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Tags Elizabeth Warren , health care reform , Medicare For All , presidential candidates

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Old 1st November 2019, 09:25 PM   #41
crescent
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Originally Posted by BobTheCoward View Post
Medicare cannot negotiate drug prices even with the power they have now. If we are offering this Medicare to all, then that same Medicare doesn't have price negotiation.

Unless that is another in the long list of things that are part of Medicare that isn't going to be part of Medicare. Medicare 4 All is the ship of Theseus of Medicare.
Presumably any legislation that changes Medicare to that extent could also change the prohibition on the government setting the prices it pays for medication. The current status of non-negotiable drug prices for medicare was controversial from day one - as it should be because it is nothing but a blind giveaway. Medicare is not set in stone, it never was and can be changed through legislation. Nearly every federal program deals with at least some level of legislated change every year via the appropriations bills, and frequently other bills as well.

Legislation is legislation. We used legislation to set up the current Medicare prescription drug plan, we can use legislation to change it.
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Old 1st November 2019, 09:28 PM   #42
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Originally Posted by Belz... View Post
Sounds like it's time to cut down on military spending a bit.
Blaspheme! Blaspheme!
Apostasy!

Iím kidding, but that is pretty close to the reaction one will get when one makes that proposal. And in age of Trump, one will most certainly be accused of hating America and trying to make America fail.

Actually, I emphatically agree with your suggestion but military spending is a juggernaut.
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Old 1st November 2019, 11:38 PM   #43
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Originally Posted by BobTheCoward View Post
Medicare cannot negotiate drug prices even with the power they have now. If we are offering this Medicare to all, then that same Medicare doesn't have price negotiation.

Unless that is another in the long list of things that are part of Medicare that isn't going to be part of Medicare. Medicare 4 All is the ship of Theseus of Medicare.
This is because of a stupid law that the Republicans put in place, all that needs to happen is to get rid of that law and allow them to do so.
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Old 2nd November 2019, 05:35 AM   #44
BobTheCoward
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Originally Posted by PhantomWolf View Post
This is because of a stupid law that the Republicans put in place, all that needs to happen is to get rid of that law and allow them to do so.
That is why I called it the ship of Theseus.
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Old 2nd November 2019, 05:45 AM   #45
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I've read statements from a handful of centrist Dem senators (Tester, Manchin, Warner, Seneca) and I conclude the odds of the filibuster being eliminated are much slimmer than I previously guesstimated. And the possibility that Medicare for all can be implemented via reconciliation is non existent. Accordingly, v0.3 of the odds that Warren's plan will be enacted if Warren (or Sanders) wins nomination:

1. Blue wave, Dems win POTUS and Senate: 25%
2. Senate gets rid of filibuster rule: 10%
3. Senators Tester and Manchin (and other centrist Dem senators) vote for Medicare for all: 10%

Based on these rough, optimistic guesstimates: .3%
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Old 2nd November 2019, 05:46 AM   #46
BobTheCoward
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Originally Posted by varwoche View Post
I've read statements from a handful of centrist Dem senators (Tester, Manchin, Warner, Seneca) and I conclude the odds of the filibuster being eliminated are much slimmer than I previously guesstimated. And the possibility that Medicare for all can be implemented via reconciliation is non existent. Accordingly, v0.3 of the odds that Warren's plan will be enacted:

1. Blue wave, Warren (or Sanders) win POTUS and Senate: 25%
2. Senate gets rid of filibuster rule: 10%
3. Senators Tester and Manchin (and other centrist Dem senators) vote for Medicare for all: 10%

Based on these rough, optimistic guesstimates: .03%.
But someone told me Warren will be able to influence sinema...
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Old 2nd November 2019, 05:52 AM   #47
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Originally Posted by Ladewig View Post
Blaspheme! Blaspheme!
Apostasy!

Iím kidding, but that is pretty close to the reaction one will get when one makes that proposal. And in age of Trump, one will most certainly be accused of hating America and trying to make America fail.

Actually, I emphatically agree with your suggestion but military spending is a juggernaut.
I wonder about that.
Used to seem untouchable, with the Soviets- then the Terrorists.
Maybe it's time to address that elephant. I am not so sure it's a third rail anymore.
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Old 2nd November 2019, 05:59 AM   #48
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Originally Posted by crescent View Post
Presumably any legislation that changes Medicare to that extent could also change the prohibition on the government setting the prices it pays for medication. The current status of non-negotiable drug prices for medicare was controversial from day one - as it should be because it is nothing but a blind giveaway. Medicare is not set in stone, it never was and can be changed through legislation. Nearly every federal program deals with at least some level of legislated change every year via the appropriations bills, and frequently other bills as well.

