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2020 Policy Talk: Healthcare


bad_teammate

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5 minutes ago, Enchubben said:

 

Austerity politics ruins lives.

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The Times newspaper said a survey by the Royal College of Ophthalmologists (RCO) found tens of thousands of elderly people are left struggling to see because of an NHS cost-cutting drive that relies on them dying before they can qualify for cataract surgery.

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If we withhold resources from the programs that help the vulnerable, we hurt the vulnerable.

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I don’t see why we can’t allow people/families who fall below a certain income to buy into Medicare. There is already a network of clinics and hospitals for them to use.

Allow people to buy private insurance across state lines without their employer. Maybe even through coops/private organizations.

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6 minutes ago, Brothahorn said:

I don’t see why we can’t allow people/families who fall below a certain income to buy into Medicare. There is already a network of clinics and hospitals for them to use.

Allow people to buy private insurance across state lines without their employer. Maybe even through coops/private organizations.

You have about 20 Democratic candidates who agree with you and 1 who doesn't.

You're in luck

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Sadly, the answer to healthcare in the U.S. is not at the federal level. All hospitals would be out of business within a few years if they were reliant on federal reimbursement. I know the pediatric space well, and as it is all children's hospitals are only profitable due to charitable giving as CHIP and Medicaid payments account for roughly 70% of their reimbursement revenue. You can say that "doctors need to make less" but that's just not a realistic short-term plan, nor is it the main driver of cost at a hospital. Long-term, AI can replace many (most?) physician decision making which will drive down physician compensation and demand.This is already happening in radiology.

Single-payer or Medicare/Medicaid for all can work, but in my opinion, only on a much more local level that the US federally. The country is just too large, both from a population standpoint and a pure geography standpoint. We are also substantively more diverse than any other country we can use as a model. The UK is roughly the size of Minnesota and ~90% white. If you want to centrally plan that health system, you can; Minnesota could come up with a pretty good plan for its healthcare system, I betcha.

To continue the comparison, there's only one truly world-class pediatric hospital in the UK - Great Ormond  Street in London. The NHS can centralize all truly high-acuity care and specialists in one location as they only need patients to travel a maximum of a few hours to arrive at the point of care. That model just can't work in the US, where you have many times greater travel times to get to location. There are probably 10 Great Ormond Street equivalents in the US. Patients require local care. If you are born in Colorado Springs with a congenital heart defect, we can't fly you to Boston Children's for a surgery as a system.

Just another example of the diversity of care we have to deal with here - my wife is a Pediatric Hematologist/Oncologist. There's another physician she works with who specializes in Sickle Cell Disease (SCD) in children, which only presents in individuals of sub-Sahara African descent (very rarely in middle eastern). This physician is trained/from the UK, but left London as SCD is classified as an "exotic disease" by the NHS as there are so few people in the UK with SCD (<500 new diagnosis per year in the entire country). She sees exponentially more patients with SCD in a large east coast pediatric hospital and can run studies that would take years in the UK.

What's the point? Every country is different and unique and models are hard to replicate. That is true in regions of the US too. If we want to actually create better healthcare in the US, we have to push decisions about healthcare down to the lowest levels feasible. To me, the state level is where most of the decisions should be made, and the federal government would be better off pushing as much money down the system closer to patients. People don't actually travel outside of their counties for healthcare - especially patients who are either on Medicare or Medicaid. If certain states - I believe Oregon did this - want to offer Medicaid for all, they should be able to with larger pools of federal funding than current levels.Other states that have large levels of economic disparity, like California, might want to think about substantially higher reimbursement rates for govt funded payers, but means test those benefits and force those with means to obtain their own insurance. States just have very divergent health issues, and there wont be a federal system smart enough or flexible enough to address needs adequately. Voters and local government should be both in charge of and accountable for what are, at the end of the day their tax dollars and their health(care).

