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Post-Coronavirus


bad_teammate

Your post-Corona vision of health response  

30 members have voted

  1. 1. If you were president with an obedient Congress, which option would be at the top of your list?

    • A public/private mix that makes related tests/treatments affordable by government fiat (when WHO declares a pandemic)
    • A public/private mix that makes related tests/treatments free by government fiat (when WHO declares a pandemic)
    • A public system that makes related test/treatments free (regardless of WHO declaration)
    • A public/private mix where the president has to bring in health insurance CEOs to beg for affordable/free tests and treatments (when WHO declares a pandemic)
    • A public/private mix that makes related tests/treatments free (regardless of WHO declaration)


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"PUBLIC" and "PUBLIC/PRIVATE" refer only to insurance, not to actual provision.

We are all happily dunking on Trump for being an idiot, which he is.

But how much different are we, really?

Imagine Coronavirus goes away and you are president with a Congress eager to pass whatever you want. You have 8 or 9 bills to choose from working around the House and your Congress is eager to join a unified front with you for forward-facing change.

Edited by bad_teammate
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Do these polls allow for ranking, because I would like public health care that makes the test/treatments free. I would like public health care for all.

However, if it was a pandemic that was out of control and we needed all hands on deck, the ability to have a private company assist with the testing but reimbursed for cost only. Difficulty being that "cost" gets inflated  but essentially--not able to profit. I don't have the acumen to know if that is doable though. It would only be in an emergency setting until the public system could equilibrate to demand.

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I'd suggest 2 but we don't necessarily have to wait for it to be a Pandemic.  Perhaps that's too fuzzy.

Ultimately, I don't think human nature and the election cycle will ever truly allow our leadership to properly react to the early days of a pandemic because when it's not bad yet, we are "overreacting" then when it gets bad, we "didn't do enough."   Until leaders start listening to the medical professionals from the outset instead of drawing their own Dunning-Kruger conclusions like Trump and his ilk did, though, this type of thing will be on loop.

Biden has come out and said he'd get out of the way and let the experts handle it.  I believe him.  I also believe that Congress (if not Dem controlled) would thwart any attempts to proactively spend money to prevent (rather than react, which is what we are doing now), so an executive would either have to just EO it and cross fingers, or we have gridlock at the worst time because Mike McCarthy's district or Mitch McConnel''s state might get negatively effected.  

The other issue that faces anyone in office is that those proactive and preventative measures in the face of an oncoming or labelled pandemic likely slow growth and hurt the economy, at least short term, in order to stave off widespread disease.  And if you successfully stave it off, you'll have those claiming leadership overreacted and hurt the economy.  That can get people beat come election time.  That will always take bravery and self-sacrifice that I don't think a lot of ambitious politicians have in them.  

I dunno -- I am just ultra-cynical right now.  Where are the fucking tests?

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31 minutes ago, bad_teammate said:

Then #3 is your option. I was trying to keep the word count down so "public" and "private" only refer to insurance.

 Way to not put the instructions at the top. Given this, deem my vote changed to #3. 

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I picked the last one. I don't think that we should be beholden to WHO to determine timing or actions related to a pandemic response.  In the case of a pandemic, it will be necessary to mobilize both private and public sector response. 

 

I see the clarification regarding public/private and am not exactly sure what distinction you are making nor its relevance, so I may not be in sync with teh intent of the question.  

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1 hour ago, bad_teammate said:

Public and private insurance.

There is no plan from anyone right now to nationalize all healthcare provision. I was operating within the realm of what people are proposing in this country.

Yeah, so not really sure the relevance that insurance coverage type really has to the vision of "health response" in the case of a pandemic.

What meaningful difference do you see in the response to date between CMS's and UNH's, for example?

In what specific ways do you think that consolidation of the efforts under CMS would address any gaps that have been identified? 

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We spend billions to protect against "stuff that can kill us."  We've defined "stuff that can kill us" as terrorists and mexicans.  Because we're stupid and bad at math.

Public health, real public health, pays more dividends than pretty much any other gov't program/action you can think of.  It keeps us safe, keeps our workplaces functioning, etc.

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unrelated question, and not trying to have this go in a "political" direction, just would like some clarification on who's responsible for what in our 'current' system.

7-10 days ago, when they were asked about availability of tests, the answer was something like, "well, the cdc is leading the charge, but they can only handle so much, so they'll roll out several thousand at a time for the next few days."  then, others got in front of cameras, and described a situation where that number would jump to over a million, then quickly after, up to ~4mm, because private medical companies would be stepping in and given the go-ahead.

of course here we are a week later, and we still don't have a constant flow of tests available (certainly not millions), for reasons that haven't clearly been identified (keep in mind, i don't need someone to point fingers, but if they could pinpoint the issue, then maybe they could fix it?).

so without making this a m4a vs private insurance type of debate, what is going wrong currently with the ill-conceived notion that "private medical companies would come in to solve the problem"?  and if healthcare turned into a single-payer govt entity, then in the future, would the cdc (or whomever) be able to handle an outbreak like this?  with all the bickering back and forth about passing bills and approving funds, it doesn't even seem like the current govt medical apparatus is even properly equipped to handle the demand.  and with that said, where the f are the private medical companies coming to the rescue?

