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A conservative alternative to Medicare for All

azgreg

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We've all been waiting for the republican's replacement for Obamacare. This guy, Heath Mayo, has come up with one.

Better Care for All: A conservative alternative to Medicare for All | Pt. 1 | by Heath Mayo | Medium
Better Care for All: A conservative alternative to Medicare for All | Pt. 2 | by Heath Mayo | Medium
Better Care for All: A conservative alternative to Medicare for All | Pt. 3 | by Heath Mayo | Medium

Now I haven't had much of a chance to go over it so maybe some of the posters here who are more versed in the industry can take a look.
 

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We've all been waiting for the republican's replacement for Obamacare. This guy, Heath Mayo, has come up with one.

Not really. The third article, where he starts laying out his suggested approach, is basically just an advertisement for the ACA (explicitly, to his credit--he points out repeatedly that the ACA already got the ball rolling on most of the items he discusses) and an argument we should double down on what it's doing. E.g., his first proposal:

1. Pay for health outcomes rather than medical procedures

The CMS fee-for-service price schedule needs to be phased out as quickly as possible. By shifting from a fee-for-service model to capitated, value-based reimbursement, we can finally begin to purchase health outcomes instead of medical procedures — which will ensure that we only buy the care we need. The good news is that this is already happening. The Affordable Care Act instituted a number of value-based reimbursement programs that are beginning to wean Medicare and Medicaid off of the government-set fee schedules.

That is good news! But "do the ACA more!" is hardly an alternative to the ACA. And that's what most of what he suggests amounts to.
 

azgreg

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Not really. The third article, where he starts laying out his suggested approach, is basically just an advertisement for the ACA (explicitly, to his credit--he points out repeatedly that the ACA already got the ball rolling on most of the items he discusses) and an argument we should double down on what it's doing. E.g., his first proposal:



That is good news! But "do the ACA more!" is hardly an alternative to the ACA. And that's what most of what he suggests amounts to.

At least there's something from a republican. Come on, throw me a bone here.
 

Gimmesometruth

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At least there's something from a republican. Come on, throw me a bone here.
Considering that the ACA is a derivative of a plan Romney used which was derived from a Heritage Foundation idea....why isn't that enough for cons to accept?
 

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At least there's something from a republican. Come on, throw me a bone here.

giphy.gif
 

aociswundumho

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Here's the one thing he gets right:

Nothing in human history has proven more adept at spurring innovation and driving down costs than competition and free markets. Wherever they have been successfully deployed, human prosperity has followed.

Then he makes the same mistake progressives make regarding healthcare:

But, the market for healthcare isn’t a typical market. First, consumers are relatively price-inelastic: if you need a heart transplant to survive, you don’t have the luxury of holding out until a cheaper option comes along. You need a heart transplant immediately — no matter what it costs.

So he uses the "emergency situation" straw man as evidence for inelastic demand in the market for healthcare, but emergency healthcare is less than 2% of the market, and even in emergency situations, bleeding, injured (but conscious) people will still shop for a ride to the hospital by taking an uber instead of using the local, price-gouging ambulance monopoly.

Note also in part 3, he forgets all the reasons he previously stated why people can't shop for healthcare:

Of course, consumers of care don’t have the luxury of being selective buyers in emergency care situations. But, for a large majority of health procedures that involve a longer lead time, consumers have time needed to kick the tires on their doctor, their hospital, the price of care, and compare the value of what they plan to purchase.

No sh**.
 

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Republicans? Health care reform? Lots of.talk and no action

Just like everything but tax cuts for the rich and deregulation that improves corporate profits
 

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Have you ever thought of what could be considered a 'conservative' plan?

These days, "conservative" in this context means limiting access and finding as many ways to wriggle out of paying for anyone's care as possible. Which, in aggregate, means a health system that doesn't finance or provide health care to people who need it--so, no system at all. Somewhere along the way "conservativism" became hard to distinguish from nihilism.

A "conservative" approach to universal health care is pretty much an oxymoron at this point.
 

aociswundumho

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These days, "conservative" in this context means limiting access and finding as many ways to wriggle out of paying for anyone's care as possible.

Which is exactly the way you behave in your personal life. Outside of your family, you don't pay for anybody else's healthcare, nor do you recognize any moral obligation to do so.
 

Greenbeard

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Which is exactly the way you behave in your personal life. Outside of your family, you don't pay for anybody else's healthcare, nor do you recognize any moral obligation to do so.

Your premium pays for whoever in your insurance pool needs care.
 

aociswundumho

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Your premium pays for whoever in your insurance pool needs care.

That's nice. I notice you didn't disagree with anything I wrote, so don't criticize conservatives for not wanting to pay for anybody else's healthcare when you hold exactly the same view.
 

