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Trumpcare- Passed the House and onto the Senate; will it pass there? And what will it finally look like? (3 Viewers)

Ratbone said:
If everyone had healthcare starting in 2 years from now even the entire healthcare industry would collapse. There is not enough care to go around. The waits for Dr's would be unreal. There is a lot of foundational things that would have to happen to provide this kind of over-arching coverage.  
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I'm not sure it'd collapse, but it's certainly not built to support the kind of care implicit in providing healthcare for all americans.

To me, that's the fundamental issue here.  

If all americans regardless of income should be able to have quality healthcare, then we need to majorly reform our system.

If we're content knowing that healthcare access will be determined by how much money you have, then we can continue to try to manipulate the free market system to provide lower costs to more people without ever fully offering coverage/access/services to all americans.  The more we focus on cost, the less we can focus on expanding access.  The more we focus on expanding access, the more cost sacrifices we have to make.

I don't see many folks admitting that the problem is that we're trying to make a system that has been designed to offer health care ONLY to those who can afford it, is being twisted into being a system that provides healthcare to people who never were its intended market.

It'd be like trying to make Apple the company provide cell phones to all americans regardless of their ability to afford the phones or not, and to provide services like support and cellular plans as well.  It's tough, if not impossible, to make a free market solution bend its will to a solution that's not free-market based.

 
matttyl said:
It is?  Advertising your prices upfront is significantly out of line with being a conservative?  I think it's simply in line with being an honest person.
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Sounded to me like he was suggesting price controls. Charge the same amount for each service and proceure? 

 
Jackstraw said:
Sounded to me like he was suggesting price controls. Charge the same amount for each service and proceure? 
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Each provider would set their own prices, though.  They would just let you know up front what that is.  Doctor A could charge a higher amount than Doctor B, though - and the market would dictate if that increase is justifiable.  You know, capitalism and such.

 
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The Commish said:
adonis said:
The issue that I see is that you have a lot of middle men in the free market solution who are set up to make profits.  There are so many intermediaries in the system that profits are taken at multiple locations.  What's more, information is held by many of these different folks and not shared in meaningful ways to help drive down costs.  These, and many more, are relics of a free market healthcare system that sprung up to meet the needs of those with healthcare issues who could afford care.

We're trying to adapt a system that was a pay-to-play designed system to one that provides healthcare for people it was never designed to provide care for.  We're twisting the free market solution in ways that it's not designed to perform, and we're seeing the issues from that.  The profit motives, and control structure, of the existing system makes it such that providing the ideological goal of some (myself included) of healthcare for everyone regardless of income, is nearly impossible to do at a reasonable rate that just doesn't result in a transfer of wealth from those paying taxes to the for-profit companies providing services in the middle.

So we can have discussions about how best to minimize the costs and maximize coverage in the current system, which will be destined to fail because we're disfiguring a system in order to meet needs it wasn't designed to support, or we could take about reforming the system as a whole in order to be one that is designed to both meet the needs of all citizens AND provide care at low cost.  
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This is an argument to be made to politicians.  Not sure you'd get much push back from those of us in this thread.  There are many many many reas
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I agree, it's a wide ranging issue.  But the central point it stems from, that I think most folks don't address is whether or not access to quality healthcare is a right that should not depend on your income level.

If that's true, major reforms are needed in order to reform the system into something that can support that objective.

If it's not, we need to accept that folks will get health care services based on their income levels and stop trying to meddle.

What I think we're seeing is a national shift towards a more rights-based concept, that's involved in a tug-of-war between the left and the right, but all being done within the current system which isn't created to support a "rights based healthcare system".  So when the right is in power, they'll pull away from a government imposed solution because they don't believe it's a right.  When the left is in power, they'll pull more back toward a single payer solution.

