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Healthcare in the US--a 2020 Thread (1 Viewer)

jm192

Footballguy
I keep getting off on these tangents with some of you guys in the Bernie and Pete threads.  I figured it would be better to make a fresh thread.  

What do you see as the Problem in 2020?  Lack of access?  Lack of ability to pay?  If you were President, how would you fix it?  And please be as specific as you can.  Rather than arguing who is the best or what way is the best, we can agree on some basic principles towards a fix.

 
I would like everyone in the country to be able to get medical care regardless of ability to pay.
As it stands, EMTALA dictates that if you show up in an ER, you MUST be cared for.  And if doctors fail to do so, they receive a 50,000$ personal fine that their malpractice insurance doesn't cover.  

So to that statement, everyone can walk into any ER for any reason and get care.  Now, they will send you a bill after the fact.  You can simply not pay it, and then whatever else happens happens.  But you can walk into the same hospital while refusing to pay your last 25 bills and EMTALA dictates you get care again.  

 
As it stands, EMTALA dictates that if you show up in an ER, you MUST be cared for.  And if doctors fail to do so, they receive a 50,000$ personal fine that their malpractice insurance doesn't cover.  

So to that statement, everyone can walk into any ER for any reason and get care.  Now, they will send you a bill after the fact.  You can simply not pay it, and then whatever else happens happens.  But you can walk into the same hospital while refusing to pay your last 25 bills and EMTALA dictates you get care again.  
I don’t mean just emergency care, I mean the sort of care that I get as someone who has health insurance through my employer.

 
As it stands, EMTALA dictates that if you show up in an ER, you MUST be cared for.  And if doctors fail to do so, they receive a 50,000$ personal fine that their malpractice insurance doesn't cover.  

So to that statement, everyone can walk into any ER for any reason and get care.  Now, they will send you a bill after the fact.  You can simply not pay it, and then whatever else happens happens.  But you can walk into the same hospital while refusing to pay your last 25 bills and EMTALA dictates you get care again.  
And that is one of the things that causes massive waste and excess costs. Emergency room visits are expensive and it is an inefficient way to deliver non-emergency care. People without insurance don't get any preventative care at all and may go to the ER for reasons that aren't truly emergencies. And people with minimal insurance may put off going to see the doctor when something is kinda serious, but not an emergent situation (yet), because of high deductibles.

 
I don’t mean just emergency care, I mean the sort of care that I get as someone who has health insurance through my employer.
Sure.  I guess that's my point, is specifics.  If all you want is for anyone to get care, the system is where you want it.  

What do you mean by the sort of care you get?  Routine primary care and checkups?

 
And that is one of the things that causes massive waste and excess costs. Emergency room visits are expensive and it is an inefficient way to deliver non-emergency care. People without insurance don't get any preventative care at all and may go to the ER for reasons that aren't truly emergencies. And people with minimal insurance may put off going to see the doctor when something is kinda serious, but not an emergent situation (yet), because of high deductibles.
Absolutely.  It doesn't change the fact that anyone can get care regardless of the ability to pay.  

High deductibles is another fantastic point.  What good is insurance if you can't get past the deductible to use it?

 
Absolutely.  It doesn't change the fact that anyone can get care regardless of the ability to pay.  

High deductibles is another fantastic point.  What good is insurance if you can't get past the deductible to use it?
The minimal high deductible plans are one of the main problems with the ACA, to be clear.

A truly uninsured and indigent patient might actually be better off than a minimally insured one if both get hit by buses and survive. The uninsured and indigent patient would have the entire bill written off by the hospital. The minimally insured one likely wouldn't. 

 
The minimal high deductible plans are one of the main problems with the ACA, to be clear.

A truly uninsured and indigent patient might actually be better off than a minimally insured one if both get hit by buses and survive. The uninsured and indigent patient would have the entire bill written off by the hospital. The minimally insured one likely wouldn't. 
Couldn't agree more.  I think the ACA has been a DISASTER for those people.

 
I’m not sure what constitutes routine primary care.  If I get cancer or some other terrible disease I believe that my health insurance would cover most of the costs of treatment.  I want that for everyone.
My dad died of prostate cancer last year. He was 89 and had Medicare, plus an affordable supplemental plan through AARP. He got good care and was out of pocket virtually nothing.

I too would like to see that for everybody that needs or wants it. 

 
As it stands, EMTALA dictates that if you show up in an ER, you MUST be cared for.  And if doctors fail to do so, they receive a 50,000$ personal fine that their malpractice insurance doesn't cover.  

