Bipartisan Health Care Effort

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gnjsdad said:
I believe Medicare negotiates rates with every private insurer. The government has no say, a situation I find astounding from a cost standpoint.

The government of every other advanced country regulates the prices of all medical goods and services. It’s why their costs are half to a third cheaper per capita than ours.
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Medicare only negotiates administrative costs with private insurers. Private insurers don’t get the reimbursements themselves. The government definitely has a say in what it pays. It’s a complicated process, and is based on “reasonable and necessary” costs as determined by the medical providers. The providers can build all their “costs” into that number, and do so, including all the administrative pork and duplicative services they can pack into them. In the private sector, and in it alone, the insurers can negotiate prices with the providers.

Failure to regulate prices, however, is not the reason many foreign costs per service are lower than ours. Much of the cost in those countries is not “counted”, as I mentioned before.

I really don’t know how much “cheaper” advanced country costs are than American costs. I did, however, compare Mexican costs with American for one insurer. They are about 1/3 to 1/2 less than ours. Some of their providers are excellent. Some are dismal or worse. That’s a problem.

But in “first world” countries, I doubt there’s much difference except in the use of medical equipment like MRIs, and the “hidden” costs that nobody counts, like the special court system in France.
 
gnjsdad said:
Such a two-tiered system would be acceptable as far as I am concerned. Those who could afford it or desire to access it would opt for the “private” area.

Seems to me the French are quite satisfied with the quality of care in the “public” sector.
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I have no idea how “the French” feel about the quality of care in the “public” sector. But for most of them, there’s no choice anyway, so their satisfaction or dissatisfaction doesn’t matter.

I do think there could be merit to a “two tier” system, so long as it’s paid for and the burden is not unfairly spread out, as is the case with Obamacare. The very first thing that would have to be determined is what to do with employment-based insurance. That is, in effect, a subsidy to larger businesses, paid for by others, due to the 'well worker effect".

Are we going to do away with it? Since about half the population gets it, I doubt it’s politically possible. Fail to do it, and the “two tier” system fails to “spread the risk” appropriately.

Since even employment-based insurance operates on the “do everything” American medical system (not the case in other countries as we have learned with Charlie Gard) I think disturbing that system would be very unacceptable to half the population.
 
Book_Worm said:
Except that it’s working in every other industrialized country in the world, for less money, and with better outcome.
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Where in the world did you get that idea? It certainly doesn’t give better outcomes or people would not die waiting for a procedure they can get here one or two days after diagnosis. Let’s get real here.
 
Sy_Noe said:
Healthcare is complicated as even the “almighty” Donald Trump eventually admitted. But one of the reasons I supported Bernie Sanders was because of his call for universal healthcare or as he has referred to it, “Medicare for all”. And short of that, all I know is I’d like, at the very least, a government option that people at least could try out and test drive. And see how it works for them.
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The Govt option you are describing requires the Govt to start delivering the healthcare services. Do you think they’ve shown themselves capable with the VA?

Why do you think they’ll get better at it if they do it more broadly?
 
Book_Worm said:
Except that it’s working in every other industrialized country in the world, for less money, and with better outcome.
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We are the United States meaning anything if this nature should be left to the individual states to decide.Not the job of the federal government to take over 1/5 of our economy.Not the job of the federal government to force us into purchasing something we may neither need or want.It isn’t working now and it will fail.That may be the silver lining in these three liberal in republican clothing senators going against their party.Like Trump said,let it implode!👍
 
Jeanne_S said:
We are the United States meaning anything if this nature should be left to the individual states to decide.Not the job of the federal government to take over 1/5 of our economy.Not the job of the federal government to force us into purchasing something we may neither need or want.It isn’t working now and it will fail.That may be the silver lining in these three liberal in republican clothing senators going against their party.Like Trump said,let it implode!👍
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I have no idea how much money the government spends on Obamacare. But I do wonder whether, if the money was simply given to the states, they could put it into the “assigned risk” fund and do better with it.
 
Ridgerunner said:
I have no idea how much money the government spends on Obamacare. But I do wonder whether, if the money was simply given to the states, they could put it into the “assigned risk” fund and do better with it.
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Or spend it on other things like pensions. 🙂
 
Ridgerunner said:
I have no idea how much money the government spends on Obamacare. But I do wonder whether, if the money was simply given to the states, they could put it into the “assigned risk” fund and do better with it.
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My guess is yes!👍
 
ProVobis said:
Or spend it on other things like pensions. 🙂
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You have a point with that. I doubt it would happen in my state, though. Our legislature is so overwhelmingly Republican that I can’t see them doing it. Besides, our state employee pensions are fully funded EXCEPT for judicial salaries and they’re in the process of changing that to defined contribution too. Judges don’t like it, of course, but it’s about time.
 
mary_bobo said:
Where in the world did you get that idea? It certainly doesn’t give better outcomes or people would not die waiting for a procedure they can get here one or two days after diagnosis. Let’s get real here.
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Yes let’s…

Wait times in the US are in line with many and actually much worse than Britain. The Commonwealth Fund, a New York-based foundation that focuses on health care, compared wait times in the United States to those in 10 other countries. “We were smug and we had the impression that the United States had no wait times — but it turns out that’s not true,” said Robin Osborn, a researcher for the foundation. “It’s the primary care where we’re really behind, with many people waiting six days or more” to get an appointment when they were sick or needed care.

nytimes.com/2014/07/06/sunday-review/long-waits-for-doctors-appointments-have-become-the-norm.html

And even data predating the ACA, shows the U.S. spent more on health care than other high-income countries but with worse outcomes.

commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective
 
Theo520 said:
The Govt option you are describing requires the Govt to start delivering the healthcare services. Do you think they’ve shown themselves capable with the VA?

