patrick.net

marcus says

Medicare for all is a no brainer at this point.

Gross

marcus says

Tenpoundbass says

Originally the New Deal policy was All Employees must make the same thing for a job regardless of the company.

Total horseshit, unless you're referring to union rules. Unions were a great thing for american workers. Funny how right wingers want to make America great again, but they forget that when ameriica was great, unions were much stronger.

Actually tpb has it vaguely right.. The 1942 Stabilization Act froze wages to avoid inflation during the war. Employers started offering health care instead of raises.

marcus says

but I agree with the OP. Medicare for all is a no brainer at this point. Medicare is already paying for most of the most expensive health care that occurs late in life anyway for the entire country. THe most efficient thing would be to bring the rest of health care in to the same system. And then find ways to lower costs.

A no brainer? Have you taken a serious look at how much FICA will have to be raised to cover medicare A and medicare tax and general income taxes to pay for part B & D? You might not be so enthusiastic. Bernie says 1.4T per year to pay for medicare for all. That is a ridiculously low number even by political promises standards. Even that low ball number would require raising income taxes by something like 10% across the board right down to the lowest earners. Without doing anything to lower the costs of health care since medicare has the same cost problems as private insurance. Actually worse since medicare is prohibited from negotiating drug prices. Like ACA medicare for all merely shifts from health care insurers or uncompensated care to taxes. It doesn't matter if you are taking the money out of the left pocket (health insurance companies) or the right pocket (taxes) if the bill is the same. Health care cost is not the same thing as health care insurance cost.

Ass, gas, or grass. No one rides free.

bob2356 says

The only real advantage Medicare has is it is funded by taxes rather than hundreds of insurance companies that must advertise, collect premiums, pay out claims, pay executive salaries, pay out dividends. pay for lobbying, negotiate fees with doctors and hospitals, etc., etc. etc. which all adds (a lot) to the cost of health care while providing zero actual health care.

Wrong. Medicare has insurance carriers that do all of those things. Also funny how you classify normal business operations as "providing zero actual health care" while lamenting the waste of a bureaucracy.

The solution is a free market system, which would include "insurance companies that must advertise, collect premiums, pay out claims, pay executive salaries, pay out dividends. pay for lobbying, negotiate fees with doctors and hospitals, etc., etc. etc." and less government intervention.

bob2356 says

Actually worse since medicare is prohibited from negotiating drug prices. L

Of course that would have to change. Attempts to do so in the past were torpedoed by primarily Republicans.

Would Medicare have to turn a profit or could it operate at cost, unlike the privates?

CBOEtrader says

Wrong. Medicare has insurance carriers that do all of those things. Also funny how you classify normal business operations as "providing zero actual health care" while lamenting the waste of a bureaucracy.

Wrong. Advantage carriers don't have to advertise for customers, they come from medicare. They don't have to collect and manage premiums, they come from medicare. They don't have to do fee for service billing, advantage is capitation. They don't have to manage actuarials and negotiate prices, they have capitation. Yet advantage costs more per beneficiary than the wasteful bureaucracy doing tradiitonal fee for service medicare and all the overhead work also.

What is lamanting a bureuaucracy? Lament means grieving or sorrow at a loss so that sentence makes very little sense. If you were trying to say praising then no I don't praise bureaucracies. But if they work better at something then I will acknowledge the fact rather than wallow in indefensible dogma.

CBOEtrader says

The solution is a free market system, which would include "insurance companies that must advertise, collect premiums, pay out claims, pay executive salaries, pay out dividends. pay for lobbying, negotiate fees with doctors and hospitals, etc., etc. etc." and less government intervention.

Same argument as georgism. Show me all the places this is working. Isn't greorgism great? You can get a 300 sq ft apartment in HK for only a million. I'm impressed.

MisterLefty says

bob2356 says

Actually worse since medicare is prohibited from negotiating drug prices. L

Of course that would have to change. Attempts to do so in the past were torpedoed by primarily Republicans.

and will be in the future.

bob2356 says

CBOEtrader says

Wrong. Medicare has insurance carriers that do all of those things. Also funny how you classify normal business operations as "providing zero actual health care" while lamenting the waste of a bureaucracy.

Wrong. Advantage carriers don't have to advertise for customers, they come from medicare. They don't have to collect and manage premiums, they come from medicare. They don't have to do fee for service billing, advantage is capitation. They don't have to manage actuarials and negotiate prices, they have capitation. Yet advantage costs more per beneficiary than the wasteful bureaucracy doing tradiitonal fee for service medicare and all the overhead work also.

What is lamanting a bureuaucracy? Lament means grieving or sorrow at a loss so that sentence makes very little sense. If you were trying to say praising then no I don't praise bureaucracies. But if they work be...

