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


88Comrade2000
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1 hour ago, No Excuses said:

 

I mean why does the government support research endeavors in any nascent technology that seems promising or could deliver entirely new tech capabilities? I don't really get what you are arguing here. A government can be data driven and also forward thinking and bold in terms of supporting early research and growth of entirely new forms of technological capabilities. This is already the case with DARPA and ARPA-E.

 

There's a difference between the government funding research, and the government pushing an idea. The government has funded research for decades now, but I generally don't think people would say the government has pushed the ideas that it is funded (pushing an idea to me is Kennedy and the moon, Reagan and SDI, etc).

 

Currently, the government funds research related to geoengineering.  Obviously, Yang isn't talking about the government continuing to do what it is doing.

 

Most new/big ideas are wrong.  Becoming married to an idea (pushing an idea) without supported data is likely to have negative costs and consequences.

 

Funding geoengineering research probably makes sense.  Pushing it as some long term solution without significant negative consequence probably doesn't.

 

And isn't supported by data.

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50 minutes ago, Renegade7 said:

2. Start negotiating medical prices down to levels between Canada and UK

 

Fundamental to the Canadian (and I believe UK) system are essentially government funded healthcare facilities (e.g. hospitals).

 

The government block grants funding to hospitals (without worrying about what the money is being spent on).

 

Which reduces over head (and likely increases fraud).  I'm doubtful that you can do A (lower medical prices) without B (funding health care facilities in way that is independent of the procedure they perform).

 

I don't think medicare for all gets you to Canadian or UK healthcare costs.

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I’m on private insurance and it sucks a giant bag of dicks.  I’m all for making tshile give up his great private insurance so we can all have nice public insurance.

 

That said, ACA market plans sucked worse than my employer based insurance.  So to me, I think it’s all or nothing.  Everyone goes public or it won’t work.

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I hear people wanting government run healthcare (with or without a private option) and I just think about two current versions of it in the military and VA.  Makes me hesitant to let them go ahead and provide for everyone.  I could possibly see a government version if people can buy better, private service when they get tired of the federal system.  But that makes Warren even scarier.  

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53 minutes ago, Renegade7 said:

MFA would have to be phased in, a siesmic shift like that cannot be taken lightly.  

 

Could be something like:

 

 

3. Make it illegal to deny Medicare or Medicaid

 

 

This is the part that terrifies me as a provider of mental health services.  I currently accept Medicaid and Medicare in my practice.  I live in South Dakota, and I feel that the reimbursement from these programs is low, but not so low that I can't afford to include some patients with these forms of insurance. However, there is no way I could get by with only seeing patients with such low reimbursement.  Also, I have worked in Illinois in the past, and it would have been impossible to see medicade patients and continue to make a living.  When I was there, reimbursement from Medicaid was around $7.50 for a 50 minute treatment session.  You would not get that $7.50 for almost two years, and you would often have to resubmit the claim multiple times in the two years you were waiting to get paid.

 

So, I was willing to treat some people for free rather than wasting time on trying to get reimbursed for the treatment provided.

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11 minutes ago, PeterMP said:

 

Fundamental to the Canadian (and I believe UK system) are essentially government funded healthcare facilities (e.g. hospitals).

 

The government block grants funding to hospitals (without worrying about what the money is being spent on).

 

Which reduces over head (and likely increases fraud).  I'm doubtful that you can do A (lower medical prices) without B (funding health care facilities in way that is independent of the procedure they perform).

There's gotta be a way to get these prices down, we are getting price gauged in this country because pharma is being allowed to do it. I'm fine with using block grants to cover the missing money to hospitals, but we'd need to bring that $150 billion number down, it should come down gradually, not jolted.

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The nation's hospitals would lose somewhere on the order of $150 billion a year, according to anarticle in The Journal of the American Medical Association. Which would mean that someone would have to be paid less, and it wouldn't just be insurance companies: It would be nurses and doctors, therapists and billing specialists, the entire universe of middle-class jobs that America's health care industry supports. Even some physicians who support single-payer have suggested they are worried about the possibility that hospitals would lose money. "The line here can't be and shouldn't be soak the hospitals," the president of Physicians for a National Health Program recently told The New York Times

 

Cuts to hospital payments, meanwhile, would be hardest to bear for rural hospitals that serve poorer populations. Many of these hospitals are, for obvious reasons, already struggling financially, and under a system of all Medicare rates, they would likely be first to close, leaving local residents with fewer health care options. Warren styles herself a populist champion of the working class, but it is not much of a stretch to say she supports a plan that would make health care worse and less accessible for the nation's rural poor

 

That last part felt completely unnecessary.  Warren said she supported Bernie's plan for MFA, here's how he said he planned to pay for it

 

https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.sanders.senate.gov/download/options-to-finance-medicare-for-all%3Finline%3Dfile&ved=2ahUKEwjckrbn34rjAhVvmeAKHTwHB1sQFjAUegQIBhAB&usg=AOvVaw2tqCxQugfNOPAoT_zhxHsW

 

I don't think they are ignoring the costs of this at all, they really do believe there's so much money at the top in this country that by taxing them we can afford it without wrecking the economy.