**and yes, i know that the trump administration is likely tamping down the emergency request for tests in order to proclaim our superior (but lower, like golf) numbers to the rest of the world and to calm our citizens, so if that's part of the problem, i totally get it.

 

tl; dr - what is going wrong in our current system to prevent widespread availability of tests?  what would/could this look like in the future with a different relationship between govt healthcare and private medical companies.

and also (to put on my political hat for a sec) doesn't this seem like a huge opportunity once the smoke has cleared to make the case for the fucking opposite of what we have now?  not to be crude, but it's going to happen.

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I'd like my taxes to pay for my healthcare like in every other civilized, industrialized nation.

This isn't some socialist pipe dream.  It's been done in many countries with a fraction of our GDP and tax base.  And it works, because they pay a fraction of our health care costs per capita.

If you Republicans want to keep that big, badass military to jack off to, you'd better figure out how to keep your tax-payers alive.

Sincerely,

Not A Liberal

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26 minutes ago, workswithseed said:

Yeah, I want to change it to the last one. 

The structure of the poll is dumb.  He splits people who favor a public/private mix between 4 choices, and funnels everyone preferring public into 1. It wasn't intended to be taken seriously. Only to provide a vehicle to talk about how M4A is awesome and would beat coronavirus without actually discussing it in a meaningful way. 

Edited by Anastasis
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Because the public/private insurance mix involve the profit motive, which is what distinguishes the other options ("affordable", "free", "beg CEOs").

A public insurance doesn't involve the profit motive, so there's no option for "free", "beg CEOs", or "NOT by government fiat").

Can you explain how you would break it up more efficiently?

I am happy to take your input, how you would you phrase the 5? :)

 

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55 minutes ago, bad_teammate said:

Because the public/private insurance mix involve the profit motive, which is what distinguishes the other options ("affordable", "free", "beg CEOs").

A public insurance doesn't involve the profit motive, so there's no option for "free", "beg CEOs", or "NOT by government fiat").

Can you explain how you would break it up more efficiently?

I am happy to take your input, how you would you phrase the 5? :)

 

Your poll choices really have 3 dimensions. public/private vs. public, affordable vs. free, and reliance on WHO declaration or not. 

 

The WHO declaration piece is kind of a left field dimension, and just muddles what I think you are trying to get at.  It can be dropped from the poll. The affordable vs. free dynamic is equally relevant to both public/private and public only.  Our current public systems have cost sharing dynamics. So really you only need 4 questions:

public, affordable

public, free

public/private, affordable

public/private, free

 

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30 minutes ago, Anastasis said:

The WHO declaration piece is kind of a left field dimension, and just muddles what I think you are trying to get at.  It can be dropped from the poll. The affordable vs. free dynamic is equally relevant to both public/private and public only.  Our current public systems have cost sharing dynamics. So really you only need 4 questions:

public, affordable

public, free

public/private, affordable

public/private, free

 

What would public/affordable be? A public plan that charges people for care? Seems bizarre so I didn't even consider that.

You're also leaving out the issue of government compulsion of private health insurers, which is a pretty massive issue. Perhaps the most important issue in terms of getting legislation passed.

Public, free (WHO declaration wouldn't matter because everything doctors decide relevant would be free anyway)
Public/Private, affordable by government fiat (w/ WHO declaration)
Public/Private, free by government fiat (w/ WHO declaration)
Public/Private, affordable by government fiat (w/o WHO declaration)
Public/Private, free by government fiat (w/o WHO declaration)
Public/Private, beg the CEOs

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Do Medicare patients have to pay for COVID testing?

If so..

Public, free
Public, affordable

Public/Private, affordable by government fiat (w/ WHO declaration)
Public/Private, free by government fiat (w/ WHO declaration)
Public/Private, affordable by government fiat (w/o WHO declaration)
Public/Private, free by government fiat (w/o WHO declaration)
Public/Private, beg the CEOs

Edited by bad_teammate
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7 minutes ago, bad_teammate said:

Do Medicare patients have to pay for COVID testing?

 

Your poll says testing/treatment.

Here is the CMS sheet which was accurate as of last week: https://www.cms.gov/files/document/03052020-medicare-covid-19-fact-sheet.pdf

Testing is covered with no OOP. Treatment falls under the normal benefit structure, which include cost sharing. 

On the private side, the major payers are all covering testing with no OOP. Aetna, Cigna, UHC, Humana, etc. in their at-risk plans.  In ASO plans where the employer is self-insured, coverage is determined by the employer.

