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Old 24th February 2020, 08:22 PM   #121
Meadmaker
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Originally Posted by Suddenly View Post
Except for healthcare. All it takes is to know someone who has trouble getting insulin or who had to enter into mortal combat with their insurance while dealing with a dire medical issue to become somewhat radicalized as to that issue.
Did I miss something? What did Trump do to health care?

I know he tried to repeal Obamacare completely, but he failed. I know that he got rid of the individual mandate, which I thought was a very bad idea (i.e. getting rid of it was the bad idea. Having it was a good idea.) However, even though I thought it repealing it was a bad idea, it was a popular idea. As far as I know, it had very little effect on most people's insurance.

I did use Obamacare plans for a few months this summer, and it was not a good thing, but I don't know if it was any worse than in 2015. I remember my brother in law ranting and raving abut how much more expensive his health care got when Obamacare went into effect, and that was why he was voting for Trump. (He was self employed, with a stay at home wife and one young child) Since I didn't use it prior to Trump's time in office, I couldn't tell you how it compares now to what it was then. I just know that this year, in 2019, it had high premiums and a high deductible, but it was good for it to be there, because with preexisting conditions, it would have been nearly impossible to obtain insurance otherwise.

So, count me in on Obamacare, but plenty of people disagree. The individual mandate seemed like a burden to people. It seems that a lot of young, healthy, people are willing to take chances on medical bankruptcy.

Last edited by Meadmaker; 24th February 2020 at 08:24 PM.
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Old 25th February 2020, 12:39 AM   #122
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Originally Posted by Meadmaker View Post
Did I miss something? What did Trump do to health care?
He and his administration ? As you correctly point out, his attempts to repeal the ACA failed.

OTOH individual states have taken steps to hamstring the ACA by a range of means and have been supported by the Trump Administration in their attempts to inflict death by a thousand cuts.

Here's an exhaustive list:

https://www.cbpp.org/sabotage-watch-...ermine-the-aca
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Old 25th February 2020, 01:00 AM   #123
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Trump has done everything in his power to make the ACA unworkable, including nominating decidedly anti-ACA judges and refusing to go after people who didn't pay the fine for not joining (before Congress took that bit away).
Trump could have assured that the ACA continued to work, or he could have pulled a NAFTA and replaced it with the exact same thing by a new name.
He didn't m
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Old 25th February 2020, 06:52 AM   #124
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Originally Posted by Meadmaker View Post
Did I miss something? What did Trump do to health care?

.
What you missed is that this wasn't about Trump. Trump is only relevant in the sense that this problem exists and he has no credibility or for that matter interest in doing anything about it. More about inaction than action.

People not affording insulin is the sort of thing that makes people want to look for solutions, not blame.
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Old 25th February 2020, 06:55 AM   #125
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The individual mandate was just one of several ways Trump (anti-Constitutionally) sabotaged ACA. (A President doesn't get to just decide not to enforce or follow a properly passed & signed law, but a Dictator does.) But it was the biggest and most important one. Without that part, its costs are mostly unfunded. It's like having Medicare For All in place, and not repealing it, but also getting rid of the tax that came with it. They've successfully forced several million people who had health insurance out of it. Winning!

Last edited by Delvo; 25th February 2020 at 07:21 AM.
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Old 25th February 2020, 07:53 PM   #126
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Originally Posted by Suddenly View Post
What you missed is that this wasn't about Trump. Trump is only relevant in the sense that this problem exists and he has no credibility or for that matter interest in doing anything about it. More about inaction than action.

People not affording insulin is the sort of thing that makes people want to look for solutions, not blame.
Well ok, but this thread is about Trump getting re-elected.

All my life, Democrats have argued for more government involvement in health care. Republicans for less. Trump carries on that trend. The thing is, the steps he has taken are pretty popular, and haven't been devastating, except possibly to people who chose not to be insured. In terms of Trump's reelection, I don't see a big event that will turn a lot of voters against him.

More people have jobs that provide insurance. That's a pretty good argument for staying the course. Or, more accurately, it's a pretty persuasive argument, which is not necessarily the same thing. Of course, health care will be a big issue for the Democratic candidate, and it will be persuasive to many, but I don't see a reason why it would be more persuasive than last time.
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Old 26th February 2020, 01:56 AM   #127
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Originally Posted by Meadmaker View Post
Well ok, but this thread is about Trump getting re-elected.

