‘Medicare for all’ advocates emboldened by ObamaCare lawsuit

[Surrealistik]

You can rest assured that (bolded above) is going to happen since that is the way of the sausage factory known as the US congress. When you cede total control of 1/6 of the US economy to a gaggle of congress critters (who will write some fill in the blanks later law - like PPACA) you are taking a huge risk. Better to have a state (or two) try these wondrous ideas of SP than to jump right in on a national scale.

I think that may have been indisputably the case earlier when people weren't as invested, but now that so much attention is on the issue, and it's become so focal, with actual, integral allies in Washington, there may actually be a chance that cost savings and substantial reform would be permitted to happen; overcoming this is definitely and by far the most difficult aspect of any significant change in the American medical system though, absolutely.

Unfortunately, even at the state level, in states that have the economies of scale which can actually make a go of it, it's difficult to get through because of entrenched monied interests; look no further than Anthony Rendon's reflexive spiking of SP in California.

 

[EMNofSeattle]

Despite the GOP's best efforts, the ACA isn't failing. That's why the GOP is on to Plan D to destroy the markets: judge-shopping for sympathetic wingnuts to buy their bad arguments.

If the ACA was designed to fail, the GOP wouldn't have to work so hard to bring it down. Their years of trying to sabotage and discredit the marketplaces, though, are part of what I was getting at in the OP.

Well if be "not failing" you mean premiums have skyrocketing and quality of care has gone down.

 

[ttwtt78640]

That's what a lot of people seem to think, yet every other advanced nation in the world has a universal health care system, and they all pay less than we do. We have actually invented a health care system that is more expensive than socialism. Think about that one for a while.

What we need is a new system, one based on real market economics, not on monopoly, and not dominated by the insurance industry.

Here's what I'd do: Issue every citizen and legal resident a credit card that can only be used for medical costs. When the amount charged on that card in a given year exceeds 10% of the holder's annual income, then the government steps in and pays the rest.

That 's it. No one would know whether the individual or the government was paying. The individual would have an incentive to shop around and compare costs. No one would face medical bankruptcy. The providers wouldn't need a staff whose expertise is not medicine, but how to collect from the insurance companies and/or the government. Medical care wouldn't be "free," but would be affordable to everyone. No papers to fill out, either, just sign the little electronic box, and the provider is paid immediately. Deadbeats would be chased by the credit card company. That's their expertise, after all.

That's a great deal for those those households making $24K or less (AGI of zero) but gets far worse very fast as household income rises. I say try whatever system seems best in a state (or two) and then see how it really works.

 

[Dittohead not!]

That's a great deal for those those households making $24K or less (AGI of zero) but gets far worse very fast as household income rises. I say try whatever system seems best in a state (or two) and then see how it really works.

It's more difficult for someone making 24K to come up with $2,400 than it is for someone making 200K to come up with $20,000.

But, everyone should have to pay something. What is free is seen as of no value. Anyway, nothing is really free.

Maybe 5% would be more realistic.

 

[Helix]

the next time that there's a chance to fix our poorly designed health care system, they need to set the goal posts better. Heritage Foundation Romneycare shouldn't have even been the fallback point. i'd start the negotiation at nationalizing the whole system (like the NHS,) and then maybe we'd end up with something like Medicaid for all when the negotiations have concluded. of course, this will require a vastly different congress.

 

[ttwtt78640]

It's more difficult for someone making 24K to come up with $2,400 than it is for someone making 200K to come up with $20,000.

But, everyone should have to pay something. What is free is seen as of no value. Anyway, nothing is really free.

Maybe 5% would be more realistic.

What is realistic is likely to be over 10% considering that medical care costs are now about 18% of the economy. My girlfriend now pays about 17% (of her SS income) for her Medicare premiums and I will soon pay about 7% (of my SS income) for my Medicare permiums - combined we pay about 10.4% of our income in Medicare premiums. This is why I always want to see the funding proposal details for any wondrous UHC schemes up front and not just the usual "who cares about those details when we know that UHC will save money overall".

