Obamacare...(new title): GOP DEATH PLAN: Don-Ryan's Express

[bearrock]

2 hours ago, Renegade7 said:

 

I'll make a deal with you: if you want to say 4 years is too fast, make your case here and show how the non-MFA candidates have defended it.  If you do, I'll post more evidence for why the no-compete candidates are saying we can't have competiting insurance packages for any elongated period of time.  Please read the links I posted in the Election thread before responding.

 

 

 

I'm gonna categorize the criticisms into broad strokes, because different candidates have slightly different flavor to it.

 

1) You can't criticize something until the details are nailed down

 

Klobuchar calls MFA aspirational.  Buttigieg asks for explanations on how we get to single payer.  We have competing MFA plans that have some fundamental differences and have proposed a smorgasbord of different options for paying for the added cost.  I get the political calculus to avoid getting bogged down on the details that gets contentious.  To a certain extent, it's a chicken or the egg question.  Do we agree on implementing a MFA and then try to work out the details or do we say we'll implement MFA if we like the details?  non-MFA candidates are essentially saying the details have to come first.  Give us a MFA plan that has the right details and then we'll support it.  

 

We can see the problem in the different permutations MFA can take.  What Bernie is proposing is a dramatic expansion of the level of coverage on top of transitioning everyone to the new Medicare plan (I call it new because in terms of coverage and function, it looks nothing like Medicare as we currently know it).  It's one thing to support allowing people to transition to current version of Medicare and then supplement it as they see fit or create a public version of the average level insurance plan and then pass on the administrative and profit savings to the consumers.  From the public's perspective, you are almost guaranteed a healthcare plan that you are familiar with, but at a much lower cost, a relatively uncontroversial move.  OTOH, if the plan is to force everyone onto essentially the platinum plan (which is the transitioning barometer the house bill is using), I may not care that the plan is cheaper than the private version of it.  What if I never wanted the platinum version to begin with?  

 

On the other hand, somebody may want not just the platinum, but want platinum+.  Sanders is on record as saying that private insurance may cover elective procedures.  House bill allows private insurance to cover what MFA doesn't cover.  But what does that mean exactly?  If I want my MRI done on MRI-o-meter 3000 but MFA only covers MRI-o-meter 2000, is that a different procedure?  

 

House version of the MFA bill also allows physicians to override HHS secretary's decision to exclude a procedure from covered list if the physician deems it medically necessary.  This looks like the mother of all loopholes to me.  

 

Then we have the coverage for undocumented immigrants.  When a plan is focused on providing a cost efficient alternative to private insurance, the coverage is not as big an issue.  As long as you pay the premium, who cares whether you are here legally or not?  But Sanders and House version of MFA's premium/tax policy is redistributive.  Those who make more money and have more money end up paying more to fund the program.  Its one thing to impose redistribution for legal residents, but how is it going to fly to have a redistributive system that provides not only basic care for people who have not paid in, but a Cadillac coverage?  House bill also excludes from coverage those who travel to US solely to obtain medical care and leaves HHS secretary to come up with definitions and regulations.  If that's not open invitation for abuse and litigation, I don't know what is.

 

So non-MFA candidates say these difficult policy issues are not reasons not to have MFA.  But until you resolve these questions and adequately address the concerns they raise, we shouldn't rush to transition to MFA.  Use the options focused on cost saving while you work on the scope of expanded coverage and all the other attendant issues with MFA.

 

2) Why shouldn't people get to choose?

 

This goes back to people who want more from their insurance plans.  Both versions of the MFA will prohibit providers from separately contracting with patients with respect to covered services.  Suppose someone wants their hospital stay to be single person room with 24 hour wait staff and meals catered by a 5 star chef?  Is that not allowed?  Can they choose to pay extra?  What if a insurance company provided other type of value added service?  People know public transportation is cheaper, better for the environment, and better for gridlocks.  But what if they just like driving their own damn car?  It's one thing to have the public option out there so that people can see with their own two eyes that government can run healthcare much better than private industry and there's a natural shift by public choice.  But it's a different thing altogether to mandate such transition by legislative fiat.  

 

3) Who gets fired?  

 

Some estimate that about 2 million jobs will disappear as a result of transitioning from private insurance to MFA.  I assume some will get picked up in the new system in some new capacity and over the long haul, it will be necessary to transition to a single payer system.  In the short term though, any plan that will result in 2 million jobs disappearing better have some clearly defined benefits to the alternatives.   That's why I put the onus on MFA to prove itself to be superior to non-MFA alternatives.

 

[Renegade7]

2 hours ago, bearrock said:

 

I'm gonna categorize the criticisms into broad strokes, because different candidates have slightly different flavor to it.

 

Cool, I have questions for both sides as well, and believe we agree on more then it appears.