This isnt how how Medicare works. The client still pays a carrier. The client still chooses a carrier from those available in his area. Usually this is a name brand they feel comfortable with, which is a direct result of marketing efforts. All Medicare carriers do the dog/pony road show to convince agents to sell their products: advantage, med supps, and RX plans.

Every step mentioned is highly regulated and wasteful, sure. The process would be much improved and a fraction of the cost if it were a free market system rather so highly regulated.

marcus says

Total horseshit, unless you're referring to union rules.

Now teacher go back and read up on the Blue Eagle and Work Progress Administration policies.

You read. Kindly show me the part about equal pay. I'll wait while the cricket chirp.

Who knows, maybe you can find some bs on an austrian economics website, or infowars.

If we are going to give free healthcare to all there should be a societal expectation for some sort of accountability for people to put an effort into staying healthy to keep costs down. I don't want to be paying more taxes for obese, smokers, drug addicts, ect that are self inflicted. It's another thing that is never brought up when comparing the US to other countries that have very successful public healthcare because their populations are healthier.

bob2356 says

A no brainer? Have you taken a serious look at how much FICA will have to be raised to cover medicare A and medicare tax and general income taxes to pay for part B & D? You might not be so enthusiastic.

We pay for health care now. This would just be another way of paying for it. Don't think there would be much difference.

RC2006 says

If we are going to give free healthcare to all there should be a societal expectation for some sort of accountability for people to put an effort into staying healthy to keep costs down. I don't want to be paying more taxes for obese, smokers, drug addicts, ect that are self inflicted. It's another thing that is never brought up when comparing the US to other countries that have very successful public healthcare because their populations are healthier.

These poor personal choices are exactly why we have on average lower life expectencies, etc... yet the pro govt crowd uses these stats to suggest our healthcare system is worse than other countries.

The truth is that our care is far too expensive. However, we still have the best care in the world. We are always ranked #1 in accessibility of care. We are also still largely leading innovation worldwide.

Get govt out of the way and costs would be 1/3rd as much.

CBOEtrader says

The truth is that our care is far too expensive. However, we still have the best care in the world. We are always ranked #1 in accessibility of care. We are also still largely leading innovation worldwide.

The actual health care is excellent. Being #1 in accessibility is perplexing. How can we be #1 with millions not having any insurance?
Even the emergency room delays treatment just to make sure you have insurance. A few years ago I had kidney stones and landed in the emergency. I was in severe pain and yet they wanted all my information and signature before proceeding to treat me." Hello? I am dying. Treat me first you morons."

marcus says

Wrong. The rate that health care costs were going up decreased under Obamacare. (not including the cost to the govt, of increased medicaid etc. for low income folks).

I am kind getting tired of arguing about this for almost ten years and yet most Democrats will not admit that Obama missed the opportunity to do something big in a positive way in healthcare

Look, the stock market went up when Trump talked about the tax cut and is almost flat after it got passed. Same for ObamaCare, all health entities (drug companies, insurers) front run the cost increases before the law actually took effect - and have been increasing from that much higher base. How do I know? Have been paying business healthcare bills for almost two decades. With a few positives, such as getting rid of pre-existing conditions, the rest of ObamaCare is a disaster from the cost perspective.

CBOEtrader says

Every step mentioned is highly regulated and wasteful, sure. The process would be much improved and a fraction of the cost if it were a free market system rather so highly regulated.

Still waiting to see the examples of places this works so well.

CBOEtrader says

This isnt how how Medicare works. The client still pays a carrier.

Medicare pays the advantage carriers. Period. The client pays the out of pocket costs and the premium to the advantage just like traditional medicare. Did you somehow think what the medicare monthly premium payment was covering all the costs? Why do you suppose there is a medicare tax, medicare as part of FICA, and medicare in the budget?

CBOEtrader says

The truth is that our care is far too expensive. However, we still have the best care in the world. We are always ranked #1 in accessibility of care. We are also still largely leading innovation worldwide.

Really?



CBOEtrader says

Get govt out of the way and costs would be 1/3rd as much.

It's true because I believe it should be true? Got any research to back that up? Will it be included in your list of successful free market health care countries?

Strategist says

We pay for health care now. This would just be another way of paying for it. Don't think there would be much difference.

It's not about changing the accounting - need a structural reform. Focus on healthier living is a start. Although it's a bit like gun rights. I want my Starbucks - it's my choice. Well I don't want to pay healthcare for your diabetic ass because you putting away more sugar than in one day than what you are supposed to in a weeks.

bob2356 says

Still waiting to see the examples of places this works so well.

In Northern California, we have Sutter that created a monopoly on health care and raised prices like crazy. Insurers can't do anything about because of gag clauses in contracts and nowhere else for people to go. The only solution is for State AG to sue them. Free market without regulation creates ridiculous monopolies that abuse their pricing power.

I agree that some regulation is necessary to keep the free market working. For example, anti-monopoly laws.