Everyone needs housing but few would accept the proposal that all will pay X% of their income and, in return, get the same government funded level of housing. Everyone needs food but few would accept the proposal that all will pay X% of their income and, in return, get the same government funded level of food.

 

[Dittohead not!]

What is realistic is likely to be over 10% considering that medical care costs are now about 18% of the economy. My girlfriend now pays about 17% (of her SS income) for her Medicare premiums and I will soon pay about 7% (of my SS income) for my Medicare permiums - combined we pay about 10.4% of our income in Medicare premiums. This is why I always want to see the funding proposal details for any wondrous UHC schemes up front and not just the usual "who cares about those details when we know that UHC will save money overall".

Everyone needs housing but few would accept the proposal that all will pay X% of their income and, in return, get the same government funded level of housing. Everyone needs food but few would accept the proposal that all will pay X% of their income and, in return, get the same government funded level of food.

But everyone should accept the idea that everyone needs health care, and that providing a needed service when the cost of a serious illness or accident can easily top a million bucks is no simple task. Yes, we spend about 18% of the GDP on health care. France, on the other hand, pays more like 7%, about as much as we spend on Medicare that only serves the more mature (I was about to say "elderly," but that includes me, and I'm fighting being "elderly.")

What we need is a more efficient system. Getting it is complex (who knew?) and fraught with unforeseen consequences.

 

[ttwtt78640]

But everyone should accept the idea that everyone needs health care, and that providing a needed service when the cost of a serious illness or accident can easily top a million bucks is no simple task. Yes, we spend about 18% of the GDP on health care. France, on the other hand, pays more like 7%, about as much as we spend on Medicare that only serves the more mature (I was about to say "elderly," but that includes me, and I'm fighting being "elderly.")

What we need is a more efficient system. Getting it is complex (who knew?) and fraught with unforeseen consequences.

OK, but even using a figure of half of our current per capita medical care spending (which is about $10K) UHC for 321M folks is an expensive undertaking. At $5K/person (annually) for 321M folks would be about $1.6T which means that double the current total federal income tax (FIT) revenue would be required to cover that cost. Subtracting the current Medicare payroll tax revenue of $275B would lower that a tad but would still require at least an 85% FIT increase to pay for UHC if it managaed to cut current medcial care costs in half.

https://www.healthsystemtracker.org...e-sector-spending-triple-comparable-countries

 

[Dittohead not!]

OK, but even using a figure of half of our current per capita medical care spending (which is about $10K) UHC for 321M folks is an expensive undertaking. At $5K/person (annually) for 321M folks would be about $1.6T which means that double the current total federal income tax (FIT) revenue would be required to cover that cost. Subtracting the current Medicare payroll tax revenue of $275B would lower that a tad but would still require at least an 85% FIT increase to pay for UHC if it managaed to cut current medcial care costs in half.

https://www.healthsystemtracker.org...e-sector-spending-triple-comparable-countries

Oh, yes, health care is an expensive issue, no doubt. Currently, as you said, it absorbs about 18% of the GDP. About half of that is federal government, including Medicare, Medicaid, and VA. The other half is from the private sector.
The entire federal government absorbs about 21% of the GDP, this regardless of the letter after the names of the congresistas and POTUS.

So, it would be tempting to say that the federal bureaucracy accounts for 3% more than health care, but there is an overlap.

Take that 9% that is federal spending on health care, and the rest of the government, everything from welfare to wars, account for about 12% of the GDP, about 2/3 as much as the overall cost of health care.

So, health care costs one and a half time as much as the entire federal government absent what it spends for health care.

Very expensive indeed.

 

[azgreg]

When you hear the words "government takeover of health care" you are hearing the talking points invented by Frank Luntz.
Pretty much ANYONE who uses that slogan cannot define the difference between single payer and socialized medicine.
They seem to think that single payer means government run hospitals and doctors working as government employees.

When you hear that slogan, understand that you're dealing with a low information person who probably only listens or watches far-Right information sources.

Morons.