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That's nice. I notice you didn't disagree with anything I wrote, so don't criticize conservatives for not wanting to pay for anybody else's healthcare when you hold exactly the same view.

You essentially wrote "I don't understand what health insurance is." I don't disagree with that admission at all, it seems obvious.

That is indeed the 'conservative' position these days.
 

aociswundumho

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You essentially wrote "I don't understand what health insurance is."

An insurance policy is a contract used to guard against the risk of a large financial loss. The irony here is that you regularly use the term insurance incorrectly. For example, if the government forced a property insurance company to give a fire insurance policy to someone whose house has already burned down, no one would call it an "insurance" policy, yet that is exactly the same situation when the government forces health insurance companies to provide policies to people who are already sick or have a pre-existing condition.

Anyway you claimed conservatives do not want to pay for anyone else's healthcare, therefore they are somehow similar to nihilists(?!). Again, they are no different from you or me, or anybody else for that matter, because there is no moral obligation to provide healthcare to strangers.
 

OscarLevant

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We've all been waiting for the republican's replacement for Obamacare. This guy, Heath Mayo, has come up with one.

Better Care for All: A conservative alternative to Medicare for All | Pt. 1 | by Heath Mayo | Medium
Better Care for All: A conservative alternative to Medicare for All | Pt. 2 | by Heath Mayo | Medium
Better Care for All: A conservative alternative to Medicare for All | Pt. 3 | by Heath Mayo | Medium

Now I haven't had much of a chance to go over it so maybe some of the posters here who are more versed in the industry can take a look.

This:

"guaranteeing access to a single government product at government-set rates while doing very little to structurally reform the delivery system."

I am on medicare, I don't care about the 'rates' I only care about my costs. now then, as for "single government product" this is nonsense. With Medicare, government does NOT provide the product, it is provided by a consortium of private clinics, all of whom compete with each other in the private markets and for medicare patients. I had MANY choices of which doctor, which plan, etc, when I signed up.
 

OscarLevant

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These days, "conservative" in this context means limiting access and finding as many ways to wriggle out of paying for anyone's care as possible. Which, in aggregate, means a health system that doesn't finance or provide health care to people who need it--so, no system at all. Somewhere along the way "conservativism" became hard to distinguish from nihilism.

A "conservative" approach to universal health care is pretty much an oxymoron at this point.

There are no conservatives, actual conservatives, in Trumpism. They have no idea how to govern, and it shows.

Republicans wouldn't even be talking about health care were it not for Obamacare. Before that, they never mentioned it, and when hillary got a bill going in the 90s, repubs killed it.
 

OscarLevant

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Here's the one thing he gets right:



Then he makes the same mistake progressives make regarding healthcare:



So he uses the "emergency situation" straw man as evidence for inelastic demand in the market for healthcare, but emergency healthcare is less than 2% of the market, and even in emergency situations, bleeding, injured (but conscious) people will still shop for a ride to the hospital by taking an uber instead of using the local, price-gouging ambulance monopoly.

Note also in part 3, he forgets all the reasons he previously stated why people can't shop for healthcare:

When I signed up for the ACA, I was given a brochure, it in were a dozen or so 'plans' Blue Cross, Cigna, Healthnet, etc.

Now then, there were levels, Bronze, Silver, Gold, etc

The bronze was the cheapest, but the deductibles were extreme.

I found the silver plan, $132 per month, $500 deductible, and $10 copays with Healthnet.

now, the ONLY reason I signed up with healthnet was because the price / deductible,/ copay was right for me.

I didn't choose it because of reputations, I had no clue about those.

after I get my plan, then I was taken to a webpage with all the doctors and clinics. I had no clue about those, either, I just threw a dart and landed on not far from my house in a nice area.

Now, my doc gave me a referral for a neurologist, I just go where he sends me, I'm not going to go on yelp and check out reviews.

This idea that 'shopping' and 'competition' works in health care like it does when you go shop for shoes, is really bizarre, it doesn't go down that way.

The second but important point is that my doctor is NOT a 'government run" business, it's a private clinic.

Medicare does not socialize medicine, it just foots the bill and private clinics may, or may not, opt in for medicare patients.

It's all voluntary, and not a government takeover.

It works beautifully for me, because my income level is the target demographic for ACA, it was designed for people like myself, and there are about 18,000,000 persons like myself, and not all of them have the wisdom to go with the silver plan, or they are poorer than me, forced to take the bronze, and they wind up complaining about the deductibles, but that was their choice. Of course, republicans are not going to mention that they had a choice, they are just going to harp on the deductibles.
 

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We've all been waiting for the republican's replacement for Obamacare. This guy, Heath Mayo, has come up with one.