 

Quote

1) You can't criticize something until the details are nailed down

 

Klobuchar calls MFA aspirational.  Buttigieg asks for explanations on how we get to single payer.  We have competing MFA plans that have some fundamental differences and have proposed a smorgasbord of different options for paying for the added cost.  I get the political calculus to avoid getting bogged down on the details that gets contentious.  To a certain extent, it's a chicken or the egg question.  Do we agree on implementing a MFA and then try to work out the details or do we say we'll implement MFA if we like the details?  non-MFA candidates are essentially saying the details have to come first.  Give us a MFA plan that has the right details and then we'll support it.  

 

For clarification, have Buttigeig and Klobachar said they'd support MFA if the details were ironed out properly?  From what I've seen them say it seems they are phrasing this debate in MFA is not worth it because it will cost the Dems rhe general election.  They are making no attempts to defend replacing peoples insurance with this new version of medicare if certain conditions they are waiting for are met, can you show where they actually say that?

 

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We can see the problem in the different permutations MFA can take.  What Bernie is proposing is a dramatic expansion of the level of coverage on top of transitioning everyone to the new Medicare plan (I call it new because in terms of coverage and function, it looks nothing like Medicare as we currently know it).  It's one thing to support allowing people to transition to current version of Medicare and then supplement it as they see fit or create a public version of the average level insurance plan and then pass on the administrative and profit savings to the consumers.  From the public's perspective, you are almost guaranteed a healthcare plan that you are familiar with, but at a much lower cost, a relatively uncontroversial move.  OTOH, if the plan is to force everyone onto essentially the platinum plan (which is the transitioning barometer the house bill is using), I may not care that the plan is cheaper than the private version of it.  What if I never wanted the platinum version to begin with?  

 

On the other hand, somebody may want not just the platinum, but want platinum+.  Sanders is on record as saying that private insurance may cover elective procedures.  House bill allows private insurance to cover what MFA doesn't cover.  But what does that mean exactly?  If I want my MRI done on MRI-o-meter 3000 but MFA only covers MRI-o-meter 2000, is that a different procedure?  

 

It's a fair criticism of the MFA group that they aren't clarifying that they are fundamentally changing what medicare is, not just expanding eligibility to everyone.  But if were going to talk about specifics, let's stick to legit examples that we can reference to in any of the proposed Bill's.  To my knowledge, theres no such thing as a MRI-o-meter 2000 or 3000, and it misseds the point that regardless of the MRI machine the MRI is covered.

 

Where are seeing that Bernies new bill is comparable to platinum+?  I'm not saying it's not true, I'm jus saying comparable is a broadterm considering hes saying everything except cosmetic is covered and the house bill expands even further regarding longterm care.  

 

At the end of the day, we talking no copays and no deductible and that not coming out your check for employer supplied insurance anymore.  The point isnt that insurance is being taken away, it's that government will provide what it thinks you need so if you do get supplemental insurance if should be cheaper because it covers less. 

 

I dont like the way this is being sold to people, whatever is missing from the new medicare can be covered with a private insurance plan still, Bernie and Warren are their own worst enemy in this perception/reality problem.

 

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House version of the MFA bill also allows physicians to override HHS secretary's decision to exclude a procedure from covered list if the physician deems it medically necessary.  This looks like the mother of all loopholes to me.  

 

I can see this, but from how it was addressed in the first link, it was to allow for doctors to do a procedure that hadnt been approved yet and tell government to add to list and pay them for it.  We complain about the government being slow sometimes, I'm fine with trying this approach because the doctors know the options better then law makers, HHS should do what can to keep up with life saving procedures, this is a way for Doctors to save a life and add the procedure to the list of approved ones instead of someone dying waiting for the law change.  If someone tries to sneak in a boob job via this clause, they'll get caught, but resources need to be devoted to reviewing these quickly.

 

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Then we have the coverage for undocumented immigrants.  When a plan is focused on providing a cost efficient alternative to private insurance, the coverage is not as big an issue.  As long as you pay the premium, who cares whether you are here legally or not?  But Sanders and House version of MFA's premium/tax policy is redistributive.  Those who make more money and have more money end up paying more to fund the program.  Its one thing to impose redistribution for legal residents, but how is it going to fly to have a redistributive system that provides not only basic care for people who have not paid in, but a Cadillac coverage?  House bill also excludes from coverage those who travel to US solely to obtain medical care and leaves HHS secretary to come up with definitions and regulations.  If that's not open invitation for abuse and litigation, I don't know what is.

 

That's tough, because I dont know where to stand on covering illegal immigrants.  I'm fine with it, but want the immigration system fixed.  How do you determine someone is flying in for cheaper procedure vs walking in because they cant afford it period? 

