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

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Old 9th November 2019, 02:25 AM   #201
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Originally Posted by xjx388 View Post
Or we could have the government be the insurer for everyone but not directly employ doctors: So-called Medicare for all. I can tell you that's another huge barrier. Doctors in my community who currently rely on government payers for the bulk of their revenue are struggling. Doctors have to see more and more patients per day -volume is how they make ends meet.
The M4A bills give doctors significantly more money. I haven't looked into the details, but I'd assume it's mostly PCPs who will get the significant raises.

Specialists (heart surgeons, oncologists, etc) dealing primarily with Medicare aren't really struggling, are they?
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Old 9th November 2019, 02:29 AM   #202
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Originally Posted by Bob001 View Post
Many doctors choose to work for HMOs or VA facilities, and earn good salaries with job security, regular work schedules, substantial administrative support and reduced administrative burdens.
I have a friend (an internal medicine MD) who quit for-profit medicine to go work for the VA, and she absolutely loves it. The pressure to see patients as income-generators (or income-losses, as the case can be) was just killing her.

She says the quality of care she can give her patients under the VA is 1000 times better. It's the real doctor-patient relationship she went to med school to have.
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Old 9th November 2019, 05:04 AM   #203
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Originally Posted by crescent View Post
The hard part is that people like that cn really suck up a lot of resources, asking for unnecessary tests, demanding to see specialists, all that. Any single-payer (or nearly single-payer) system is going to have to deal with people who do that.
The 'ask your doctor about MedicationX' aspect of American healthcare is a by product of a profit driven healthcare system. In the UK you don't 'demand' tests or to see a specialist, you go to your GP and they decide what is wrong and what tests need to be run, nobody is running adverts telling you that you need a particukar drug or a whole body MRI. My late sister was an utter hypocondriac, but other than eight minute appointment slots there was little she could suck out the system unless there was a genuine problem.
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Old 9th November 2019, 05:09 AM   #204
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Originally Posted by ponderingturtle View Post
Or you know not because the doctor who would even order the MRI can't see him for months.
Or he could have no medical insurance, or not be able to afford the co-pay and never get an MRI.
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Old 9th November 2019, 05:41 AM   #205
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Originally Posted by P.J. Denyer View Post
Or he could have no medical insurance, or not be able to afford the co-pay and never get an MRI.
For a lot of people in the US, the waiting list isn't months. It's forever.
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Old 9th November 2019, 10:32 AM   #206
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Originally Posted by xjx388 View Post
Sounds exactly like exactly what I'm proposing except you've left out the definition of basic health care benefits. Clearly, you are saying that the US should do what the UK does and have an NHS-style single payer plan. The barriers to such a plan in the US are many. First of all, you'd have to convince doctors to close up their private practices and start working directly for the government at government salaries. That ain't gonna fly.

Or we could have the government be the insurer for everyone but not directly employ doctors: So-called Medicare for all. I can tell you that's another huge barrier. Doctors in my community who currently rely on government payers for the bulk of their revenue are struggling. Doctors have to see more and more patients per day -volume is how they make ends meet. The administrative burden is huge, especially now with the whole "Value Based Care" thing. So you can't have "Medicare" for all, you'll have to totally redefine the program into something else.

The thing is, we hear this a lot: Just do what Canada/UK/Utopia does! The problem is that we are not those places. We have our own issues and established socioeconomic culture. You can't just plop your VHS tape into our Betamax player.


USA in 'country that put man on the moon uniquely unable to do things that other countries with far fewer resources and influence manage on a regular basis' shocker.