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15 hours ago, eljinca said:

Sadly, the answer to healthcare in the U.S. is not at the federal level. All hospitals would be out of business within a few years if they were reliant on federal reimbursement. I know the pediatric space well, and as it is all children's hospitals are only profitable due to charitable giving as CHIP and Medicaid payments account for roughly 70% of their reimbursement revenue. You can say that "doctors need to make less" but that's just not a realistic short-term plan, nor is it the main driver of cost at a hospital. Long-term, AI can replace many (most?) physician decision making which will drive down physician compensation and demand.This is already happening in radiology.

Single-payer or Medicare/Medicaid for all can work, but in my opinion, only on a much more local level that the US federally. The country is just too large, both from a population standpoint and a pure geography standpoint. We are also substantively more diverse than any other country we can use as a model. The UK is roughly the size of Minnesota and ~90% white. If you want to centrally plan that health system, you can; Minnesota could come up with a pretty good plan for its healthcare system, I betcha.

To continue the comparison, there's only one truly world-class pediatric hospital in the UK - Great Ormond  Street in London. The NHS can centralize all truly high-acuity care and specialists in one location as they only need patients to travel a maximum of a few hours to arrive at the point of care. That model just can't work in the US, where you have many times greater travel times to get to location. There are probably 10 Great Ormond Street equivalents in the US. Patients require local care. If you are born in Colorado Springs with a congenital heart defect, we can't fly you to Boston Children's for a surgery as a system.

Just another example of the diversity of care we have to deal with here - my wife is a Pediatric Hematologist/Oncologist. There's another physician she works with who specializes in Sickle Cell Disease (SCD) in children, which only presents in individuals of sub-Sahara African descent (very rarely in middle eastern). This physician is trained/from the UK, but left London as SCD is classified as an "exotic disease" by the NHS as there are so few people in the UK with SCD (<500 new diagnosis per year in the entire country). She sees exponentially more patients with SCD in a large east coast pediatric hospital and can run studies that would take years in the UK.

What's the point? Every country is different and unique and models are hard to replicate. That is true in regions of the US too. If we want to actually create better healthcare in the US, we have to push decisions about healthcare down to the lowest levels feasible. To me, the state level is where most of the decisions should be made, and the federal government would be better off pushing as much money down the system closer to patients. People don't actually travel outside of their counties for healthcare - especially patients who are either on Medicare or Medicaid. If certain states - I believe Oregon did this - want to offer Medicaid for all, they should be able to with larger pools of federal funding than current levels.Other states that have large levels of economic disparity, like California, might want to think about substantially higher reimbursement rates for govt funded payers, but means test those benefits and force those with means to obtain their own insurance. States just have very divergent health issues, and there wont be a federal system smart enough or flexible enough to address needs adequately. Voters and local government should be both in charge of and accountable for what are, at the end of the day their tax dollars and their health(care).

It works in Sweden, you retarded bigot! /surlylib

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18 hours ago, eljinca said:

Single-payer or Medicare/Medicaid for all can work, but in my opinion, only on a much more local level that the US federally. The country is just too large, both from a population standpoint and a pure geography standpoint. We are also substantively more diverse than any other country we can use as a model. The UK is roughly the size of Minnesota and ~90% white. If you want to centrally plan that health system, you can; Minnesota could come up with a pretty good plan for its healthcare system, I betcha.

To continue the comparison, there's only one truly world-class pediatric hospital in the UK - Great Ormond  Street in London. The NHS can centralize all truly high-acuity care and specialists in one location as they only need patients to travel a maximum of a few hours to arrive at the point of care. That model just can't work in the US, where you have many times greater travel times to get to location. There are probably 10 Great Ormond Street equivalents in the US. Patients require local care. If you are born in Colorado Springs with a congenital heart defect, we can't fly you to Boston Children's for a surgery as a system.

What does the issue of geographic dispersal have to do with single-payer vs. private health insurance?

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On 4/7/2019 at 12:31 PM, Brothahorn said:

I don’t see why we can’t allow people/families who fall below a certain income to buy into Medicare. There is already a network of clinics and hospitals for them to use.

Allow people to buy private insurance across state lines without their employer. Maybe even through coops/private organizations.