So to that statement, everyone can walk into any ER for any reason and get care.  Now, they will send you a bill after the fact.  You can simply not pay it, and then whatever else happens happens.  But you can walk into the same hospital while refusing to pay your last 25 bills and EMTALA dictates you get care again.  
When this is your only option something is wrong with the system. 

 
When this is your only option something is wrong with the system. 
Sure.  But if the "goal" is that everyone should have access to care regardless to pay, then there's the answer.  It exists.  The problem is solved.  We can all stop worrying about it.  

If the goal is more primary care, then that's different.  And I'm just trying to pin down to the nitty gritty exactly what is being viewed as the goal.

 
In terms of politics, I fear the public won’t like what’s being offered: 

1. Trump wants to finish getting rid of Obamacare, and though he promises to protect pre-existing conditions, his Justice Department is actively working in the opposite direction. 

2. The Democrats seem ready at this moment to abandon Obamacare in favor of a new Medicare for All program. 

Neither choice is what the public wants. It’s an incredible irony: poll after poll suggests that this is the #1 concern of voters, and we’re about to be stuck with two Presidential candidates who aren’t responding to what the vast majority of Americans desire (namely, the protection and improvement of ACA). 

 
Sure.  But if the "goal" is that everyone should have access to care regardless to pay, then there's the answer.  It exists.  The problem is solved.  We can all stop worrying about it.  

If the goal is more primary care, then that's different.  And I'm just trying to pin down to the nitty gritty exactly what is being viewed as the goal.
Make it so the average person doesn’t go into catastrophic debt because they want to continue living. One way to do that is to make primary care more accessible, I would think, but I’m not an expert. There are a lot of angles to consider. I don’t want to be charged $20 for a box of Kleenex because everyone is walking out on ER bills for care.

I think a big misconception some people have is that suddenly all the hospitals will be flooded with poor people making it more difficult to get care of you have insurance. This is already the case, and it actually could currently be limiting people’s access to ER care because they’re busy with non emergency issues. 
 

What do you see as the goal regarding healthcare? 

 
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Make it so the average person doesn’t go into catastrophic debt because they want to continue living. One way to do that is to make primary care more accessible, I would think, but I’m not an expert. There are a lot of angles to consider. I don’t want to be charged $20 for a box of Kleenex because everyone is walking out on ER bills for care.

I think a big misconception some people have is that suddenly all the hospitals will be flooded with poor people making it more difficult to get care of you have insurance. This is already the case, and it actually could currently be limiting people’s access to ER care because they’re busy with non emergency issues. 
 

What do you see as the goal regarding healthcare? 
I said in either of the Pete or the Bernie thread that more Primary care is a huge part of the key--if not the key.  I think we'd see a lot fewer catastrophic bills if everyone went to primary care.  But I think in order to get it to the right place, we need more primary care doctors.  Currently primary care docs make the lowest of their respective totem poles.  Family Medicine, General Internal medicine and Peds are the lowest paying specialties.  And in each of those--working in the hospital or urgent care pays better.  

The hospital is absolutely already full of poor people who got into problems because they didn't want to go to primary care.  Diabetes don't get foot exams--they get infections and amputations.  People don't get their blood pressure controlled--they develop heart failure or have strokes.  

 
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I said in either of the Pete or the Bernie thread that more Primary care is a huge part of the key--if not the key.  I think we'd see a lot fewer catastrophic bills if everyone went to primary care.  But I think in order to get it to the right place, we need more primary care doctors.  Currently primary care docs make the lowest of their respective totem poles.  Family Medicine, General Internal medicine and Peds are the lowest paying specialties.  And in each of those--working in the hospital or urgent care pays better.  

The hospital is absolutely already full of poor people who got into problems because they didn't want to go to primary care.  Diabetes don't get foot exams--they get infections and amputations.  People don't get their blood pressure controlled--they develop heart failure or have strokes.  
As much as this seems counter-intuitive, I think the education requirements for different areas of medical care should be less restrictive. Technology can increasingly do the basic functions of a primary care doctor, and technology should be part of the answer. Actually, technology may be able to do a better job. It would take some investment and some bureaucratic changes to make it so an office could be staffed by nurses and a “watson” type system. It takes the biggest cost out of the office, the salary for the doctor. 

