patrick.net

bob2356 says

The VA is more like denmark or iceland's systems. Doctors are employees. There is no billing costs and no incentive to over treat. The VA negotiates for better prices on drugs. There is no profit mark ups across the board for each and every item. The VA in general does a good job. Especially considering they treat 9 million people in 1200 facilities, many with really unique and severe issues. There have been problems, but in any system that large there are going to be problems even in the private sector.

bob2356 says

f you think sky high private insurance premiums for medicare age people are going to be popular then I have a shitload of slightly damp land in florida to sell you.

So you would support a VA system for all of America? It would also cut down on the practice of "defensive medicine" and the large slice that goes to lawyers.

TwoScoopsPlissken says

bob2356 says

f you think sky high private insurance premiums for medicare age people are going to be popular then I have a shitload of slightly damp land in florida to sell you.

How much were premium increases arrested or even reversed under ACA during the Obama years?

Huh? How is this relevant to the idea of dropping everyone out of medicare and making them buy private insurance?

Strategist says

So you would support a VA system for all of America? It would also cut down on the practice of "defensive medicine" and the large slice that goes to lawyers.

That would be a public health care system in the Beveridge model. Government owns the health care facilities and doctors are employees. There are a number of countries using this model with good success. Spain, NZ, Hong Kong, Scandinavia, Cuba, and the originator Great Britain which is the least successful. There is also the Bismark model, National Health Insurance model, and of course the out of pocket model, aka no public health care.

I would support a Beveridge model, not necessarily the VA. I lived for many years in a Beveridge system and it worked well. BUT, public health care is never going to happen in the US. There is far, far too much profit in the current model being made by people and institutions with powerful political influence aka major campaign contributors. The US truly has the most corrupt democracy in the world and it's all perfectly legal.

What I am saying is it would have been much more sensible (and still would be sensible) to roll the uninsured (the entire point of the ACA supposedly) into an expanded VA and charged them income based premiums rather than the all consuming damn the expense monster called ACA. But that would mean knowing the difference between the cost of health care and the cost of health care insurance which Obama either didn't understand or he got rolled by the insurance carriers or if he was so desperate to keep a campaign promise he didn't care. Plus if the VA starting charging people what it actually costs for their health care they would end up stealing people that are buying their own insurance from private insurance (and private insurance profits) right and left. Not going to happen.

WarrenTheApe says

bob2356 says

f you think sky high private insurance premiums for medicare age people are going to be popular then I have a shitload of slightly damp land in florida to sell you.

I didn't say that. Learn to read.

''

WarrenTheApe says

Personally, I think government should just get out of health care altogether.

Sorry, please explain the other meanings of "the government should get out of health are altogether". I thought it was very unequivocal but apparently not.

bob2356 says

I would support a Beveridge model, not necessarily the VA. I lived for many years in a Beveridge system and it worked well. BUT, public health care is never going to happen in the US. There is far, far too much profit in the current model being made by people and institutions with powerful political influence aka major campaign contributors. The US truly has the most corrupt democracy in the world and it's all perfectly legal.

With $trillions at stake, the potential losers will fight tooth and nail to the bitter end. It's gonna be like moving a mountain.

WarrenTheApe says

The whole reason why health care is expensive is because of the government. Period.

Because most politicians are in the pockets of special interests.

WarrenTheApe says

The whole reason why health care is expensive is because of the government. Period.

Its because they are only involved to make corporations profit, just like everything else they get involved in, it has to be all or nothing. I just fear our government is no longer capable of doing great things, all sides are so suspicious of each other and the sad thing is that they should be.

Without competition, it’ll fail.

Only private sector can produce anything good and sustainable.

FortWayne says

Without competition, it’ll fail.

Only private sector can produce anything good and sustainable.

Capitalism and competition are wonderful, but there are times when it fails and the government has to step in. In the case of our healthcare, capitalism and competition has failed to bring about affordable healthcare. Costs are insane compared to the rest of the developed world. It clearly needs fixing.
As a family we have great health insurance through a major corporation where my wife works just enough hours to qualify for the benefits. I am self employed. Our out of pocket expenses I believe are close to $10K per year. We still worry about healthcare because the system is so screwed up.
We even have health insurance for our precious German Shepherd. She was hospitalized for 36 hours last month and the total cost was $3,000 plus the follow ups. This is absolutely insane.

Break monopolies, costs will drop.

Healthcare is heavily monopolized.

Strategist says

FortWayne says

Without competition, it’ll fail.

Only private sector can produce anything good and sustainable.