Until one side wins the argument, we're going to be in varying degrees of sub-optimal solutions, and of course, those without much income, or who are very sick, will be the ones to pay the most...as is the case so often in these debates nationally.

 
adonis said:
I don't see many folks admitting that the problem is that we're trying to make a system that has been designed to offer health care ONLY to those who can afford it, is being twisted into being a system that provides healthcare to people who never were its intended market.
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I think all of us (in this thread at least) questioning the viability of health care as a for profit endeavor if the main goal is to provide health care to as many people as possible are admitting this problem. The problems arise when you start considering the side effects of moving to a socialized health care environment in the midst of a largely free market economy/society. How do we encourage enough people to be health care "professionals" in the areas covered by socialized health care? How do we continue to develop innovative treatments, drugs, and health care technologies in such an environment? Many have rightly pointed out that our current imperfect system is somewhat propping up many of the socialized health care programs in other countries via differences in the prices of treatments, drugs, etc. here (where much of these things are developed) vs. what they're sold for in those other countries. You have to address the sources of the costs as well, otherwise the socialized health care system won't have the same quality of support or resources as we have now.

 
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Da Guru said:
Lawyers & Lawsuits
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If that were true, then you would expect states with medmal tort reform (like Texas) to see lower health care costs after the reform was enacted.

That has not happened.

The same group of researchers also looked at the effect of tort reform on healthcare costs and found no evidence that they fell after 2003. The researchers compared healthcare costs in Texas counties where doctors faced a higher risk of lawsuits with those with a lower risk. The assumption was that physicians in high-risk counties were practicing more defensive medicine prior to 2003, and that fewer unnecessary procedures would be performed after 2003. However, they found that there were slightly more procedures performed in high-risk counties after the law was passed.

In seven categories of risk, Dallas and Tarrant were in the third-highest category while Collin and Denton were in the fourth-highest category.

A third report by non-profit advocacy group Public Citizen in October 2011 echoed the conclusions of both research studies. The report, called “A Failed Experiment,” found that Medicare spending and private insurance premiums both have risen faster than the national average since tort reform.

See also -  Link

 
Gr00vus said:
I think all of us (in this thread at least) questioning the viability of health care as a for profit endeavor if the main goal is to provide health care to as many people as possible are admitting this problem. The problems arise when you start considering the side effects of moving to a socialized health care environment. How do we encourage enough people to be health care "professionals" in the areas covered by socialized health care? How do we continue to develop innovative treatments, drugs, and health care technologies in such an environment? Many have rightly pointed out that our current imperfect system is indirectly propping up many of the socialized health care programs in other countries via differences in the prices of treatments, drugs, etc. here (where much of these things are developed) vs. what they're sold for in those other countries. You have to address the sources of the costs as well, otherwise the socialized health care system won't have the same quality of support or resources as we have now.
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I agree, and that was my main point where all this came from.

If your goal is to provide healthcare coverage to everyone, the arguments you make that stem from that are different than if you believe that the costs in the current system are the problem.

There are many other countries that do single payer that we can learn from and improve upon.  The United States wasn't the first democracy in the world, but we took good ideas from others and incorporated them into our system and devised the best country the world has ever seen.

I don't know if lightning can strike twice with that, but if healthcare access is a right, then the arguments about what we should do about it shift from optimizing the current system to envisioning a new system that provides quality care to all at minimal cost, and possibly we can set up the best healthcare system for all the world has ever seen.

 
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adonis said:
I agree, it's a wide ranging issue.  But the central point it stems from, that I think most folks don't address is whether or not access to quality healthcare is a right that should not depend on your income level.

If that's true, major reforms are needed in order to reform the system into something that can support that objective.

If it's not, we need to accept that folks will get health care services based on their income levels and stop trying to meddle.

What I think we're seeing is a national shift towards a more rights-based concept, that's involved in a tug-of-war between the left and the right, but all being done within the current system which isn't created to support a "rights based healthcare system".  So when the right is in power, they'll pull away from a government imposed solution because they don't believe it's a right.  When the left is in power, they'll pull more back toward a single payer solution.

Until one side wins the argument, we're going to be in varying degrees of sub-optimal solutions, and of course, those without much income, or who are very sick, will be the ones to pay the most...as is the case so often in these debates nationally.
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or just die

 
shader said:
Well there are many reasons.  They should all be addressed.  Putting so much political work and capital into a national healthcare plan, while costs are spiraling out of control, makes no sense.

There should instead be committees of people trying to fix the issue of high costs.  Trump claims he's going to begin addressing drug costs.  I have no idea if he will (I doubt it).  But at least that's an attempt to get at the real problem.  

