patrick.net

marcus says

How to Build on Obamacare

How about addressing the real problem. The insane prices and not being able to compare prices of procedures. You fix those 2 problems and the rest will take care of itself.

marcus says

Improving Obamacare requires doing more, not less, moving left, not right. That’s not what Republicans want to hear.

The Affordable Care Act is fundamentally flawed. It cannot be patched up because it concedes the very reforms that are needed to fix health care.

Yes, the ACA should be repealed. But it should not be repealed and replaced with the previous system, which is what the republicans want. Instead, it should be replaced with what the American people wanted in the first place.

The ACA basically says keep the system we had, but add some more subsidies and require everyone to purchase private health insurance. This is the problem. Private health insurance does not work. Capitalism has had a century to produce decent health insurance and it has failed miserably. Private profit and a healthy infrastructure are mutually exclusive. The answer is to remove the private profit motive from health insurance. To do this is to abandon the very foundations of the ACA.

The system that we build should have the following properties.
1. No private health insurance.
2. No marriage of health insurance and employment.
3. The same coverage for all persons in the United States, citizen or visitor. Yes, that even means illegal immigrants. The solution to that problem is deportation and prison for those using economic slave labor.
4. A single payer system, i.e. a single clearinghouse that receives and pays all bills. This will eliminate waste, and it will prevent charging different people for the same service at the same location.
5. All prices are published before hand to the single payer system. No price changes after the fact.
6. Funding comes from public taxes. Part of the taxation can be income-based, but some of it should be based on the number of children and dependents you have.

The system may also have some of the following properties.
7. Elimination of drug patents. The financial incentives will be given directly to scientists inventing drugs, not to corporations. Funding of research will be public as will the ownership of drugs.
8. Doctors are paid by results rather than by treatment.
9. Tests are standardize and streamlined to reduce costs. Damn few tests should cost more than a few dollars. Use robots like Amazon.com does. If necessary, conducting tests can be done by NPOs.
10. The elimination of all paper and the standardization of all forms and records in a national repository.
11. The nationalization of all hospitals.
12. The nationalization of clinics and private practices.

Do the first six things, debate the last six things, and implement some of the last six, and the health care system will actually work. The ACA cannot be patched to do the above. It must be replaced with a real plan that looks after the interests of the patient, not big business.

You can have a healthy nation with low health care costs or big profits for the health industry. You cannot have both.

komputodo says

The insane prices and not being able to compare prices of procedures. You fix those 2 problems and the rest will take care of itself.

Actually, there are quite a few problems to fix to lower health care costs significantly. Yes, we have to do those those things, but we also have to do other things. Plus, the first thing is really a dozen things in itself.

Dan8267 says

1. No private health insurance.

Those town hall meetings where democrats weren't hardly even allowed to talk, with screams of "death panels" and the tea party nonsense were very instructive about the way that the corporate world (insurance and big pharm in this case) can marshall resources to fight what the people want and deserve. IT is too bad that OBama didn't go for it. Maybe it was a bad call, or maybe it was true that he wouldn't be able to pull it off, becasue the right wing would have gotten all of the TPBs and CICs into a rabid frenzy fighting it.

IT's really amazing when you think about it. The way they can play the huge segment of the population that Fox news and talk radio have been cultivating the past couple of decades.

komputodo says

How about addressing the real problem. The insane prices and not being able to compare prices of procedures. You fix those 2 problems and the rest will take care of itself.

Yes!

We need to fix those things first.

marcus says

Those town hall meetings where democrats weren't hardly even allowed to talk, with screams of "death panels" and the tea party nonsense were very instructive about the way that the corporate world (insurance and big pharm in this case) can marshall resources to fight what the people want and deserve. IT is too bad that OBama didn't go for it. Maybe it was a bad call, or maybe it was true that he wouldn't be able to pull it off, becasue the right wing would have gotten all of the TPBs and CICs into a rabid frenzy fighting it.

IT's really amazing when you think about it. The way they can play the huge segment of the population that Fox news and talk radio have been cultivating the past couple of decades.

The solution is simple. You give every adult a one-time chance to be in the public system or not. If they choose not, then they get nothing. Hospitals don't even have to treat them for emergencies. They are at the mercy of the private sector.

If they choose in, they are taxed and they get fully paid health care at the prices set by the government for both them and for the health care providers. Hospitals and providers cannot refuse to treat those in the system.

As people turn 18, they choose to be either in the system or out. To be fair, every 20 years people out of the system are given the choice of entering it by paying all the back-taxes they would have paid if they entered the system at the first chance. Those who stay out of the system simply pay more for health care and die when they can't afford health care. It's a self-correcting problem. Within two generations, everyone left alive will support the system and be happy.

OK, fix costs and lack of price transparency, and make a public option available.

marcus says

The point, however, is that building on Obamacare wouldn’t be hard, and wouldn’t even be all that complicated.

https://www.nytimes.com/2017/03/27/opinion/how-to-build-on-obamacare.html

Even the NYT doesn't know the difference between the cost of health care and the cost of health care insurance. Unbelievable.

rando says

komputodo says

How about addressing the real problem. The insane prices and not being able to compare prices of procedures. You fix those 2 problems and the rest will take care of itself.

Yes!

We need to fix those things first.

Doesn't anybody know where the high cost of US health care comes from? Or how public health systems work and why? Amazing.