Capitalism and competition are wonderful, but there are times when it fails and the government has to step in. In the case of our healthcare, capitalism and competition has failed to bring about affordable healthcare. Costs are insane compared to the rest of the developed world. It clearly needs fixing.
As a family we have great health insurance through a major corporation where my wife works just enough hours to qualify for the benefits. I am self employed. Our out of pocket expenses I believe are close to $10K per year. We still worry about healthcare because the system is so screwed up.
We even have health insurance for our precious German Shepherd. She was hospitalized for 36 hours last month and the total cost was $3,000 plus the follow ups. This is absolutely insane.

Tenpoundbass says

Originally the New Deal policy was All Employees must make the same thing for a job regardless of the company.

Total horseshit, unless you're referring to union rules. Unions were a great thing for american workers. Funny how right wingers want to make America great again, but they forget that when ameriica was great, unions were much stronger.

The worker has less and less leverage all the time. And the typical anti public sector right winger seemingly wants the owners to take away even more leverage from workers.

THe idea of some kind of national health program like they have in England, or the VA is nice, but I agree with the OP. Medicare for all is a no brainer at this point. Medicare is already paying for most of the most expensive health care that occurs late in life anyway for the entire country. THe most efficient thing would be to bring the rest of health care in to the same system. And then find ways to lower costs.

marcus says

And then find ways to lower costs.

Lower costs means lower GDP. What do you think grew economy of the financial crisis - ObamaCare.

Wrong. The rate that health care costs were going up decreased under Obamacare. (not including the cost to the govt, of increased medicaid etc. for low income folks).

Valid point though, that health care is a big part of our economy.

Patrick says

More about the CoC:

My wife loves the CoC

marcus says

Medicare for all is a no brainer at this point.

Gross

marcus says

Tenpoundbass says

Originally the New Deal policy was All Employees must make the same thing for a job regardless of the company.

Total horseshit, unless you're referring to union rules. Unions were a great thing for american workers. Funny how right wingers want to make America great again, but they forget that when ameriica was great, unions were much stronger.

Actually tpb has it vaguely right.. The 1942 Stabilization Act froze wages to avoid inflation during the war. Employers started offering health care instead of raises.

marcus says

but I agree with the OP. Medicare for all is a no brainer at this point. Medicare is already paying for most of the most expensive health care that occurs late in life anyway for the entire country. THe most efficient thing would be to bring the rest of health care in to the same system. And then find ways to lower costs.

A no brainer? Have you taken a serious look at how much FICA will have to be raised to cover medicare A and medicare tax and general income taxes to pay for part B & D? You might not be so enthusiastic. Bernie says 1.4T per year to pay for medicare for all. That is a ridiculously low number even by political promises standards. Even that low ball number would require raising income taxes by something like 10% across the board right down to the lowest earners. Without doing anything to lower the costs of health care since medicare has the same cost problems as private insurance. Actually worse since medicare is prohibited from negotiating drug prices. Like ACA medicare for all merely shifts from health care insurers or uncompensated care to taxes. It doesn't matter if you are taking the money out of the left pocket (health insurance companies) or the right pocket (taxes) if the bill is the same. Health care cost is not the same thing as health care insurance cost.

Ass, gas, or grass. No one rides free.

bob2356 says

The only real advantage Medicare has is it is funded by taxes rather than hundreds of insurance companies that must advertise, collect premiums, pay out claims, pay executive salaries, pay out dividends. pay for lobbying, negotiate fees with doctors and hospitals, etc., etc. etc. which all adds (a lot) to the cost of health care while providing zero actual health care.

Wrong. Medicare has insurance carriers that do all of those things. Also funny how you classify normal business operations as "providing zero actual health care" while lamenting the waste of a bureaucracy.

The solution is a free market system, which would include "insurance companies that must advertise, collect premiums, pay out claims, pay executive salaries, pay out dividends. pay for lobbying, negotiate fees with doctors and hospitals, etc., etc. etc." and less government intervention.

bob2356 says

Actually worse since medicare is prohibited from negotiating drug prices. L

Of course that would have to change. Attempts to do so in the past were torpedoed by primarily Republicans.

Would Medicare have to turn a profit or could it operate at cost, unlike the privates?

CBOEtrader says

Wrong. Medicare has insurance carriers that do all of those things. Also funny how you classify normal business operations as "providing zero actual health care" while lamenting the waste of a bureaucracy.

Wrong. Advantage carriers don't have to advertise for customers, they come from medicare. They don't have to collect and manage premiums, they come from medicare. They don't have to do fee for service billing, advantage is capitation. They don't have to manage actuarials and negotiate prices, they have capitation. Yet advantage costs more per beneficiary than the wasteful bureaucracy doing tradiitonal fee for service medicare and all the overhead work also.