I worked for the two largest healthcare companies in the US.  I've seen the enormous amount of waste (just in IT).  These companies are "for profit".  They want to get as much money as they can.  Their customers are sick and dying people.  
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So do you (and @matttyl) think health care providers should be nationalized? Doing that would solve much of the problem?

Do catholic hospitals typically have lower prices?

 
adonis said:
There are many other countries that do single payer that we can learn from and improve upon.  The United States wasn't the first democracy in the world, but we took good ideas from others and incorporated them into our system and devised the best country the world has ever seen.
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Continuing to play devil's advocate. Those other countries are able to keep their taxes from rising significantly because they pay less for the same drugs, etc. that we pay full price for here, where we allow our pharmaceutical and med tech companies to profit from their innovations to the fullest extent possible. I.e. the U.S. patient is subsidizing healthcare for a lot of these other countries.

 
shader said:
whoknew said:
Why are hospital bills so high?
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Well there are many reasons.  They should all be addressed.  Putting so much political work and capital into a national healthcare plan, while costs are spiraling out of control, makes no sense.

There should instead be committees of people trying to fix the issue of high costs.  Trump claims he's going to begin addressing drug costs.  I have no idea if he will (I doubt it).  But at least that's an attempt to get at the real problem.  

I worked for the two largest healthcare companies in the US.  I've seen the enormous amount of waste (just in IT).  These companies are "for profit".  They want to get as much money as they can.  Their customers are sick and dying people.  
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So long as you keep the system we have, we're going to be unable to make any real headway on lowering costs while expanding access.  

I work in the healthcare industry too, and have worked on many different sides of the coin, from providing direct care, training physicians, working in a large hospital system and working in a non-profit organization that seeks to improve care and reduce costs...

High costs are a result of the system we have.  Poor outcomes are a result of the system we have.  Healthcare disparities based on race and income are a result of the system we have. 

It's not a system designed to do what we're now asking it to do.  Society in general is waking up, in part, to the idea that healthcare coverage is a right for all people...and that national debate is shifting in that direction.  Along the way, we'll go back and forth in fits and starts, but so long as we're operating under the current system, which evolved in a free market system to ONLY provide healthcare to those who could afford it, we're going to be fighting a losing battle against costs.

 
matttyl said:
No, I don't. 
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I think both you and @shader wrote that health care providers were for profit - and that seemed to suggest it was a problem. Did I read that wrong? And if it is a problem, how should it be fixed? Just have the gov't regulate prices? Is that possible? Maybe force them to use whatever pricing the gov't already negotiates with medicaid/care?

 
Gr00vus said:
Continuing to play devil's advocate. Those other countries are able to keep their taxes from rising significantly because they pay less for the same drugs, etc. that we pay full price for here, where we allow our pharmaceutical and med tech companies to profit from their innovations to the fullest extent possible. I.e. the U.S. patient is subsidizing healthcare for a lot of these other countries.
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Those are good concerns that need to be addressed.  But those don't come into the discussion if we're just talking about ways to reduce costs in our current system.

If we accept that the current system IS the system we're going to rely on to provide care to all of our people, then right off the bat we're going to have to admit it won't provide care to all of the people, and a big portion of the costs will go to padding the pockets of the companies looking to make profits.  Additionally, there will be all sorts of legal issues with data sharing, with protective practices regarding information from hospitals and clinics, with high costs of medical school and needing to make high incomes in metro-areas to repay them.  Healthcare disparities naturally follow.  High costs naturally follow.

There are so many issues that naturally follow from our current system that seeking to reduce all the bad things about it seems to be an ever climbing hill with more regulations needed, more restrictions, more market control, more laws about privacy and data sharing, more patient privacy acts...and so on.  It's a huge mess because we're trying to heavily regulate a system in such a way to make it do something it's not designed to do, and at the TOP of that list is that it's not designed to be a low cost provider of services, and it never will be.

 
whoknew said:
So do you (and @matttyl) think health care providers should be nationalized? Doing that would solve much of the problem?

Do catholic hospitals typically have lower prices?
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I've worked for a catholic hospital and while it doesn't return profits to shareholders, it makes money just like any other hospitals, and at the same rates as other hospitals...its goal isn't to serve people at lower costs, it's to serve people with a christian attitude...but it has to make money in order to stay in business, and it keeps a lot of money stored up for rainy days.

 
matttyl said:
The only way you'd have one (pre-ACA, or with what I was describing) is if you had been uninsured for over 63 days straight.  So the solution is to not do that. 