 

Is that reason enough not to do MFA before fixing the immigration system?  I dont think we should turn people away for life saving procedures, does that mean we let people fly here from other countries because our system is cheaper then their own? You dont have nearly the level of medical bankruptcies in other countries as you do here, and that's because a lot of the systems on the table to emulate prevent that from happening.  

 

I dont want to turn people away from medical care they need and not sold if we open the flood gates that everyone will come here for medical treatment.  You still have to apply for visas and asylum.

 

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So non-MFA candidates say these difficult policy issues are not reasons not to have MFA.  But until you resolve these questions and adequately address the concerns they raise, we shouldn't rush to transition to MFA.  Use the options focused on cost saving while you work on the scope of expanded coverage and all the other attendant issues with MFA.

 

The biggest problem I see raised with just having the public option is that negotiating medicare prices wont stop the meteoric rise in prices for everyone else that dint have to abide by Medicare pricings.  This again is not just about universal coverage but universal price control, as proposed in the house and Bernie Bills.  

 

https://www.charlotteobserver.com/opinion/opn-columns-blogs/article234971212.html

 

People throw out the price tag of MFA, but what's the price tag of public option?  How come we only here about MFA scaring people off versus whether public option can stop rising healthcare costs?  Because of how much this directly impacts me and my family, I'm tired of being told winning an election is more important then fixing the problem.

 

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2) Why shouldn't people get to choose?

 

This goes back to people who want more from their insurance plans.  Both versions of the MFA will prohibit providers from separately contracting with patients with respect to covered services.  Suppose someone wants their hospital stay to be single person room with 24 hour wait staff and meals catered by a 5 star chef?  Is that not allowed?  Can they choose to pay extra?  What if a insurance company provided other type of value added service?  People know public transportation is cheaper, better for the environment, and better for gridlocks.  But what if they just like driving their own damn car?  It's one thing to have the public option out there so that people can see with their own two eyes that government can run healthcare much better than private industry and there's a natural shift by public choice.  But it's a different thing altogether to mandate such transition by legislative fiat.  

 

Are there insurance plans that cover the option of requiring a single room and 5 star chef?  Are we talking about Mayo Clinic?  Pretty sure if you are there for something life threatening and all they have is single rooms with 5 star chefs it will be covered.  Again, I want to stick to examples of what isnt covered in the proposed changes ro MFA and thus had to be covered with a supplemental private insurance plan.  

 

 

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3) Who gets fired?  

 

Some estimate that about 2 million jobs will disappear as a result of transitioning from private insurance to MFA.  I assume some will get picked up in the new system in some new capacity and over the long haul, it will be necessary to transition to a single payer system.  In the short term though, any plan that will result in 2 million jobs disappearing better have some clearly defined benefits to the alternatives.   That's why I put the onus on MFA to prove itself to be superior to non-MFA alternatives.

 

 

Where did you get that 2 million number from?  Does it factor the money the House bill sets aside to address this and retraining g or block Grant's for the hosptials to keep them from closing?  My biggest problem with 4 years is a someone might get laid off halfway through their new bachelors, so I'll look for more specifics on whether this extra money supplements unemployment to stay at the same rate of pay or is money allocated to state level unemployment so they can stay on it for longer.  If you see it before I do, I'm open to criticizing it as well, because it should be full pay, not half pay, because government is causing the economic hardship they will be covering.

Edited September 28, 2019 by Renegade7

[bearrock]

1 hour ago, Renegade7 said:

 

Cool, I have questions for both sides as well, and believe we agree on more then it appears.

 

 

For clarification, have Buttigeig and Klobachar said they'd support MFA if the details were ironed out properly?  From what I've seen them say it seems they are phrasing this debate in MFA is not worth it because it will cost the Dems rhe general election.  They are making no attempts to defend replacing peoples insurance with this new version of medicare if certain conditions they are waiting for are met, can you show where they actually say that?

 

So this is Klobuchar's quote from a CNN town hall earlier this year:

https://www.ontheissues.org/2020/Amy_Klobuchar_Health_Care.htm

 

Q: Your opinion on expanding ObamaCare?

A: I believe we have to get to universal health care in this country. We have to make sure that we build on the work of the Affordable Care Act. We need to expand coverage so that people can have a choice for a public option. You can do it with Medicare. You could also do it with Medicaid. This is a bill that I am an original co-sponsor of. It basically says let's expand Medicaid so you can buy into Medicaid and it will bring the prices down and we can cover more people. The other part of the equation is doing something about prescription drugs. I have one of the original bills to push to have Medicare negotiate prices, lift the ban, bring in less expensive drugs from Canada and stop the practice where pharma pays off generics to keep their products off the market.

 

Q: And Medicare for all?