 

[Surrealistik]

OK, but even using a figure of half of our current per capita medical care spending (which is about $10K) UHC for 321M folks is an expensive undertaking. At $5K/person (annually) for 321M folks would be about $1.6T which means that double the current total federal income tax (FIT) revenue would be required to cover that cost. Subtracting the current Medicare payroll tax revenue of $275B would lower that a tad but would still require at least an 85% FIT increase to pay for UHC if it managaed to cut current medcial care costs in half.

https://www.healthsystemtracker.org...e-sector-spending-triple-comparable-countries

I don't see what the problem is, given the long term dividends paid to the economy (less wastage/money for nothing and no value added elements like inflated health sector salaries/supplier margins, redundant bureaucracy and in general more resources freed up for redeployment elsewhere to more productive ventures) and of course, public health.

Or we can continue upkeep a vastly more inefficient and costly system that continues to sacrifice both for the sake of lining the pockets entrenched minority on the provider/payer/supplier side, with cost inflation continuing to outstrip the alternatives while life expectancy continues to decline (2 years counting baby!) unlike virtually every other developed country.

Seems like a no-brainer to me.

 

[Pedestrian]

By what metric? Life expectancy has declined for the third straight year under Obamacare.

Not even a nice deflection.

Life expectancy dropped since the GOP has gone after the ACA and the last two years under them and trump.

Most of it is caused by capitalism when as soon as the capitalist found the huge profit center

in such addictive pain drugs. (opioids)

Never seen any addiction the capitalist didn't love, even if...it kills you.

 

[Pedestrian]

You do know that Medicare does not pay the billed amount by any Dr. or Hospital, these bills are greatly discounted, which called, approved by Medicare. Thus no Doctor or Hospital can survive only on Medicare patience. In the end if our system was converted to Medicare for all, the cost to keep Doctors on deck and Hospitals open would require Medicare to greatly raise their pay schedule. Thus skyrocket tax increases.

Yes, because of the American creed...of greed.

 

[Pedestrian]

I don't see what the problem is, given the long term dividends paid to the economy (less wastage/money for nothing and no value added elements like inflated health sector salaries/supplier margins, redundant bureaucracy and in general more resources freed up for redeployment elsewhere to more productive ventures) and of course, public health.

Or we can continue upkeep a vastly more inefficient and costly system that continues to sacrifice both for the sake of lining the pockets entrenched minority on the provider/payer/supplier side, with cost inflation continuing to outstrip the alternatives while life expectancy continues to decline (2 years counting baby!) unlike virtually every other developed country.

Seems like a no-brainer to me.

But we both and all need to understand...this is America. So it is not about health care, your health or life expectancy.

In America life and all of life's issues, are all about money...pure and simple.

 

[Checkerboard Strangler]

Morons.

DING!!!

:applaud

 

[Greenbeard]

Don't you just love irony? I know I do. Conservatives, self described, that is, hurrying along the inevitable acceptance of Medicare for all, a long time goal of the left wing. Here's yet another, in light of this statement:

Of course we all know that 180 degree turnarounds by the Trump Administration are nothing new, but still, isn't that another interesting bit of irony?

Indeed, they've accepted--rhetorically at least--that we need in place a system that includes those with pre-existing conditions. And they've seemingly ruled out the market-based ways of doing that. Only leaves one other class of approaches for them to work with.

By what metric? Life expectancy has declined for the third straight year under Obamacare.

Virtually any metric. Costs, access, quality, take your pick:

• Medicare’s cost surprise: It’s going down
• Health Spending Growth Slowing, More on Pace with Economic Growth
• Employers’ Health Care Cost Growth Has Plateaued
• Since Obamacare Became Law, 20 Million More Americans Have Gained Health Insurance
• How the Affordable Care Act Drove Down Personal Bankruptcy: Expanded health insurance helped cut the number of filings by half
• Baby Survival Rates Improved in States With Affordable Care Act, Data Show
• Out-of-hospital cardiac arrests fell under the Affordable Care Act
• Medical care, health have improved for low-income adults under ACA
• Affordable Care Act Increased Rate of Early Cancer Diagnoses
• Uninsured cancer patients saw increased coverage for care following Medicaid expansion
• ACA credited with earlier diagnosis of gynecologic cancers in young women
• Fewer Patients Have Been Dying From Hospital Errors Since Obamacare Started

The life expectancy stats you're referencing are primarily due to so-called "deaths of despair": drug overdoses, suicides, etc. To the extent the health system has anything to do with that, it's the culmination of two decades of overreliance on the prescription pad culminating in the ongoing opioid epidemic.