 

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Just now, Anastasis said:

Your poll says testing/treatment.

Here is the CMS sheet which was accurate as of last week: https://www.cms.gov/files/document/03052020-medicare-covid-19-fact-sheet.pdf

Testing is covered with no OOP. Treatment falls under the normal benefit structure, which include cost sharing. 

On the private side, the major payers are all covering testing with no OOP. Aetna, Cigna, UHC, Humana, etc. in their at-risk plans.  In ASO plans where the employer is self-insured, coverage is determined by the employer.

 

That sucks ass. I thought testing and treatment would be free for Medicare patients, this is insane.

So would you agree that a better list would be 7 options?

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Just now, bad_teammate said:

That sucks ass. I thought testing and treatment would be free for Medicare patients, this is insane.

So would you agree that a better list would be 7 options?

No.  A simpler list would be a better list.  The WHO dimension is still unnecessary and irrelevant. 

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17 hours ago, Brisketexan said:

Whatever, y'all do your thing after it's over.  I'll do what I was born to do.....put on my uniform and lead a rag-tag bunch looking for a leader into the light of a new day...

The-Postman-1997-Movie-Free-Download-720

I'm the guy in the back with the flaps on his hat sticking out.

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On 3/12/2020 at 12:00 PM, Texas Jeff said:

I'll have whatever South Korea is having...

Smart citizens? Not an option. 

post-coronavirus is the same attitude Trump campaigned on

US manufacturing

strong borders

We can pretend to make things "free" all you want, doesn't matter if they aren't being produced here, and if we can't control who comes here.

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1 hour ago, Zavala said:

and if we can't control who comes here.

This is the fucking insanity.  You want to close our borders to tourists?  To business travel?  You fucking dumbfuck, the virus didn't arrive here via a coyote sneaking a truckload of Hondurans across the Rio Grande.  It arrived on a commercial flight with someone who had visited family, or gone overseas for work, or had gone skiing in Italy, or something like that....or all of those somethings.

The fact that you mouthbreathers use this to amp up your xenophobia is fucking amazing.

How about this, you shitty-at-math brainless shitnugget -- how about we allocate our resources to the things that really fucking threaten us, like [checks notes] GLOBAL PANDEMICS, and not shit that isn't a real threat, like MS-13?  Your orange god SHUT DOWN the fucking office responsible for that, while diverting millions to a wall that doesn't even protect anyone.  Sorry, y'all are literally the fucking LAST people we should listen to if we want to talk about things that will actually make Americans safer.

Jesus.  The stupid, it burns.

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Throw me in the category of not knowing what the poll meant to begin with.  This poll makes no sense.  It unnecessarily combines insurance system with pandemic disaster relief, but then limits the options presented.

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i'm a little behind on the medical side of this, but to me there are two separate issues here - (1) how much would tests/treatment cost and (2) how quick and effectively will we be able to produce tests and/or a vaccine?  obviously in an emergency pandemic, you need everyone to be able to get tests and treatment for free.  but my question (and i kinda asked it earlier but nobody responded) is about the production of tests and vaccines. 

let's start with testing: right now, i was under the impression that the govt couldn't handle it, so we would turn to private biomedical companies.  so where are they?  i get that the cdc can't do it alone, but why are we still hanging around 10-15k available tests (or tests administered)?  who gives the go-ahead for the private industry to step in?  are they waiting for a deal to be made?  why are random doctors or labs working around the clock in different states, but the big picture hasn't improved?

and in a m4a scenario, would the new and improved cdc (or whatever the govt entity would be) be able to handle this?  and if not, would private companies be able to step in and act in the same way they (theoretically) should be now, or would they be too neutered in that system?

forgetting what testing and treatment costs the patient for a minute, who exactly has dropped the ball on available testing?  even the cdc is behind where they're supposed to be at this point.  is it all just staffing/funding cuts?  what am i missing here?  in the eternal argument of govt healthcare vs private industry, how are both fucking this up right now?

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Here I think is the real reality.

Assuming adequate supply of healthcare, indigent people are going to show up at an ER or public health clinic and receive treatment no different from the fully insured.  That is, the ones in an emergent condition.

There doesn't seem to be anything healthcare can do for those not in an emergent condition except advise them to stay home and wash their hands.  Or get bed rest and plenty of fluid.

At least for this pandemic, and most viral pandemics, where there isn't any real preventive medical care.  Because it's preventive care and relatively minor and chronic, but not acute, conditions that private-insurance-based healthcare disserves the poor or uninsured.

The REAL question, in the context of a pandemic, is what has the private insurance model done to the supply of healthcare?  And what would some "public" alternative do to it?

An interesting data point.  As of 2000, the WHO ranked Italy's health care as second best in the world, behind France.  A lot of good it did them.

 

Edited by TwiceHorn
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