A: I think it's something that we can look to for the future, but I want to get action now. 

 

Buttigieg on this issue:

https://www.ontheissues.org/2020/Pete_Buttigieg_Health_Care.htm

 

A single-payer environment is probably the right answer in the long term, but I think any politician who throws around phrases like Medicare for all has to explain how we would get there. What you want to do is you take something like Medicare, you put it on the exchanges as a public option, and if people like me are right that that is both good coverage and more cost efficient, then more and more people will buy in and it will be a very natural glide path towards the single-payer environment.

 

Now it may be that they privately think single payer will happen when hell freezes over but they can't say that out loud.  And to your point, it is not as if they make clear exactly what they'd need for them to get on board with MFA right now.  But I take encouragement from the perspective that in 3 years since 2016, at least within the Dem primary, the conversation has shifted to a point where no one disputes that some version of single payer system is the final destination.

 

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It's a fair criticism of the MFA group that they aren't clarifying that they are fundamentally changing what medicare is, not just expanding eligibility to everyone.  But if were going to talk about specifics, let's stick to legit examples that we can reference to in any of the proposed Bill's.  To my knowledge, theres no such thing as a MRI-o-meter 2000 or 3000, and it misseds the point that regardless of the MRI machine the MRI is covered.

 

Where are seeing that Bernies new bill is comparable to platinum+?  I'm not saying it's not true, I'm jus saying comparable is a broadterm considering hes saying everything except cosmetic is covered and the house bill expands even further regarding longterm care.  

 

At the end of the day, we talking no copays and no deductible and that not coming out your check for employer supplied insurance anymore.  The point isnt that insurance is being taken away, it's that government will provide what it thinks you need so if you do get supplemental insurance if should be cheaper because it covers less. 

 

I dont like the way this is being sold to people, whatever is missing from the new medicare can be covered with a private insurance plan still, Bernie and Warren are their own worst enemy in this perception/reality problem.

 

 

House is using a plan designed to be comparable platinum plan on the ACA market as a public option bridge to MFA in 2 years. 

 

On the benefits under Sanders' version https://www.vox.com/2019/4/10/18304448/bernie-sanders-medicare-for-all. 

 

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The biggest difference between this plan and the version Sanders introduced in 2017 is the addition of a long-term care benefit that would cover care for Americans with disability at home or in community settings. This benefit was also added into the House version of the Medicare-for-all bill earlier this year.

 

The plan is significantly more generous than the single-payer plans run by America’s peer countries. The Canadian health care system, for example, does not cover vision or dental care, prescription drugs, rehabilitative services, or home health services. Instead, two-thirds of Canadians take out private insurance policies to cover these benefits. The Netherlands has a similar set of benefits (it also excludes dental and vision care), as does Australia.

 

What’s more, the Sanders plan does not subject consumers to any out-of-pocket spending on health aside from prescriptions drugs. This means there would be no charge when you go to the doctor, no copayments when you visit the emergency room. All those services would be covered fully by the universal Medicare plan.

 

This, too, is out of line with many international single-payer systems, which often require some payment for seeking most services. Taiwan’s single-payer system charges patients when they visit the doctor or the hospital (although it includes an exemption for low-income patients). In Australia, people pay 15 percent of the cost of their visit with any specialty doctor.

 

The Sanders plan is more generous than the plans Americans currently receive at work, too. Most employer-sponsored plans last year had a deductible of more than $1,000. It is more generous than the current Medicare program, which covers Americans over 65 and has seniors pay 20 percent of their doctor visit costs even after they meet their deductibles.

 

Medicare, employer coverage, and these other countries show that nearly every insurance scheme we’re familiar with covers a smaller set of benefits with more out-of-pocket spending on the part of citizens. Private insurance plans often spring up to fill these gaps (in Canada, for example, vision and dental insurance is often sponsored by employers, much like in the United States).

 

The reason they went this way is clear: It’s cheaper to run a health plan with fewer benefits. The plan Sanders proposes has no analog among the single-payer systems that currently exist. By covering a more comprehensive set of benefits and asking no cost sharing of enrollees, it is likely to cost the government significantly more than programs other countries have adopted.

 

Again, I'm not saying that Sanders' is the wrong approach.  But it is going to be a political sticking point for sure when we talk about the kind of expansion of tax revenues that will be needed to fund the program.  But inclusion of things like long term care makes sense anyway because we currently use medicaid as a backstop to funding long term care.  It invites and is indeed rife with abuse with people trying to game the system to qualify without losing their assets in the process.  I think it's much more preferable to sell it as a risk to be insured against and simply fund it that way instead of saying it is a catastrophic scenario which will be covered with government dollars so prove that you fall under the catastrophic case to qualify for medicaid.  But then MFA advocates have frame it as a transparency, risk insurance kind of way, not just having it viewed as adding populist benefit to medicare.  

