will be significantly better.


Wow, did you or did you not beat me to it, justin. That article is a nothing more than a superficial political (not policy based) hit piece.

Catherine Rampell is not a policy specialist. She's someone the Washington Post, the principle enforcer of the status quo in American national politics, would probably have assigned the job to of adding a discouraging voice to the chorus of critics who themselves enjoy comprehensive healthcare but continue to work against it for everyone else on behalf of the many health care industry lobbies who control both political parties in America.

That's why I don't subscribe to the WaPo unless they're practically giving away digital subscriptions. It is a newspaper that makes my blood boil.

Here's a much better analysis by a more qualified writer in the NYTimes. Doing this on an iPhone so forgive everything about the posting job I'm going to do here. Just copying and pasting what I can.

Buried Inside Bernie Sanders's Bill: A Fallback Plan

Margot Sanger-Katz

SEPT. 15, 2017

The Bernie Sanders “Medicare for All” plan promises rapid, sweeping change to the American health care system, with the elimination of all private insurance and the creation of a costly new government insurance program that will cover everyone and nearly every medical service.

But deep in its back pages is a more modest fallback plan.

The bill, introduced this week, has attracted the endorsement of 15 Democratic senators, including several of the party’s most ambitious liberals. But many more Democrats this week said they’d like to pursue more limited steps to expand health insurance coverage and the government’s role in the system. It turns out that the Sanders bill also has provisions along those lines. Taken together, the bill encapsulates much of the coming Democratic debate about the direction of health care.

In the statements of the bill’s co-sponsors, one can detect an openness to less tranformational approaches to health reform. “This bill is aspirational, and I’m hopeful that it can serve as a starting point for where we need to go as a country,” Senator Al Franken of Minnesota wrote in a Facebook post. He described the bill as a “marker” and “one way to achieve universal coverage.”

Parts of the Sanders bill help establish a road map for what some other strategies might look like.

The provisions are tucked into Title X of the bill and describe the four-year transition between current policy and the Sanders bill’s goal of a Medicare-for-all system. During that interim, some younger Americans would be able to buy access to the traditional Medicare program, which is now mainly for those 65 and up. The provisions would also establish an option for Americans to buy access to a Medicare-like government plan that would be sold on the Obamacare exchanges.

The public option section was written by Senator Kirsten Gillibrand of New York, a longtime proponent of the idea. As part of the Sanders bill, she said, a public option would help the government prepare to administer a full-fledged Medicare-for-all program.

Bernie Sanders’s proposal has big implications for consumers and the health care industry.

“One part of the bill that I worked with my colleagues to put in was the ability for every American to buy into a nonprofit public option as part of a four-year transition to get to single-payer in this country,” she said during the news conference introducing the bill. “This would create affordable, public health care that is available to any American to purchase in the already available exchanges.”

The idea of mixing public and private insurance in a competitive marketplace was a goal of many Democrats during the writing of the Affordable Care Act. The hope was that a public option would provide more choice to consumers and more pricing discipline for insurers. The idea didn’t have enough support to stay in the final bill, but it has been experiencing a bit of a comeback. Before the 2016 election, both President Obama and Hillary Clinton, the Democratic presidential nominee, endorsed a public option. Mrs. Clinton also endorsed the idea of a Medicare buy-in for older Americans.

Other Democrats are working on similar provisions that would provide more access to public health insurance without upending the existing private system. Senator Chris Murphy of Connecticut, who has not endorsed the Sanders bill, has said he’s developing legislation to allow Americans to buy into the Medicare program, as Mr. Sanders’s bill does for Americans of certain ages. (A group of House Democrats has already offered one piece of legislation to create such a program.)

And Senator Brian Schatz of Hawaii, who did co-sponsor the Sanders bill, has said he’s working on legislation that would allow people to pay their way into the federal-state Medicaid program, while simultaneously making changes to Medicaid.

Such plans might avoid some of the difficult politics of adopting a total Medicare-for-all, because they would allow Americans who have private coverage to keep it if they wished.

There are some technical challenges to buy-in programs. Medicare primarily serves older Americans, and it would need different benefits and providers to serve children and women of reproductive age, for example. The bills will also need to decide on a price for the public plan. The Gillibrand provision assigns price-setting responsibility for the public option to the Department of Health and Human Services. Some Medicare buy-in plans would require people to pay the average cost of Medicare benefits, which would make coverage quite expensive.