Legislation is legislation. We used legislation to set up the current Medicare prescription drug plan, we can use legislation to change it.
They want to make Medicare 4 all and also completely change Medicare. Meanwhile there is a program that already does this called Medicaid (and actually knows how to do things like cover healthy adults under 65).
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Old 2nd November 2019, 06:43 AM   #49
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Itís a good point...Medicare as it is currently would not meet the needs of the entire population. Itís geared towards serving the retired and disabled. For one thing, there is very little preventive care as you currently understand it now; no annual physical, few immunizations, mostly screenings for diseases of aging.

It would have to be substantially expanded and altered in order to serve all of us. At that point it isnít really Medicare anymore.

Medicare-For-All is just a catchy slogan that takes advantage of our familiarity with the Medicare name. What weíd end up with would look very little like Medicare.
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Old 2nd November 2019, 06:48 AM   #50
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Originally Posted by BobTheCoward View Post
They want to make Medicare 4 all and also completely change Medicare. Meanwhile there is a program that already does this called Medicaid (and actually knows how to do things like cover healthy adults under 65).


Medicaid-For-All is not going to fly, methinks.
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Old 2nd November 2019, 07:00 AM   #51
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Originally Posted by xjx388 View Post
Medicaid-For-All is not going to fly, methinks.
I think you are correct about that, however, perhaps we could wind up with something like this:
https://www.pewtrusts.org/en/researc...-the-uninsured
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Old 2nd November 2019, 07:47 AM   #52
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Originally Posted by Distracted1 View Post
I think you are correct about that, however, perhaps we could wind up with something like this:
https://www.pewtrusts.org/en/researc...-the-uninsured

Medicaid presents another set of difficulties. For starters, the reimbursement would have to be raised if you want more docs to accept it. I think youíd have to introduce co-pays/co-insurance in order to reduce the over utilization problem. Itís also a program designed for a specific population.

Thatís really the problem: the US does not have a medical program that could be readily expanded to cover us all.
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Old 2nd November 2019, 08:27 AM   #53
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Originally Posted by xjx388 View Post
Medicaid presents another set of difficulties. For starters, the reimbursement would have to be raised if you want more docs to accept it. I think youíd have to introduce co-pays/co-insurance in order to reduce the over utilization problem. Itís also a program designed for a specific population.

Thatís really the problem: the US does not have a medical program that could be readily expanded to cover us all.
A) there are copays in Medicaid

B) it is not designed for a specific person. It covers people from birth to end of life in a nursing facility.
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Old 2nd November 2019, 08:51 AM   #54
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Originally Posted by BobTheCoward View Post
A) there are copays in Medicaid



B) it is not designed for a specific person. It covers people from birth to end of life in a nursing facility.
A)Depends on the State

B)Medicaid provides care that is generally designed for vulnerable populations: mainly women and children. The benefits for those populations are, again depending on the State, more comprehensive than any other insurance plan. In Texas, thereís the womenís health program and the Health Steps for kids. The idea being that those vulnerable populations need extra support.

Medicaid is also designed to support Medicare for low-income people. It pays for home provider services and a bunch of stuff that would normally be paid out of pocket.

Those programs would not transfer well to the entire population at a cost that would be manageable.
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Old 2nd November 2019, 10:28 AM   #55
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Originally Posted by xjx388 View Post
A)Depends on the State

B)Medicaid provides care that is generally designed for vulnerable populations: mainly women and children. The benefits for those populations are, again depending on the State, more comprehensive than any other insurance plan. In Texas, thereís the womenís health program and the Health Steps for kids. The idea being that those vulnerable populations need extra support.

Medicaid is also designed to support Medicare for low-income people. It pays for home provider services and a bunch of stuff that would normally be paid out of pocket.

Those programs would not transfer well to the entire population at a cost that would be manageable.
Your initial claims are wrong. You don't have to introduce copays...they are already introduced.