 

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I can see this, but from how it was addressed in the first link, it was to allow for doctors to do a procedure that hadnt been approved yet and tell government to add to list and pay them for it.  We complain about the government being slow sometimes, I'm fine with trying this approach because the doctors know the options better then law makers, HHS should do what can to keep up with life saving procedures, this is a way for Doctors to save a life and add the procedure to the list of approved ones instead of someone dying waiting for the law change.  If someone tries to sneak in a boob job via this clause, they'll get caught, but resources need to be devoted to reviewing these quickly.

 

That's tough, because I dont know where to stand on covering illegal immigrants.  I'm fine with it, but want the immigration system fixed.  How do you determine someone is flying in for cheaper procedure vs walking in because they cant afford it period? 

 

Is that reason enough not to do MFA before fixing the immigration system?  I dont think we should turn people away for life saving procedures, does that mean we let people fly here from other countries because our system is cheaper then their own? You dont have nearly the level of medical bankruptcies in other countries as you do here, and that's because a lot of the systems on the table to emulate prevent that from happening.  

 

I dont want to turn people away from medical care they need and not sold if we open the flood gates that everyone will come here for medical treatment.  You still have to apply for visas and asylum.

 

I agree that these are tough issues to address and there are many reasonable options to choose from.  You want to give doctors leeway to push for care that is not yet approved, but have to guard against abuse.  These are things that may just take time to work out over time, regardless of whether you full on implement MFA or use public option as a bridge.

 

With respect to undocumented, I think it would be preferable to tie these kind of redistributive benefits to history of paying income taxes.  We can still use EMTLA as a backstop to providing emergency and life saving care.  But to qualify to buy in to the type of robust and all encompassing single payer plan the country deserves, perhaps we use a certain level of paying into the system as a qualification for the undocumented.  Having said that, it would obviously be much preferable to have a true immigration reform so that we don't have to deal with this kind of nonsense within the context of a healthcare debate.

 

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The biggest problem I see raised with just having the public option is that negotiating medicare prices wont stop the meteoric rise in prices for everyone else that dint have to abide by Medicare pricings.  This again is not just about universal coverage but universal price control, as proposed in the house and Bernie Bills.  

 

https://www.charlotteobserver.com/opinion/opn-columns-blogs/article234971212.html

 

People throw out the price tag of MFA, but what's the price tag of public option?  How come we only here about MFA scaring people off versus whether public option can stop rising healthcare costs?  Because of how much this directly impacts me and my family, I'm tired of being told winning an election is more important then fixing the problem.

 

 

This is fair.  First and foremost, the goal of any healthcare reform has to be reining in the skyrocketing cost of care.  Buttigieg does actually want a unified medicare pricing applied to private insurance too from the get go.  That has a lot of appeal to me.  Give the benefit of group price negotiation to everyone in the country regardless of whether they use private or public insurance and see which option can administer the plans better.  This also gives us time to work out the remedies necessary to prop up hospitals hit hard with sudden lowering of reimbursement rates before private insurance completely goes away.

 

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Are there insurance plans that cover the option of requiring a single room and 5 star chef?  Are we talking about Mayo Clinic?  Pretty sure if you are there for something life threatening and all they have is single rooms with 5 star chefs it will be covered.  Again, I want to stick to examples of what isnt covered in the proposed changes ro MFA and thus had to be covered with a supplemental private insurance plan.  

 

This example is actually what I know of the South Korean model, which is also a single payer system.  SK government's health insurance will cover a standard room (like 6 patients in the room) and if you want a 2 person room or a private room, you pay out of pocket or use supplemental insurance on top of the government plan.  This kind of segregation of Gov't insurance only vs gov't ins + supplemental coverage is seen throughout a lot of SK health care.  Gov't insurance will cover amalgam filing or metal crown, but not procelain.  It will cover a CT, but not an MRI unless it is medically necessary.  Then of course, medically necessary gets hairy, especially when it comes to diagnostics.  Some people choose to pay out of pocket if their doctor pushed for it but it got denied by the gov't insurance.   Cancer patients here and SK too were recommended Neulasta shots to boost white blood cell after chemo.  It took a long time for insurance companies to come around to the fact that Neulasta shots improved long term outcome.  Before they started getting covered, people were faced with hard choices of paying out of pocket for the shots, which costs something like $1400 per shot if I remember correctly.  And this was a shot after each chemo session.  Blech....

