"Hello, this is Mark from the Bernie Sander office. I'm calling about the refoond that Bernie Sander will pay you in the amount of two hoondred and ninety eight dollahs for your tech support problem. Are you near your computer right now?"
Why Trump will be reelected
- Thread starter Trebuchet
- Start date
"Hello, this is Mark from the Bernie Sander office. I'm calling about the refoond that Bernie Sander will pay you in the amount of two hoondred and ninety eight dollahs for your tech support problem. Are you near your computer right now?"
TurkeysGhost
Penultimate Amazing
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People love choice. "Am I going to pay my rent this month, or am I going to buy enough insulin to survive?"
dudalb
Penultimate Amazing
So you think people should have no choice in Health Care, and leave it all in the hands of the all knowing all wise bureaucrats?
I see that invidual freedom has a small place in your political philosophy.
You don't understand American at all. All of America is not a ultra liberal neighborhood in Boston.
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dudalb
Penultimate Amazing
I want to make it clear, I am not a fan our our current health care system. I am just very skeptical that M4A, and not allowing any private opitions for health care, is the way to go.
Seems to me we are falsely limiting it to just two choices.
Seems to me we are falsely limiting it to just two choices.
Hellbound
Merchant of Doom
They’re necessary now, but having worked in the insurance industry, they just shift the admin overhead from the doctor’s office to the clearing house. We had to support multiple types of input chains and secure transfer methods for the different clearing houses (and that’s just one insurance company).
Medicare, while being particular in their standards, were actually easier to work with (primarily because they had rules and standards for everything, and followed them).
Just as an example, one of the first jobs I had at the insurance company (in IT) was setting up a secure FTP with one of those clearing houses. We spent months going to meetings, planning out file formats, responsibilities, naming conventions, etc, all of which I programmed into the file transfer system for automation.
From day one, they ignored that. We got files named whatever, not placed in the right pick-up locations, not in the right formats, etc. It stayed that way for several years, until we finally stopped doing business with them. And they were not a small company, either. We ran into similar issues with every clearing house (although not to the same degree as with that one).
Heck, we even had issues with other insurance companies in our same network, at times, trying to move claims through our own proprietary system.
We never had the same frequency of issues with Medicare. Now they did some things in ways that were inefficient, but you knew what to expect. It was much easier to automate.
There’s no doubt in my mind that single payer would reduce the admin overhead significantly. Not sure how much, though.
To answer someone’s question about reimbursements:
Insurance companies sign agreements with providers that limit the charge for certain procedures/medications. A doctors office may decide to accept InsureCo, say. The office wants that because it broadens the customer base (they can get new customers that use InsureCo). The insurance company uses various methods to decide what’s a reasonable price for various services, and the provider agrees to charge those prices to InsureCo patients (there may be negotiation and such here). Medicare works basically the same. If you take InsureCo, then your InsureCo patients can only get charged the negotiated amount for an X-ray, say. That’s why you may see a bill that says something like: Cost without insurance: $2000, Insurance pays: $1350, You pay: $150 (where the insurance payout plus your copay don’t add up to the uninsured cost). Part of that providers agreement with InsureCo says they can only charge $1500 for that procedure.
On mandating insurance for everyone:
In the US, law dictates that a provider has to provide service to save life, limb, or eyesight, regardless of ability to pay. Yet the law doesn’t fund any of that. That’s part of why some procedures are so much more in the uninsured costs: its also trying to recoup non paying patients. That’s not nearly all of the cost, mind, but a part. And part of what the ACA was trying to help with by making sure everyone had to be insured.
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Hellbound
Merchant of Doom
I agree with this. Medicare doesn’t work for everything/everyone. That’s why various Medicare supplemental plans (private plans) exist. It’s not as simple as just saying “everyone is Medicare now”. That system would have to be restructured to some degree.
My main opposition to Bernie us the same: doing away with private options may make sense down the road, but trying to do it now, without a plan on how to change Medicare to make Ed it work for everyone, is going to fail (even assuming he could ever get it implemented politically). And that will likely set back efforts at any universal healthcare system when it does (“we tried that, it didn’t work”).
I’d rather wait four or eight years for UHC that works, with incremental improvements along the way, than try for a nebulous plan that will fail and cost sixteen years before we try again. Heck, even 20 years of incremental improvement would be better than a failure and 20 years of nothing.
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Delvo
Дэлво Δε&#
The problems with a partial/gradual approach (other than deliberately leaving some fraction of the problem we're trying to solve unsolved)...
1. Because this country is so oligarchical, any program that only benefits the non-rich is a target which the rich send their servants in government after like attack dogs. The only programs the rich who mostly run the country don't want destroyed are the ones they use themselves.
2. As long as insurance companies remain after whatever law on this issue is passed, they will continue bribing the politicians to give them back what was taken away.
1. Because this country is so oligarchical, any program that only benefits the non-rich is a target which the rich send their servants in government after like attack dogs. The only programs the rich who mostly run the country don't want destroyed are the ones they use themselves.
2. As long as insurance companies remain after whatever law on this issue is passed, they will continue bribing the politicians to give them back what was taken away.
Puppycow
Penultimate Amazing
Yes, people should be free to choose homeopathy or the power of prayer or a vegan diet as a cure for cancer.
Bureaucrats are not all knowing and all wise of course, but people with no scientific understanding of how medicine works left to their own devices might be better off in many cases if a bureaucrat with some actual understanding of medicine made the choice for them.
This is why we only allow doctors to prescribe certain medicines, and don't just leave it up to patients to choose what to take.