We can't have a system where someone can simply just buy coverage when they need it.  That simply won't work.  I myself sold a policy to a woman 7 months pregnant (she created her own qualifying event by having a justice of the peace wedding)....only to have her drop the policy 2 months after delivery.  Pre-ACA she couldn't have done that because it would have been a pre-exisiting condition (unless she had always had coverage). 

If our goal is getting and keeping people in the pool, a pre-exisition condition limitation will do that.  Might even do it better than the current "individual mandate".  But people turned it into such a bad word, even though I think many didn't really know what it meant.
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Okay that makes sense.   Thanks for the response.

 
Henry Ford said:
It's really not because of lawyers and lawsuits.

Source: I make so little money off of med mal cases, they're really not worth taking anymore unless it's because some poor guy/gal really needs help.
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Just because you didn't have any big cases doesn't mean they don't happen all the time.

 
matttyl said:
The only way you'd have one (pre-ACA, or with what I was describing) is if you had been uninsured for over 63 days straight.  So the solution is to not do that. 

We can't have a system where someone can simply just buy coverage when they need it.  That simply won't work.  I myself sold a policy to a woman 7 months pregnant (she created her own qualifying event by having a justice of the peace wedding)....only to have her drop the policy 2 months after delivery.  Pre-ACA she couldn't have done that because it would have been a pre-exisiting condition (unless she had always had coverage). 

If our goal is getting and keeping people in the pool, a pre-exisition condition limitation will do that.  Might even do it better than the current "individual mandate".  But people turned it into such a bad word, even though I think many didn't really know what it meant.
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I think the problem was that it was conflated with the ability to deny a policy or ability to charge enormous premiums for the pre-existing condition.  As I said before, I don't have as much of an issue with having to wait for coverage to kick in as I have a problem with not being able to reasonably access the insurance market at all because of cost/denials for people with pre-existing conditions.

 
adonis said:
don't see many folks admitting that the problem is that we're trying to make a system that has been designed to offer health care ONLY to those who can afford it, is being twisted into being a system that provides healthcare to people who never were its intended market
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What "system" are you speaking of?  It's tough to discern your point because you use health care and insurance as synonyms.  They aren't.  I remember when I was a kid my parents talking about whether or not to use the insurance on certain things.  Was it worth it to file with insurance if the premium wasn't going to be met for the year risking an increase in rates with each claim made (very similar to how we think about and use car insurance today.  It seems to me we have morphed into this new version of insurance (courtesy of our Washington DC politicians) where insurance is essentially "mandatory" to the point I don't even know why it's called insurance.  It's a required part of the equation anymore.

That's probably why you don't see people admitting it.....we're not sure it's all that true.

 
Henry Ford said:
It's really not because of lawyers and lawsuits.

Source: I make so little money off of med mal cases, they're really not worth taking anymore unless it's because some poor guy/gal really needs help.
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Just going by what two doctor friends who have private practices are always saying and complaining about.  As usual I have no scientific data to back it up.

 
Warrior said:
Just because you didn't have any big cases doesn't mean they don't happen all the time.
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The average payout in 2015 for medical malpractice that caused someone to be a quadriplegic, nationwide, was just over $1 million.  If you think that's a lot of money for a case that leaves someone a quadriplegic, I don't know what to tell you.

The average death case was less than $400,000.00. 

Edit:  The majority of states have instituted "tort reform in medicine" laws that limit recovery severely.  It's what's led to lowered recovery, and has not led to lower health care costs.  It just leaves people who have been wronged without enough money to cover their care.

 
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adonis said:
I agree, it's a wide ranging issue.  But the central point it stems from, that I think most folks don't address is whether or not access to quality healthcare is a right that should not depend on your income level.
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If you're going to go down this path, it's our tax structure you ultimately have an issue with.  Our taxes is how the government gets the money for these programs.  Our taxes are based on income, so now you're into the world of talking about altering our tax structure (which I don't necessarily have a problem with)

 
whoknew said:
I think both you and @shader wrote that health care providers were for profit - and that seemed to suggest it was a problem. Did I read that wrong? And if it is a problem, how should it be fixed? Just have the gov't regulate prices? Is that possible? Maybe force them to use whatever pricing the gov't already negotiates with medicaid/care?
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Yes, providers are for profit.  That's an issue, but I'm not sure that's a problem.  One solution that would go a long way would be to make their prices transparent.  Let the market help regulate costs.