 

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Where did you get that 2 million number from?  Does it factor the money the House bill sets aside to address this and retraining g or block Grant's for the hosptials to keep them from closing?  My biggest problem with 4 years is a someone might get laid off halfway through their new bachelors, so I'll look for more specifics on whether this extra money supplements unemployment to stay at the same rate of pay or is money allocated to state level unemployment so they can stay on it for longer.  If you see it before I do, I'm open to criticizing it as well, because it should be full pay, not half pay, because government is causing the economic hardship they will be covering.

 

https://khn.org/news/analysis-a-health-care-overhaul-could-kill-2-million-jobs-and-thats-ok/

 

I think most of these job losses are for the "middleman" positions, not just hospital positions.  All those people pushing papers because the medical billing system requires more intermediaries to process than a lawsuit in court.  In the long run, yes these jobs have to go away.  They are born of inefficiencies in the system.  Just as we don't prop up dying coal mining or manufacturing jobs, we shouldn't prop up these jobs in the long run either.  And I could even get on board with destroying these jobs in 2 years or 4 years.  But then we need a plan to transition these people to a livelihood that much more quickly.

 

I want a single payer system.  It makes sense and it is just, a golden combination for policy.  But we're not gonna get many shots at this and I want it done right from the get go.  If push comes to shove and someone told me I had to pick right now between MFA and one of the alternatives out there, I honestly don't know which I would choose.  But that's exactly why I want MFA proponents like Sanders and Warren to keep honing their messaging and tweaking their plans to improve it.  I would much prefer to support immediate transition MFA wholeheartedly and without reservation.

[gbear]

With Trump poised for next attempt to unravel the ACA, I thought I should post this:

https://www.washingtonpost.com/health/i-would-be-dead-or-i-would-be-financially-ruined/2019/09/29/e697149c-c80e-11e9-be05-f76ac4ec618c_story.html

[bearrock]

54 minutes ago, gbear said:

With Trump poised for next attempt to unravel the ACA, I thought I should post this:

https://www.washingtonpost.com/health/i-would-be-dead-or-i-would-be-financially-ruined/2019/09/29/e697149c-c80e-11e9-be05-f76ac4ec618c_story.html

 

Access to medical care helps people gets healthier.  What an incredible concept.  

[LadySkinsFan]

[Cooked Crack]

 

Repubicans will never bring it up.

[visionary]

 

[JCB]

Bunch of bull****.

[Cooked Crack]

 

[Cooked Crack]

 

[Bozo the kKklown]

American Prospect: The Medicare for All Cost Debate Is Extremely Dishonest
 

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Over the weekend in Indianola, Iowa, Elizabeth Warren announced that she would soon roll out specific details for financing Medicare for All, the culmination of a week of “but how will you pay for that” demands from the media and rival presidential candidates.

 

That a nation with millions of uninsured people and tens of thousands of unnecessary deaths from lack of access to health care is consumed with talking about taxes, rather than the revolution in human rights that would come from universal coverage, tells you a lot about life in the United States, and why we still suffer from a broken system.

But this triumph of budgetary scolding is being applied unevenly. If we want to talk about “paying” for universal coverage, we should expand the discussion to all the candidates who claim to support it.

 

While Joe Biden and Pete Buttigieg and others have howled about cost, there’s a deception at the heart of their own plans: either they put just as much health care costs on the federal government as the Warren-Sanders single-payer model, or they’re effectively useless. 

 

Biden and Buttigieg have separately proposed public options that would compete with private insurance. In Biden’s plan, even those with employer-sponsored insurance could opt out and choose the public plan. Buttigieg would offer subsidies to help people pay for the public option, capping the cost of insurance at 8.5 percent of income.

 

Both explicitly pitch this as a cheaper way to establish universal coverage. But that claim relies on a hide-the-ball scenario. Biden or Buttigieg’s public option, over time, will either serve as a weak alternative to private coverage, with high premiums and substandard coverage. Or, backed by government bargaining power, it will outshine private insurance and gradually supplant it. Buttigieg himself talks about his plan as a “glide path” to Medicare for All.

 

If it doesn’t work, the public option will certainly be cheap, but it also won’t help anybody at a meaningful scale. If it does attract millions of customers, then in the long run, it would approach a single-payer system. At that point, on the “how will you pay for that” question that Biden and Buttigieg are posing, it faces the same challenges as the Warren-Sanders model.
 

Biden and Buttigieg take advantage of the fact that we use a bizarre and often faulty system to “score” legislation in the Congressional Budget Office, which only looks at a ten-year window for budgetary impact. If the public option is good, and it eventually becomes a kind of Medicare for All, the cost spike would all happen outside the ten-year window. So Biden and Buttigieg are either lying about how effective their public options will be, or they’re lying about how much they will ultimately cost. They can’t have it both ways.

More in the link above.

[Bozo the kKklown]

 

[Larry]

Attempting to divert discussion of the various Dem health care proposals, here.  