 
I'll even add on to this: speaking for me personally here obviously, but is certainly the attitude of most who support it:

-- even if I have to pay more in taxes
:thumbup:   I get free healthcare (disabled Vet) and wish I could share it with everyone.  I'm not rich, but would be willing to pay more to help others get it, or give my free healthcare to someone else.  I have to buy a family plan for my wife and kids anyway.  The VA does bill it for services so I do feel good that the VA gets additional funds outside of taxpayer dollars, but it's not much.  

 
The problem is that the system is so far broken that any fix will be time consuming, expensive and will be hated by a good chunk of the country. You’ve got one side that wants to flip the table over and start a new system and the other side that has no plan or intention to help more people get access to health care. While I see Medicare For All as a successful endpoint, it’s not going to happen any time soon.

We have too many people who are users (using more than they pay in)‘ than payers. This is a problem that will only get worse with time. The imbalance pushes premiums and costs up and further pushes the heathy individuals out of the system until they are no longer are healthy.

Any plan needs to bring them back into the system getting the preventive care that will keep them healthy. The problem is that the current methods of doing that is government subsidies and high deductible plans. Solve that problem and you might be onto something.

 
jm192 said:
I keep getting off on these tangents with some of you guys in the Bernie and Pete threads.  I figured it would be better to make a fresh thread.  

What do you see as the Problem in 2020?  Lack of access?  Lack of ability to pay?  If you were President, how would you fix it?  And please be as specific as you can.  Rather than arguing who is the best or what way is the best, we can agree on some basic principles towards a fix.
At the simplest level, we spend 2x what other developed nations spend on healthcare, for results that aren’t superior.

 
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jm192 said:
As it stands, EMTALA dictates that if you show up in an ER, you MUST be cared for.  And if doctors fail to do so, they receive a 50,000$ personal fine that their malpractice insurance doesn't cover.  

So to that statement, everyone can walk into any ER for any reason and get care.  Now, they will send you a bill after the fact.  You can simply not pay it, and then whatever else happens happens.  But you can walk into the same hospital while refusing to pay your last 25 bills and EMTALA dictates you get care again.  
Not as  true as you state it!

The ER (and its physicians) at a facility that accepts Medicare (which is pretty close to all) must screen and stabilize you before dumping you, not treat you.   Not "care for you" in the sense that those that want healthcare for everyone.  

 
Not as  true as you state it!

The ER (and its physicians) at a facility that accepts Medicare (which is pretty close to all) must screen and stabilize you before dumping you, not treat you.   Not "care for you" in the sense that those that want healthcare for everyone.  
Again, I'm a physician, so I deal with it on a daily basis.  

EMTALA is an anti-dumping policy.  If you have the capacity to treat a patient and do not do so--that in itself is an EMTALA violation.  Because you have "dumped" the patient.  Specialists take "EMTALA" call.  And if a patient needs a specialist in the ER and that specialist fails to show up--that's a violation.  Furthermore, if you send a patient to a facility for a specialist that you have at your hospital--that is a violation.

A hospital in the state I live in got an EMTALA violation for not taking a surgical patient.  The patient goes to hospital A which has an ER but no surgeon.  Surgeon at Hospital B says no I'm not taking the patient.  Surgeon at hospital C takes the patient and reports surgeon at Hospital B because he should have under EMTALA taken the patient.  Surgeon and Hospital at Hospital B both get penalties.  

A medical screening exam leads to medical liability as well.  And no physician is prepared to take on that lawsuit.  "Well, I found out from my screening exam that you are bleeding to death.  But because you have no insurance, I will just now allow it to happen."  It simply doesn't work that way.  

The screen and stablize applies to cases in which the ER is connected to a hospital without a certain speciality.  If you're having a heart attack and your local ER doesn't have a cardiologist--they have to screen and stablize you--then they are able to send you to the hospital with the cardiologist.  And the Hospital with the cardiologist is obliged via EMTALA to accept that patient.

 
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The problem is that we still have a significant portion of the population that believe that ordinary people can be rational consumers of healthcare.  This idea failed when we got high "skin in the game" deductibles about fifteen years ago.  It fails when we send ordinary people off to exchanges to pick their own insurance plans.   It fails when we wonder why the guy in the coma failed to argue for in network providers rather than later complain about his surprise billing.  (ER doctors are among the worst at this.)  It fails when a parent insists on one doctor or facility over another for their child because of name recognition rather than any real metrics.  The problem is that we believe that there can be a free market for health care.  Sure market forces can be involved at various points, but asking average Joe to be the one that drives the decisions is the problem.

 
Again, I'm a physician, so I deal with it on a daily basis.  