Take the mandate out.

don't bother planning as it will be repealed and replaced soon. it is NOT over yet.

This will affect the level of competent doctors, as the well educated will seek other areas of employment to maximize their income.

Dan8267 says

8. Doctors are paid by results rather than by treatment.

BlueSardine says

This will affect the level of competent doctors, as the well educated will seek other areas of employment to maximize their income.

Let them. Income should be based on productivity. Basing it on anything else is a perverse incentive that lowers overall wealth production.

If what you predict happens then it means we have too many doctors and not enough other things, or that the other things are siphoning wealth rather than producing it, in which case the solution is to stop that siphoning.

Healthcare a la AF

Dan8267 says

Let them. Income should be based on productivity. Basing it on anything else is a perverse incentive that lowers overall wealth production.

Spoken like a hardcore Republican!

I think Hospitals ruined healthcare. In every doctor's office or private practice I've ever been to or heard of, the doctor sets prices that are fair and fairly transparent, and seems primarily concerned with doing their job providing healthcare to patients. Most are even concerned about their patients welfare!
But somehow when you get a hospital with the massive administrative apparatus that goes with that complexity, lawyerly tactics and financial scamming starts to be the norm until the prices and services are a labyrinthine mess designed for one purpose: maximize hospital revenues.
And when a huge corporation owns the hospital and a similar group of healthcare facilities, things get truly Byzantine to the point where only the opposing administration of an insurance company can bully or browbeat the hospital into either capitulation or grudging satisfaction.

Regulating hospital administrators is the first step. Allowing doctors greater freedom to operate their practice with a business model of their choosing is the other. If hospitals get too oppressive, doctors can bypass them and provide similar services on their own. This is already happening somewhat with surgery centers which the doctor can rent by the hour to perform surgery.

APOCALYPSEFUCK_is_ADORABLE says

Shoot the sick in the face.

Don't waste a bullet. Use a knife.Cut their throats.
Use the knife OVER & OVER.

Quigley says

Dan8267 says

Let them. Income should be based on productivity. Basing it on anything else is a perverse incentive that lowers overall wealth production.

Spoken like a hardcore Republican!

That's a load of crap. The last thing republicans want is for income to be based on wealth production. That would mean all the working class would make more money, and the owner class much, much less.

komputodo says

How about addressing the real problem. The insane prices and not being able to compare prices of procedures. You fix those 2 problems and the rest will take care of itself.

Democrats aren't actually interested in solving any problems, just making more socialism.

APOCALYPSEFUCK_is_ADORABLE says

Now that is the kind of efficiency that was prized by the Founding Fathers!

Who could pick up used lead bullets and make their own new bullets..

Quigley says

Dan8267 says

Let them. Income should be based on productivity. Basing it on anything else is a perverse incentive that lowers overall wealth production.

Spoken like a hardcore Republican!

I need some of what you're smoking. Holy shit!

Quigley says

And when a huge corporation owns the hospital and a similar group of healthcare facilities, things get truly Byzantine to the point where only the opposing administration of an insurance company can bully or browbeat the hospital into either capitulation or grudging satisfaction.

So you are saying the health insurance companies are keeping the cost of health care down in the US. That's very different point of view.

bob2356 says

So you are saying the health insurance companies are keeping the cost of health care down in the US. That's very different point of view.

Well, they WERE. Then Obamacare came along with a mandate that made insurance company profits dependent on medical expenditures, since the insurance company had to spend 80% income on such. So all of a sudden insurance had every incentive to pay hospitals MORE money instead of less, which of course increased necessary premiums paid by the insured to cover the much increased costs of healthcare. But the insurance companies were fine with this because they were the beneficiaries of an additional mandate whereby the populace had little choice but to buy their now ridiculously overpriced product.

This is why, or part of why, that bill must be completely abolished and we start from scratch. I prefer something similar to what Senator Rand Paul has proposed, which is about putting the power back with doctors and consumers, as well as ensuring healthcare is available for those who truly need it.

I really wanted Rand for POTUS, but he wasn't a big enough bullshitter, didn't lie enough, wasn't connected to the correct media weasels, and was overall way too nice. Also his hair wasnt photogenic enough. You'd be surprised how often that one detail matters in American politics...

Quigley says

bob2356 says

So you are saying the health insurance companies are keeping the cost of health care down in the US. That's very different point of view.

Well, they WERE. Then Obamacare came along with a mandate that made insurance company profits dependent on medical expenditures, since the insurance company had to spend 80% income on such.

You really don't have the vaguest clue how the medical system works financially do you?

Dan8267 says

The Affordable Care Act is fundamentally flawed. It cannot be patched up because it concedes the very reforms that are needed to fix health care.

Yes, the ACA should be repealed. But it should not be repealed and replaced with the previous system, which is what the republicans want. Instead, it should be replaced with what the American people wanted in the first place.

....

I read these piece and got intellectually erect.

ObamneyCare is a complete joke, it just guarantees profits for healthcare denial (aka Health Insurance).

Medicare for all. 1/3 employee, 1/3 employer, 1/3 general revenue. Asset forfeiture on illegal employers (inc. landlords and AirBNB types who employ illegal housecleaners or landscapers) will help pay for it.

APOCALYPSEFUCK_is_ADORABLE says

Unless doctors, hospitals and insurers are FREE! to bankrupt every last AMERICA!n into homelessness and starvation, FREE!dom has no meaning!

Spoken like a true trump voter.