All my life, Democrats have argued for more government involvement in health care. Republicans for less. Trump carries on that trend. The thing is, the steps he has taken are pretty popular, and haven't been devastating, except possibly to people who chose not to be insured. In terms of Trump's reelection, I don't see a big event that will turn a lot of voters against him.

More people have jobs that provide insurance. That's a pretty good argument for staying the course. Or, more accurately, it's a pretty persuasive argument, which is not necessarily the same thing. Of course, health care will be a big issue for the Democratic candidate, and it will be persuasive to many, but I don't see a reason why it would be more persuasive than last time.
Tell that to the people whose hospitals have closed:

Quote:
The Affordable Care Act’s Medicaid expansion drove down the uninsured rate in the United States.

Now a new study suggests that the expansion boosted the financial health of many hospitals that serve a high number of the uninsured, especially in rural areas.

Researchers found that hospitals in the 32 states and District of Columbia that expanded Medicaid were more than 6 times less likely to close than hospitals in the 18 states that said no to the expansion.

Some areas were helped more than others by the Medicaid expansion.

“The effect, in terms of the closure rates between expansion and non-expansion states, seems to be especially strong for rural hospitals,” said study author Gregory Tung, PhD, an assistant professor in the Colorado School of Public Health at the University of Colorado.
Quote:
Before 2012, there were similar rates of hospital closures in Medicaid expansion and non-expansion states.

The two groups started to diverge in 2012, after the Supreme Court decided that the Medicaid expansion should be optional for states.

After this time, closure rates declined in expansion states, while they remained high in non-expansion states.
https://www.healthline.com/health-ne...spitals-open#1
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Old 26th February 2020, 05:34 AM   #128
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Originally Posted by Stacyhs View Post
Tell that to the people whose hospitals have closed:




https://www.healthline.com/health-ne...spitals-open#1
I'm still missing something.

In a thread about Trump getting re-elected, you just posted links from an article that included, "since 2012...…"






The Democratic candidate can certainly try to make a case that government should provide or be involved more in health care, and I have no doubt he will do so.

But they did last time, too, and they did to one extent or another in every election I can remember. Sometimes it was a stronger message, sometimes weaker, but this issue has a long history. The point is that there's no great talking point of "Because Trump got elected, something very bad happened."

There's a "we need to do more than Trump is doing" argument, but that's not nearly as powerful, and in fact is looked upon skeptically by an awful lot of Americans.

ETA: Whether or not it should be. This thread is about politics, i.e. how people vote, not necessarily how people ought to vote if they knew what was good for them.

Last edited by Meadmaker; 26th February 2020 at 05:42 AM.
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Old 26th February 2020, 05:53 AM   #129
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The reason why even those Republicans who despise Trump will vote for him is this:
they are horrified of a Democrat using the precedent Trump has set for Abuse of Power and Obstruction of Justice.
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Old 26th February 2020, 06:01 AM   #130
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Wow. After last night's debate, I don't think any of the candidates are going to have much of a turnout. None of them are Obama or Bill Clinton, able to pull center votes in huge numbers.
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Old 26th February 2020, 06:37 AM   #131
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Originally Posted by Drewbot View Post
Wow. After last night's debate, I don't think any of the candidates are going to have much of a turnout. None of them are Obama or Bill Clinton, able to pull center votes in huge numbers.
The Bernie Bros have forced to abandon, in fact full on reject and demonize, the center in the vague hopes of some massive demographic of Far Left in America that for all of our sakes I hope really does exist.
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Old 26th February 2020, 07:03 AM   #132
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Originally Posted by JoeMorgue View Post
The Bernie Bros have forced to abandon, in fact full on reject and demonize, the center in the vague hopes of some massive demographic of Far Left in America that for all of our sakes I hope really does exist.

Actually, I've seen more demonization of Bernie and his supporters than the other way around.
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Old 26th February 2020, 07:17 AM   #133
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Old 26th February 2020, 07:23 AM   #134
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Originally Posted by The Great Zaganza View Post
The reason why even those Republicans who despise Trump will vote for him is this:
they are horrified of a Democrat using the precedent Trump has set for Abuse of Power and Obstruction of Justice.
I've said it before I and got crap for it.