Say you tore your ACL.  Imagine if you could call up your four local hospitals and get an "out the door" price from each of them for what an ACL reconstruction surgery would cost.  You could actually shop like you do with a car.  I tried to do this (unsuccessfully) with my son's delivery a year and a half ago, and the billing lady at the hospital looked at me as if I had 3 heads. 

 
matttyl said:
Yes, I'm the one who brought that up.  It's infuriating - both as the insured, as well as being a broker/agent.  That's one thing that both sides should be able to agree on, and it would actually go a long way to lower costs, which is the point. 

Yes, insurance companies are limited in what they can make (I don't know of any other company with such restrictions).  I just feel that when you look at that income objectively, it's not as bad as you would think.  $85 per insured person per year.  That's one more trip to the doctor for everyone and the company didn't make anything. 
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I am pretty sure the oil industry effectively has limits on what they can make. I don't think the $85 (if that is an accurate number) is really relevant since that doesn't include the 100 million in compensation the CEO received, not to mention the other top brass. Again, I have no issues with companies making money - it is just in this case the game is rigged against the consumer. The consumer really doesn't have a choice in what they are paying because they aren't the ones negotiating the cost of the initial services.

 
Godsbrother said:
Okay that makes sense.   Thanks for the response.
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So with that in mind, what are your thoughts on a "pre-exisiting condition" limitation.  People really confused that term with underwriting, which is a completely different ball of wax.

Do you, and others, think that a "pre-exisiting condition limitation" is reasonable?  Do you think it would be an effective "individual mandate" is set up properly?

 
Gr00vus said:
adonis said:
Those are good concerns that need to be addressed.
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Until we can address them with realistic solutions, convincing people that socialized health care is the right direction becomes more difficult.
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I think that making a fair argument that other countries provide coverage to more folks at a lower cost using a single payer system, is a start.  

 
Medical malpractice payouts in 2015 totaled just under $4 billion nationwide.  National healthcare costs were roughly $3.2 trillion.  So medical malpractice payouts accounted for approximately one tenth of one percent of healthcare spending.

I'm having a hard time attributing health care costs to medical malpractice suits.

 
sn0mm1s said:
I am pretty sure the oil industry effectively has limits on what they can make. I don't think the $85 (if that is an accurate number) is really relevant since that doesn't include the 100 million in compensation the CEO received, not to mention the other top brass. Again, I have no issues with companies making money - it is just in this case the game is rigged against the consumer. The consumer really doesn't have a choice in what they are paying because they aren't the ones negotiating the cost of the initial services.
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Well, the consumer has the choice to go to a different company.  If a company didn't pay it's CEO $100m or whatever (which by the way the vast bulk of is in stock options and such, not cash) and paid them a more reasonable amount, their costs are lower and they can sell policies for less and obtain more market share. 

 
adonis said:
I think that making a fair argument that other countries provide coverage to more folks at a lower cost using a single payer system, is a start.  
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Right up until you postulate that those other countries costs are low because U.S. patients are subsidizing them through paying insane markup for the same products those countries get closer to the price of manufacture. What happens to the availability and quality of those products if the manufacturers have a greatly reduced chance of making money on them and/or recouping the cost of dead end R&D through money made on the successful products because the U.S. is now a socialized health care environment with cost controls in place?

 
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The Commish said:
adonis said:
don't see many folks admitting that the problem is that we're trying to make a system that has been designed to offer health care ONLY to those who can afford it, is being twisted into being a system that provides healthcare to people who never were its intended market
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What "system" are you speaking of?  It's tough to discern your point because you use health care and insurance as synonyms.  They aren't.  I remember when I was a kid my parents talking about whether or not to use the insurance on certain things.  Was it worth it to file with insurance if the premium wasn't going to be met for the year risking an increase in rates with each claim made (very similar to how we think about and use car insurance today.  It seems to me we have morphed into this new version of insurance (courtesy of our Washington DC politicians) where insurance is essentially "mandatory" to the point I don't even know why it's called insurance.  It's a required part of the equation anymore.