Delvo
Дэлво Δε&#
I think the idea there is supposed to be the "choice" of private medical insurers or plans, but it makes even less sense in that case. Nobody chooses which medical insurance company their employer offers insurance from. And with that narrowed down to one, the "choice" between plans from that insurance company is a matter of how many dollars to spend in one way or at one time versus how many to spend in another way or at another time, all on a company which will drop you when you need it if it can find a way. Nobody actually likes or wants that, especially not compared to literally not needing ever make any such gambling decisions at all. If someone keeps punching you while asking you before each punch what part of your body you want to get punched in next, and then finally offers to just quit punching you, you don't demand that he keep punching you just so you can keep choosing where to get punched. Nobody really would. Not even the people who claim that somebody somewhere out there would.
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dudalb
Penultimate Amazing
I was thinking more in the way of People being able to choose their own doctors,and not have one assigned to them.
BTW last time I looked, in the US you need a doctor to prescribe most medicines also.
Hellbound
Merchant of Doom
See, this is what confuses me.
How do these apply to a staged approach, or even a better plan that allows for private insurance as well (like most European countries), but somehow these factors aren’t an issue in a “let’s start a war of annihilation against private insurance”?
If the insurance companies are powerful enough to stop incremental change, how are they not going to fight harder to stop something that will remove them entirely?
Not to mention that I don’t think a plan that bans private insurance would pass in the first place, so my evaluation is no change (Bernie’s “ plan”) vs a gradual change towards (IMO) a better model.
And also, as I stated, I think the simple “give everyone Medicare” model will fail. I’ve not seen anything that gives any details on how it would work, and questions about even basic outlines are answered with a lot of rhetoric. And the fact that this is being pushed as the only solution, when it’s obvious that it hasn’t been considered in detail, seems even more counter-rational.
My worry is that, at best, this will be the left’s version of Trumps wall: a lot of sound-good promises, but what would actually be implemented is going to cost more than promised, do less than promised, and sour pretty much everyone on any additional move in that direction.
TurkeysGhost
Penultimate Amazing
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I don't live in Boston, I'm a Suburban Turkey.
The "choice" i have in my healthcare is either the high deductible or very high deductible plan my job offers. I can't change that option unless I quit my job, and the next job probably offers a very similar plan.
Bureaucrats are already deciding my health care fate. The current bureaucrats just so happen to be health insurance profiteers rather than government agents.
Dread Pirate Roberts
Critical Thinker
You bring this up a lot, so I'm curious. What choices for Health Care do you currently have? For me it's 3 Cigna PPO plans. They don't offer different doctors or care of course, it's just so I can decide how much money I'm willing to pay for the privilege of lower deductibles and office visits.
The choice argument really isn't a valid one unless you're saying I have to choice to look for another job if I don't like my insurance company.
Trebuchet
Penultimate Amazing
I have (oh, the horror!) government health insurance! And unlike most of my previous private insurance plans, it allows me to choose my own doctor, instead of having a "network".
In this state, Physicians Assistants (PA's) and Accredited Registered Nurse Practitioners (ARNP's) can prescribe if they are working under the supervision of a doctor.
ETA: Oh, and regarding the bureaucrats: They have lots of those in private insurance. I trust the government ones more as they are not specifically being paid to minimize the amount they cover.
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Segnosaur
Penultimate Amazing
Two points:
- True, an employee doesn't decide what insurer their employer uses. But, people can use the health benefits plan when they decide what job to take. (After all, if you're a skilled employee, I doubt you will automatically take a job that pays minimum wage because "I gotta have a job". You chose where you work based on the compensation they offer. "This job pays X, gives me Y vacation days, and health care that covers Z... do I think that's adequate compensation?")
- Some people might want to pay for private insurance, even if that's not offered by their employer. That's what sometimes happens in the U.K.... many private insurance plans are sold directly to the public, even though they have a public plan that is fairly comprehensive
We can all go around the room and agree that universal healthcare is just the bee's knees.
None of us where voting for Trump in the first place, so it's accomplished nothing.
Again if someone has a way to get a "You vote doesn't count because you're wrong and stupid" rule into place in the next 250 days let me know. Otherwise this is spinning wheels.
None of us where voting for Trump in the first place, so it's accomplished nothing.
Again if someone has a way to get a "You vote doesn't count because you're wrong and stupid" rule into place in the next 250 days let me know. Otherwise this is spinning wheels.
The Great Zaganza
Maledictorian
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- 29,949
The Trump campaign claims to have a $billion lined up for 2020; but it should worry them that half that amount doesn't even buy you a Nomination, as the Bloomberg example shows.
Mike!
Official Ponylandistanian National Treasure. Re
I'm pretty sure Trump knows he's already the Republican candidate, so a nomination isn't really unnecessary.
Parsman
Muse
Why would it be just the two choices? We have had the NHS in the UK for more than 70 years now which covers everyone out of taxation. Despite what some people say it is a good system, if I get in a serious accident and am badly injured or if I develop a long term health condition I will be treated free and for as long as it takes. However if I felt that the care wasn't sufficient I could take out private insurance or pay to go private. Available health care for all doesn't stop there being a private sector and if it is as good in the USA as some Americans seem to think why shouldn't it continue to thrive in a joint system?
Upchurch
Papa Funkosophy
This.
I made what I thought was a rational plea aimed towards the Bernie-Bro that, he wins the nomination, Biden is the best chance to get rid of Trump and maybe it would be best to not demonize him if you are going to have to end up voting for him.
Based on the feedback I got from that, I think it's safe to say that Trump has it in the bag.