How Trump is "Presidenting" is not going unnoticed and we'd be fools to think that even the noblest and purest of heart people aren't looking at how much of his... self he's been able to force into the Presidency by just ignoring the rules, playing the "I can do anything I want unless somebody stops me" and... gears are turning in their heads.

I guarantee you there is at least some teeny, tiny voice in the head of every person on stage at the Democratic Election saying some variation on the "Oh you see... all we have to do is get a good person in that position and everything is going to be okay... and aren't you just that person?"

Now, to be clear, even the worst person on queue for the Dems is a 1,000x better then Trump and that little voice is going to be largely overshadowed in most of their cases by varying levels of base competence and general human decency that Trump doesn't have, but the voice is there.

The whole "Wholly crap, all you have to do is just ignore a bunch of unspoken rules or just do stuff and wait for someone to stop you and you can't get a lot of crap done, or at least create a lot of drama and attention" is not a genie we are going to be able to stuff back into the bottle.
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Old 26th February 2020, 07:24 AM   #135
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Originally Posted by Cabbage View Post
Actually, I've seen more demonization of Bernie and his supporters than the other way around.
When Bernie wins he can make toil in the Health Care and Student Loan Relief mines to pay for my sins. I'll be too happy Trump didn't win to care.
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Old 26th February 2020, 11:32 AM   #136
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Originally Posted by Cabbage View Post
Actually, I've seen more demonization of Bernie and his supporters than the other way around.
And if he gets the nomination, you ain't see nuthin' yet!
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Old 26th February 2020, 12:09 PM   #137
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Originally Posted by Trebuchet View Post
And if he gets the nomination, you ain't see nuthin' yet!

I would hope that at least the Democrats stop demonizing him at that point, but honestly I'm not sure.
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Old 26th February 2020, 12:59 PM   #138
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Originally Posted by Meadmaker View Post
I'm still missing something.

In a thread about Trump getting re-elected, you just posted links from an article that included, "since 2012...…"
>snip<

.
You stated that
Quote:
The thing is, the steps he has taken are pretty popular, and haven't been devastating, except possibly to people who chose not to be insured. In terms of Trump's reelection, I don't see a big event that will turn a lot of voters against him.
(#126)

The quotes I provided show how hospitals, particularly rural hospitals, have been negatively affected in states that did not expand Medicaid under the ACA.

Quote:
President Trump has made clear that his goal remains to repeal the Affordable Care Act (ACA), including its expansion of Medicaid to low-income adults, and to impose rigid caps on the federal government’s Medicaid spending. While Congress considered and rejected a series of proposals to cut Medicaid and repeal the ACA in 2017, the Administration has continued to pursue the overarching policy goals of those bills through its budget proposals, litigation seeking to overturn the entire ACA, and administrative actions. Restrictions it has put in place administratively have already cost many thousands of people their health coverage and access to care and could harm millions more.
Quote:
The Trump Administration proposed a rule in November 2019 that would make it harder for states to pay for their share of Medicaid costs. If finalized, the rule could require many states to change how they finance their Medicaid programs — eliminating some financing options that have long been available to states. These changes would dramatically affect state budgets and could lead to significant cuts to benefits, coverage, and provider payments.
https://www.cbpp.org/research/health...es-to-medicaid

The hospitals depend on being paid by those covered by Medicaid. When the number of people on Medicaid goes down, the hospitals still provide care, but are not reimbursed for the cost. That is why the rate of hospital closure in non-Medicaid expanded states is 6X higher than those in states that expanded it.

Last edited by Stacyhs; 26th February 2020 at 01:03 PM.
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Old 26th February 2020, 01:30 PM   #139
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Originally Posted by Sideroxylon View Post
“Toxic Bernie Bro culture” is narrative propagated by political opponents that provides many a non
Sequitur justification for suspicion of the candidate.
I would just like to point out that the biggest Bernie Bro on these forums last time around voted for Trump and was a huge supporter of Trump.

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Originally Posted by Segnosaur View Post
True, you can have privately owned hospitals in a publicly funded system.