In terms of catching things earlier, getting people access to the care they need, and protecting their finances while they're getting that care, the ACA has been a large leap in the right direction.

 

[Greenbeard]

I'm aware that Medicare negotiates prices and discounts billing. I'm also aware that providers bill more than they expect to get to Medicare and to the insurers. I'm also quite sure you can't back up your opinion that private insurance is subsidizing Medicare.

MedPAC, the body charged with advising Congress on Medicare payment policy, will tell you that Medicare payments don't cover the costs of delivering care to Medicare beneficiaries. E.g., per their spring report to Congress earlier this year, margins on Medicare patients at hospitals were -11% this year. Even the subset of providers they identify as "relatively efficient providers" have negative margins on their Medicare business.

The reason it works anyway is that hospitals have bed capacity and Medicare reimbursement covers variable costs so there's still an incentive to see the marginal Medicare patient. If you buy a car, there's no reason not let me carpool with you if you've got the extra seat and I kick in some cash to cover my share of the gas and maybe your time. But after a while you can't look over to me and think "he's getting a great deal, I think I'll just pay the way he is." You still need to make the car payments! If you stop doing that, my sweet set-up no longer works and neither of us has access to a car. We either need to scale back the health system we have or someone needs to pay for it.

For-profit hospitals tend to do better on Medicare business than not-for-profits because they have more streamlined cost structures. Should all hospitals in the country seek to emulate those for-profits that are doing okay on their Medicare business? Is the relative leanness of the expenses at those hospitals a good thing? A bad thing? I don't know, but if the idea is to induce reimbursement shocks to push all hospitals to act like those ones, seems like we should do a deeper dive on why their costs are so low and whether that's a desirable state we'd do well to export to every hospital in the country. I doubt anyone would embrace a suggestion that all hospitals in the country should be for-profits just on the basis of their lower costs.

Moreover, though conservatives may oppose ACA for all the wrong reasons (and progressives have only ever opposed it on the basis it does too little without actually working to undermine it as a rule), there is indeed certainly bipartisan agreement on the desirability of Medicare for All with roughly 70% popular support last I checked, including a majority of Republicans, to say nothing of the fact that both sides acknowledge the ongoing, blatant and systemic failure of market-based healthcare in America.

Weird, it's kind of like that's the exact premise of this thread.

 

[Born Free]

I'm aware that Medicare negotiates prices and discounts billing. I'm also aware that providers bill more than they expect to get to Medicare and to the insurers. I'm also quite sure you can't back up your opinion that private insurance is subsidizing Medicare.

Then tell me why many Doctors will not accept Medicare patients?

I'm not aware that Medicare negotiates with anyone, they set the price as they see fit. And what they see as compensation is peanuts compared to what is necessary to keep the doors open.

Prove me wrong

 

[Surrealistik]

MedPAC, the body charged with advising Congress on Medicare payment policy, will tell you that Medicare payments don't cover the costs of delivering care to Medicare beneficiaries. E.g., per their spring report to Congress earlier this year, margins on Medicare patients at hospitals were -11% this year. Even the subset of providers they identify as "relatively efficient providers" have negative margins on their Medicare business.

The reason it works anyway is that hospitals have bed capacity and Medicare reimbursement covers variable costs so there's still an incentive to see the marginal Medicare patient. If you buy a car, there's no reason not let me carpool with you if you've got the extra seat and I kick in some cash to cover my share of the gas and maybe your time. But after a while you can't look over to me and think "he's getting a great deal, I think I'll just pay the way he is." You still need to make the car payments! If you stop doing that, my sweet set-up no longer works and neither of us has access to a car. We either need to scale back the health system we have or someone needs to pay for it.

