Presidential Election: 11/3/20 ---Now the President Elect Joe Biden Thread

[Hersh]

7 hours ago, Renegade7 said:

This is part of a bigger conversation in Americans not doing enough to take care of their health and the doctors jus saying yes to everything.  Universal Healthcare by itself wont encourage healthier lifestyles of the average Americans. That's a bigger problem that comes to the food we made avaliable and pollution.

 

 

I wish politician would have the courage to talk about this more. Granted, genetics play a huge role too but there are a lot of self-inflicted health care issues in our country. 

[Renegade7]

6 hours ago, PeterMP said:

 

1.  Yes, I think attacking it in parts makes sense.  But Bernie's plan would be expected to make the other part of the problem worse.  If you have a problem that has multiple contributing factors starting to solve the problem through something that is likely to make one of your contributing factors worse doesn't make much sense.  In the US, non-beneficial over consumption is a problem that is affecting health care costs (not claiming it is the major or principle issue, but it is a contributing factor).  It is reasonable what Sanders is proposing will make it worse.  Attacking the problem in parts makes sense as long as part of attacking the problem isn't likely to make other parts of the problem worse.  Because attacking a problem in parts in ways that make parts of the problem worse doesn't probably actually help you solve the problem.

 

Both his senate and the house bill expect 3-4 years after the bill is signed before going into affect.  That should be more then enough time to pass Bill's to address other factors in this conversation.  Otherwise, let's jus pass one bill that fixes everything?  That's not how democracy works.

 

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2.  The piece isn't really related to the health of the people in the US.  Over consumption can and is a problem in most every country, which is why they have practices in place to control them. (which Bernie's plan doesn't have.)

 

So to be clear, are we talking about everyone automatically becoming a hypochondriac, doctors overprescribing because they can and dont care, or leave the door open for unlimited preventative healthcare and early detection?  If those things are addressed how will that change your opinion of the senate or house bill?  Keep in mind, to me this sounds like every poll in this issue, that MFA as a concept isnt as bad as the proposed implementation.

 

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3.  Do you understand why other prices (e.g. hospitals) are going up?

 

Honestly, I'd say no because everytime I think I do, another factor or expectation is brought forward.  What I do know is this situation is complex and this bill is how to pay for it while capping pricing across the board.  There are other factors that I'm open to understanding, but that's not my job, that's theres to figure out how to deal with it, not tell me its impossible or two large a problem to address all at once or in chunks thus let's settle for what will get them elected.

 

 

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It is also a little odd for somebody saying we don't have to fix all of the issues with healthcare at the same time complaining about a plan that emphasizes part of the reason that health care costs are going up.

 

Do you think it might make sense to take major steps to fix the biggest problem, some things that might help fix other things, and then sort of see what happens?

 

I dont like your tone.  We should be able to chew gum and walk at the same time, so stop coming at me like I'm jus trying to simplify this issue so I can win a debate with you.  Again, this directly impacts my life and my family. I dont have a lot of patience for being lectured like I'm a child when I know what it's like to see my parents ration their medication with my own two eyes.

[Larry]

17 minutes ago, Renegade7 said:

Both his senate and the house bill expect 3-4 years after the bill is signed before going into affect.  That should be more then enough time to pass Bill's to address other factors in this conversation.

 

I seem to remember hearing "We'll tweak it over the next few years after we pass it" before  

 

(I agree, that's the mature, responsible, way to legislate.  just saying we can't always count on mature, responsible, legislation.)  

[TheGreatBuzz]

9 minutes ago, Larry said:

just saying we can't always count on mature, responsible, legislation legislators.

FTFY.

[PeterMP]

1 hour ago, Renegade7 said:

 

Both his senate and the house bill expect 3-4 years after the bill is signed before going into affect.  That should be more then enough time to pass Bill's to address other factors in this conversation.  Otherwise, let's jus pass one bill that fixes everything?  That's not how democracy works.

 

So to be clear, are we talking about everyone automatically becoming a hypochondriac, doctors overprescribing because they can and dont care, or leave the door open for unlimited preventative healthcare and early detection?  If those things are addressed how will that change your opinion of the senate or house bill?  Keep in mind, to me this sounds like every poll in this issue, that MFA as a concept isnt as bad as the proposed implementation.

 

Honestly, I'd say no because everytime I think I do, another factor or expectation is brought forward.  What I do know is this situation is complex and this bill is how to pay for it while capping pricing across the board.  There are other factors that I'm open to understanding, but that's not my job, that's theres to figure out how to deal with it, not tell me its impossible or two large a problem to address all at once or in chunks thus let's settle for what will get them elected.