EMTALA is an anti-dumping policy.  If you have the capacity to treat a patient and do not do so--that in itself is an EMTALA violation.  Because you have "dumped" the patient.  Specialists take "EMTALA" call.  And if a patient needs a specialist in the ER and that specialist fails to show up--that's a violation.  Furthermore, if you send a patient to a facility for a specialist that you have at your hospital--that is a violation.

A hospital in the state I live in got an EMTALA violation for not taking a surgical patient.  The patient goes to hospital A which has an ER but no surgeon.  Surgeon at Hospital B says no I'm not taking the patient.  Surgeon at hospital C takes the patient and reports surgeon at Hospital B because he should have under EMTALA taken the patient.  Surgeon and Hospital at Hospital B both get penalties.  

A medical screening exam leads to medical liability as well.  And no physician is prepared to take on that lawsuit.  "Well, I found out from my screening exam that you are bleeding to death.  But because you have no insurance, I will just now allow it to happen."  It simply doesn't work that way.  
Nothing you said is an argument to my point.   If a patient arrives in the ER and is found to have cancer the facility and physicians is obligated to stabilize the patient so they can walk out or be transferred somewhere else.  They do not have to prepare and execute a plan to fight the cancer.  

Now a great deal of our hospitals have deep religious roots and part of their charters is to simply take on such patients even as they have merged into much larger secular systems so we have that going for us, but that isn't EMTALA.  

 
The problem is that we still have a significant portion of the population that believe that ordinary people can be rational consumers of healthcare.  This idea failed when we got high "skin in the game" deductibles about fifteen years ago.  It fails when we send ordinary people off to exchanges to pick their own insurance plans.   It fails when we wonder why the guy in the coma failed to argue for in network providers rather than later complain about his surprise billing.  (ER doctors are among the worst at this.)  It fails when a parent insists on one doctor or facility over another for their child because of name recognition rather than any real metrics.  The problem is that we believe that there can be a free market for health care.  Sure market forces can be involved at various points, but asking average Joe to be the one that drives the decisions is the problem.
The in-network/out of network shouldn't apply to Emergency rooms at the very least and it should probably extend to hospitalized services.  

You can't show up in a true emergency and worry about whether or not the 1 or 2 doctors there are "in network."  

 
Again, I'm a physician, so I deal with it on a daily basis.  

EMTALA is an anti-dumping policy.  If you have the capacity to treat a patient and do not do so--that in itself is an EMTALA violation.  Because you have "dumped" the patient.  Specialists take "EMTALA" call.  And if a patient needs a specialist in the ER and that specialist fails to show up--that's a violation.  Furthermore, if you send a patient to a facility for a specialist that you have at your hospital--that is a violation.

A hospital in the state I live in got an EMTALA violation for not taking a surgical patient.  The patient goes to hospital A which has an ER but no surgeon.  Surgeon at Hospital B says no I'm not taking the patient.  Surgeon at hospital C takes the patient and reports surgeon at Hospital B because he should have under EMTALA taken the patient.  Surgeon and Hospital at Hospital B both get penalties.  

A medical screening exam leads to medical liability as well.  And no physician is prepared to take on that lawsuit.  "Well, I found out from my screening exam that you are bleeding to death.  But because you have no insurance, I will just now allow it to happen."  It simply doesn't work that way.  

The screen and stablize applies to cases in which the ER is connected to a hospital without a certain speciality.  If you're having a heart attack and your local ER doesn't have a cardiologist--they have to screen and stablize you--then they are able to send you to the hospital with the cardiologist.  And the Hospital with the cardiologist is obliged via EMTALA to accept that patient.
As a physician and someone who works in health care day in and day out, you'll find out in this forum that your actual experience doesn't count.  Talking points and pandering count. 

I wish you good luck on your endeavor, but there are those in here who will fight to the death because they read an article online somewhere.  You being a physician is irrelevant.

 
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The in-network/out of network shouldn't apply to Emergency rooms at the very least and it should probably extend to hospitalized services.  

You can't show up in a true emergency and worry about whether or not the 1 or 2 doctors there are "in network."  
Exactly.  If you want to be critical of democrats then be critical of the House Ways and Means "surprise billing" bill from last week (give or take) as opposed to what (based on reporting) seemed like a better  option in the GOP senate.  The senate bill being better if you are a consumer, worst if you are a provider or an arbitration professional.

 
Nothing you said is an argument to my point.   If a patient arrives in the ER and is found to have cancer the facility and physicians is obligated to stabilize the patient so they can walk out or be transferred somewhere else.  They do not have to prepare and execute a plan to fight the cancer.  