That's probably why you don't see people admitting it.....we're not sure it's all that true.
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The system I'm speaking of is the health care system.  It encompasses health care services and health insurance, and includes insurance companies, provider clinics, hospitals, EMR's, the pharmaceutical industry, lobbyists, the list of regulations pertaining to the industry, and much more.

This whole system grew up naturally as part of a system that provided care in return for money.  As the type of care expanded, and the costs increased, other services came into being like insurance.  The entire system stemmed from a for profit, pay for service model.  Over the past few years, we've been trying to make it be something it's not.  We want to change the system into a pay for performance model.  We want the system to cover folks it wasn't intended to cover.  And then we complain about inefficiencies or higher costs, both to citizens and the government.

At what point can we just admit that we're trying to make a cat talk, walk and act like a dog, and complaining the whole time that it still is holding on strong to its feline tendencies?

 
Henry Ford said:
I think the problem was that it was conflated with the ability to deny a policy or ability to charge enormous premiums for the pre-existing condition.  As I said before, I don't have as much of an issue with having to wait for coverage to kick in as I have a problem with not being able to reasonably access the insurance market at all because of cost/denials for people with pre-existing conditions.
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Yes, underwriting.  Not the same thing.  Guaranteed issue (and community rating) is what did away with that.  Pre-ex condition limitations are something else completely.  Just another thing that the average media outlet doesn't know the difference of. 

 
matttyl said:
So with that in mind, what are your thoughts on a "pre-exisiting condition" limitation.  People really confused that term with underwriting, which is a completely different ball of wax.

Do you, and others, think that a "pre-exisiting condition limitation" is reasonable?  Do you think it would be an effective "individual mandate" is set up properly?
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I agree that you can't have someone that elects not to pay for health insurance wait for them to need it and then wanting to buy it so that part I understand.  It would be kinda like not having car insurance, wrecking your car and then trying to buy insurance after that fact.  Pretty cut and dry.

However let's say a patient with a heart condition or Crohn's disease losing their job and not being able to afford COBRA is without insurance for 3 or 4 months.   It really sucks that they would have to pay 6 months of health insurance before they would begin getting coverage for their medical condition.  If that is what you are saying.

 
Gr00vus said:
adonis said:
I think that making a fair argument that other countries provide coverage to more folks at a lower cost using a single payer system, is a start.  
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Right up until you postulate that those other countries costs are low because U.S. patients are subsidizing them through paying insane markup for the same products those countries get closer to the price of manufacture. What happens to the availability and quality of those products if the manufacturers have a greatly reduced chance of making money on them and/or recouping the cost of dead end R&D through money made on the successful products?
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I'm not going to pretend to be a one stop shop for all solutions to our healthcare system, or be able to easily say what'll solve all the legitimate concerns.  I'm just saying it's a good starting point.  And pharma is only one piece of the cost puzzle.  Other pieces are definitely within reason for us to solve more straightforwardly.

It's interesting though, because the parallels between the pharma business using the americans to subsidize care to the rest of the world is a similar argument to the one Trump makes about American free trade subsidizing growth in the rest of the world at the expense of American workers.  He is, or others have, proposed various solutions aimed at stemming the outflow of jobs to the rest of the world from america, but even some of those solutions will result in americans having to pay more for stuff.

So perhaps some of the solutions to solving the pharma issue with us subsidizing R&D and lower cost medicine to the rest of the world will either result in the rest of the world paying more, or us paying more, or both.  I don't know.  Perhaps it has to do with overhauling our patent system in terms of how it deals with generic vs name brand medicine.  Perhaps it has to do with how we issue grants for basic research which expand and are used by companies to fund their breakthroughs and keep all the profits, vs a profit sharing concept with the federal government when NIH funded (or other agency funded) research is used to develop a profitable drug?  

I dont' know, but I do know that most people in our country aren't currently wrestling with these ideas.  Our current public discourse is around pre-existing conditions, subsidies or tax credits to be able to afford private health care, whether we're going to give block grants to states to help fund Medicaid or not, and just how many people are not going to be able to afford private health insurance or be able to handle a medical emergency without going bankrupt.