 

I dont like your tone.  We should be able to chew gum and walk at the same time, so stop coming at me like I'm jus trying to simplify this issue so I can win a debate with you.  Again, this directly impacts my life and my family. I dont have a lot of patience for being lectured like I'm a child when I know what it's like to see my parents ration their medication with my own two eyes.

 

1.  Okay, but why doesn't he lay out those other bills now.

 

Consumption going up doesn't require for everybody to become a hypochondriac.  People already do use health care that doesn't really affect their health and it is completely reasonable that people will do more of so without co-pays and deductibles.  And doctors do over prescribe tests and drugs for different reasons, including (but not limited to) pay per a procedure practices that don't end under Bernie's plan.

 

Everybody isn't a hypochondriac now and many people have strong incentives to not use (much) health care, but over consumption happens now.

 

https://hbr.org/2014/12/how-to-stop-the-overconsumption-of-health-care

 

If by M4A you mean Bernie's specific plan, then yes it is a bad implementation.  I'm not a huge fan of most nationalized medicine plans because I don't think they address the underlying issues that already affect other industries and society in general, but they also do have advantages (e.g. reduce over head) for a particularly important industry so am not really against nationalized healthcare.  But Sander's appears to be a particularly bad implementation of it.

 

If Sander's plan was literally Medicare for all, then that would be much more acceptable.

 

2.  Then how do you know that Biden's isn't enough?

 

How do you conclude "It's not enough, bro, it's too heavily focused on drug prices, every price concerning health care is going up, not jus drug prices."

 

when you don't know why those costs are going up.

 

(Hospital costs are going up because:

 

1.  More use of more modern procedures.  Whether this is actually necessary and actually helping people or simply over consumption is a hard thing to figure out.

 

2.  Consolidation and the creation of vertical and horizontal monopolies.  Coupled with issues of lack of access in rural areas.

 

3.  (very slightly) shifting costs from people and organizations (i.e. the government through medicare and medicaid) to people that can.

)

 

Biden's plan is to go after #2 specifically and potentially #1.

 

3.  I don't really care if you don't like my tone.

[PeterMP]

1 hour ago, Renegade7 said:

 

Have you watched his interview with Joe Rogan?  It frustrates me, neither his bill nor the house bill abolish private insurance, I dont get why he keeps saying that, its killing him

 

https://www.cbs.com/shows/cbs_this_morning/video/Mm2TsVsKjqTFpXWHr6aA0gEqucC2HJ3h/bernie-sanders-on-the-role-of-insurance-companies-under-medicare-for-all-/

 

Skip to 1:55 where he clarifies they will be left to conversation what Medicare doesnt, hes not abolishing them

 

Because he's more interested in keeping his base riled up because he thinks it will help him win elections than having honest conversations.

[Renegade7]

6 minutes ago, PeterMP said:

 

1.  Okay, but why doesn't he lay out those other bills now.

 

Consumption going up doesn't require for everybody to become a hypochondriac.  People already do use health care that doesn't really affect their health and it is completely reasonable that people will do more of so without co-pays and deductibles.  And doctors do over prescribe tests and drugs for different reasons, including (but not limited to) pay per a procedure practices that don't end under Bernie's plan.

 

If by M4A you mean Bernie's specific plan, then yes it is a bad implementation.  I'm not a huge fan of most nationalized medicine plans because I don't think they address the underlying issues that already affect other industries and society in general, but they also do have advantages (e.g. reduce over head) for a particularly important industry so am not really against nationalized healthcare.  But Sander's appears to be a particularly bad implementation of it.

 

If Sander's plan was literally Medicare for all, then that would be much more acceptable.

 

I mean, hes already a huge proponent of green new deal and environmental protection, that's a huge factor in the environment itself making us sick.  I'm not sure how to legislate how people take care of their bodies or if that's really the governments place.  But like Warren, hes far more strict on existing regulations designed to to protect food. 

 

Does that mean he should propose a plan to make all food organic by such and such date?  Some of these issues I can respect saying he wants to address without asking him to make the bill by himself.  His bill and the house bill will have to meet in the middle on a lot of issues, the house doesnt make prescription drugs free, that tells me the conversation on unfretted consumption is being had.

 

As for trying to convince you we should do MFA, this isnt the right thread for that.

 

6 minutes ago, PeterMP said:

2.  Then how do you know that Biden's isn't enough?

 

How do you conclude "It's not enough, bro, it's too heavily focused on drug prices, every price concerning health care is going up, not jus drug prices."