 

Yes and No. The whole "buy private insurance across state lines" is a talking point that has no basis in reality other than sounds really good to people that have no knowledge of how health care/health insurance works. (that isn't a slight at you just an annoyance that keeps coming up because idiots in DC keep saying it because it sounds like a legit option that would make everyone happy)

All insurance companies, doctors, hospitals, companies in ALL states are saving money by limiting networks which makes it easier for all parties to have a better grasp on total costs. It's why pretty much every ACA plan is either a HMO or some other limited network. That is done to keep costs down.

 

 

15 hours ago, bad_teammate said:

What does the issue of geographic dispersal have to do with single-payer vs. private health insurance?

 

Medicare for all- Medicare currently has different reimbursement rates in every state. Getting an MRI in New York or Texas costs a hell of a lot more than getting one in South Dakota or Mississippi. The overhead costs and a million other factors are accounted for in the reimbursement rate for every single coded claim. 

I am all for changes but until someone in DC actually comes up with a plan to tackle cost of care it's really just repackaging a pile of shit. 

 

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1 hour ago, JimmyHoffa said:

I am all for changes but until someone in DC actually comes up with a plan to tackle cost of care it's really just repackaging a pile of shit.

Sure, I'm just wondering about these different complaints against single-payer that don't seem to actually have anything to do with single-payer.

You could do cost controls even MORE easily in a single-payer system.

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Why it matters: Critics and skeptics of "Medicare for All" worry about eliminating people's existing coverage because most people are relatively satisfied with their employer-based plans. But millions of workers and their families already switch or lose their insurance from their jobs.

By the numbers: More than 66 million Americans voluntarily quit their jobs, were laid off, or otherwise separated from their employers in 2018, and that high turnover rate has continued into 2019, according to data from the Bureau of Labor Statistics.

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On ‎3‎/‎18‎/‎2019 at 5:02 PM, CooterBrown said:

 


If you consider the elimination of health insurance costs and out of pocket health expenses, it’s probably a decrease in overall costs even if technically your taxes go up.

 

you cannot possibly believe this to be true.  There is simply no program that eliminates a private option, has a government full of incompetents who outspend cash flow by over 1,000,000,000,000 (that is one trillion) every year take over a program, and somehow ends up being "cheaper".  It is simply impossible.  

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1 minute ago, pepper brooks said:

you cannot possibly believe this to be true.  There is simply no program that eliminates a private option, has a government full of incompetents who outspend cash flow by over 1,000,000,000,000 (that is one trillion) every year take over a program, and somehow ends up being "cheaper".  It is simply impossible.  

As opposed to the private sector, which is full of sharp-minded captains of industry

lol

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1 minute ago, bad_teammate said:

As opposed to the private sector, which is full of sharp-minded captains of industry

lol

are you trying to say that the likes of AOC, Pelosi, Turkey neck McConnel, and Paul Ryan, are somehow "sharp minded" as opposed to say, Bezos, Diman, Dell, Gates, et al?  Actually, you probably would believe that.  we are done here. 

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Just now, pepper brooks said:

are you trying to say that the likes of AOC, Pelosi, Turkey neck McConnel, and Paul Ryan, are somehow "sharp minded" as opposed to say, Bezos, Diman, Dell, Gates, et al?  Actually, you probably would believe that.  we are done here. 

The only person out of all of those you listed who is worth a crap is AOC.

A single-payer insurance plan for all Americans administered by the government will be more efficient and well-run than the current system of private health insurance plans and companies.

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Insurance should be insurance.  For the care you cannot afford.  Everything else should be out of pocket paid straight to the provider of services from the consumer using the services.  There is zero reason for routine medical expenses to require a third party payor.  Imagine the savings just by getting rid of the middle man and all the back office billing bullshit for 95% of all health care transactions?  And the self rationing and shopping competitors that would occur if you had to pay out of pocket for most of your expenses.

Those that cannot afford catastrophic coverage can get government assistance to defray costs.

I busted up my knee a couple months ago.  The amount of paper work generated for the MRI and two doctor visits was mind blowing.

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2 minutes ago, bad_teammate said:

The only person out of all of those you listed who is worth a crap is AOC.

A single-payer insurance plan for all Americans administered by the government will be more efficient and well-run than the current system of private health insurance plans and companies.