Seriously, every time I hear someone say "But we can't do that in the US because we're special" I always hear 'special' in the same way I heard it when my aged aunt was talking about the boy next door with learning difficulties. "No," she said in hushed tones, "I know you and all the other little Polandballs can do it, but The USA is special so he can't join in on the healthcare game. You can play with him after school.
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Old 9th November 2019, 10:42 AM   #207
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Originally Posted by xjx388 View Post
....
We have our own issues and established socioeconomic culture. You can't just plop your VHS tape into our Betamax player.
What exactly do you mean by "socioeconomic culture" that would make any American universal care plan impossible?
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Old 9th November 2019, 10:48 AM   #208
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Originally Posted by P.J. Denyer View Post
The 'ask your doctor about MedicationX' aspect of American healthcare is a by product of a profit driven healthcare system. In the UK you don't 'demand' tests or to see a specialist, you go to your GP and they decide what is wrong and what tests need to be run, nobody is running adverts telling you that you need a particukar drug or a whole body MRI. My late sister was an utter hypocondriac, but other than eight minute appointment slots there was little she could suck out the system unless there was a genuine problem.
Just curious, in the UK if you don't like what your GP is telling you, can you get a second opinion? If you think, say, your chest pains might be something worse than indigestion, can you go to a cardiologist on your own? There's a lot of bad medical care in the U.S., but patients (at least the ones with good insurance) are able to assert more control over their care and treatment than some systems might allow.
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Old 9th November 2019, 11:07 AM   #209
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Originally Posted by Bob001 View Post
Just curious, in the UK if you don't like what your GP is telling you, can you get a second opinion?
Yes. You can get yourself a whole new GP if you like.


Quote:
If you think, say, your chest pains might be something worse than indigestion, can you go to a cardiologist on your own?

Yes, you can pay for a private cardio appointment or, as I say, get a different GP for a second opinion.

Quote:
There's a lot of bad medical care in the U.S., but patients (at least the ones with good insurance) are able to assert more control over their care and treatment than some systems might allow.

In the UK you can demand a different GP, a second opinion or, if you have funds or appropriate private healthcare (Such as Bupa) you can go see a private doctor outside of the system.
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Old 9th November 2019, 11:41 AM   #210
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Originally Posted by Bob001 View Post
What exactly do you mean by "socioeconomic culture" that would make any American universal care plan impossible?
We're cantankerous bitches.
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Old 9th November 2019, 11:46 AM   #211
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Originally Posted by 3point14 View Post
Yes. You can get yourself a whole new GP if you like.





Yes, you can pay for a private cardio appointment or, as I say, get a different GP for a second opinion.




In the UK you can demand a different GP, a second opinion or, if you have funds or appropriate private healthcare (Such as Bupa) you can go see a private doctor outside of the system.
Thanks!
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Old 9th November 2019, 12:40 PM   #212
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Originally Posted by Bob001 View Post
Just curious, in the UK if you don't like what your GP is telling you, can you get a second opinion? If you think, say, your chest pains might be something worse than indigestion, can you go to a cardiologist on your own? There's a lot of bad medical care in the U.S., but patients (at least the ones with good insurance) are able to assert more control over their care and treatment than some systems might allow.

In Canada, you can go to as many different GP's as you want/need to. If you don't like your GP, you get yourself a new GP from anywhere you choose (so long as that GP is able to take on a new patient). You can also tell your GP that you want to see a specialist whether your GP agrees with you or not, and most times he/she will oblige and refer you to a specialist as per your request. If they don't, then you find yourself a new GP that will.

And so on and so forth.

In other words, you as the patient have control over your healthcare wants/needs, not the other way around. You can go to as many doctors and specialists as you need to until your medical needs/concerns are properly assessed, diagnosed, and remedied.

It seems all these myths, legends, misinformation and disinformation politicians and their ilk have been drilling into Americans' heads about other medical systems really has worked.

You guys have been hoodwinked.
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Old 9th November 2019, 12:45 PM   #213
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Originally Posted by AnonyMoose View Post
You guys have been hoodwinked.

It's the end result of 40 years of anti-government propaganda.

"I'm from the government, I'm here to help" and all that utter bollocks.


I don't think people are buying it quite as readily these days.
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Old 9th November 2019, 01:00 PM   #214
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Originally Posted by AnonyMoose View Post
....
You guys have been hoodwinked.
The thing is that if an American has good group insurance through a corporate or government employer -- as the large majority do -- the system generally works pretty well. It is usually heavily -- sometimes fully -- subsidized, and if you have a problem your benefits office will help you. Medicare also works pretty well for the people who are covered by it.