For-profit hospitals tend to do better on Medicare business than not-for-profits because they have more streamlined cost structures. Should all hospitals in the country seek to emulate those for-profits that are doing okay on their Medicare business? Is the relative leanness of the expenses at those hospitals a good thing? A bad thing? I don't know, but if the idea is to induce reimbursement shocks to push all hospitals to act like those ones, seems like we should do a deeper dive on why their costs are so low and whether that's a desirable state we'd do well to export to every hospital in the country. I doubt anyone would embrace a suggestion that all hospitals in the country should be for-profits just on the basis of their lower costs.

Maybe we should instead look into why other countries have vastly lower costs and go from there?

Weird, it's kind of like that's the exact premise of this thread.

Weird, it's kind of like you're trying to equivocate dissatisfaction with ACA as being a peculiar and exclusive artifact of the so called 'far right and far left', while trying to draw some kind of meaningful parallel between them where none actually exists beyond said dissatisfaction. Surely there's no conscious angle or spin here to dismiss, discredit or otherwise marginalize people you happen to disagree with; surely you of all people would never do such a thing, even as you paint people as being 'far left' for championing policy that's become mainstream and already in force throughout the rest of the developed world.

There is no real alignment between progressives and conservatives on healthcare, beyond perhaps support of MFA (though you can bet your ass that conservative politicos that are taking steps against ACA care nothing for MFA, and certainly aren't doing it in order to further the latter); that they dislike ACA for very different reasons means essentially squat in terms of any kind of actual convergence of opinion/stance, as does the fact that progressives have seized on the opportunity presented by destructive Republican meddling to advance their policy goals.

 

[Born Free]

Yes, because of the American creed...of greed.

Yeah over a third of their life is learning to be a Dr. that you depend on for your health. And you call them greedy bastards for wanting to be compensated to pay back loans to get there and provide a decent life for themselves.

I'll bet you never owned a company, let alone managed anything.

 

[Greenbeard]

There is no real alignment between progressives and conservatives on healthcare, beyond perhaps support of MFA .

I know you're raring to argue, but restating the premise of the thread is not the way to do it.

 

[Surrealistik]

I know you're raring to argue, but restating the premise of the thread is not the way to do it.

Let me help you out here: the essential premise at the heart of your post was essentially a knowing slander against progressives by both trying to exaggerate an at best tentative parallel between them and the 'far right' (but really, it's the right in general) as being meaningful and implicit of an 'enemy within', and then strawmanning them as the 'far left'; just fess up to it man, you'll feel better for it. It's obvious you want to brand us all as extremists and far left crazies to be safely ignored and dismissed, as many pundits do on a daily, and routine basis, using many of the same talking points and sophistic argumentation. Since you're apparently having difficulty differentiating between the 'far left' and progressives, I'll clarify:

A progressive is someone who advocates for MFA/UHC, a progressive (pun unintended) tax code, money out of politics, reduced military spending and adventurism, and expanded if not universal post secondary education.

A far left extremist is someone who physically assaults people for contrary conservative views, labours to have said contrary views censored, and believes people should be arrested for using the wrong gender pronouns; hopefully that clarifies things.


Further, in case you haven't yet noticed, it's your habitual, likely compulsive disingenuity that gets me motivated to argue.

 

[Greenbeard]

Let me help you out here: the essential premise at the heart of your post was essentially a knowing slander against progressives by both trying to exaggerate an at best tentative parallel between them and the 'far right' (but really, it's the right in general) as being meaningful and implicit of an 'enemy within', and then strawmanning them as the 'far left'; just fess up to it man, you'll feel better for it.

I know what the premise of the thread is because (1) I wrote it, and (2) I wrote it. It's still there in black and white. The right and left perspectives on health care have been converging for some time, and the repudiation of market dynamics by the right will do more to usher in a Medicare-for-all-type system than the advocacy of the left ever did. Only Nixon could go to China.