The market place would be far more efficient if government would stay the fuck out of it outside of providing some level of catastrophic coverage for low income folks.

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A free market cannot function for things that are:
- Essential to all humans to live
- Economically unprofitable
- Dangerous to health or the environment

If it's simply a matter of producing spatulas and underwear, the private sector is great. No one needs either to survive; neither is killing the planet; both can be produced profitably.

When it comes to those three factors, however, there has to be government intervention. It's unavoidable for anyone who wants a society in which people are not dying because they are poor and in which the environment is not being actively destroyed (i.e., 99.99% of humans, even supposed libertarians).

Government involvement in our healthcare system is non-optional.

Free market gospel religionists need to be honest about this.

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1 hour ago, Johnny Sack said:

The market place would be far more efficient if government would stay the fuck out of it.

this is a rightwing myth.  there is no truth to this statement.  government is typically slow to act, if they are involved that means the citizens asked them to be involved.  same with regulations. i get so sick and tired of trump and all the conservatives saying regulations are bad.   regulations are only passed if citizens asked for it to be passed.  they were voted on and agreed to.  now they're all bad and need to be repealed?  bullshit.

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20 minutes ago, thrillhammer said:

this is a rightwing myth.  there is no truth to this statement.  government is typically slow to act, if they are involved that means the citizens asked them to be involved.  same with regulations. i get so sick and tired of trump and all the conservatives saying regulations are bad.   regulations are only passed if citizens asked for it to be passed.  they were voted on and agreed to.  now they're all bad and need to be repealed?  bullshit. 

You talk myths but say regulations were "voted on and agreed to"?

Edited by Johnny Sack
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1 hour ago, bad_teammate said:

A free market cannot function for things that are:
- Essential to all humans to live
- Economically unprofitable
- Dangerous to health or the environment

If it's simply a matter of producing spatulas and underwear, the private sector is great. No one needs either to survive; neither is killing the planet; both can be produced profitably.

When it comes to those three factors, however, there has to be government intervention. It's unavoidable for anyone who wants a society in which people are not dying because they are poor and in which the environment is not being actively destroyed (i.e., 99.99% of humans, even supposed libertarians).

Government involvement in our healthcare system is non-optional.

Free market gospel religionists need to be honest about this.

 

I have no problem admitting that. (I am all for a catastrophic level of care backed by the Fed) Want office visit copays, drug copays, ER copays, help hitting that catastrophic level of care? Well then you need to purchase INSURANCE to offset that added cost. 

There now are you willing to admit that Medicare isn't perfect, has a massive amount of fraud, is overused, offers shitty reimbursement rates to medical professionals, paperwork nightmare, more doctors continue to not accept it, and for the only way for it to truly work the way people think it will would be to limit care and/or require approval for costly test procedures, waiting periods etc. (ie- death panels GASP!)? 

And even doing all that probably does nothing but increase cost of care? 

Perfect, glad we are on the same page.  

 

1 hour ago, Johnny Sack said:

The market place would be far more efficient if government would stay the fuck out of it outside of providing some level of catastrophic coverage for low income folks.

 

And this is what "Medicare for All" will become. And I would be fine with that like I said above. But those expecting Uncle Sam to come in and solve all their problems and cover all of those visits to ER because they have a hangnail or drank too many big gulps and have a stomach ache well they are going to be just as screwed in whatever new "for all" program  that gets passed. 

 

And like in everything else the "have's" will have options (private care doctors, hospitals, facilities) and the have not's will be stuck with the shit (no choice if you want it paid for here you go).

 

And by the way the system is very much broken but like a hell of a lot of things the government isn't going to swoop in and solve everyone's problems like some many people assume. 

 

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45 minutes ago, BradInATX said:

It's from your link.

That phrase isn't there, and I didn't know if you were talking a voluntary career turnover or voluntary plan turnover.

So, back to your question now that I understand what you meant and can engage in good faith...

How does rising voluntary turnover make the case for M4A? Not trying to get at you here, but from where I sit those stats actually hurt the case for it.