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36 minutes ago, TheGreatBuzz said:

I hear people wanting government run healthcare (with or without a private option) and I just think about two current versions of it in the military and VA.  Makes me hesitant to let them go ahead and provide for everyone.  I could possibly see a government version if people can buy better, private service when they get tired of the federal system.  But that makes Warren even scarier.  

 

Was reading an article today about a VA hospital giving fake appointments to make it seem like they were keeping up with them.  That tells me that a government run hospital system like what the UK does wouldn't work here, based on the track record. 

 

It may be inevitable if we did this for certain hospitals to stay a lot, like rural ones.  But then they say people like nurses should be paid more, wonder what that means...

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1 hour ago, TheGreatBuzz said:

 

 

I'm military.  Not a system you want to copy.

That’s why I asked. You should opt for a private insurance with your wife, but I’m not sure if you have or haven’t.

 

Also, I’m sure those people without insurance would love to opt into the system you deride. 

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1 hour ago, Springfield said:

I’m on private insurance and it sucks a giant bag of dicks.  I’m all for making tshile give up his great private insurance so we can all have nice public insurance.

 

exactly. 

 

Remember that next time you’re inclined to start whining about how some group of people doesn’t care about you. 

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1 hour ago, Nerm said:

So, I was willing to treat some people for free rather than wasting time on trying to get reimbursed for the treatment provided.

 

 

Is there any math on the number of people that would start getting treatment with this plan to help try and offset the attempts to bring down prices?  

 

Maryland from my understand in one of the links takes medicare prices and middle point to market price for medicare pricing.  It doesn't have as much of the cost savings, but it brings it more to a different equilibrium.  Wouldn't if the government was trying to cover the loses more from this, we could grow the number of practices to keep up with it?

 

It's costing us a lot not making sure people can afford to get mental health treatment in this country, a lot.  

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As to the VA, I have to admit to being conflicted.  

 

If you want to get told how the VA is a Chamber of Horrors, you can at least find anecdotal evidence of that. 

 

But then, I also read articles in which the VA is rated better for patient satisfaction than private medical care.   (I'm even going to ignore the articles I find published by the VA.)  

 

Just looking, here's an actual peer-reviewed scientific paper on the subject.  

 

Quote

Sixty-nine articles were identified (including 31 articles from the prior systematic review and 38 new articles) that address one or more Institute of Medicine quality dimensions: safety (34 articles), effectiveness (24 articles), efficiency (9 articles), patient-centeredness (5 articles), equity (4 articles), and timeliness (1 article). Studies of safety and effectiveness indicated generally better or equal performance, with some exceptions. Too few articles related to timeliness, equity, efficiency, and patient-centeredness were found from which to reliably draw conclusions about VA care related to these dimensions.

 

Another peer reviewed study.  (Although I note:  This appears to be a scientific analysis of how different hospitals are ranked on Yelp.)  

 

Quote

Results: The mean patient rating for VA hospitals (± standard deviation) was higher (3.64 ± 1.0) than the rating for affiliated hospitals (3.09 ± 0.8; P = .0036). There was no significant correlation in rating between a VA hospital and its affiliate (r = 0.07; P = .59). After adjustment for hospital characteristics, the adjusted rating difference (VA-affiliate hospitals) was 0.65 (95% confidence interval, 0.18-1.12). 

 

If you want media reports, things seem more mixed.  

 

Reuters: VA may top other hospitals in quality but not patient satisfaction

 

Quote

 

Veterans Affairs (VA) hospitals in the U.S. may deliver higher quality care than other medical centers but still get lower marks on patient satisfaction, a new study suggests.

 

Researchers examined data for 129 VA and 4,010 non-VA hospitals nationwide and found the VA had lower rates of six complications tied to quality: pressure ulcers, deaths of surgical patients with serious treatable conditions, care-related lung injuries, clots in the vein in surgical patients, catheter-related bloodstream infections, post-operative bloodstream infections and post-operative surgical wound ruptures. Rates of other complications tied to quality were similar at VA and non-VA hospitals.

 

For some common medical problems, the VA also had lower mortality rates and lower rates of repeat hospitalizations than other hospitals, the study found.

 

But when it came to several measures of patient satisfaction like doctors’ and nurses’ communication skills and pain management, the VA lagged behind.

 

 

So I'm not really sure who to believe.  

 

 

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34 minutes ago, BenningRoadSkin said:

 

Also, I’m sure those people without insurance would love to opt into the system you deride. 