Better Care for All: A conservative alternative to Medicare for All | Pt. 1 | by Heath Mayo | Medium
Better Care for All: A conservative alternative to Medicare for All | Pt. 2 | by Heath Mayo | Medium
Better Care for All: A conservative alternative to Medicare for All | Pt. 3 | by Heath Mayo | Medium

Now I haven't had much of a chance to go over it so maybe some of the posters here who are more versed in the industry can take a look.

He spends most of his time outlining the general principles and policy directions. But he doesn't actually do a lot to suggest policy changes.

Here is what I would recommend on healthy lifestyles alone:
I would enact a widespread health and fitness plan in the US. That means a mandatory high school class that teaches healthy cooking and proper nutrition. Another class that teaches common sense health advise like taking care of your teeth, preventative care knowledge, sunscreen, ergonomics, not abusing medications, etc. We also need to beef of physical ed. No more stacks and junk food allowed at public high school and no junk food can be served at public colleges. Beefing up health and fitness education in schools. Heavily regulating and taxing junk food. Requiring that stores and restaurants provide mostly healthy opinions. Requiring that health care companies provide deep discounts to people with healthy lifestyles. Maybe even make that a tax deduction. We can combine blood pressure, weight measures, and step counters to do this.

The more you learn about healthcare, the more you learn about how a healthy lifestyle greatly reduces the chance of most of these conditions. We are learning more and more about how a lack of exercise and a lifetime and eating garbage good results in people's bodies falling apart.
 

Greenbeard

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When I signed up for the ACA, I was given a brochure, it in were a dozen or so 'plans' Blue Cross, Cigna, Healthnet, etc.

Now then, there were levels, Bronze, Silver, Gold, etc

The bronze was the cheapest, but the deductibles were extreme.

I found the silver plan, $132 per month, $500 deductible, and $10 copays with Healthnet.

now, the ONLY reason I signed up with healthnet was because the price / deductible,/ copay was right for me.

I didn't choose it because of reputations, I had no clue about those.

after I get my plan, then I was taken to a webpage with all the doctors and clinics. I had no clue about those, either, I just threw a dart and landed on not far from my house in a nice area.

Now, my doc gave me a referral for a neurologist, I just go where he sends me, I'm not going to go on yelp and check out reviews.

This idea that 'shopping' and 'competition' works in health care like it does when you go shop for shoes, is really bizarre, it doesn't go down that way.

But what you're describing is what shopping is. The ACA marketplaces organize the market such that you can compare like products to like products, i.e., by the generosity of the plan (that's what the bronze-silver-gold metal tiers are). The plans all have to offer baseline comprehensive benefits and consumer protections so you can make informed apples-to-apples comparisons. You picked a plan based on the price, because you could easily see that it had the most competitive premium in the metal tier you preferred. That's good! It keeps the sellers' feet to the fire and gets the buyer what he was looking for.

Now you may have wanted more information--and that's good, too. The ACA marketplaces were always required to use a star rating system to provide information to shoppers on the relative quality of plans in the market. They didn't have that functionality at the outset because it takes time to set up and the data on many of the plans wasn't there at the beginning. The marketplace does have it now.

Quality ratings of health plans on HealthCare.gov
HealthCare.gov offers a health insurance plan quality ratings (or “star ratings”) program.

Overall health insurance plan quality ratings
Each rated health plan has an “Overall” quality rating of 1 to 5 stars (5 is highest), which accounts for member experience, medical care, and health plan administration.

This gives you an objective way to quickly compare plans, based on quality, as you shop.

Similarly, some people already have relationships with health care providers and want to make sure they are in-network so filtering by plans that include those providers offers useful information to shoppers. And if you don't already have a doctor, the ACA required the government to make available comparative quality information on physicians. It's still got a ways to go but it's an important step toward helping people make informed decisions.

The ACA laid a lot of important groundwork but there's more we can do to help people make informed, meaningful choices, both when they're buying an insurance plan and when they're seeking care. If only because there's no way to get around the fact that at some point people will have to make decisions.
 

The Old Soul

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Again, they are no different from you or me, or anybody else for that matter, because there is no moral obligation to provide healthcare to strangers.
An insurance policy is a contract used to guard against the risk of a large financial loss. The irony here is that you regularly use the term insurance incorrectly. For example, if the government forced a property insurance company to give a fire insurance policy to someone whose house has already burned down, no one would call it an "insurance" policy, yet that is exactly the same situation when the government forces health insurance companies to provide policies to people who are already sick or have a pre-existing condition.