The problem, of course, is that not everybody has such insurance, and even if you do, you can lose it if you leave your job. But people who benefit from the system as it is are understandably leery of giving up what works in favor of an unknown, uncertain alternative.

That's why a public option -- or as Mayor Pete calls it, "Medicare-for-All-Who-Want-It" -- is a more politically palatable proposal. If the public option is better than private coverage, people will choose to migrate to it over time, but there won't be a "Today one way, tomorrow another" transition.

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Old 9th November 2019, 01:02 PM   #215
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Originally Posted by 3point14 View Post
It's the end result of 40 years of anti-government propaganda.

"I'm from the government, I'm here to help" and all that utter bollocks.


I don't think people are buying it quite as readily these days.

Anti-government propaganda, plus corporations dictating to politicians how they want the system to work, instead of the other way around.... Which, come to think of it, might explain their vehement anti-government sentiments?

It really is a sad state of affairs what they've got going on over there.

That's not to say our governments/politicians aren't a bunch of idiots too (if only I had a nickel for every time I wanted to light a match to 24 Sussex Drive), but at least we the people still have some say over our own health and welfare.
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Old 9th November 2019, 01:17 PM   #216
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Originally Posted by Bob001 View Post
The thing is that if an American has good group insurance through a corporate or government employer -- as the large majority do -- the system generally works pretty well. It is usually heavily -- sometimes fully -- subsidized, and if you have a problem your benefits office will help you. Medicare also works pretty well for the people who are covered by it.

The problem, of course, is that not everybody has such insurance, and even if you do, you can lose it if you leave your job. But people who benefit from the system as it is are understandably leery of giving up what works in favor of an unknown, uncertain alternative.

That's why a public option -- or as Mayor Pete calls it, "Medicare-for-All-Who-Want-It" -- is a more politically palatable proposal. If the public option is better than private coverage, people will choose to migrate to it over time, but there won't be a "Today one way, tomorrow another" transition.

That's a valid point.

Transitions are never easy for most people, so baby steps would probably be the best option. Until Americans get a firsthand taste of what we in other countries are already accustomed to, they'll be leery every step of the way.
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Old 9th November 2019, 02:26 PM   #217
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Originally Posted by Bob001 View Post
That's why a public option -- or as Mayor Pete calls it, "Medicare-for-All-Who-Want-It" -- is a more politically palatable proposal. If the public option is better than private coverage, people will choose to migrate to it over time, but there won't be a "Today one way, tomorrow another" transition.
"Medicare for all who want it" is "Medicare for all who can afford it".

If it's subsidized enough to make it truly universal and also so affordable it outcompetes private insurance, it'll be deemed "too expensive" by its own current proponents. So what you'll get is an underfunded plan that does what it's designed to do - basically nothing.
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Old 9th November 2019, 04:25 PM   #218
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Originally Posted by Bob001 View Post
That's why a public option -- or as Mayor Pete calls it, "Medicare-for-All-Who-Want-It" -- is a more politically palatable proposal. If the public option is better than private coverage, people will choose to migrate to it over time, but there won't be a "Today one way, tomorrow another" transition.
The problem with this is that it allows the Insurance companies to operate at a loss to under cut the public option until the Repubs get back into power and gut the public option, at which point they can go back to gouging people for their healthcare.
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Old 9th November 2019, 08:13 PM   #219
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Originally Posted by AnonyMoose View Post
Anti-government propaganda, plus corporations dictating to politicians how they want the system to work, instead of the other way around.... Which, come to think of it, might explain their vehement anti-government sentiments?
It's lobbying. Which is straight up purchasing policy. That coupled with campaign donations and democracy is ******.



Quote:
It really is a sad state of affairs what they've got going on over there.

That's not to say our governments/politicians aren't a bunch of idiots too (if only I had a nickel for every time I wanted to light a match to 24 Sussex Drive), but at least we the people still have some say over our own health and welfare.