Might make them feel good that they can say they have coverage.  But what exactly would they be getting?  I once had what turned out to be a kidney stone and for about 4 days they told me I had ALS.  

 

Edit:  @Larry this is anecdotal but my sister is a case manager for the VA and listening to some of her stories, I'm glad I have military medicine.  And that's sad.  In the cases where VA looks good compared to other systems,  it just tells me how bad those other systems are.

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11 hours ago, twa said:

Warren reminds me of Carter in some ways, and not good ones .

 

I was thinking more along the lines of Dukakis and Kerry. 

 

The country seems to be allergic to Democrats from the Northeast.  I guess its OK from the South or Midwest though.  That would be my main concern with Warren.

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1 minute ago, DCSaints_fan said:

 

I was thinking more along the lines of Dukakis and Kerry. 

 

The country seems to be allergic to Democrats from the Northeast.  I guess its OK from the South or Midwest though.  That would be my main concern with Warren.

 

Carter was big on plans and the belief govt could make things better, intelligence does not equal leadership or even the right path.

 

He had good intentions though. :pint:

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1 hour ago, BenningRoadSkin said:

That’s why I asked. You should opt for a private insurance with your wife, but I’m not sure if you have or haven’t.

 

Also, I’m sure those people without insurance would love to opt into the system you deride. 

We have plain ol' free tricare. I'm heathy *pew pew*, and thanks to abolishing "preexisting conditions", I am confident I could receive sufficient care until employer open enrollment came around. 

 

I also consistently see/hear multiple military families on food stamps, WIC, etc who CHOOSE to switch to the tricare co-pay/coinsurance version in lieu of free version due to lack of satisfactory care.

 

 

1 hour ago, tshile said:

 

exactly. 

 

Remember that next time you’re inclined to start whining about how some group of people doesn’t care about you. 

But why aren't you both just purchasing a better insurance? Even if not via employer, I 100% guarantee you the additional premium cost is a hell of a lot cheaper than what your taxes would turn into with a good government "for all" plan. #facts

 

 

53 minutes ago, Renegade7 said:

Is it employer based?  It would be political suicide to not make sure Medicare could match what's available via employer, let alone open market

I don't follow

....employer plans and open market plans....and obamacare plans have no distinction except for who pays the premium/determination of premium.

Health plans are health plans are health plans.

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I have Plan F to supplement Medicare and basically it covers anything that Medicare doesn't. I currently pay $185/month and that will go up. I also pay the $135  from my Social Security account and that will go up too.  I see my doctor quarterly with blood tests too and I don't pay anything. I found a Part D prescription drug plan that costs $10.40/month and I don't pay for my prescriptions through the plan's arrangement with CVS. 

 

I am trying to live on my SS check and didn't want gigantic health bills that I couldn't pay. Plus with my plans I can choose my doctors etc. because moving to another state this was important.

 

We need to stop rejections and the continual submission of claims. The paperwork is a killer and a total game for private insurance companies.

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5 minutes ago, thegreaterbuzzette said:

 

I don't follow

....employer plans and open market plans....and obamacare plans have no distinction except for who pays the premium/determination of premium.

Health plans are health plans are health plans.

1

 

There's a max package you can get from your employer based insurance, at least my experience.  

 

That's different if I go even outside the ACA exchanges and see what's the best available in terms of coverage regardless of cost.  That was brought up earlier about people that maybe we're self-employeed and just gave themselves and their families they best they could find because they could afford it.  

 

All three of those are different in terms of what to expect from any place to get insurance from.

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7 minutes ago, Renegade7 said:

 

There's a max package you can get from your employer based insurance, at least my experience.  

 

That's different if I go even outside the ACA exchanges and see what's the best available in terms of coverage regardless of cost.  That was brought up earlier about people that maybe we're self-employeed and just gave themselves and their families they best they could find because they could afford it.  

 

All three of those are different in terms of what to expect from any place to get insurance from.

Yes employers get to pick what plans if any they offer. Some offer phenomenal plans and pay 100% premiums. Others offer the crappiest plans allowable by ACA (often labeled catastrophic plans) which actually end up requiring low wage earners to pay more out of pocket then if they had no insurance at all.

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46 minutes ago, Renegade7 said:

 

Is there any math on the number of people that would start getting treatment with this plan to help try and offset the attempts to bring down prices?  

 

Maryland from my understand in one of the links takes medicare prices and middle point to market price for medicare pricing.  It doesn't have as much of the cost savings, but it brings it more to a different equilibrium.  Wouldn't if the government was trying to cover the loses more from this, we could grow the number of practices to keep up with it?

 

It's costing us a lot not making sure people can afford to get mental health treatment in this country, a lot.  

 

I don't follow much of news about these issues as a public policy debate.  So, I am not sure what solutions are being proposed.  As a practical matter, however, paying providers less for the time they spend treating mental health issues will reduce the number of people willing to spend time providing treatment.

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