 

when you don't know why those costs are going up.

 

(Hospital costs are going up because:

 

1.  More use of more modern procedures.  Whether this is actually necessary and actually helping people or simply over consumption is a hard thing to figure out.

 

2.  Consolidation and the creation of vertical and horizontal monopolies.

 

3.  (very slightly) shifting costs from people and organizations (i.e. the government through medicare and medicaid) to people that can.

)

 

Biden's plan is to go after #2 specifically and potentially #1.

 

I said I dont know every cause and open to understanding, not that I'm clueless.  I went to his website and posted the link in my response to you, where does it address #1 in regards to more then jus drug prices?  What about simply giving birth to a kid or just getting a ride in an ambulance?

 

https://joebiden.com/healthcare/

 

6 minutes ago, PeterMP said:

3.  I don't really care if you don't like my tone.

 

The default position of the board is to be respectful to other members.  Board rules aside, I'm asking you to stop being condescending to me so we can have a civil conversation.  I dont understand why you dont care, is because you are behind a computer screen instead of sitting right in front of me?

[PeterMP]

41 minutes ago, Renegade7 said:

 

I mean, hes already a huge proponent of green new deal and environmental protection, that's a huge factor in the environment itself making us sick.  I'm not sure how to legislate how people take care of their bodies or if that's really the governments place.  But like Warren, hes far more strict on existing regulations designed to to protect food. 

 

Does that mean he should propose a plan to make all food organic by such and such date?  Some of these issues I can respect saying he wants to address without asking him to make the bill by himself.  His bill and the house bill will have to meet in the middle on a lot of issues, the house doesnt make prescription drugs free, that tells me the conversation on unfretted consumption is being had.

 

As for trying to convince you we should do MFA, this isnt the right thread for that.

 

 

I said I dont know every cause and open to understanding, not that I'm clueless.  I went to his website and posted the link in my response to you, where does it address #1 in regards to more then jus drug prices?  What about simply giving birth to a kid or just getting a ride in an ambulance?

 

https://joebiden.com/healthcare/

 

 

The default position of the board is to be respectful to other members.  Board rules aside, I'm asking you to stop being condescending to me so we can have a civil conversation.  I dont understand why you dont care, is because you are behind a computer screen instead of sitting right in front of me?

 

1.  As has been stated in this thread by others, the idea that people getting sick (earlier in life) raises costs isn't well supported.  And there's little evidence to the value of most organic foods. 

 

And reducing CO2 output won't necessarily do anything for other types of pollution.  In fact things like solar panels are based on pretty unhealthy molecules so if the green new deal results in more solar panels generated in the US, almost by default you'll have more people exposed to those chemicals and negative health consequences as a result.

 

So you have big trouble if those are important ideas for reducing health care costs.

 

But that's not what I'm talking about anyway.  Bernie's plan is likely going to make consumption of unnecessary health care worse and as such drive up costs in a way that it makes it look like we're getting a better value even if we aren't.

 

2.  Biden's plan doesn't really address #1 in terms of drug prices.  Most plans don't directly.  The only way to address #1 is to have somebody other than somebody's doctor to say which tests and things should be done for somebody. I  don't think anybody running for President is doing that (even Sanders).

 

If you increase competition by preventing or eliminating mergers, prices for everything should come down.  Consolidation in all industries, including health care, causes prices to raise for pretty much everything.  In addition, there is a public option.  If you have a baby and have insurance through a public option, then your costs are likely to come down (vs. if you have no insurance).

 

And okay, based on what you do know, how do you know that Biden's efforts to go after #2 and #3 isn't enough?  If we can back track some of the consolidation that has happened in the health care industry and have a public option that gives people (more) choices, how do you know that isn't enough to generally lower health care costs? (coupled with increase support of lower class people).

 

What support do you actually have to conclude:

 

"It's not enough, bro, it's too heavily focused on drug prices, every price concerning health care is going up, not jus drug prices."

 

3.  I generally don't care if people don't like my tone, but I do care even less over a computer because tone is pretty much meaningless.  It isn't like you can actually hear my tone.  Your concept of my tone is generally based on your perception of what I've written and that very much depends on my background in terms of how I write vs. you.  And there are too many people with too many different backgrounds for me to worry about how one person perceives my tone in written text vs. making the points I want to make as quickly and directly as possible.

[Renegade7]

5 minutes ago, PeterMP said:

 

3.  I generally don't care if people don't like my tone, but I do care even less over a computer because tone is pretty much meaningless.  It isn't like you can actually hear my tone.  Your concept of my tone is generally based on your perception of what I've written and that very much depends on my background in terms of how I write vs. you.  And there are too many people with too many different backgrounds for me to worry about how one person perceives my tone in written text vs. making the points I want to make as quickly and directly as possible.