 

In last week's episode, @Renegade7 and @PeterMP are discussing claims about the cost savings proposal of Bernie's MFA proposal.  

 

Renegade, 

 

You're still doing exactly what the article says people are doing - Taking a sentance from the study that says "Bernie's plan will save $2T if every thing he says, comes true.  But there's no way those predictions will possibly come true", and then ignoring the fact that it's not a believable projection.  

 

And when Peter points out that the projection is based on fantasy assumptions, your response is "well, he modified his plan so that it includes more money to cover for those facts", and then arguing that we should still stick with the fantasy number.  

 

[Renegade7]

3 minutes ago, Larry said:

Attempting to divert discussion of the various Dem health care proposals, here.  

 

In last week's episode, @Renegade7 and @PeterMP are discussing claims about the cost savings proposal of Bernie's MFA proposal.  

 

Renegade, 

 

You're still doing exactly what the article says people are doing - Taking a sentance from the study that says "Bernie's plan will save $2T if every thing he says, comes true.  But there's no way those predictions will possibly come true", and then ignoring the fact that it's not a believable projection.  

 

And when Peter points out that the projection is based on fantasy assumptions, your response is "well, he modified his plan so that it includes more money to cover for those facts", and then arguing that we should still stick with the fantasy number.  

 

Everything you jus said was true until the last sentence and hope @PeterMP gets that.  I'm done with that number i was wrong, and I'll stop bringing up the study.  That's not even where the conversation started, it was the last sentence in a post that showed that the majority of the country wants this but disagrees on how to do or it or the details of it.  

 

We cant keep saying it's going to close hospitals if the latest Bill's set aside money to prevent that.  I'm getting tired of seeing that.

[Larry]

OK, now, as to some of those assumptions:  

 

I have no clue where that "40% reduction to providers" number came from.  I have a lot of trouble believing that right now, private insurers are paying, on average, 40% more money per care than Medicare pays.  I'm aware that Medicare currently pays less than private insurers.  But I doubt it's 40% less than the average.  

 

But then you get into "how much would MFA simply cut the amount they pay to providers?".  Immediately followed by "What do you think the effects of cutting the amount of money providers get, by X%, would be?"  

 

In short, I have to say, any plan that bases it's numbers around the assumption of "well, we'll just pay providers less, and let them deal with it", I'm really dubious about.  

 

- - - - - 

 

Now, as to "reducing overhead"?  

 

I could easily see the notion that MFA might result in lower overhead costs.  

 

Not because I believe that the government is vastly more efficient than a private corporation that gets to keep whatever money they save.  

 

But because I could see the argument that replacing all of the different insurance plans, and all of the rules which they impose and change at whim, with a single system (even a poorly designed government one) might be an advantage, simply because providers will only have to deal with one bureaucracy, instead of dozens.  

 

I'd have no trouble believing that MFA might reduce overhead costs.  At least a little.  

 

[LadySkinsFan]

This move to public option or M4A must be a multi-year plan to include moving administration people to new jobs and job re-training as necessary. It took decades to get into this situation and it will take years to craft a new system. 

 

I know with certainty that Republicans will stand the way of any kind of kind of realistic heath system planning. You know that ACA is basically a Republican driven system from MA until they abandoned all semblance of any humanitarian consideration over extreme profits. 

 

That's why this election season is so important.

[Larry]

1 minute ago, LadySkinsFan said:

I know with certainty that Republicans will stand the way of any kind of kind of realistic heath system planning.

 

Yeah, I don't know why, but I have this feeling that they will work diligently, at every level of government, to try to break things in any way they can.  Systematically.  For a decade or longer.  

 

No clue why.  Just a disturbance in the Force.  

 

[PeterMP]

53 minutes ago, Larry said:

I'd have no trouble believing that MFA might reduce overhead costs.  At least a little.  

 

1.  The 40% number comes from the government (CMS) and is for hospitals.

 

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/2018TRAlternativeScenario.pdf

 

2.  For doctors in general, the difference is about 20% and expected to continue to decline (same links as above).

 

3.  As of 2019, the current plan didn't lay out payments for hospitals and doctors so is vague in terms of what they get paid so people are assuming the 40-20% numbers.  

 

https://khn.org/news/delaneys-debate-claim-that-medicare-for-all-will-shutter-hospitals-goes-overboard/

 

4.  Medicare's overhead costs is significantly less than private insurance (probably about 5% as compared to 15%).  Most of the difference is not things like forms.  Part of that is things like marketing and advertising is part of over head costs and Medicare does much less of that than private insurance.  (Do you get those ads by insurance companies saying, healthcare provider X isn't reasonable and won't agree to take your insurance in the future.  Call them and complain.  That's an overhead cost.)  Competing for customers is a big part of the over head costs for private insurance.