I have no qualms about stating how banjaxed the American system is as I can state with absolute certainty that ours is, athe very, very least, as bad as theirs right now. It wasn't, oh ay about three or four years ago. It totally is now.
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Old 9th November 2019, 08:21 PM   #220
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Originally Posted by Bob001 View Post
The thing is that if an American has good group insurance through a corporate or government employer -- as the large majority do -- the system generally works pretty well. It is usually heavily -- sometimes fully -- subsidized, and if you have a problem your benefits office will help you. Medicare also works pretty well for the people who are covered by it.

The problem, of course, is that not everybody has such insurance, and even if you do, you can lose it if you leave your job. But people who benefit from the system as it is are understandably leery of giving up what works in favor of an unknown, uncertain alternative.

That's not the only problem.

https://www.bloomberg.com/news/artic...illion-in-2020


(This leads me to wonder if Ford buy health insurance, I can't find out if they buy it or just underwrite it themselves. If they do underwrite it themselves, then isn't that just the cost of healthcare for 56,000 people? It's a large enough pool and won't contain the very young, the very old or the unemployable. If they don't underwrite it themselves, they're mental.)

(18 grand per emplyee per year...?

I'm getting something wrong somewhere.)

Quote:
That's why a public option -- or as Mayor Pete calls it, "Medicare-for-All-Who-Want-It" -- is a more politically palatable proposal. If the public option is better than private coverage, people will choose to migrate to it over time, but there won't be a "Today one way, tomorrow another" transition.
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Old 10th November 2019, 08:44 AM   #221
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Originally Posted by 3point14 View Post
That's not the only problem.

https://www.bloomberg.com/news/artic...illion-in-2020

(This leads me to wonder if Ford buy health insurance, I can't find out if they buy it or just underwrite it themselves. If they do underwrite it themselves, then isn't that just the cost of healthcare for 56,000 people? It's a large enough pool and won't contain the very young, the very old or the unemployable. If they don't underwrite it themselves, they're mental.)
....
I don't know about Ford, but many large corporations are self-insuring. That means they pay claims out of their own money, instead of paying premiums that an insurance company invests. But they pay an insurer to administer the policy, process claims, etc. It's not like Ford is going to hire doctors or create a provider network. So they're saving what would be the insurer's profits, but the cost of delivering care isn't much less.

The issue in cases like this is that over decades unions have given up pay raises in return for benefits and job security. If union members lose their paid insurance, whether the company takes it away or whether private insurance disappears, it's the same as a big pay cut. That's another argument for "Medicare-for-All-Who-Want-It," without turning the current system upside down.
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Old 10th November 2019, 08:48 AM   #222
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Originally Posted by PhantomWolf View Post
The problem with this is that it allows the Insurance companies to operate at a loss to under cut the public option until the Repubs get back into power and gut the public option, at which point they can go back to gouging people for their healthcare.
Maybe, but the insurance companies are mostly corporations with stockholders who would not be enthusiastic about losing money now in service to some long-term strategy. And once a public option is established and people start benefiting from it, it would be very hard to turn back. The Repubs spent six years trying to kill the ACA, and they're still trying, but the millions of people who couldn't get insurance and have it now are pushing back.
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Old 10th November 2019, 08:53 AM   #223
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Originally Posted by Bob001 View Post
If union members lose their paid insurance, whether the company takes it away or whether private insurance disappears, it's the same as a big pay cut.
No, it's not.

If it's just the gov paying the bill for their insurance, at no cost to them (like in the Warren plan), instead of their employer paying the insurance company (but the employer paying the government instead), it's not "like" a pay cut at all.

They lose nothing.
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Old 10th November 2019, 08:56 AM   #224
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Originally Posted by kellyb View Post
"Medicare for all who want it" is "Medicare for all who can afford it".