Two other modest regulations that I like to harp on:

1. require presentation of prices in advance of treatment for non-emergencies, so people can use the market to shop around
2. fix emergency treatment prices by law, since there is no time to shop

If prices are secret (or very hard to discover), there is no free market anyway, and no incentive for any provider to keep prices down.

RC2006 says

It's another thing that is never brought up when comparing the US to other countries that have very successful public healthcare because their populations are healthier.

Which countries do you feel are healthier and what is healthier to you? Ireland, England, NZ, Australia, Canada are all within 2-3% of US obesity. Many countries have much, much higher smoking rates especially in europe.. Alcohol consumption in the US is very moderate compared to Europe or commonwealth countries. What is your criteria?

bob2356 says

Medicare pays the advantage carriers. Period.

Wrong. Your Medicare account pays if you have enough employed quarters in your work history. OR the payment can be subsidized if you are poor, like any govt subsidy.

You are digging a deeper whole proving you don't know how medicare works. FYI: I sell about 30 medicare policies/month.

CBOEtrader says

Wrong. Your Medicare account pays if you have enough employed quarters in your work history. OR the payment can be subsidized if you are poor, like any govt subsidy.

That's not what Bob was even arguing. He said that for Advantage Part C plans. medicare still pays everything except the tiny monthly premium paid by the person. The difference is with Medicare part A - medicare pays the provider directly. With Part C, Medicare pays Insurer who pays the provider.

anotheraccount says

Free market without regulation creates ridiculous monopolies that abuse their pricing power.

Monopolies are almost always govt induced, exactly as they are here in dozens of blue cross counties. Your example is a data point showing the error of a govt intervention.

W/o intervention there would be thriving competition.

bob2356 says

Which countries do you feel are healthier and what is healthier to you?

https://goo.gl/images/s3pYbg

bob2356 says

Ireland, England, NZ, Australia, Canada are all within 2-3% of US obesity.

nope, wrong again.

It's not our healthcare that causes lower life expectancy and higher infant mortality rates, it's our lifestyle decisions.

Those lifestyle decisions are largely cultural issues falling along racial lines. New Hampshire is as healthy as any European country whereas Mississippi is a disaster.

anotheraccount says

I am kind getting tired of arguing about this for almost ten years and yet most Democrats will not admit that Obama missed the opportunity to do something big in a positive way in healthcare

The so-called Blue Dog democrats would have voted with the Republicans to torpedo single payer. The votes just were not there.

anotheraccount says

yet most Democrats will not admit that Obama missed the opportunity to do something big in a positive way in healthcare

What's to admit ? Nobody denies there were many better solutions we could have had. The question is, if he had tried, would he have been able to get it thorough.

Obama himself said single payer would be better, but look how hard it was for him to get the Heritage foundation plan through. He made the decision that he wouldn't be able to get a plan through that changes the system that drastically. I guess it might be an open question as to whether it might have been better in the long run for him to have tried to make the drastic change and failed, than what he did get through.

Certainly anyone with a so called "preexisting condition" would be glad he went the route he did. Others might feel that we should have held out for either no change or a complete change all at once. And nothing in between.

The hypothesis of single payer makes some sense, but it would be a disaster in execution as is most government-owned agencies, which are riddled with inefficiency and red tape because politicians are purely motivated about getting re-elected. This means making agencies bigger with more free goodies for the public, who doesn't know what's good for them. Government forcing price reductions would hurt innovation and our quality of care. As Patrick said, we need 100% price transparency and that will start reducing the cost of care, which is the root of the problem.

Another bullshit myth: Exercise is necessary to lose weight.

Intake to your Mouth is 80-90% of Weight Loss. All Exercise does for weight loss is maybe let you have dessert once or twice a week or help you burn an extra half-pound every so often, depending on how fat you are.

Fucking Planet Fitness hands out Pizza Rolls, "Oh, I'm so healthy, I did 30 minutes on the Tread Mill after I had half a dozen Bagel Crisps." Dumbass, get back on the Treadmill for another hour to burn off those carbs.

TwoScoopsPlissken says

Another bullshit myth: Exercise is necessary to lose weight.

+1000

marcus says

Certainly anyone with a so called "preexisting condition" would be glad he went the route he did. Others might feel that we should have held out for either no change or a complete change all at once. And nothing in between.

Your line of reasoning is the justification that happened much later after the law was passed closer to 2012 election. Obama simply gave in to healthcare industry and Republicans. I was here on this board arguing against the strategy that Democrats took. It one of the main reasons why Trump got elected too - it gave Republicans a talking point for 6 years.

The way I see it is that during Republican administrations in the last 30 years things get screwed up - unpaid for tax cuts, stupid legislation such as Medicare Part D giveaway to pharma. Then Democrats have a chance to fix things and they only go 1/3 of the way at best. When Republicans are in power, they get passed everything they wanted to pass. Tax cut last year is a prime example and Democrats did not even put much of a fight.