Does bring up a few issues though:

- Does BernieCare allow for that? Its all well and good to come up with ur own ideas about what health care should be like, but if the politicians are pushing something else, our own plans are irrelevant

- Who decides what the fees are? Does the government force all hospitals to accept the same payment? Or do they offer certain fees and the hospital can take it or leave it? And if the fees offered are less than the cost to run the hospital (or are less profitable than other uses of the real estate), are you prepared to see a reduction in hospital beds (with the possibility of wait lists)?
I thought that medicare had most of this worked out to some degree. Isn't that why he is calling for M4A instead of starting from scratch?
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Old 26th February 2020, 01:54 PM   #140
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Originally Posted by Dr. Keith View Post
Quote:
True, you can have privately owned hospitals in a publicly funded system.

Does bring up a few issues though:

- Does BernieCare allow for that? Its all well and good to come up with ur own ideas about what health care should be like, but if the politicians are pushing something else, our own plans are irrelevant

- Who decides what the fees are? Does the government force all hospitals to accept the same payment? Or do they offer certain fees and the hospital can take it or leave it? And if the fees offered are less than the cost to run the hospital (or are less profitable than other uses of the real estate), are you prepared to see a reduction in hospital beds (with the possibility of wait lists)?
I thought that medicare had most of this worked out to some degree. Isn't that why he is calling for M4A instead of starting from scratch?
From what I understand, not all doctors/hospitals accept medicare. And supposedly the costs reimbursed by medicare can actually be less than the cost of treatment.

From: https://www.cnn.com/2019/03/18/polit...als/index.html
Medicare payments only covered 87% of costs... "Hospitals are already paid far less than the cost of caring for Medicare patients, and more patients with Medicare would strain hospitals even more, and could threaten hospitals' survival," wrote Rick Pollack, chief executive of the association.

(Note that the figures come from a group called the American Hospital Association, which is a private group, but the figures seem to fit in with other numbers I've seen.)

So, if Medicare-for-all is expanded:
- Doctors who previously rejected Medicare patients will have to change their practices. How do you do that?
- Some medical facilities may end up losing money (and end up going out of business) if the reimbursement by Medicare is not enough to cover the costs. What happens then?

Now, there are some claims about how it will ultimately save doctors/hospitals money by making things more efficient. I remain skeptical (since often medicare payments are late, which may cause a cashflow problem with medical facilities.)
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Old 26th February 2020, 02:15 PM   #141
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Originally Posted by Delvo View Post
The individual mandate was just one of several ways Trump (anti-Constitutionally) sabotaged ACA. (A President doesn't get to just decide not to enforce or follow a properly passed & signed law, but a Dictator does.) But it was the biggest and most important one. Without that part, its costs are mostly unfunded. It's like having Medicare For All in place, and not repealing it, but also getting rid of the tax that came with it. They've successfully forced several million people who had health insurance out of it. Winning!
You are off here. The individual mandate was eliminated as part of the Tax Cuts and Jobs Act of 2017; not by EO. Also, the marketplace and subsidies are still in place, so anyone who wants an "ACA" plan can still get one. No one has been forced out of health insurance; but people who had to have one before may have opted not to, now that they won't get penalized.
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Old 26th February 2020, 02:25 PM   #142
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Originally Posted by Segnosaur View Post
From what I understand, not all doctors/hospitals accept medicare. And supposedly the costs reimbursed by medicare can actually be less than the cost of treatment.

From: https://www.cnn.com/2019/03/18/polit...als/index.html
Medicare payments only covered 87% of costs... "Hospitals are already paid far less than the cost of caring for Medicare patients, and more patients with Medicare would strain hospitals even more, and could threaten hospitals' survival," wrote Rick Pollack, chief executive of the association.

(Note that the figures come from a group called the American Hospital Association, which is a private group, but the figures seem to fit in with other numbers I've seen.)

So, if Medicare-for-all is expanded:
- Doctors who previously rejected Medicare patients will have to change their practices. How do you do that?
- Some medical facilities may end up losing money (and end up going out of business) if the reimbursement by Medicare is not enough to cover the costs. What happens then?