What is lamanting a bureuaucracy? Lament means grieving or sorrow at a loss so that sentence makes very little sense. If you were trying to say praising then no I don't praise bureaucracies. But if they work better at something then I will acknowledge the fact rather than wallow in indefensible dogma.

CBOEtrader says

The solution is a free market system, which would include "insurance companies that must advertise, collect premiums, pay out claims, pay executive salaries, pay out dividends. pay for lobbying, negotiate fees with doctors and hospitals, etc., etc. etc." and less government intervention.

Same argument as georgism. Show me all the places this is working. Isn't greorgism great? You can get a 300 sq ft apartment in HK for only a million. I'm impressed.

MisterLefty says

bob2356 says

Actually worse since medicare is prohibited from negotiating drug prices. L

Of course that would have to change. Attempts to do so in the past were torpedoed by primarily Republicans.

and will be in the future.

bob2356 says

CBOEtrader says

Wrong. Medicare has insurance carriers that do all of those things. Also funny how you classify normal business operations as "providing zero actual health care" while lamenting the waste of a bureaucracy.

Wrong. Advantage carriers don't have to advertise for customers, they come from medicare. They don't have to collect and manage premiums, they come from medicare. They don't have to do fee for service billing, advantage is capitation. They don't have to manage actuarials and negotiate prices, they have capitation. Yet advantage costs more per beneficiary than the wasteful bureaucracy doing tradiitonal fee for service medicare and all the overhead work also.

What is lamanting a bureuaucracy? Lament means grieving or sorrow at a loss so that sentence makes very little sense. If you were trying to say praising then no I don't praise bureaucracies. But if they work be...

This isnt how how Medicare works. The client still pays a carrier. The client still chooses a carrier from those available in his area. Usually this is a name brand they feel comfortable with, which is a direct result of marketing efforts. All Medicare carriers do the dog/pony road show to convince agents to sell their products: advantage, med supps, and RX plans.

Every step mentioned is highly regulated and wasteful, sure. The process would be much improved and a fraction of the cost if it were a free market system rather so highly regulated.

marcus says

Total horseshit, unless you're referring to union rules.

Now teacher go back and read up on the Blue Eagle and Work Progress Administration policies.

You read. Kindly show me the part about equal pay. I'll wait while the cricket chirp.

Who knows, maybe you can find some bs on an austrian economics website, or infowars.

If we are going to give free healthcare to all there should be a societal expectation for some sort of accountability for people to put an effort into staying healthy to keep costs down. I don't want to be paying more taxes for obese, smokers, drug addicts, ect that are self inflicted. It's another thing that is never brought up when comparing the US to other countries that have very successful public healthcare because their populations are healthier.

bob2356 says

A no brainer? Have you taken a serious look at how much FICA will have to be raised to cover medicare A and medicare tax and general income taxes to pay for part B & D? You might not be so enthusiastic.

We pay for health care now. This would just be another way of paying for it. Don't think there would be much difference.

RC2006 says

If we are going to give free healthcare to all there should be a societal expectation for some sort of accountability for people to put an effort into staying healthy to keep costs down. I don't want to be paying more taxes for obese, smokers, drug addicts, ect that are self inflicted. It's another thing that is never brought up when comparing the US to other countries that have very successful public healthcare because their populations are healthier.

These poor personal choices are exactly why we have on average lower life expectencies, etc... yet the pro govt crowd uses these stats to suggest our healthcare system is worse than other countries.

The truth is that our care is far too expensive. However, we still have the best care in the world. We are always ranked #1 in accessibility of care. We are also still largely leading innovation worldwide.

Get govt out of the way and costs would be 1/3rd as much.

CBOEtrader says

The truth is that our care is far too expensive. However, we still have the best care in the world. We are always ranked #1 in accessibility of care. We are also still largely leading innovation worldwide.

The actual health care is excellent. Being #1 in accessibility is perplexing. How can we be #1 with millions not having any insurance?
Even the emergency room delays treatment just to make sure you have insurance. A few years ago I had kidney stones and landed in the emergency. I was in severe pain and yet they wanted all my information and signature before proceeding to treat me." Hello? I am dying. Treat me first you morons."

marcus says

Wrong. The rate that health care costs were going up decreased under Obamacare. (not including the cost to the govt, of increased medicaid etc. for low income folks).