 

I see.  So I think I just realized something about you, myself, and this message board I should've got a long time ago.  I'm going to step away from this conversation on that note.

[88Comrade2000]

MT governor Steve Bullock is suspending his campaign today.

 

[Forehead]

11 hours ago, PeterMP said:

 

1.  As has been stated in this thread by others, the idea that people getting sick (earlier in life) raises costs isn't well supported.  And there's little evidence to the value of most organic foods. 

 

This is correct from what I understand.  My mother was a lifer in USDA and USTR, including when the protocols for "organic" were negotiated.  She told me from firsthand knowledge of the discussions that the thresh hold to claim something as organic is pretty low and not worth the cost, it is essentially pissing away money.

[bearrock]

17 hours ago, PeterMP said:

2.  If you increase competition by preventing or eliminating mergers, prices for everything should come down.  Consolidation in all industries, including health care, causes prices to raise for pretty much everything.  In addition, there is a public option.  If you have a baby and have insurance through a public option, then your costs are likely to come down (vs. if you have no insurance).

 

And okay, based on what you do know, how do you know that Biden's efforts to go after #2 and #3 isn't enough?  If we can back track some of the consolidation that has happened in the health care industry and have a public option that gives people (more) choices, how do you know that isn't enough to generally lower health care costs? (coupled with increase support of lower class people).

 

 

Assumption that market forces will lower healthcare costs also assumes that consumers will put cost at a very high consideration.  If that were true, people would switch to HMOs.  The way we structure healthcare reimbursements in this country, lowering cost has a limited impact on the patient's bottom line because major procedures will eat up the annual allotment of deductible, which means that provider A being 20% cheaper than provider B doesn't matter as long as both are above the maximum patient responsibility threshold.  The cost savings of minor procedures between providers typically are not high enough for patients to choose doctor B they like less than doctor A.  

[PleaseBlitz]

8 hours ago, Rdskns2000 said:

MT governor Steve Bullock is suspending his campaign today.

 

 

Who?

[tshile]

22 minutes ago, bearrock said:

Assumption that market forces will lower healthcare costs also assumes that consumers will put cost at a very high consideration. 

my understanding is that reports already show people are, it just depends on what exactly you're looking at.

 

for instance, mri/cat scans are ones that always come up in conversation with the people i know. places that recently invested in these machines to offer these services (recently as in with respect to when ACA became a thing, so 10-12 years ago) are having problems because the market has changed dramatically because people are price shopping these services which has screwed up expected # of patients to use the service as well as the bigger picture of how much to charge for the service (price competitively vs factoring in the investment cost)

 

I think something personal like the doctor you're using, makes sense. It's someone you can talk to, has a personality, has credentials, etc.

 

A 'machine', there's no attachment there and people go straight to price.

 

[PleaseBlitz]

People are also assuming that people understand costs up front, which just isn't true in our system for distribution of medical services.  

[tshile]

13 minutes ago, PleaseBlitz said:

People are also assuming that people understand costs up front, which just isn't true in our system for distribution of medical services.  

watching someone go through the process of trying to figure out the expected cost of the birth of their first child is a hoot

 

(as in depressing and only somewhat funny cause you remember doing it...)

[skinsmarydu]

And I saw a bit about how 3 hospitals within a reasonable area had a range of costs for the same procedure that varied by thousands of dollars. (sorry, I don't recall the details) 

How often does one shop for prices? Moreover, why should we need to? 

[Larry]

8 hours ago, Rdskns2000 said:

MT governor Steve Bullock is suspending his campaign today.

 

 

29 minutes ago, PleaseBlitz said:

 

Who?

Why. 

[PleaseBlitz]

17 minutes ago, tshile said:

watching someone go through the process of trying to figure out the expected cost of the birth of their first child is a hoot

 

(as in depressing and only somewhat funny cause you remember doing it...)

 

Right. Most other places there is a menu of costs or some kind of disclosure scheme. “I’d like the C-section with epidural, hold the mandatory 3rd day ‘for monitoring ‘“ is not a thing I’ve seen. 

[Cooked Crack]

 

 

[bearrock]

1 hour ago, tshile said:

my understanding is that reports already show people are, it just depends on what exactly you're looking at.