Our discourse is so far off from something productive in terms of reforming the system that it's frustrating.  I'd much rather hear the many more folks far smarter than me talk about the various options we have and debate them, than engaging in the nickel-and-dime cost savings stuff we're trying to do in the current system, all the while screwing over the less fortunate among us.

 
The Commish said:
adonis said:
I agree, it's a wide ranging issue.  But the central point it stems from, that I think most folks don't address is whether or not access to quality healthcare is a right that should not depend on your income level.
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If you're going to go down this path, it's our tax structure you ultimately have an issue with.  Our taxes is how the government gets the money for these programs.  Our taxes are based on income, so now you're into the world of talking about altering our tax structure (which I don't necessarily have a problem with)
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I don't really have a problem with our tax structure.  I have a problem with the system we're trying to use to provide healthcare to our population.  If we want to offer health care services to all, irrespective of income, the system we have is almost one of the worst we could imagine to solve that problem.

 
adonis said:
I'm not going to pretend to be a one stop shop for all solutions to our healthcare system, or be able to easily say what'll solve all the legitimate concerns.  I'm just saying it's a good starting point.  And pharma is only one piece of the cost puzzle.  Other pieces are definitely within reason for us to solve more straightforwardly.

It's interesting though, because the parallels between the pharma business using the americans to subsidize care to the rest of the world is a similar argument to the one Trump makes about American free trade subsidizing growth in the rest of the world at the expense of American workers.  He is, or others have, proposed various solutions aimed at stemming the outflow of jobs to the rest of the world from america, but even some of those solutions will result in americans having to pay more for stuff.

So perhaps some of the solutions to solving the pharma issue with us subsidizing R&D and lower cost medicine to the rest of the world will either result in the rest of the world paying more, or us paying more, or both.  I don't know.  Perhaps it has to do with overhauling our patent system in terms of how it deals with generic vs name brand medicine.  Perhaps it has to do with how we issue grants for basic research which expand and are used by companies to fund their breakthroughs and keep all the profits, vs a profit sharing concept with the federal government when NIH funded (or other agency funded) research is used to develop a profitable drug?  

I dont' know, but I do know that most people in our country aren't currently wrestling with these ideas.  Our current public discourse is around pre-existing conditions, subsidies or tax credits to be able to afford private health care, whether we're going to give block grants to states to help fund Medicaid or not, and just how many people are not going to be able to afford private health insurance or be able to handle a medical emergency without going bankrupt.

Our discourse is so far off from something productive in terms of reforming the system that it's frustrating.  I'd much rather hear the many more folks far smarter than me talk about the various options we have and debate them, than engaging in the nickel-and-dime cost savings stuff we're trying to do in the current system, all the while screwing over the less fortunate among us.
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:goodposting:

 
timschochet said:
Paul Ryan is on TV right now, defending the law. "This is an act of mercy."
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Is he mentioning how he's trying to sneak Medicare privatization into it?

The GOP plan would:

Expand health savings accounts

Offer refundable tax credits to subsidize the purchase of private health insurance and decrease dependence on employer-sponsored plans

Cap the tax exclusion for employer-provided health insurance

Allow people to purchase insurance across state lines

Provide $25 billion in funding for high-risk pools over 10 years

Devolve Medicaid to the states, either through a block grant or a “per capita allotment”

Partially privatize Medicare beginning in 2024 through a “premium support” option
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In the end we can afford it and it is about just favoring greed over basic human caring.  It is truely sad and I will never undestand how people can fight so hard against abortion and universal healthcare.  Makes zero sense and I am not for abortion but I am not self-righteous enough to think I know what is best for someone else.  The hypocrisy breeds hate of these people in me as I see them as very bad people.  Religion might breed the most evil on earth.

 
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adonis said:
The Commish said:
adonis said:
don't see many folks admitting that the problem is that we're trying to make a system that has been designed to offer health care ONLY to those who can afford it, is being twisted into being a system that provides healthcare to people who never were its intended market
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What "system" are you speaking of?  It's tough to discern your point because you use health care and insurance as synonyms.  They aren't.  I remember when I was a kid my parents talking about whether or not to use the insurance on certain things.  Was it worth it to file with insurance if the premium wasn't going to be met for the year risking an increase in rates with each claim made (very similar to how we think about and use car insurance today.  It seems to me we have morphed into this new version of insurance (courtesy of our Washington DC politicians) where insurance is essentially "mandatory" to the point I don't even know why it's called insurance.  It's a required part of the equation anymore.