Now a great deal of our hospitals have deep religious roots and part of their charters is to simply take on such patients even as they have merged into much larger secular systems so we have that going for us, but that isn't EMTALA.  
I disagree.  It's not my experience at all.  

Most cancer, as tragic as it is, is not an emergency.  Furthermore, you can't diagnose it without a biopsy.  You can't treat it without a biopsy.  If you show up in an ER with a lung mass or an abdominal mass, etc:  a large percentage of the time, you'll be hospitalized.  You'll meet the person who can biopsy/remove it.  You'll meet an oncologist.  Those that aren't hospitalized will be given a follow up with the appropriate physicians to keep the ball rolling.  ER doctors don't do chemo plans, you are correct.  But they will make the appropriate referral or hospitalize you.  

People who don't have primary care doctors that show up with poorly controlled problems tend to be admitted whereas they would be sent home if they weren't.  Drives up the cost.  But they get the care.  

I think most are saying we want some sort of plan that pays for major cost problems--catastrophe sort of plan.

 
It's been my assumption that government programs like PQRS, APM and MACRA are foundational elements to regulating quality of care/patient experience on a national level, and are themselves an indicator that the USA will at some point will institute national healthcare coverage.

What are your opinions on these programs?

 
As a physician and someone who works in health care day in and day out, you'll find out in this forum that your actual experience doesn't count.  Talking points and pandering count. 

I wish you good luck on your endeavor, but there are those in here who will fight to the death because they read an article online somewhere.  You being a physician is irrelevant.
I hope you are wrong about this.  My experience on this board has been different — most people put a lot of stock in someone else’s experience-driven perspective (almost too much at times).  But you are right, there are definitely folks in here who just flat out disregard experience of others.  One specific poster loves to make assumptions about Mayor Pete’s activities at McKinsey, and literally disregards/ignores/chafes at the reality I’ve shared from my own experience.  That said - most folks appreciate that stuff.

Anyway, I hope people keep sharing their own experience.  It’s helpful!

 
I disagree.  It's not my experience at all.  

Most cancer, as tragic as it is, is not an emergency.  Furthermore, you can't diagnose it without a biopsy.  You can't treat it without a biopsy.  If you show up in an ER with a lung mass or an abdominal mass, etc:  a large percentage of the time, you'll be hospitalized.  You'll meet the person who can biopsy/remove it.  You'll meet an oncologist.  Those that aren't hospitalized will be given a follow up with the appropriate physicians to keep the ball rolling.  ER doctors don't do chemo plans, you are correct.  But they will make the appropriate referral or hospitalize you.  

People who don't have primary care doctors that show up with poorly controlled problems tend to be admitted whereas they would be sent home if they weren't.  Drives up the cost.  But they get the care.  

I think most are saying we want some sort of plan that pays for major cost problems--catastrophe sort of plan.
The post that you responded to with EMTALA was-

fatguyinalittlecoat said:
I would like everyone in the country to be able to get medical care regardless of ability to pay.
The point I was making was that EMTALA won't provide the medical care necessary to treat the person with cancer other than when the cancer has done such damage that the patient is showing up at the ER.  And that is true for lots of other things.   While in other threads there have been debates on whether or not preventive medicine actually saves in the long run* I'm just pointing out that for those that see healthcare as a human right, or just simply believe that we are all better off when those we come in contact with are healthier that [just] addressing emergencies isn't what they (we) mean when we want "medical care".   That while EMTALA addresses this to a point, it isn't the solution and in someways is part of the problem.

*smokers die young before expensive end of life care seniors soak up,  there are things that can be prevented with expensive drugs but its cheaper to treat the few that get those conditions than it is to prevent it, etc. 

 
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jm192 said:
I keep getting off on these tangents with some of you guys in the Bernie and Pete threads.  I figured it would be better to make a fresh thread.  

What do you see as the Problem in 2020?  Lack of access?  Lack of ability to pay?  If you were President, how would you fix it?  And please be as specific as you can.  Rather than arguing who is the best or what way is the best, we can agree on some basic principles towards a fix.
The system is broken. Costs must go down.

Finally, healthcare should not be a for-profit entity. Could you imagine if the US military or the VA was a for-profit entity?

 
jm192 said:
As it stands, EMTALA dictates that if you show up in an ER, you MUST be cared for.  And if doctors fail to do so, they receive a 50,000$ personal fine that their malpractice insurance doesn't cover.  