Anyway you claimed conservatives do not want to pay for anyone else's healthcare, therefore they are somehow similar to nihilists(?!).
Anybody else? Its a sad world when compassion for fellow humans is trumped by a buck. I for one am not "anybody else," nor am I proud that other Americans feel no obligation to the society we claim to be Greatest In The World. Contrary to popular belief, empathy and kindness are virtues,not obstacles.
 

OscarLevant

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An insurance policy is a contract used to guard against the risk of a large financial loss. The irony here is that you regularly use the term insurance incorrectly. For example, if the government forced a property insurance company to give a fire insurance policy to someone whose house has already burned down, no one would call it an "insurance" policy, yet that is exactly the same situation when the government forces health insurance companies to provide policies to people who are already sick or have a pre-existing condition.

Anyway you claimed conservatives do not want to pay for anyone else's healthcare, therefore they are somehow similar to nihilists(?!). Again, they are no different from you or me, or anybody else for that matter, because there is no moral obligation to provide healthcare to strangers.

I find it amusing your choice of words, which is typical of those on the right, ie., any word someone on the right or right of center can find to cast aspersion on a particular policy they do not like, they will find words that smack of propaganda.

So, in their bizarro world, helping those who can't afford health care is 'providing health care to strangers'.

their trick is to take the argument out of the collective sphere, where it should be, for purposes of policy, and reduce to a 'personal emotional level'

So, instead a policy that provides a system that makes health care affordable to those who cannot afford it, the argument now becomes:

"They take your money from your account and give it to a stranger".

Or,often a right winger will say 'they take your money have give it to bums who don't want to work".

Nice trick. But that is incredibly disingenuous.

we have agreed, long ago, to establish a government 'by and for the people', thus, what is, or is not, 'moral' is determined by lawmakers, i.e., representatives who are elected

in a civilized society, Democrats declare that there is a moral obligation to help the disadvantaged ( but repubs call them 'bums' 'strangers' 'lazy peole who do not want to work' etc ). However, the majority of the electorate agree with the democrat message. Recent elections establish this fact. To wit: 2,868,676 more votes were cast for Democrats in 2016, 9,710,275 more votes were cast for democrats in the house in 2018, and 17,537,638 more votes were cast for democrats in the senate in 2018

Therefore, if we respect the will of the majority of representatives, who were elected, they declare that government has a moral responsibility to
provide affordable health care to those who cannot afford it.

Therefore, as to what is, or is not moral, that is ultimately decided by the electorate. in terms of absolutes, there is no such thing as 'morals' or write or wrong, it's that we, collectively, via the vote, decide on these matters. That's it. If the voter will it, then that's what it is.

Now, whether or not the structure of the electoral process is just, that the balance of the representatives actually reflects the will of the people, that is another argument altogether. (Dems argue there is plenty that needs fixing in this area )

Republicans are word manipulators. Taxes are a collective effort, and the proper way to frame an argument about taxes MUST be done according to it's proper sphere, which the fact that taxes are a collective effort in nature, and how to determine tax policy should be done in terms of what is good for society, as a whole. Making an argument about a particular tax, framing it as a person thing, that is arguing from anecdote, and that is an effort to manipulate minds, and not an effort to be honest about the subject, it is propaganda.

Framing an argument for a tax designed to make health care affordable to those who cannot afford it as ' taking money out of your account and giving it to bum stranger who doesn't want to work' (or something similar, as those on the right often do ) is propaganda.

Does the left do this? I'm certain they do, and I say to the right, do call us out on it, when we do. I say, let's be honest about our arguments.

Let us all sit down and talk, and quit talking past each other. Being dishonest, calling each other names, increases the divide, and that only pleases Putin.
 
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aociswundumho

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Anybody else? Its a sad world when compassion for fellow humans is trumped by a buck.

Well, I guess it's a sad world then, because you behave the exactly the same way. You have excess money that you could give away to people much poorer than you - but you don't. Instead, you keep those dollars for yourself. In your own life, compassion for fellow humans is trumped by a buck.

So, in their bizarro world, helping those who can't afford health care is 'providing health care to strangers'.

That's correct. If you tax me and give my money to a stranger in order to pay for his healthcare, then that is "providing healthcare to strangers".

their trick is to take the argument out of the collective sphere, where it should be, for purposes of policy, and reduce to a 'personal emotional level'

Yea, I'm the one playing word games and you come up with "collective sphere" and "purposes of policy". Need I suggest where you can shove that collective sphere?

So, instead a policy that provides a system that makes health care affordable to those who cannot afford it, the argument now becomes:

It doesn't make healhcare affordable to those who can't afford it. Ask anyone who has received a bill from a US hospital.

Or,often a right winger will say 'they take your money have give it to bums who don't want to work".

Nope. Makes no difference if he's a homeless bum or Jeff Bezos.
 
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