It is designed to cover old and young, healthy and sick, male and female.
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Old 2nd November 2019, 10:57 AM   #56
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Originally Posted by varwoche View Post
I've read statements from a handful of centrist Dem senators (Tester, Manchin, Warner, Seneca) and I conclude the odds of the filibuster being eliminated are much slimmer than I previously guesstimated. And the possibility that Medicare for all can be implemented via reconciliation is non existent. Accordingly, v0.3 of the odds that Warren's plan will be enacted if Warren (or Sanders) wins nomination:

1. Blue wave, Dems win POTUS and Senate: 25%
2. Senate gets rid of filibuster rule: 10%
3. Senators Tester and Manchin (and other centrist Dem senators) vote for Medicare for all: 10%

Based on these rough, optimistic guesstimates: .3%
Yup. It's interesting as seeing how a candidate solves a problem, but there is little chance of it actually happening.
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Old 2nd November 2019, 01:09 PM   #57
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Originally Posted by varwoche View Post
I've read statements from a handful of centrist Dem senators (Tester, Manchin, Warner, Seneca) and I conclude the odds of the filibuster being eliminated are much slimmer than I previously guesstimated. And the possibility that Medicare for all can be implemented via reconciliation is non existent. Accordingly, v0.3 of the odds that Warren's plan will be enacted if Warren (or Sanders) wins nomination:

1. Blue wave, Dems win POTUS and Senate: 25%
2. Senate gets rid of filibuster rule: 10%
3. Senators Tester and Manchin (and other centrist Dem senators) vote for Medicare for all: 10%

Based on these rough, optimistic guesstimates: .3%
I think your 10% on removing the filibuster is high. Senator Kyrsten Sinema (D-AZ) has announced that she will not support getting rid of the filibuster.
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Old 2nd November 2019, 03:57 PM   #58
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Originally Posted by xjx388 View Post
....
I think youíd have to introduce co-pays/co-insurance in order to reduce the over utilization problem. Itís also a program designed for a specific population.
....
What is the over-utilization problem? People are going to doctors with trivial stuff, or because they don't have any other place to go, or what? Some of that could be fixed with education, or phone consultations, or walk-in clinics staffed with NPs, or other methods. And the "specific population" for Medicaid is basically poor. But people are poor for a lot of different reasons. That doesn't mean they don't need or deserve good services.

Why is something that every other country provides its citizens just impossible for the U.S.?
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Old 2nd November 2019, 04:03 PM   #59
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Originally Posted by xjx388 View Post
....
It would have to be substantially expanded and altered in order to serve all of us. At that point it isnít really Medicare anymore.

Medicare-For-All is just a catchy slogan that takes advantage of our familiarity with the Medicare name. What weíd end up with would look very little like Medicare.
The basic structure of Medicare is that patients choose their own providers, and doctors and hospitals run their own businesses. Medicare is a single-payer insurance program that covers all Medicare patients and pays all Medicare providers. Expanding who is covered and what is covered wouldn't need to alter the basic framework, unlike, say, trying to copy the UK's NHS. And creating a Medicare-for-All-Who-Want-It public option would allow patients to compare Medicare with whatever other insurance is available. This just doesn't seem impossible.
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Old 2nd November 2019, 04:47 PM   #60
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Originally Posted by Bob001 View Post
What is the over-utilization problem? People are going to doctors with trivial stuff, or because they don't have any other place to go, or what? Some of that could be fixed with education, or phone consultations, or walk-in clinics staffed with NPs, or other methods. And the "specific population" for Medicaid is basically poor. But people are poor for a lot of different reasons. That doesn't mean they don't need or deserve good services.

Why is something that every other country provides its citizens just impossible for the U.S.?
No country provides what Sanders proposed.
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Old 2nd November 2019, 04:50 PM   #61
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Originally Posted by Bob001 View Post
The basic structure of Medicare is that patients choose their own providers, and doctors and hospitals run their own businesses. Medicare is a single-payer insurance program that covers all Medicare patients and pays all Medicare providers. Expanding who is covered and what is covered wouldn't need to alter the basic framework, unlike, say, trying to copy the UK's NHS. And creating a Medicare-for-All-Who-Want-It public option would allow patients to compare Medicare with whatever other insurance is available. This just doesn't seem impossible.
Who is covered and what is covered sounds like the basic framework.
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Old 2nd November 2019, 05:42 PM   #62
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Originally Posted by BobTheCoward View Post
No country provides what Sanders proposed.
You're wrong.
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Old 2nd November 2019, 05:47 PM   #63
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Medicare focuses on an elderly population often with chronic or acute disease. Expanding this to the general, younger, generally healthier population represents lower costs on average per person.
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Old 2nd November 2019, 05:52 PM   #64
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Originally Posted by acbytesla View Post
You're wrong.
Name the country.
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Old 2nd November 2019, 05:57 PM   #65
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Originally Posted by BobTheCoward View Post
Your initial claims are wrong. You don't have to introduce copays...they are already introduced.



It is designed to cover old and young, healthy and sick, male and female.