 

Part of the difference is also due to things like fraud prevention and controlling usage.  Private insurance also spends a lot more money to not document the not covering of things in terms of lawsuits and making sure they are abiding by their agreements in the policies (otherwise they get sued).

 

Overhead costs in the US compared to Canada in 1999 were about 30%.

http://nejm.org/doi/full/10.1056/NEJMsa022033

 

That's consistent with a more recent study just looking at hospitals.

 

https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2013.1327

 

And again, a lot of that isn't things like forms.  It is things associated with the costs of acquiring patients, and then documenting that they are doing things based on the agreements they have for those patients, while controlling costs by limiting usage (denying claims), and fraud prevention.

 

Though, Sanders has also proposed things that I don't think other countries do that will increase administrative costs.  For example, Sanders wants to force hospital to track and provide patient/staffing ratios. 

 

5.  We can almost certainly generate a healthcare system that covers everything Sanders wants to for less than what we spend now, but I'm dubious that it is anywhere near what Sanders seems to think it will be.  There's really no good way to estimate what it will be.  Again, outside of the likes of Cuba, no country in the word does what Sanders is suggesting.  Changes in consumption are really just best guesses (most people think we'll see an increase of over 10% in usage.)

 

6.  And it will almost certainly come with changes to the health care system.  At a time that much of the world is increasing what their citizens pay for the healthcare to control usage of healthcare, Sanders is talking about massively going in the other direction.  There are much more basic things that we can do that will help lower costs without becoming an experiment for the rest of the world that much of the rest of the world is actually moving away from.

 

Edited November 2, 2019 by PeterMP

[Larry]

3 minutes ago, PeterMP said:

Though, Sanders has also proposed things that I don't think other countries do that will increase administrative costs.  For example, Sanders wants to force hospital to track and provide patient/staffing ratios. 

 

I can tell you that at least at the nursing homes I've worked at, that's absolutely one of the things the state looks at, when their auditors show up.  (My facility got fined for not meeting it.)  (Deservedly.)  

 

I don't think they report it constantly.  It's a case of, when State shows up, (unannounced) they go over the records for the last two pay periods.  

[PeterMP]

Just to be clear too with respect to my last post, controlling usage (and so costs) isn't always bad.  Private insurance spends more money controlling usage than medicare or most single payers systems.  That shows up as over head.  Uncontrolled or poorly controlled usage means money spent on unnecessary healthcare costs, but that makes over head ratios not look as bad too.

 

Poorly controlled usage:  https://www.newyorker.com/magazine/2009/06/01/the-cost-conundrum

 

 

[Springfield]

Reading the Post’s description of Warren’s plan, I find it hard to believe that doctor pay won’t go down (or remain stagnant) as a result of this.  Also, it seems that she’s a bit ambitious on how much it will actually cost.

 

Id love it, but I’m dubious about doing it without raising taxes on the middle class and from what I gathered, Warren’s plan was mostly all to large corporations and high income earners.

[LadySkinsFan]

Look, we need to start somewhere, that's why it's a multi-year plan that has to be implemented, it's probably a ten year plan with multiple steps getting to an end result, with adjustments along the way. 

 

It's not going to happen overnight and it needs to be approached this way. 

 

And Republicans need to stop interfering with humanitarian efforts by pushing maximum profits for for profit businesses and shareholders. There's no logical reason why we can't have hospitals in rural areas. 

 

I know that if my brother hadn't had decent insurance, he never would have left the small rural hospital in the Northern Neck of VA and been helicoptered to Uni of Richmond CCU where he was until he died two weeks later. He would have died in the rural hospital. 

 

The bills were mountainous from treatments that didn't help. 

 

Rural hospitals are needed to help those who have a chance of living with prompt treatment, and not die because they have to travel long distances using expensive methods like long ambulance rides or helicopters.

[gbear]

Just want to add two things I thought

About last night. 

1. Up until a couple of years ago when the U.S. took back over immigration, CNMI was alowed to continue the practice of hiring Temp immigrants from Vietnam and China and paying them well below minimum wage. The deal was they paid $2 an hour but had to include free room, board and HEALTHCARE.  Note, they did not have to cover insurance. I think about why companies went that route, and what does that say about the cost of insurance now versus the costs of treatment for whole population,s of treatment. Those business owners thought there was money to be saved pati,g for treatments.

2. I was happy to see Warren take the position immigration is a boon for our economy. I have been waiting for a dem to start making that point. Hell, I have made the point on here many times how much danger of an aging workforce poses to our economy and other first world countries' economies. However, I have no idea how much imigration can be counted on to fund a healthcare system overhaul.

[skinsmarydu]

My husband heard Warren's plan costs 52T over 10 years, and I heard 20.5. 

Which is it?