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1st November 2019, 09:25 PM | #41 |
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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. |
1st November 2019, 09:28 PM | #42 |
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Blaspheme! Blaspheme!
Apostasy! I’m 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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1st November 2019, 11:38 PM | #43 |
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2nd November 2019, 05:35 AM | #44 |
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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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2nd November 2019, 05:46 AM | #46 |
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2nd November 2019, 05:52 AM | #47 |
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2nd November 2019, 05:59 AM | #48 |
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2nd November 2019, 06:43 AM | #49 |
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It’s a good point...Medicare as it is currently would not meet the needs of the entire population. It’s 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 isn’t really Medicare anymore. Medicare-For-All is just a catchy slogan that takes advantage of our familiarity with the Medicare name. What we’d end up with would look very little like Medicare. |
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2nd November 2019, 06:48 AM | #50 |
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2nd November 2019, 07:00 AM | #51 |
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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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2nd November 2019, 07:47 AM | #52 |
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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 you’d have to introduce co-pays/co-insurance in order to reduce the over utilization problem. It’s also a program designed for a specific population. That’s really the problem: the US does not have a medical program that could be readily expanded to cover us all. |
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2nd November 2019, 08:27 AM | #53 |
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2nd November 2019, 08:51 AM | #54 |
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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, there’s the women’s 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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2nd November 2019, 10:28 AM | #55 |
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2nd November 2019, 10:57 AM | #56 |
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2nd November 2019, 01:09 PM | #57 |
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2nd November 2019, 03:57 PM | #58 |
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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.? |
2nd November 2019, 04:03 PM | #59 |
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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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2nd November 2019, 04:47 PM | #60 |
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2nd November 2019, 04:50 PM | #61 |
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2nd November 2019, 05:42 PM | #62 |
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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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2nd November 2019, 05:52 PM | #64 |
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2nd November 2019, 05:57 PM | #65 |
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Like I said, whether there are copays or not depends on the State. Texas does not have Medicaid plans with copays. What and who it’s 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 doesn’t 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 doesn’t cover men unless they meet very specific conditions: mostly disability or if they care for a child. Single women without children also have reduced, women’s 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 wouldn’t resemble Medicaid anymore. |
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2nd November 2019, 05:59 PM | #66 |
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2nd November 2019, 06:30 PM | #67 |
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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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2nd November 2019, 07:33 PM | #68 |
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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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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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2nd November 2019, 08:25 PM | #70 |
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2nd November 2019, 08:35 PM | #71 |
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France, for one.
Quote:
Probably Germany, too.
Quote:
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2nd November 2019, 08:41 PM | #72 |
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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? |
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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2nd November 2019, 08:49 PM | #74 |
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2nd November 2019, 09:24 PM | #75 |
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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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2nd November 2019, 10:59 PM | #76 |
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2nd November 2019, 11:10 PM | #77 |
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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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2nd November 2019, 11:44 PM | #78 |
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3rd November 2019, 12:45 AM | #79 |
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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 |
3rd November 2019, 01:11 AM | #80 |
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