 

for instance, mri/cat scans are ones that always come up in conversation with the people i know. places that recently invested in these machines to offer these services (recently as in with respect to when ACA became a thing, so 10-12 years ago) are having problems because the market has changed dramatically because people are price shopping these services which has screwed up expected # of patients to use the service as well as the bigger picture of how much to charge for the service (price competitively vs factoring in the investment cost)

 

I think something personal like the doctor you're using, makes sense. It's someone you can talk to, has a personality, has credentials, etc.

 

A 'machine', there's no attachment there and people go straight to price.

 

 

I can see those kind of services (mri/cat scans) being more amenable to market forces.  I mean I wouldn't say it doesn't have any impact, just limited impact (although I recently told a friend that she should shop around for pricing on an mri and she looked at me like I was speaking Klingon).  But fairly expensive scans are somewhat of a unique situation cause it will likely exceed your deductible, but not eat up all your coinsurance.  

1 hour ago, tshile said:

watching someone go through the process of trying to figure out the expected cost of the birth of their first child is a hoot

 

(as in depressing and only somewhat funny cause you remember doing it...)

 

One thing I found interesting was when we had our first child, Anthem charged a flat fee of $4000.  That covered whatever happened, including any kind of surgery.  When we had our second child 3 years later, we still had the same policy at Anthem, but now something changed and they took a deposit up front, but itemized later.  I think it cost a little less the second time around, but not by that much.  

[Cooked Crack]

 

 

Thread. End the EC.

[gbear]

I notice the assumption all MRI are the same. Depending on what they are used for, the newer MRI are both stronger and faster. This can matter when looking for some things in the brain (I suspect other parts too, but I know brain). For those scared, open can help or the ones we can listen to music while the scan is running.

 

As a second note, those of us in the Baltimore/DC area are in the market that has one of the highest ratios of doctors to patients in the world. So we have options and are acting like everyone has the choices to pick the doctor or service provider they want. In a lot of "fly-over land" there may only be one choice in easy driving distance. In those situations, market forces are not helpful. 

 

So most of us don't have a ready means of knowing what something should cost because we dont have a way of understanding what differentiates services in terms of need or better service. Then many of us have no choice even if we are capable of making informed decisions.

[PeterMP]

4 hours ago, bearrock said:

 

Assumption that market forces will lower healthcare costs also assumes that consumers will put cost at a very high consideration.  If that were true, people would switch to HMOs.  The way we structure healthcare reimbursements in this country, lowering cost has a limited impact on the patient's bottom line because major procedures will eat up the annual allotment of deductible, which means that provider A being 20% cheaper than provider B doesn't matter as long as both are above the maximum patient responsibility threshold.  The cost savings of minor procedures between providers typically are not high enough for patients to choose doctor B they like less than doctor A.  

 

There are multiple studies that show consolidation is a major driving force of increase patient costs.

 

E.g. https://blog.definitivehc.com/hospital-market-consolidation-patient-costs

 

and competition keeps prices low:  https://med.stanford.edu/news/all-news/2014/10/competition-keeps-health-care-costs-low--researchers-find.html

 

We can argue over the mechanism of the process, but it is hard to believe if consolidation is driving price increases to patients and competition is tied to lower prices that reversing  the consolidations that have happened won't lower prices.

 

Now, it might not be much or enough (and I tend to think it won't and if you go back to one of my posts I alluded to doing what was done to the insurance industry to other industries, and I suspect that we'll probably have to do the same with healthcare providers (e.g. profits and upper level management compensation will have to be capped for large health care providers)).

 

But to unilaterally declare it isn't enough or to hold that it won't work at all isn't supported by the evidence.

 

Up to a 54% increase for a hospital isn't something to sneeze at.

 

And as @Renegade7 stated it is a complex problem and attacking it in pieces probably makes sense.

 

If you can get a national public option and caps on drug prices to with stand court challenges and show they work, then doing more with respect to health care providers becomes a lot more feasible (at that time, the providers will become willing negotiators in terms of future and further regulation).

 

(**EDIT**
I'm sure if you look, you can find old posts of mine here where I argue that the health care market/industries are heavily inelastic.  Which is essentially what you are arguing and has been a pretty common view by liberal economists.  But over the last 5+ years there has been a number of studies that show that isn't the case.  I'm honestly not sure why the markets appear to be as elastic as they are, but it is hard to argue with the studies that have come out.  And I'd still argue the health care market/industries aren't rational or good markets for the reasons laid out by @gbear , but it is pretty clear they are heavily elastic (and going to a nationalized health care system won't make them rational or good markets either, I don't think.).)

[TheGreatBuzz]

I just want to know where I can apply to be a member of the Death Panels.