There are also questions about what a public option would mean for private competition.

But expect those details to be part of the coming debate.


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PostPosted: 09/18/17 8:34 am    ::: Reply Reply with quote

PUmatty wrote:
cthskzfn wrote:
PUmatty wrote:
John Conyers has been introducing a single payer bill every year since 2003.


Indeed. But, he's only a Rep. And, a black one at that so, you know, it doesn't count.


BERNIE! BERNIE! BERNIE!


you missed the sarcasm?



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PUmatty



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PostPosted: 09/18/17 9:09 am    ::: Reply Reply with quote

cthskzfn wrote:
PUmatty wrote:
cthskzfn wrote:
PUmatty wrote:
John Conyers has been introducing a single payer bill every year since 2003.


Indeed. But, he's only a Rep. And, a black one at that so, you know, it doesn't count.


BERNIE! BERNIE! BERNIE!


you missed the sarcasm?


I think you may have. I can't stand Bernie.


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PostPosted: 09/18/17 10:44 am    ::: Reply Reply with quote

GlennMacGrady wrote:
Whatever health care is, it is not being provided by Obamacare. Obamacare does not provide health care. To some people, it provides health insurance policies, but the deductibles and premiums are so high as to render actual medical care back to the luxury status. To others, Obamacare provides a rationed and spotty medical care system (Medicaid) paid for by a bureaucratically circuitous redistribution of taxpayer wealth.


Just not accurate. I have a MOST affordable policy through ACA that's serving me very well. Projecting these 'absolutes' as complete truth is not conducive to clarity.

tfan wrote:
I wish Ross Perot had been elected. He had a line in a Presidential debate about if we couldn't figure out how to do health care, he'd go ask Europe how they do it. But I suppose the same problem would exist - getting the American rich to accept the European model.


Not a Perot fan here but, ya.....this model CAN AND DOES WORK, in industrialized/advanced civilizations. Adopting single payer means SOMEBODY here (____?) stands to lose vast amounts of wealth, and that 'somebody' has a very powerful lobby.



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PostPosted: 09/18/17 1:00 pm    ::: Reply Reply with quote

Howee wrote:
GlennMacGrady wrote:
Whatever health care is, it is not being provided by Obamacare. Obamacare does not provide health care. To some people, it provides health insurance policies, but the deductibles and premiums are so high as to render actual medical care back to the luxury status. To others, Obamacare provides a rationed and spotty medical care system (Medicaid) paid for by a bureaucratically circuitous redistribution of taxpayer wealth.


Just not accurate. I have a MOST affordable policy through ACA that's serving me very well. Projecting these 'absolutes' as complete truth is not conducive to clarity.

tfan wrote:
I wish Ross Perot had been elected. He had a line in a Presidential debate about if we couldn't figure out how to do health care, he'd go ask Europe how they do it. But I suppose the same problem would exist - getting the American rich to accept the European model.


Not a Perot fan here but, ya.....this model CAN AND DOES WORK, in industrialized/advanced civilizations. Adopting single payer means SOMEBODY here (____?) stands to lose vast amounts of wealth, and that 'somebody' has a very powerful lobby.



Nutshell, end of story.



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ArtBest23



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PostPosted: 09/18/17 1:37 pm    ::: Reply Reply with quote

As an aside before I get to the main point, you can't assume who will pay what, because there is no legislation. If you think a bill is going to pass with the rich picking up the entire tab, you're dreaming. "Tax the rich to pay for it" is just the kind of unrealistic phony Sanders/Warren/Harris pandering that will end up getting us four more years of the Donald.

But, as to the main point

justintyme wrote:
And they definitely would love the idea of not having to worry about deductibles and co-pays.


I'm sure they would. But this type of thinking is exactly why it won't work here. Co-pays and deductibles aren't primarily about collecting money from patients. In reality they are primary tools for utilization management. If people have to pay something themselves, they don't go completely hog wild, and actually exercise a little appropriate restraint.

Want a real world example? Back in the 80s, health care for dependants of active duty military and for retirees was provided through the CHAMPUS program. CHAMPUS operated basically by requiring beneficiaries to go to military health facilities, or to private providers only with a referral from a military health facility. It was cumbersome, unpopular, and costs were skyrocketing out of control.