Why do you think they’ll get better at it if they do it more broadly?
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Yes now that Republicans with control of everything, the House, the Senate, the White House and the SCOTUS… have failed as promised for 7 years to repeal and replace Obamacare with something as Mr Trump promised would be such a beautiful picture and terrific and great insurance for everybody with no one losing coverage and it would be a lot less expensive for everyone… and they were even unable to do so with merely a 50 vote threshold rather than 60 when they have over 50 senators.
 
Sy_Noe said:
Yes now that Republicans with control of everything, the House, the Senate, the White House and the SCOTUS… have failed as promised for 7 years to repeal and replace Obamacare with something as Mr Trump promised would be such a beautiful picture and terrific and great insurance for everybody with no one losing coverage and it would be a lot less expensive for everyone… and they were even unable to do so with merely a 50 vote threshold rather than 60 when they have over 50 senators.
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Let’s not get too smug too soon. It could still happen.

It’s not “control” when you have 52 members in a senate in which many things require 60 votes and the opposition party is utterly determined to defeat anything the slim majority wants to do.

And the Repubs don’t “control” the Supreme Court, either. Gorsuch’s confirmation only returned it to the status quo prior to Scalia’s death.

It’s not over until it’s over.
 
Ridgerunner said:
It’s not “control” when you have 52 members in a senate in which many things require 60 votes and the opposition party is utterly determined to defeat anything the slim majority wants to do.
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They could change this rule with a simple majority vote.
And the Repubs don’t “control” the Supreme Court, either. Gorsuch’s confirmation only returned it to the status quo prior to Scalia’s death.
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There are 5 Republican-nominated justices to 4 Democrat-appointed justices.
 
Sy_Noe said:
Yes let’s…

Wait times in the US are in line with many and actually much worse than Britain. The Commonwealth Fund, a New York-based foundation that focuses on health care, compared wait times in the United States to those in 10 other countries. “We were smug and we had the impression that the United States had no wait times — but it turns out that’s not true,” said Robin Osborn, a researcher for the foundation. “It’s the primary care where we’re really behind, with many people waiting six days or more” to get an appointment when they were sick or needed care.
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There are undoubtedly places where one would have six days’ wait for routine office care. There are places where one would not, including where I live. One day is about the max for me, and sometimes not even that. I get in on the same day most of the time.

But is routine office care the test? From your article:

"Americans are more likely to wait for office-based medical appointments that are not good sources of revenue for hospitals and doctors. In other countries, people tend to wait longest for expensive elective care — four to six months for a knee replacement and over a month for follow-up radiation therapy after cancer surgery in Canada, for example.

In our market-based system, patients can get lucrative procedures rapidly, even when there is no urgent medical need: Need a new knee, or an M.R.I., or a Botox injection? You’ll probably be on the schedule within days."

And in my experience, that’s true. If the primary care doctor thinks you need an MRI for a shoulder strain, you’ll get it that same day or next day at the longest. If the doctor suspects cancer, you will almost certainly be at the oncologist’s that day if you make it there. AT most a couple of days.

And then too, Brit care is deteriorating due to costs. Looks like more and more Brits are turning to private care. Let’s see what the socialists say about their socialist system. Among other things, it’s deeply in the red and losing both physicians and nurses.

wsws.org/en/articles/2013/10/19/heal-o19.html
 
lmachine said:
They could change this rule with a simple majority vote.

There are 5 Republican-nominated justices to 4 Democrat-appointed justices.
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It’s true the Repubs could do away with the “traditional” rule in the Senate. That they don’t is, in my opinion, worthy of criticism. They apparently don’t realize yet that they’re in a war, not a gentlemens’ club.

Anthony Kennedy can be thought of as “conservative” in many things. But when it comes to prolife issues, he’s a howling liberal. To his credit, though, partial birth abortion was too much for even him. So he joined with the other Repub justices to allow states to ban it. Not surprisingly all four Dem appointees wanted partial birth abortion to be the “law of the land”.
 
Ridgerunner said:
Let’s not get too smug too soon. It could still happen.

It’s not “control” when you have 52 members in a senate in which many things require 60 votes and the opposition party is utterly determined to defeat anything the slim majority wants to do.
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What happened to simple things like removing the tax on medical supplies or buying across state lines which might bring some bipartisan support? IMO they could get it if they don’t call it “repeal;” but if they insist on “repeal” the Democrats will be determined to defeat anything that falls within its realm. Nothing to scratch your head over.
 
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