Like I said, whether there are copays or not depends on the State. Texas does not have Medicaid plans with copays.

What and who itís designed to cover also varies by State. What they all have in common is that they are designed to cover vulnerable populations; people living at or near the poverty line. That population has unique needs that the rest of the population does not.

For example, in Texas, Medicaid covers things like home care providers (assistance with cleaning, cooking and housework) that are not covered by any other insurance plans. It picks up a portion of the Medicare deductibles, but not copays; doctors who take Medicare and Medicaid have to write-off whatever Medicaid doesnít cover. It mandates many more well-child services than commercial insurance does. It covers over-the-counter meds if a doctor prescribes them. It covers in-office education. It covers rides to the doctor.

The benefits are much more comprehensive than any commercial insurance. However, it doesnít cover men unless they meet very specific conditions: mostly disability or if they care for a child. Single women without children also have reduced, womenís health benefits. Texas has a Buy-In program but only for people and children with disabilities.

Expanding Texas Medicaid to all would require much alteration of benefits so much so that it wouldnít resemble Medicaid anymore.
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Old 2nd November 2019, 05:59 PM   #66
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Originally Posted by Giordano View Post
Medicare focuses on an elderly population often with chronic or acute disease. Expanding this to the general, younger, generally healthier population represents lower costs on average per person.


How so? Medicare doesnít cover things that would be required for the general younger healthy population.
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Old 2nd November 2019, 06:30 PM   #67
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Originally Posted by Craig4 View Post
This is a "we're not ready for it" fail. Let a candidate who advocates for "keep your private insurance but here's Medicare if you need it" proceed and let people gradually conclude Medicare for all is better. Maybe we will adopt a system like most of Western Europe. Just don't risk four more years of Trump over it.


Originally Posted by varwoche View Post
This seems like a wise approach, just in terms of logistics and ease of implementation.

I think so too.

There's also a trust issue. Every time a politician has a great plan for something it never really pans out, or the details change after election.

Last time health care was fiddled with, not only could I not "keep my doctor" but my rates went up 90 percent. Guess who pays for my health care now? And it isn't nearly as good. I'm not happy about that and I don't forget easy.

Just because Warren or anyone else says it's true doesn't make it so. When I see a plan like this I assume that it will be completely different come time to implement it, and much more expensive.

52 Trillion will become something more, just like the bullet train here in Cali with its ever-increasing price tag. Just like everything.

We definitely need health care reform but politicians are known for either lying or not knowing what they are talking about, or both.
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Old 2nd November 2019, 07:33 PM   #68
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Originally Posted by mgidm86 View Post
I think so too.

There's also a trust issue. Every time a politician has a great plan for something it never really pans out, or the details change after election.

Last time health care was fiddled with, not only could I not "keep my doctor" but my rates went up 90 percent. Guess who pays for my health care now? And it isn't nearly as good. I'm not happy about that and I don't forget easy.
.....
Details, please. Who paid previously, who pays now, and what makes it "not as good?" Maybe you switched jobs? Maybe your employer cut the percentage he paid? That was not the common experience, and under the ACA 20+ million people got insurance that they couldn't get before. I doubt they're sorry about it.
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Old 2nd November 2019, 07:36 PM   #69
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Last time health care was 'fiddled with', I was put on Medicaid just in time to be diagnosed with cancer. Tests and treatment were fully paid for (though I may not ever be able to get private insurance). I don't forget easy either.
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Old 2nd November 2019, 08:25 PM   #70
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Originally Posted by Silly Green Monkey View Post
Last time health care was 'fiddled with', I was put on Medicaid just in time to be diagnosed with cancer. Tests and treatment were fully paid for (though I may not ever be able to get private insurance). I don't forget easy either.
Note that under the ACA you can't be turned down for a pre-existing condition. Dear Leader wants to restore your freedom to not be able to buy insurance.

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Old 2nd November 2019, 08:35 PM   #71
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Originally Posted by BobTheCoward View Post
Name the country.

France, for one.
Quote:
In its 2000 assessment of world health care systems, the World Health Organization found that France provided the "close to best overall health care" in the world.[
https://en.wikipedia.org/wiki/Health_care_in_France

Probably Germany, too.
Quote:
According to the Euro health consumer index, which placed it in seventh position in its 2015 survey, Germany has long had the most restriction-free and consumer-oriented healthcare system in Europe. Patients are allowed to seek almost any type of care they wish whenever they want it.
https://en.wikipedia.org/wiki/Healthcare_in_Germany
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Old 2nd November 2019, 08:41 PM   #72
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Originally Posted by xjx388 View Post
....
Expanding Texas Medicaid to all would require much alteration of benefits so much so that it wouldnít resemble Medicaid anymore.
Maybe it would resemble Medicaid as it's provided in some other states.