If it's subsidized enough to make it truly universal and also so affordable it outcompetes private insurance, it'll be deemed "too expensive" by its own current proponents. So what you'll get is an underfunded plan that does what it's designed to do - basically nothing.
I don't know why that would have to be. A public option would not be profit-based, so there's no reason to think it wouldn't cost less than the current system. An intermediate step might be to expand Medicaid everywhere, as the ACA tried to do, so people who couldn't afford the standard public option would be able to qualify more easily for Medicaid.

It's not clear why a universal system with an income-based subsidy would have to be so much more expensive overall than the total premiums people pay now.
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Old 10th November 2019, 08:58 AM   #225
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Originally Posted by Bob001 View Post
Maybe, but the insurance companies are mostly corporations with stockholders who would not be enthusiastic about losing money now in service to some long-term strategy. And once a public option is established and people start benefiting from it, it would be very hard to turn back. The Repubs spent six years trying to kill the ACA, and they're still trying, but the millions of people who couldn't get insurance and have it now are pushing back.
Underfunding the public option to make it non-competitive with private insurance is probably what they'd do. They can make the premiums unaffordable, or make the premiums affordable, but grossly underpay doctors, so no doctors will accept it.

They are several ways the PO can/will be designed to NOT be a transition to single payer.

Big Money isn't backing this ill-defined scheme because they want a smooth, orderly, natural, transition to single payer.
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Old 10th November 2019, 09:03 AM   #226
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Originally Posted by Bob001 View Post
I don't know why that would have to be. A public option would not be profit-based, so there's no reason to think it wouldn't cost less than the current system. An intermediate step might be to expand Medicaid everywhere, as the ACA tried to do, so people who couldn't afford the standard public option would be able to qualify more easily for Medicaid.

It's not clear why a universal system with an income-based subsidy would have to be so much more expensive overall than the total premiums people pay now.
It would have to be, because it's what the donor class would demand of THEIR candidate, be it Pete or Biden.

They don't want single payer. Ever. The monopsony power would create a mechanism for overall cost reduction, so our costs could come in line with the rest of the developed world's. Our healthcare spending coming in line with the rest of the world's would make a lot of currently rich people a significantly less rich. The system as it is is a total gravy train for a whole lot of people.
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Old 10th November 2019, 09:04 AM   #227
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Originally Posted by kellyb View Post
No, it's not.

If it's just the gov paying the bill for their insurance, at no cost to them (like in the Warren plan), instead of their employer paying the insurance company (but the employer paying the government instead), it's not "like" a pay cut at all.

They lose nothing.
The government would pay for coverage with a new tax. If workers don't pay premiums now, but they have to start paying a new tax for a universal coverage plan, isn't that a loss out-of-pocket? Are you presuming the employer would pay the new tax on their behalf? The employers are trying to cut back now.

The unions certainly don't think they would lose "nothing."
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Old 10th November 2019, 09:12 AM   #228
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Originally Posted by kellyb View Post
It would have to be, because it's what the donor class would demand of THEIR candidate, be it Pete or Biden.

They don't want single payer. Ever. The monopsony power would create a mechanism for overall cost reduction, so our costs could come in line with the rest of the developed world's. Our healthcare spending coming in line with the rest of the world's would make a lot of currently rich people a significantly less rich. The system as it is is a total gravy train for a whole lot of people.
That's all pretty sinister. Medicare has been a generally successful, respected program for 60 years. Expanding that known, well-established program to cover more people is just not a radical concept. The people who benefit most from the current system would fight back, and would no doubt have to be accommodated one way or another, but I don't think it's hopeless, and neither do all of the Democratic candidates and their supporters.
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Old 10th November 2019, 09:26 AM   #229
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Originally Posted by Bob001 View Post
The government would pay for coverage with a new tax. If workers don't pay premiums now, but they have to start paying a new tax for a universal coverage plan, isn't that a loss out-of-pocket? Are you presuming the employer would pay the new tax on their behalf? The employers are trying to cut back now.

The unions certainly don't think they would lose "nothing."
The Warren plan is that only employers pay the tax. Not workers, at all.