If iwog was here, even he would agree with this assessment.

MisterLefty says

The so-called Blue Dog democrats would have voted with the Republicans to torpedo single payer. The votes just were not there.

The vote should have taken place to show where everyone stands.

WarrenTheApe says

What do you mean that you sell medicare policies?

You can be a broker for supplemental to Medicare Part A and B and Medicare part C plans (plans run by insurers - paid by Medicare). I don't think you can sell Medicare Part A or B itself.

WarrenTheApe says

What do you mean that you sell medicare policies?

He must be talking about so called supplemental policies.

anotheraccount says

Your line of reasoning is the justification that happened much later after the law was passed closer to 2012 election

No. I was not happy at the time that he wasn't going for single payer, and OBama clearly explained, he would have liked to, but he didn't believe it could be done, and that it would be too "disruptive" or something to that effect. In other words there were too many interests, insurance, pharma lobbyinsts etc that would not allow it to occur. IT's either what he determined or what his advisors told him. So he didn't even try.

Remember the state of the economy too. Destroying the whole health insurance market was probably part of what the "disruptive" comment was about (or whatever the wording was.

anotheraccount says

unpaid for tax cuts, stupid legislation such as Medicare Part D giveaway to pharma

Don't forget wars put on the credit card - literally not funded.

ThreeBays says

What would be wrong with raising taxes by 10% or whatever it took,

When CA toyed with the idea of "single payer" the "whatever it took" came at additional 15% state income tax, iirc. It's way more than "raising taxes by 10%".

I have never seen a cost effective government problem that had no unintended consequences.

They fuck everything up, and stay in business because they can just tax us for their mistakes.

CBOEtrader says

bob2356 says

Which countries do you feel are healthier and what is healthier to you?

https://goo.gl/images/s3pYbg

bob2356 says

Ireland, England, NZ, Australia, Canada are all within 2-3% of US obesity.

nope, wrong again.

It's not our healthcare that causes lower life expectancy and higher infant mortality rates, it's our lifestyle decisions.

Cdc and most other sources say 35-36%. So it;s 4% not 3% difference mea fucking culpa.

Lifestyle choices like drinking and smoking which most of europe does a lot more of? Oh no of course not, no one has ever died from smoking or drinking.

ThreeBays says

What would be wrong with raising taxes by 10% or whatever it took, if it replaced the cost paid out of pockets and payrolls? Healthcare already costs $10,000 per person.

Forest not trees. That is what we are searching for.

Nothing in theory (except the real possibility not funding it like medicare D and simply ringing up more debt) other than it simply shifts the same high costs around. We are looking for a reduction in health care costs, not moving around the deck chairs on the titanic. Continuing to do exactly what we do now with a different payer isn't going to reduce costs much. Medicare is simply another insurance company, with somewhat lower overhead, but still more of the same.

Throwing around the term single payer like it is some kind of magic is both meaningless and absurd. Other countries have made hard choices about health care for their citizens of which single payer is only a part of the overall puzzle.

If you want a government run system, then copy one that works better (or less badly) than what we have, e.g. the UK NHS as noted in Bob's table above. BTW, Bob's table omits Japan, which has also a better (or less bad) system including hospital price controls. Japan leads the world in high tech medicine and life expectancy, while spending half as much per capita as the USA.

In the USA, Medicare is part of the problem. The cost disparity between the USA and the rest of the world began with Medicare. Other insurance follows mostly Medicare coverage on a somewhat higher fee-for-service basis. In 50 years of Medicare, costs have increased exponentially while life expectancy increased only 3 years among the covered cohort, mostly due to fewer people smoking. Since Obamneycare mandated insurance, costs have continued to increase, while life expectancy has fallen.

The biggest revenue recipient from both Medicare and Obamneycare is the American Hospital Association, based in Chicago. It would require willful ignorance to believe a Chicago politician would have no connection to that patronage network. There was real momentum towards change in 2008, but it got subverted in 2009 and 2010. Research got cut, protecting subsidies for entrenched revenue models against potentially disruptive innovation. American hospitals charge now more than 10 times what Japanese hospitals charge, and many of the Japanese hospitals have better technology and better results.

Draining the Medicare and Obamneycare patronage swamp would require a leader independent of it and willing to endure the slings and arrows of outrageous media misrepresentation. When the current President proposed ending subsidies for essentially disproved mental "health" modalities that have a 90%+ failure rate, the revenue recipients diagnosed him as crazy, and millions afflicted with TDS believed them. Commercial media depend on patronage including DTC ads from PhRMA and insurance and now even hospital corporations advertise on TV; the networks stoke TDS to prevent anyone disrupting their subsidies.