That's probably why you don't see people admitting it.....we're not sure it's all that true.
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The system I'm speaking of is the health care system.  It encompasses health care services and health insurance, and includes insurance companies, provider clinics, hospitals, EMR's, the pharmaceutical industry, lobbyists, the list of regulations pertaining to the industry, and much more.

This whole system grew up naturally as part of a system that provided care in return for money.  As the type of care expanded, and the costs increased, other services came into being like insurance.  The entire system stemmed from a for profit, pay for service model.  Over the past few years, we've been trying to make it be something it's not.  We want to change the system into a pay for performance model.  We want the system to cover folks it wasn't intended to cover.  And then we complain about inefficiencies or higher costs, both to citizens and the government.

At what point can we just admit that we're trying to make a cat talk, walk and act like a dog, and complaining the whole time that it still is holding on strong to its feline tendencies?
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Then I am not on board with the design of the system as you lay it out here.  I think it's patently false otherwise "insurance" as we know it today would have played the same role 40 years ago that it does today.  It didn't.  I can agree we've sort of morphed into this characterization but that's ultimately at the feet of the politicians in Washington DC for pandering to the industry as a whole rather than watching out for us as citizens.  They've been picking and choosing winners/losers for decades in this space.  I see no indication that's the way it was initially designed though.  Of course it's origins were of the "pay for services" model.  That's not the same thing we're seeing today though.  Not even close IMO.  

And what makes it worse on us as US citizens is the fact that we (the American citizens) are the coffers for the companies based here in the US where they get to make up on "lost" profits in other countries where those governments have had the sense to draw a line in the sand.

 
matttyl said:
Yes, underwriting.  Not the same thing.  Guaranteed issue (and community rating) is what did away with that.  Pre-ex condition limitations are something else completely.  Just another thing that the average media outlet doesn't know the difference of. 
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You could fill an encyclopedia with things the average media outlet doesn't understand. 

 
Gr00vus said:
Continuing to play devil's advocate. Those other countries are able to keep their taxes from rising significantly because they pay less for the same drugs, etc. that we pay full price for here, where we allow our pharmaceutical and med tech companies to profit from their innovations to the fullest extent possible. I.e. the U.S. patient is subsidizing healthcare for a lot of these other countries.
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Been saying this for a while.  The first thing that needs to be passed is allowing reimportation of perscription drugs.  We should delay it for a couple years to allow the drug companies to renegotiate with other countries to even that playing field.  Certainly one brick in the wall is that we are subsidizing the rest of the world here.

Henry Ford said:
I'm having a hard time attributing health care costs to medical malpractice suits.
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The argument is the defensive medicine that goes along with this.

 
adonis said:
Again, the issue with healthcare nationwide isn't that simple.  Many folks believe the real issue is that not everyone can afford healthcare.  There are no cost savings methods you or anyone else can propose that will make healthcare costs affordable to those with chronic illnesses or who are poor or both, without huge government subsidies.

The issue for myself, or maybe other liberal-folks on this issue is that we think ALL people regardless of income have a right to healthcare.  This seems to be a fundamental difference with other folks like yourself and others who have replied that the fundamental issue is cost.
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Liberal rights seem to be a whole helluva lot more expensive. 

Not to mention authoritatively oppressive to those who have to pay for them. 

 
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adonis said:
I'm not sure what this being a free country has to do with anything.  If we had a single payer system, it'd be a free country.  If we look to the free market to solve the health care access/costs, it's still a free country.  The issue at heart is what the role of government is in ensuring access to affordable health care for all citizens.  Republicans don't believe it has a role, others on the democratic side do...
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The more control a government has in individuals healthcare the more you get it's not fair I pay insurance all my life and others don't and get a free ride. ( just one of the reasons given for a mandated citizenry to insure themselves. ) 

it's not fair I diet and exercise and others don't and pay the same/get the same etc etc. ( already hear these gripes but no mandates....yet ) 

So the free aspect of a Nation and it's people is you aren't really free you are just extended some leeway in running your life. How much leeway is determined by who the people allow to be their masters in DC. 

 
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