Part of the pain of changing jobs is inconsistency and gaps in healthcare coverage. M4A would solve that problem for people. I'm not sure if that addresses your question. If not, maybe rephrase it because I might not be understanding.

20 minutes ago, JimmyHoffa said:

There now are you willing to admit that Medicare isn't perfect, has a massive amount of fraud, is overused, offers shitty reimbursement rates to medical professionals, paperwork nightmare, more doctors continue to not accept it, and for the only way for it to truly work the way people think it will would be to limit care and/or require approval for costly test procedures, waiting periods etc. (ie- death panels GASP!)? 

All systems are imperfect; private and governmental. I have never denied this.

Private and public health insurance relies on reducing the cost of care to control costs overall. Death panels exist in the private and public insurance worlds. Care rationing exists in the private and public insurance worlds. Waiting periods exist in the private and public insurance worlds.

Public insurance is not magic, it's just better.

Quote

But those expecting Uncle Sam to come in and solve all their problems and cover all of those visits to ER because they have a hangnail or drank too many big gulps and have a stomach ache well they are going to be just as screwed in whatever new "for all" program  that gets passed. 

 

I sincerely don't understand what you're talking about here. People are just going to start going to the ER for funsies?

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8 minutes ago, bad_teammate said:

That phrase isn't there, and I didn't know if you were talking a voluntary career turnover or voluntary plan turnover.

So, back to your question now that I understand what you meant and can engage in good faith...

How does rising voluntary turnover make the case for M4A? Not trying to get at you here, but from where I sit those stats actually hurt the case for it.

Part of the pain of changing jobs is inconsistency and gaps in healthcare coverage. M4A would solve that problem for people. I'm not sure if that addresses your question. If not, maybe rephrase it because I might not be understanding.

All systems are imperfect; private and governmental. I have never denied this.

Private and public health insurance relies on reducing the cost of care to control costs overall. Death panels exist in the private and public insurance worlds. Care rationing exists in the private and public insurance worlds. Waiting periods exist in the private and public insurance worlds.

Public insurance is not magic, it's just better.

I sincerely don't understand what you're talking about here. People are just going to start going to the ER for funsies?

Where I'm going with it is that I don't think the premise of the original Tweet you posted really holds up. It's probably a nitpick, but I  do analytics on labor and the workforce and such for a living, so it caught my eye because it's right down my wheelhouse. 

I totally agree with you that healthcare can hold people in jobs they hate or should be growing beyond. I think (though my opinion on healthcare is fluid) that I'm for a public option that one can buy in and out of that would make it easier to switch jobs or take a hiatus. I detest that people, even up to the middle class, can end up stuck in a job because if they leave, they lose healthcare for their entire family. Free or very low cost for those below a  means test, and for those above (IE middle class), some sort of deferral program for the premiums that lets you coast until you replace the income. 

I think discouraging risk taking, which our current healthcare system does, is patently un-American. The healthcare system (amongst tons of other laws/factors), have significantly depressed entrepreneurship and small business, which sucks. 

I just don't think rising voluntary turnover proves anything for M4A or a public option. It actually shows that, in aggregate, people are more willing to leave their jobs, which sort of runs counter to the point the author was trying to make. It doesn't change anything, it was just a weird annoying tweet that didn't make the point it thought it did, and it irritated me enough to post about it. 

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Just now, BradInATX said:
5 minutes ago, bad_teammate said:
quit, laid off, fired, retire
Only one of those is fairly characterized as "voluntary"

Right. What point does that make?

Those were the 4 categories in the Tweet. You latched onto one aspect. (Also, not all quitting is truly voluntary.)

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1 hour ago, bad_teammate said:

All systems are imperfect; private and governmental. I have never denied this.

Private and public health insurance relies on reducing the cost of care to control costs overall. Death panels exist in the private and public insurance worlds. Care rationing exists in the private and public insurance worlds. Waiting periods exist in the private and public insurance worlds.

Public insurance is not magic, it's just better.

 

Yes and No. 

Yes- those all do exist in both worlds.

No- The VA, Medicare, Medicaid have far worse issues with waiting periods, red tape, denials then the private insurance industry. I am not saying that private is perfect either but it's a hell of a lot better at controlling costs and ease of approval process than the Public side of things.  