Bernie's (primary) proposed funding scheme would have had the legitimate issue you mention, though.
eta:

But Bernie recently negotiated with unions to add to his plan that employers would have to give union members raises equal to what they were spending on healthcare if the gov started providing healthcare funded by taxing employees.
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Old 10th November 2019, 09:35 AM   #230
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Originally Posted by Bob001 View Post
That's all pretty sinister. Medicare has been a generally successful, respected program for 60 years. Expanding that known, well-established program to cover more people is just not a radical concept. The people who benefit most from the current system would fight back, and would no doubt have to be accommodated one way or another, but I don't think it's hopeless, and neither do all of the Democratic candidates and their supporters.
The Medicare they let people buy into under Biden's "public option" or Pete's "M4AWWI" would probably be set up to have different "rules" than the standard Medicare people are on now.

They definitely would not massively change 65+ people's current medicare as part of the plan (although Biden, and I'd guess Pete, want to cut Medicare already as standard "entitlement reform.")

Either way, make no mistake - the whole point of Pete and Biden "plans" is (or will be...they're not giving out/don't have any specifics at all so far) to NOT significantly change or improve the system, much less transition to single payer.

Everything "we" see as "dysfunction," the Biden/Pete donors see as their cash cow.
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Old 10th November 2019, 09:42 AM   #231
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Originally Posted by kellyb View Post
The Medicare they let people buy into under Biden's "public option" or Pete's "M4AWWI" would probably be set up to have different "rules" than the standard Medicare people are on now.

They definitely would not massively change 65+ people's current medicare as part of the plan (although Biden, and I'd guess Pete, want to cut Medicare already as standard "entitlement reform.")

Either way, make no mistake - the whole point of Pete and Biden "plans" is (or will be...they're not giving out/don't have any specifics at all so far) to NOT significantly change or improve the system, much less transition to single payer.

Everything "we" see as "dysfunction," the Biden/Pete donors see as their cash cow.
Or they do think it is an improvement


One piece of evidence that democrats think it is a good idea is how upset progressive democrats were when the ACA did not include it.

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Old 10th November 2019, 10:00 AM   #232
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Originally Posted by BobTheCoward View Post
One piece of evidence that democrats think it is a good idea is how upset progressive democrats were when the ACA did not include it.
That was before most of us "lowly voter progressives" figured out that most democratic politicians calling themselves progressives were full of ****.

The public option could only work if the fiscal conservative democrats like Biden and Pete were dead serious about making sure it's designed to be way better than private insurance (which would end up functioning as a transition to single payer.) But they're not.

Transitioning to single payer is what they (or, their donors...same difference with politicians like them) do NOT want.
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Old 10th November 2019, 10:15 AM   #233
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Originally Posted by kellyb View Post
That was before most of us "lowly voter progressives" figured out that most democratic politicians calling themselves progressives were full of ****.

The public option could only work if the fiscal conservative democrats like Biden and Pete were dead serious about making sure it's designed to be way better than private insurance (which would end up functioning as a transition to single payer.) But they're not.

Transitioning to single payer is what they (or, their donors...same difference with politicians like them) do NOT want.
Speculation
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Old 10th November 2019, 10:21 AM   #234
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Originally Posted by BobTheCoward View Post
Speculation
Uh huh. lol
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Old 12th November 2019, 03:40 AM   #235
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Originally Posted by Bob001 View Post
The government would pay for coverage with a new tax. If workers don't pay premiums now, but they have to start paying a new tax for a universal coverage plan, isn't that a loss out-of-pocket? Are you presuming the employer would pay the new tax on their behalf? The employers are trying to cut back now.

The unions certainly don't think they would lose "nothing."

Whatever the employer pays now for healthcare, rather than paying that to the provider it pays t to the government who get the whole thing cheaper due to the way risk pools work.

The employee still gets healthcare and has lost nothing.