Here's the question: Do you accept the premise that everybody -- rich or poor, employed or not, healthy or sick -- should have access to health care? If so, how would you provide it?

If not, who would you leave out?
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Old 2nd November 2019, 08:48 PM   #73
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I think it would be a mistake to eliminate co-pays altogether.

In Japan, where everyone is covered by one of two national health insurance schemes, you still pay a modest fee when you visit a doctor. The fee is very reasonable: the equivalent of a few dollars in most cases, but it isn't free. Make it free and that's going to be a recipe for people going to the doctor when they don't even need to.
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Old 2nd November 2019, 08:49 PM   #74
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Originally Posted by Puppycow View Post
I think it would be a mistake to eliminate co-pays altogether.

In Japan, where everyone is covered by one of two national health insurance schemes, you still pay a modest fee when you visit a doctor. The fee is very reasonable: the equivalent of a few dollars in most cases, but it isn't free. Make it free and that's going to be a recipe for people going to the doctor when they don't even need to.
Is the fee means-tested? If somebody doesn't have any money does he still get to see the doc?
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Old 2nd November 2019, 09:24 PM   #75
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Originally Posted by Puppycow View Post
I think it would be a mistake to eliminate co-pays altogether.

In Japan, where everyone is covered by one of two national health insurance schemes, you still pay a modest fee when you visit a doctor. The fee is very reasonable: the equivalent of a few dollars in most cases, but it isn't free. Make it free and that's going to be a recipe for people going to the doctor when they don't even need to.
That will never happen. Going to a doctor is time not spent doing anything else. No one goes "huh, nothing to do for a few hours. Well, lets go to the doctor!" Just as no one goes "huh, nothing to do for a few hours. Why not take the car to the dealership?" We go to places because we need to go to them or want to be there, not because they're free.
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Old 2nd November 2019, 10:59 PM   #76
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Question

Originally Posted by Bob001 View Post
Both have copays making them less generous than Sanders's plan.
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Old 2nd November 2019, 11:10 PM   #77
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Originally Posted by Silly Green Monkey View Post
That will never happen. Going to a doctor is time not spent doing anything else. No one goes "huh, nothing to do for a few hours. Well, lets go to the doctor!" Just as no one goes "huh, nothing to do for a few hours. Why not take the car to the dealership?" We go to places because we need to go to them or want to be there, not because they're free.
Some people do go to the doctor a lot, unnecessarily. There are hypochondriacs and also people who just panic over what turns out to be nothing. In olden times you'd find "FF" in some patient medical records, short for "frequent flyer". At least a nominal copay does serve to curb some of this behavior.

People go look at cars for fun and out of boredom as well.

I don't go to doctors or dealerships for no reason myself, but I have frequently gone into stores and not purchased anything. From their POV I am just as bad.
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Old 2nd November 2019, 11:44 PM   #78
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Originally Posted by BobTheCoward View Post
No country provides what Sanders proposed.
BobTheCoward is right, actually.

Sanders' proposal is more generous than any healthcare system on the planet. That's the super high bar I'm afraid progressives will stick too hard to.
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Old 3rd November 2019, 12:45 AM   #79
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Originally Posted by Venom View Post
BobTheCoward is right, actually.

Sanders' proposal is more generous than any healthcare system on the planet. That's the super high bar I'm afraid progressives will stick too hard to.
Well, the Republicans might be better off in the sense that their incredibly impossible and destructive proposals are put in so vague terms and vast holes are explained away by magical thinking that no-one really bothers to take them seriously. And so something bit less awful ends up being enacted. Being detailed and serious might not be a bonus (though I think it makes sense, now, for Warren to release this plan).

Anyway, maybe it's a good tactic to go whole hog with healthcare and end up with something less. And these Democratic plans are quite different in the sense that they really would hugely help the country and save waste and produce way better care than under the current system
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Old 3rd November 2019, 01:11 AM   #80
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Originally Posted by Silly Green Monkey View Post
That will never happen. Going to a doctor is time not spent doing anything else. No one goes "huh, nothing to do for a few hours. Well, lets go to the doctor!" Just as no one goes "huh, nothing to do for a few hours. Why not take the car to the dealership?" We go to places because we need to go to them or want to be there, not because they're free.
Have you heard of hypochondriacs or Munchausen Syndrome? Malingering? It happens.
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