 

1 hour ago, bad_teammate said:

I sincerely don't understand what you're talking about here. People are just going to start going to the ER for funsies?

 

Yes as they currently do. And for stupid shit that they could get medicine for at their nearest pharmacy for $3.  

 

 

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3 minutes ago, JimmyHoffa said:

No- The VA, Medicare, Medicaid have far worse issues with waiting periods, red tape, denials then the private insurance industry. I am not saying that private is perfect either but it's a hell of a lot better at controlling costs and ease of approval process than the Public side of things.  

Then why are those programs so popular compared to private insurance?

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7 minutes ago, JimmyHoffa said:

No- The VA, Medicare, Medicaid have far worse issues with waiting periods, red tape, denials then the private insurance industry. I am not saying that private is perfect either but it's a hell of a lot better at controlling costs and ease of approval process than the Public side of things.  

 

 

The VA is far better than the private sector at negotiating prescription drug prices. Like we had to get a "coupon" from a pharmacy so we didn't have to pay $200 for ear drops after our daughter got ear tubes. The private sector is so much worse than our current government provided healthcare in a lot of ways, especially when it comes to having to fight the fuck out of them to get them to cover procedures they say they will (then deny for some convenient reason)

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1 minute ago, GSU&UT said:

Compelling argument, I fucking love paying $3500 in premiums a year where each of us has a $1500 deductible and a $2000 out of pocket max (last I checked) instead of just having a single payer tax.

~*~*~*~ the efficiency of the markets ~*~*~*~*~

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5 minutes ago, JimmyHoffa said:

The VA, Medicare, Medicaid have far worse issues with waiting periods, red tape, denials then the private insurance industry. I am not saying that private is perfect either but it's a hell of a lot better at controlling costs and ease of approval process than the Public side of things.  

One thing that the VA does well is contracting on medications.  Of course the mechanism by which they do this is a closed national formulary with highly restrictive utilization management.   

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1 minute ago, GSU&UT said:

The VA is far better than the private sector at negotiating prescription drug prices. Like we had to get a "coupon" from a pharmacy so we didn't have to pay $200 for ear drops after our daughter got ear tubes. The private sector is so much worse than our current government provided healthcare in a lot of ways, especially when it comes to having to fight the fuck out of them to get them to cover procedures they say they will (then deny for some convenient reason)

 

No doubt. But a lot of that has to do with the fact the private side is subsidizing the public and the entire world's drug usage. Big Pharma is a massive issue but the FDA had a lot of blood on their hands for the approval process and loop holes they have in place to allow Big Pharma to fuck everyone over.

 

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5 minutes ago, GSU&UT said:

Compelling argument, I fucking love paying $3500 in premiums a year where each of us has a $1500 deductible and a $2000 out of pocket max (last I checked) instead of just having a single payer tax.

 

That's a fucking steal for great coverage. 

Try paying $12K a year for an $8K deductible/out of pocket with no coverage until the $8K is met. By the way that guy was paying $1200 a year with a $2K out of pocket max pre ACA.  

 

3 minutes ago, bad_teammate said:

~*~*~*~ the efficiency of the markets ~*~*~*~*~

 

And the ACA strapping a rocket to the ass of premiums. 

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I mean the government is going to get involved in one way or another whether you like it or not because the private sector is quite literally killing people right now with raising prescription drug prices for no other reason than to drive profits. The insane rising cost of insulin and other prescription drugs is literally being investigated now in congressional hearings about how CVS and other pharmacies are using middle-men to set drug prices.

https://www.businessinsider.com/senate-drug-pricing-hearing-testimony-cigna-humana-cvs-unitedhealth-2019-4

 

2 minutes ago, JimmyHoffa said:

 

No doubt. But a lot of that has to do with the fact the private side is subsidizing the public and the entire world's drug usage. Big Pharma is a massive issue but the FDA had a lot of blood on their hands for the approval process and loop holes they have in place to allow Big Pharma to fuck everyone over.