The employer pays less for healthcare due to the massive risk pool and the massive buying advantages than can be obtained from being an utterly huge purchaser (this is the bit that scares some people).
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Old 12th November 2019, 04:03 AM   #236
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Originally Posted by 3point14 View Post
Whatever the employer pays now for healthcare, rather than paying that to the provider it pays t to the government who get the whole thing cheaper due to the way risk pools work.

The employee still gets healthcare and has lost nothing.

The employer pays less for healthcare due to the massive risk pool and the massive buying advantages than can be obtained from being an utterly huge purchaser (this is the bit that scares some people).
That can't possible work! You need to come down from your ivory tower, if more people get covered for healthcare there'll be less for me, and anyway if people can't put aside a couple of million for healthcare emergencies why should I be violently forced by the government to pay for their healthcare!
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Old 12th November 2019, 07:03 AM   #237
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Originally Posted by 3point14 View Post
Whatever the employer pays now for healthcare, rather than paying that to the provider it pays t to the government who get the whole thing cheaper due to the way risk pools work.

The employee still gets healthcare and has lost nothing.

The employer pays less for healthcare due to the massive risk pool and the massive buying advantages than can be obtained from being an utterly huge purchaser (this is the bit that scares some people).
One obvious difference is that an employer now pays to insure his employees, who are at least healthy enough to hold full-time jobs. Universal coverage has to include everybody, including people who are too sick to work. That money has to come from somewhere, and it's more likely to come from taxes on everybody, rather than just employers.

And insurance companies today are huge purchasers, much bigger than any doctor or hospital. Medicare today is the biggest purchaser of all. But it borders on magical thinking to expect a bigger risk pool by itself to reduce costs dramatically. That's like talking about cutting Pentagon spending by just eliminating "waste, fraud and abuse." There's no line for that on the budget.
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Old 12th November 2019, 07:27 AM   #238
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Originally Posted by Bob001 View Post
One obvious difference is that an employer now pays to insure his employees, who are at least healthy enough to hold full-time jobs. Universal coverage has to include everybody, including people who are too sick to work. That money has to come from somewhere, and it's more likely to come from taxes on everybody, rather than just employers.

And insurance companies today are huge purchasers, much bigger than any doctor or hospital. Medicare today is the biggest purchaser of all.
And is prohibited from leveraging that. And is still cheaper than private healtcare. And the US still pay more per capita to cover some people than the UK pay per capita to cover everyone.



Quote:
But it borders on magical thinking to expect a bigger risk pool by itself to reduce costs dramatically. That's like talking about cutting Pentagon spending by just eliminating "waste, fraud and abuse." There's no line for that on the budget.

The large risk pool will have an effect, but I see your point.

I see much more mileage in negotiated discounts. I'm extremely happy with the NHS throwing it's weight about at the interaction between private pharma companies and itself to obtain the best deal it can for me.
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Old 12th November 2019, 07:39 AM   #239
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Originally Posted by Bob001 View Post
What exactly do you mean by "socioeconomic culture" that would make any American universal care plan impossible?
Our demand of the human sacrifice of the poor as motivation to work harder. If you are not killed for slacking off there simply are not enough consequences. Sure this catches the then unlucky who end up sick and then out of work because of the illness but sacrifices must be made!
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Old 12th November 2019, 08:21 AM   #240
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Originally Posted by Bob001 View Post
One obvious difference is that an employer now pays to insure his employees, who are at least healthy enough to hold full-time jobs. Universal coverage has to include everybody, including people who are too sick to work. That money has to come from somewhere, and it's more likely to come from taxes on everybody, rather than just employers.

And insurance companies today are huge purchasers, much bigger than any doctor or hospital. Medicare today is the biggest purchaser of all. But it borders on magical thinking to expect a bigger risk pool by itself to reduce costs dramatically. That's like talking about cutting Pentagon spending by just eliminating "waste, fraud and abuse." There's no line for that on the budget.
But with universal coverage the "risk pool" no longer exists: everyone pays in, every medical expense that gets generated gets paid. There is no longer a gamble that this person will get sick and this person won't. We won't be paying to hedge against possible hypothetical medical expenses, we'll just pay for the ones that actually occur.
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