Now, there are some claims about how it will ultimately save doctors/hospitals money by making things more efficient. I remain skeptical (since often medicare payments are late, which may cause a cashflow problem with medical facilities.)
I don't see how (theoretically) having only one payor will make things more efficient; we would still have to bill for services and wait 2 weeks (at least) for payment. Medicare would still have all the rules in place for "clean claims," documentation requirements, getting approval for certain services, etc etc. We would still have to fight with Medicare through appeals of denials, rejected claims, etc. The administrative burden would not be eased at all. I seriously doubt a rise in Medicare rates would happen in an environment where it now has to cover everybody in the nation.

Right now, there are very few doctors who could make it if all they took was Medicare. I mean, maybe they could if they increased volume and cut costs a bit. But that comes with tradeoffs: less time with patients, primarily. The rates are simply too low. We need to have a payor mix that includes cash patients and commercial insurance.
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Old 26th February 2020, 02:47 PM   #143
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Originally Posted by xjx388 View Post
Quote:
From what I understand, not all doctors/hospitals accept medicare. And supposedly the costs reimbursed by medicare can actually be less than the cost of treatment.
...
So, if Medicare-for-all is expanded:
- Doctors who previously rejected Medicare patients will have to change their practices. How do you do that?
- Some medical facilities may end up losing money (and end up going out of business) if the reimbursement by Medicare is not enough to cover the costs.

Now, there are some claims about how it will ultimately save doctors/hospitals money by making things more efficient. I remain skeptical (since often medicare payments are late, which may cause a cashflow problem with medical facilities.)
I don't see how (theoretically) having only one payor will make things more efficient; we would still have to bill for services and wait 2 weeks (at least) for payment. Medicare would still have all the rules in place for "clean claims," documentation requirements, getting approval for certain services, etc etc. We would still have to fight with Medicare through appeals of denials, rejected claims, etc. The administrative burden would not be eased at all. I seriously doubt a rise in Medicare rates would happen in an environment where it now has to cover everybody in the nation.
I think one of the problems with the current system is that doctors/hospitals may have to deal with multiple insurance companies, and that there is often negotiations that happen over fees. (e.g. hospital says "We charge X", insurance says "We'll give Y"). Having a single point of payment and set fee schedules would simplify things, although I don't think it will give anywhere near the savings people think it will.
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Old 26th February 2020, 03:26 PM   #144
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Originally Posted by Segnosaur View Post
I think one of the problems with the current system is that doctors/hospitals may have to deal with multiple insurance companies, and that there is often negotiations that happen over fees. (e.g. hospital says "We charge X", insurance says "We'll give Y"). Having a single point of payment and set fee schedules would simplify things, although I don't think it will give anywhere near the savings people think it will.
From a doctor's office perspective, we send all our claims to one clearinghouse. We get all our remittance back from them. We can send 1000 claims to 200 payers or 1000 claims to 1 payer, it's the same exact process. We don't charge different fees to different payers; we have one fee schedule and get different amounts back. All of that is pretty much processed electronically and it's actually very efficient now, other than how long they take to pay us. Some payers, like BCBS, often pay us within 2-3 days. Other, smaller payers can take a month. Medicare is a standard two weeks.

So it wouldn't really mean much for us at all to only have one payer to deal with. The problem is that Medicare is a bear to deal with on everything else.
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Old 26th February 2020, 03:35 PM   #145
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Originally Posted by xjx388 View Post
From a doctor's office perspective, we send all our claims to one clearinghouse. We get all our remittance back from them. We can send 1000 claims to 200 payers or 1000 claims to 1 payer, it's the same exact process. We don't charge different fees to different payers; we have one fee schedule and get different amounts back. All of that is pretty much processed electronically and it's actually very efficient now, other than how long they take to pay us. Some payers, like BCBS, often pay us within 2-3 days. Other, smaller payers can take a month. Medicare is a standard two weeks.

So it wouldn't really mean much for us at all to only have one payer to deal with. The problem is that Medicare is a bear to deal with on everything else.
The clearinghouse sounds like a parasitic middleman.
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Old 26th February 2020, 03:52 PM   #146
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Originally Posted by Sideroxylon View Post
Quote:
From a doctor's office perspective, we send all our claims to one clearinghouse. We get all our remittance back from them.
The clearinghouse sounds like a parasitic middleman.
They are performing a function that would have to be done regardless of whether it is a public or private system.

Somewhere someone has to push some paper around... to ensure ensure the doctor or hospital gets paid, to make sure there is no fraud going on, etc.