 

I have a hard time believing this, it's often repeated and I don't think there's a lot of evidence that we're merely just subsidizing the rest of the world's (and the VA's) drug costs. It's not that complicated, most of the pharmaceutical companies (beyond of which a ton of pharmokinetic research is done literally at universities like UT) are just lining their pockets with more money.

 

https://thehill.com/opinion/healthcare/369727-us-drug-prices-higher-than-in-the-rest-of-the-world-heres-why

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2 minutes ago, JimmyHoffa said:

 

That's a fucking steal for great coverage. 

Try paying $12K a year for an $8K deductible/out of pocket with no coverage until the $8K is met. By the way that guy was paying $1200 a year with a $2K out of pocket max pre ACA.  

 

 

And the ACA strapping a rocket to the ass of premiums. 

Hi, the god damned CATO institute literally concluded that universal single payer healthcare would cost us less money than our current system. Please continue to defend the status quo

 

https://www.thenation.com/article/thanks-koch-brothers-proof-single-payer-saves-money/

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Copying this post of mine from the Bernie thread

Great counter to the supposed greatness of Canadian style Berniecare. His draft legislation compels everyone to government care destroying my private health insurance along with hundreds of millions of others. Our system of private insurance needs a new generation of Republican Gen-Xers like myself to come up with a way to keep private insurance and help subsidize basic, no frills care for the non-Medicaid qualifying lower class. Republicans need to get on the ball and counter with reform to the private health insurance model. We need to hammer away at the awful wait times for appointments and procedures in Canada and the U.K. and how in the U.K. the doctors in the NHS are mostly 3rd world foreigners with real British doctors available for pricey concierge care. Note that that even that wasn’t good enough for Mick Jagger and other wealthy Brits who come here to get the best medical care in the world. 

https://www.wsj.com/articles/europes-alternative-to-medicare-for-all-11555457596

Not so fast. The experience of Canada, which follows the Sanders model, shows that single payer is not the best way to achieve the goal of access to timely care. Its single-payer program is universal, funded by taxpayers without deductibles or copayments, and excludes premiums for most users. Objective measures of performance show it’s a comparatively expensive system whose results are mediocre—and sometimes very poor.

A Fraser Institute study published in November examined 28 universal health-care systems across 45 indicators of performance. After adjusting for differences in the proportion of seniors, Canada ranked among the top spenders—fourth-highest as a percentage of gross domestic product and 10th-highest per capita. Yet it had less medical resources available for patients and painfully long wait times for specialists. Canada ranked 26th out of 28 for number of physicians, 22nd out of 27 for MRI units, and 25th out of 26 for hospital beds.

Overall, Canada performs worse than other universal-coverage countries, particularly Switzerland, the Netherlands and Germany. Why? Unlike Canada’s single-payer system, the Swiss, Dutch and German systems rely on private insurers, whether nonprofit or for-profit. Government helps the needy make premium payments.

German enrollees can use a public system composed of 145 competing independent nonprofit “sickness funds” or buy insurance from 43 companies or nonprofits. In the Netherlands and Switzerland, residents must select a standard insurance package from private insurers, of which both countries have dozens.

 Unlike the U.S., with Medicare and its massive trillion-dollar unfunded liabilities, these countries cannot pass unreimbursed current expenses onto future generations. If the expenses of private insurers exceed their revenues, they face bankruptcy.

 

 

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Medicare and Medicaid really only work BECAUSE of the private commercial insurance plans.  Providers basically break even (at best) with Medicare reimbursement and lose money for Medicaid patients.  Private insurance makes up the rest of the costs and profits for most medical providers.   

In many cases large employers have had it with placing the entire system on their backs. They're finding other solutions for their employees where possible. The end result will be more pressure on employers/employees that don't have the buying power to do so.

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44 minutes ago, bad_teammate said:

The unavoidable consequence of forcing everyone into the inefficient and corrupt nightmare that is private health insurance.

You and I agree: ACA is right-wing garbage

except that whole issue that not one single person of the "right wing" voted for it, but keep on wallowing in and believe the fantasy of the utopian left that has left a wake of nothing but failure everywhere that ideology has been implemented.  

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