The paranoia or oversensitivity or whatever baggage it is you're bringing into this thread can be left at the door.

 

[Surrealistik]

I know what the premise of the thread is because (1) I wrote it, and (2) I wrote it. It's still there in black and white. The right and left perspectives on health care have been converging for some time, and the repudiation of market dynamics by the right will do more to usher in a Medicare-for-all-type system than the advocacy of the left ever did. Only Nixon could go to China.

The paranoia or oversensitivity or whatever baggage it is you're bringing into this thread can be left at the door.

In light of your posting history and record, our past exchanges, as well as the words you actually used, I don't see anything paranoid or oversensitive about my interpretation of your post whatsoever.

That having been said, if you had just left it at an observation of the interesting convergence between the left and right (minus the 'far' adjective, because it's not really appropriate/accurate in either case) regarding ACA specifically, I wouldn't have really had a problem. Indeed I agree, there is an amusing union of dissatisfaction between the majority of the right and a big subset of the left RE: ACA for pretty much the opposite reasons; they feel it goes a little too far (or alternately is a 'failure'), and we feel it does far too little. Further, yes, I do feel that in its pursuit of dismantling ACA, the right plays into the hands of progressives, albeit not at all intentionally, and certainly with no unity of purpose.

I would however, completely disagree with what I feel to be a fallacious if not ridiculous assertion that you can't often determine from the ongoing healthcare convo whether someone leans left or right. Even with a plurality of Republicans being in favour of MFA, a rather larger chunk standard against it vis a vis oppositional segments of Dems/Independents, particularly if you call it something like say singlepayer. On the subject of ACA, even though progressives are dissatisfied with it, they are not committed to its demolition/teardown/neutering unlike a typical Republican (heaven forbid you call it Obamacare). Moreover, there is no way you can reasonably assert that mainstream Republican leadership, those among the right which have pursued this dismantling, has MFA as their end goal; I don't see how one could even begin to arrive at that conclusion, even if they might be argued to indirectly and inadvertently work in that direction.

Lastly, I would also dispute the idea that the right has done more in advancement of MFA/SP, inadvertently or not, than the left ever did. After all, it was essentially Sanders alone who made the idea a mainstream concept, and grew the associated movement's momentum, motivation and awareness to the fever pitch it's at today.

 

[Dittohead not!]

MedPAC, the body charged with advising Congress on Medicare payment policy, will tell you that Medicare payments don't cover the costs of delivering care to Medicare beneficiaries. E.g., per their spring report to Congress earlier this year, margins on Medicare patients at hospitals were -11% this year. Even the subset of providers they identify as "relatively efficient providers" have negative margins on their Medicare business.

The reason it works anyway is that hospitals have bed capacity and Medicare reimbursement covers variable costs so there's still an incentive to see the marginal Medicare patient. If you buy a car, there's no reason not let me carpool with you if you've got the extra seat and I kick in some cash to cover my share of the gas and maybe your time. But after a while you can't look over to me and think "he's getting a great deal, I think I'll just pay the way he is." You still need to make the car payments! If you stop doing that, my sweet set-up no longer works and neither of us has access to a car. We either need to scale back the health system we have or someone needs to pay for it.

For-profit hospitals tend to do better on Medicare business than not-for-profits because they have more streamlined cost structures. Should all hospitals in the country seek to emulate those for-profits that are doing okay on their Medicare business? Is the relative leanness of the expenses at those hospitals a good thing? A bad thing? I don't know, but if the idea is to induce reimbursement shocks to push all hospitals to act like those ones, seems like we should do a deeper dive on why their costs are so low and whether that's a desirable state we'd do well to export to every hospital in the country. I doubt anyone would embrace a suggestion that all hospitals in the country should be for-profits just on the basis of their lower costs.



Weird, it's kind of like that's the exact premise of this thread.

Where in that 563 page "summary" does it say that private insurance is subsidizing Medicare?