I am kind getting tired of arguing about this for almost ten years and yet most Democrats will not admit that Obama missed the opportunity to do something big in a positive way in healthcare

Look, the stock market went up when Trump talked about the tax cut and is almost flat after it got passed. Same for ObamaCare, all health entities (drug companies, insurers) front run the cost increases before the law actually took effect - and have been increasing from that much higher base. How do I know? Have been paying business healthcare bills for almost two decades. With a few positives, such as getting rid of pre-existing conditions, the rest of ObamaCare is a disaster from the cost perspective.

CBOEtrader says

Every step mentioned is highly regulated and wasteful, sure. The process would be much improved and a fraction of the cost if it were a free market system rather so highly regulated.

Still waiting to see the examples of places this works so well.

CBOEtrader says

This isnt how how Medicare works. The client still pays a carrier.

Medicare pays the advantage carriers. Period. The client pays the out of pocket costs and the premium to the advantage just like traditional medicare. Did you somehow think what the medicare monthly premium payment was covering all the costs? Why do you suppose there is a medicare tax, medicare as part of FICA, and medicare in the budget?

CBOEtrader says

The truth is that our care is far too expensive. However, we still have the best care in the world. We are always ranked #1 in accessibility of care. We are also still largely leading innovation worldwide.

Really?



CBOEtrader says

Get govt out of the way and costs would be 1/3rd as much.

It's true because I believe it should be true? Got any research to back that up? Will it be included in your list of successful free market health care countries?

Strategist says

We pay for health care now. This would just be another way of paying for it. Don't think there would be much difference.

It's not about changing the accounting - need a structural reform. Focus on healthier living is a start. Although it's a bit like gun rights. I want my Starbucks - it's my choice. Well I don't want to pay healthcare for your diabetic ass because you putting away more sugar than in one day than what you are supposed to in a weeks.

bob2356 says

Still waiting to see the examples of places this works so well.

In Northern California, we have Sutter that created a monopoly on health care and raised prices like crazy. Insurers can't do anything about because of gag clauses in contracts and nowhere else for people to go. The only solution is for State AG to sue them. Free market without regulation creates ridiculous monopolies that abuse their pricing power.

I agree that some regulation is necessary to keep the free market working. For example, anti-monopoly laws.

Two other modest regulations that I like to harp on:

1. require presentation of prices in advance of treatment for non-emergencies, so people can use the market to shop around
2. fix emergency treatment prices by law, since there is no time to shop

If prices are secret (or very hard to discover), there is no free market anyway, and no incentive for any provider to keep prices down.

RC2006 says

It's another thing that is never brought up when comparing the US to other countries that have very successful public healthcare because their populations are healthier.

Which countries do you feel are healthier and what is healthier to you? Ireland, England, NZ, Australia, Canada are all within 2-3% of US obesity. Many countries have much, much higher smoking rates especially in europe.. Alcohol consumption in the US is very moderate compared to Europe or commonwealth countries. What is your criteria?

bob2356 says

Medicare pays the advantage carriers. Period.

Wrong. Your Medicare account pays if you have enough employed quarters in your work history. OR the payment can be subsidized if you are poor, like any govt subsidy.

You are digging a deeper whole proving you don't know how medicare works. FYI: I sell about 30 medicare policies/month.

CBOEtrader says

Wrong. Your Medicare account pays if you have enough employed quarters in your work history. OR the payment can be subsidized if you are poor, like any govt subsidy.

That's not what Bob was even arguing. He said that for Advantage Part C plans. medicare still pays everything except the tiny monthly premium paid by the person. The difference is with Medicare part A - medicare pays the provider directly. With Part C, Medicare pays Insurer who pays the provider.

anotheraccount says

Free market without regulation creates ridiculous monopolies that abuse their pricing power.

Monopolies are almost always govt induced, exactly as they are here in dozens of blue cross counties. Your example is a data point showing the error of a govt intervention.

W/o intervention there would be thriving competition.

bob2356 says

Which countries do you feel are healthier and what is healthier to you?

https://goo.gl/images/s3pYbg

bob2356 says

Ireland, England, NZ, Australia, Canada are all within 2-3% of US obesity.

nope, wrong again.

It's not our healthcare that causes lower life expectancy and higher infant mortality rates, it's our lifestyle decisions.

Those lifestyle decisions are largely cultural issues falling along racial lines. New Hampshire is as healthy as any European country whereas Mississippi is a disaster.

anotheraccount says

I am kind getting tired of arguing about this for almost ten years and yet most Democrats will not admit that Obama missed the opportunity to do something big in a positive way in healthcare

The so-called Blue Dog democrats would have voted with the Republicans to torpedo single payer. The votes just were not there.