So to that statement, everyone can walk into any ER for any reason and get care.  Now, they will send you a bill after the fact.  You can simply not pay it, and then whatever else happens happens.  But you can walk into the same hospital while refusing to pay your last 25 bills and EMTALA dictates you get care again.  
This is so incredibly cost prohibitive. This is a huge problem. Preventative care is where the value is at. However, there is no money in services. All the money is made in pills and tests. 

 
RedmondLonghorn said:
The minimal high deductible plans are one of the main problems with the ACA, to be clear.

A truly uninsured and indigent patient might actually be better off than a minimally insured one if both get hit by buses and survive. The uninsured and indigent patient would have the entire bill written off by the hospital. The minimally insured one likely wouldn't. 
Agree. Costs are way too high. 

 
As a physician and someone who works in health care day in and day out, you'll find out in this forum that your actual experience doesn't count.  Talking points and pandering count. 

I wish you good luck on your endeavor, but there are those in here who will fight to the death because they read an article online somewhere.  You being a physician is irrelevant.
His perspective as a physician is certianly valued and appreciated. But, just because he is a physician in no way means he has the correct answers to fix our broken system

 
The US military basically works for a for-profit entity. That’s a problem.
I don’t get your point. How can the US military be for profit when it doesn’t make any money?  It’s role is to provide coverage for all US citizens. It does this through a budgeting process. Why can’t US health care be the same way?

 
I don’t get your point. How can the US military be for profit when it doesn’t make any money?  It’s role is to provide coverage for all US citizens. It does this through a budgeting process. Why can’t US health care be the same way?
My point is the degree to which military procurement and even US foreign policy is influenced by the defense industry.

 
His perspective as a physician is certianly valued and appreciated. But, just because he is a physician in no way means he has the correct answers to fix our broken system
You're right.  Talking points and pandering is the way to go.  Let's ignore people who do this every day.

 
L

His perspective as a physician is certianly valued and appreciated. But, just because he is a physician in no way means he has the correct answers to fix our broken system
In fact...he may benefit from the broken system staying that way.

 
I hear you, but I’m not seeing the relation nor point. It feels like you are tying things together for an unknown reason. 
Odd. You are the one who brought up the US military. You said imagine if it was run as a “for profit” entity. I simply pointed out that it is closer to that already than many people believe.

 
Odd. You are the one who brought up the US military. You said imagine if it was run as a “for profit” entity. I simply pointed out that it is closer to that already than many people believe.
Thanks. I get it now.  Now that I understand your position, I understand why we are talking past each other  

I believe the goal of the [money side] of the US military is to keep its OpEx budget and continue to increase its CapEx budget.  That’s not a for-profit model.

if it was, we would see it operated much different  

 
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Problem is for an unimaginable [for me in my comfortable bubble] share of the population that "major cost" "catastrophe" is merely $500.  
 yeah, I think there’s going to have to be Concessions on both sides. I don’t think that $500 should be considered a catastrophic expense. It certainly makes life harder, and people should be willing to work with them to finance it.

 
Here's something I don't understand, maybe some of you who work in the industry can explain it to me.

As it stands now we have a healthcare industry that makes $100B a year (I'm basing this off what Sanders says, I haven't checked) so obviously there is profit in healthcare.

On  the other hand I hear people say things like "Medicare for All will bankrupt us".  

So here's the question - If the private industry makes $100B, and having that same industry run by the government will bankrupt us... what accounts for the loss of profit + however much of a loss would "bankrupt" us?

My thoughts...

- Private industry has been doing this for a long time so there would be learning curve

- Denials of coverage (sometimes mandatory) would not occur - GOOD!

- Government is usually less efficient than private industry

What else am I missing?  Is government inefficiency really enough to blow through that much profit? 

 
Here's something I don't understand, maybe some of you who work in the industry can explain it to me.

As it stands now we have a healthcare industry that makes $100B a year (I'm basing this off what Sanders says, I haven't checked) so obviously there is profit in healthcare.

On  the other hand I hear people say things like "Medicare for All will bankrupt us".  

So here's the question - If the private industry makes $100B, and having that same industry run by the government will bankrupt us... what accounts for the loss of profit + however much of a loss would "bankrupt" us?

My thoughts...

- Private industry has been doing this for a long time so there would be learning curve

- Denials of coverage (sometimes mandatory) would not occur - GOOD!

- Government is usually less efficient than private industry

What else am I missing?  Is government inefficiency really enough to blow through that much profit? 
The difference is that the government is not even required to show a profit for shareholders. If they could somehow break even it would be a win.

 

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