Whether that is done by an independent company or by some government minions, you will always have this necessary overhead.
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Old 26th February 2020, 03:58 PM   #147
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Originally Posted by xjx388 View Post
From a doctor's office perspective, we send all our claims to one clearinghouse. We get all our remittance back from them. We can send 1000 claims to 200 payers or 1000 claims to 1 payer, it's the same exact process. We don't charge different fees to different payers; we have one fee schedule...
You may only have one fee schedule, but an insurance company will have to deal with multiple doctors/hospitals, which may charge different amounts.
Quote:
and get different amounts back.
How exactly does that work? If you charge $100 for a procedure, do you know ahead of time how much you'll get back from the insurance company? Are some companies cheaper than others? If an insurance company offers very little back, do you go after the patient for the difference?

Note: I'm not saying that its a bad system, and some of the claims of "massive savings" by going to Medicare are probably wrong. I am just acknowledging that there may be some inefficiencies in the billing process.
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Old 26th February 2020, 04:35 PM   #148
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Originally Posted by Sideroxylon View Post
The clearinghouse sounds like a parasitic middleman.
Yeah, giving people a choice in Health Care is so evil....
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Old 26th February 2020, 04:37 PM   #149
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Originally Posted by Sideroxylon View Post
The clearinghouse sounds like a parasitic middleman.
Maybe, but it's no worse and maybe a bit better then a medical office being ran like your typical DMV.....
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Old 26th February 2020, 04:49 PM   #150
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Originally Posted by Cabbage View Post
Actually, I've seen more demonization of Bernie and his supporters than the other way around.
"Bernie Bro" started out at a term for the most loyal and fanatical members of Sanders' base.

But then it turned into Sanders' base.

Now it appears some posters have started calling out supposed Bernie Bros in this subforum.

Amazing.
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Old 26th February 2020, 05:28 PM   #151
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Originally Posted by Cabbage View Post
Actually, I've seen more demonization of Bernie and his supporters than the other way around.
Around here, yes. On Twitter and Facebook, no.
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Old 26th February 2020, 06:12 PM   #152
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Originally Posted by Venom View Post
"Bernie Bro" started out at a term for the most loyal and fanatical members of Sanders' base.

But then it turned into Sanders' base.

Now it appears some posters have started calling out supposed Bernie Bros in this subforum.

Amazing.
Because the Berniebros went on a Jihad aganst any Democrate who did not support Bernie or dared to question anything Bernie said or did.
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Old 26th February 2020, 06:16 PM   #153
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Originally Posted by dudalb View Post
Because the Berniebros went on a Jihad aganst any Democrate who did not support Bernie or dared to question anything Bernie said or did.

Could you provide examples of this behavior? I think your description is somewhat hyperbolic, I'm curious if you can demonstrate otherwise.
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Old 26th February 2020, 07:02 PM   #154
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I would also like to see examples of this, dudalb.
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Old 26th February 2020, 07:14 PM   #155
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Originally Posted by dudalb View Post
Because the Berniebros went on a Jihad aganst any Democrate who did not support Bernie or dared to question anything Bernie said or did.
Abernhu Ackbah!
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Old 26th February 2020, 07:58 PM   #156
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It's satrap!
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Old 26th February 2020, 08:12 PM   #157
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Originally Posted by StillSleepy View Post
It's satrap!
Well played.
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Old 26th February 2020, 09:26 PM   #158
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Originally Posted by Sideroxylon View Post
The clearinghouse sounds like a parasitic middleman.


Maybe? Not from my perspective, but the issues seem complex. Their job is to interface with all the insurance companies, Medicare and Medicaid. That way, we (and our billing system)don’t have to worry about configuring claim formats to be compatible with each insurance company. And they don’t have to worry about matching up with our system.

Granted, if everyone just agreed on one transaction standard and one response standard, that would be great; but, that isn’t the reality we live in. In the end, the clearinghouses have made everything work together transparently and efficiently.
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Old 26th February 2020, 11:10 PM   #159
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Do you think India might help Trump?
Delhi Violence: BJP General Secretary threatens to interfere in US elections after Bernie's statement
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Old 27th February 2020, 12:58 AM   #160
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Originally Posted by Susheel View Post
Trump will likely welcome it.
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