So Congress enacted the Tricare Demonstration Project (for California and two adjacent states) and when that demonstration period ended, applied Tricare nationwide.

The legislation was clear that the impetus for Tricare was to bring in commercial health insurance companies to run a combination HMO, PPO, and FFS program for activity duty dependents and for retirees, with the goal that these commercial companies would apply commercial network management and utilization management techniques in order to bring down costs.

But the reality is that beneficiaries don't like utilization management. Americans want to get unlimited healthcare, from anyone they want, get any services, devices, and drugs they want, and have someone else - anyone - pay the entire bill. Everybody wants unlimited free healthcare. It's completely unrealistic, but that is the attitude that anyone devising a healthcare system in this country must confront.

In the real world, this can't happen, and so everyone's health plans have limits, on number of doctor visits, days of physical therapy, pre-approvals for some procedures, exclusions for experimental or not-generally-accepted treatments, drug formularies, and most commonly, co-pays and deductibles.

Except when we start talking about the federal treasury and military benefits all that goes out the window. So while Congress said they wanted commercial companies to use commercial utilization management techniques for Tricare, they promptly folded to pressure from highly organized veterans groups and prohibited or severely limited what techniques could be used to restrain utilization and costs. And as a result, Tricare is almost certainly the most luxurious healthcare program in the country, and the costs take a ridiculously large chunk out of the defense budget. There are virtually no drug co-pays so Tricare has the highest Rx utilization of any healthplan. I have friends who are retired military officers entitled to Tricare for life who are executives with large defense contractors entitled to good free commercial family health insurance from their employers who turn the company insurance down because the Tricare benefits are so much richer. No nationwide program that cost as much as Tricare costs would be remotely affordable.

Yet you assume that a single payer national plan would have no deductibles and no co-pays. Not feasible.

The US population has completely unrealistic expectations and demands about healthcare. The irreconcilable reality is that a program that provided the unlimited, unrestrained, unreviewed, no-questions-asked free healthcare that Americans want would be completely unaffordable. (Or would require such severe price controls on providers that within a few years we would have large scale provider shortages.) A program that would would require co-pays, pre-approvals, formularies, gatekeepers, and other highly unpopular restraints on utilization such that it would never be politically acceptable.

Do you think that Americans are going to stand for the government deciding which treatments and drugs will be reimbursed and which won't? Americans can't separate the notions of having free choice about what healthcare they want to receive from the question of who will pay for it. They want whatever they want, and they want someone else to pay. Remember all the Obamacare government "death panel" rubbish? The ridiculous "keep government out of Medicare" signs? You ain't seen nothin' ''till you see a national mandatory government run program institute formularies and pre-approvals.

And before you point to Medicare, realize that (1) most people are still buying private insurance on top of Medicare because Medicare is, by itself, inadequate; (2) in many parts of the country (like DC), a huge portion of the doctor community doesn't participate in Medicare; and (3) Medicare is is basically funded by a Ponzi scheme based on assumptions about increasing workforce and payrolls. As a national health plan, even with all its inadequacies, it would be bankrupt.

Conceptually, a single payer plan can make sense. But expectations in Europe for example are a lot different than they are in the US. People accept a lot of management, controls, and delays that would never fly here. I personally don't think an economically viable plan will ever be politically acceptable. Which means either that it can't ever be enacted, or that a bad plan will be enacted that either provides lousy healthcare, or bankrupts the country, or more likely both.

I think people need to come up with plan B.


ArtBest23



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PostPosted: 09/18/17 1:41 pm    ::: Reply Reply with quote

jammerbirdi wrote:

The provisions are tucked into Title X of the bill and describe the four-year transition between current policy and the Sanders bill’s goal of a Medicare-for-all system. During that interim, some younger Americans would be able to buy access to the traditional Medicare program, which is now mainly for those 65 and up. The provisions would also establish an option for Americans to buy access to a Medicare-like government plan that would be sold on the Obamacare exchanges.



I'm curious. Do the working people who buy into Medicare still have to pay the Medicare payroll tax in addition to their premiums? I'm sure that would be popular. But if not, how is Medicare supposed to be funded ?


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