Health Care Reform Part IV: The Trumpening

Treat for you @argentine soccer fan starts at the 0.47

 

His goal is up for nomination for the Puskas Award
That would be something if he would win that award.

 

@argentine soccer fan, I am bumping this from the Election thread to the current Healthcare Reform thread:

Let me preface this by saying I am answering your comments.

Oh, boy, I really did not think I was going to get into this discussion today. However, here goes.

First,
You are confusing health coverage with health care. Almost nobody in the US is advocating for a public health care system.

Medicare for All (if we want to agree on that name) is a publicly funded, publicly administered health insurance system, paid for through a component of employee and employer FICA.

Functionally, it is not fundamentally different than an employer-based health insurance system (including the employer/employee funding model), except with five important distinctions:
-it is not tied to your current employer, it would travel with you whenever or where ever you change jobs
-it could not be changed, dropped, reduced or otherwise f*cked with by your employer
-it would be non-profit, taking the vultures out of the system
-it would create the largest possible pool of participants, thus, in reality, providing better coverage at an ultimately lower cost, as those with higher risks would be offset by those with lower risks, just like in every other form of insurance.
-it would also partially fund Medicaid, to provide that comprehensive coverage for individuals you are not employed (for whatever reason), are employed at an employer that would not provide private coverage, are ill/living with a disability, etc. Yes, there is a bit social welfare, but goddamn it, that is a good thing. I don't want people getting sick and dying 'in the streets.' Do you?

Second,
1. It is not a question between "public hospitals" and "private hospitals" as there are very few public hospitals. So, really, not much a choice.
2. Nobody is saying it is stupid to have private insurance. I have private insurance, as do the vast, vast percentage of people in this nation. It is primary option and prior to the ACA, pretty much the only option, unless you are retired (Medicare), are a low income senior or living with a disability (Medicaid), a veteran (VA) or (thanks to the ACA) either able to purchase on an exchange or "fortunate" enough to be low income and living in a state with Medicaid expansion.
What I am suggesting is two-fold:
a. There are tens of millions who are uninsured, there are tens of millions (probably approaching 100 million) who already have "public" health insurance. They should have coverage.
b. It would be far less expensive, with far better outcomes to take the profit out

3. The "taxes" the for-profit medical industry plays, in particular by for-profit hospitals, is negligible from a funding of the system perspective AND in relation to the profit they receive from simply serving as a middle man, driving up your costs. It is worse with so-called non-profit hospitals. They pay almost no taxes-especially property taxes and "corporate" taxes, since they are private, but technically non-profit.

4. It is important to remember exactly what health insurance is. Health insurance does not provide any service other than spreading the risk of loss as wide as possible, while minimizing the expenses.

5. Your coercion argument is beyond comprehension.
I have to quote this, as I do not want to be accused of putting words in your mouth: "On the other hand, if you coerce me to join the public option against my will, then you will be destroying one of the sources of funds for your public option, while in the process taking away my right to choose."
I am really quite shocked that you would raise it.

a. What "choice" are you describing? The choice NOT to have insurance? Most employer-based insurance does not have many "choices." You get the plan, or a small number of options, the employer chooses. There is very little choice.
b. The "source of funding" from taxation is negligible.
c. Note, I am not advocating the "taking away" the right "to choose." However, it is important to remember that employers do not "give" you health insurance. The employer based health insurance is part of an employment package, at least for those employees who receive the "benefit" of employer based health insurance. If employers did not provide it, they could pay employees more. Also, most employees pay a percentage of the premiums directly, as well as paying the total premium indirectly through lower wages (since the employers calculate the cost of coverage in the compensation package).
Now realistically, this should be pretty much a wash, as the FICA would go up to pay for the "public insurance" Medicare for All program.
d. None of this has any effect upon how much doctors or medical professionals earn, by the way. They should at the top of the economic ladder. The education, dedication, pressure and risk they endure means they should be rewarded accordingly.
e. Your statement "coerce me to join the public option against my will" defies logic. If one "coerces" you to "join the public option" it would NOT be an "option" would it? This statement makes no sense.

Finally, nobody's plan, destroys the ability of anyone to obtain private health insurance. You could still do that. It would, eventually, become prohibitively expensive.

You have the OPTION to hire your own fire brigade if you choose. Nobody is stopping you. However, 1) you would still have to pay taxes to fund the public system and 2) it would be insanely expensive to have your own fire station, fire marshal, fire trucks and, of course, Dalmatian.

I will end on a comment I have made a few times in the past.
I do not have kids, I have never had kids, I never will have kids. However, I own a house and most of my property taxes to funding the local system (with a part for police, fire and other governmental services). That is part of the commons, it is a benefit to society to have public schools and an educated populace. I receive absolutely NO direct benefit, but there are immeasurable indirect benefits of having an educated populace. For all of the downsides to the current state of public education (and improvement is desperately needed), it is way better to have an educated populace than not.

I see the exact same argument in favor of public health insurance. Having an insured and protected population is a tremendous benefit to the nation. From lower costs of emergency rooms, to fewer infectious diseases, to a better response to something like a pandemic.

Considering the ACA was modeled on the Heritage Institute, Mitt Romney's plan in Mass. and far more "radical" plans throughout the western world, calling it "left wing" is a bit disingenuous.

I am sorry that you believe that "rights" are left wing.

 

Well, your employer is already doing that, so thank your employer.
Actually, your employer is not dong that, your employer's for-profit health insurance company is doing that. Oh, and they will "manage" that for you with a very strong eye towards their own profit, at your expense.
So you can thank your abusive "uncle," I guess.

Once again, under ANY system, including NHS, you can "determine for yourself" if you wish to pay for other care. That is your choice.

 

There's a reason why it is called Medicare for all. You'd be "buying into" the Medicare program. So if you're doctors accept Medicare, you'd be fine.

 

In the Dutch system you can choose at your insurer between an insurance policy that gives you the freedom to choose whatever hospital or doctor you want in the Netherlands (called restitutiepolis) and one that is cheaper, but then your bound to the hospitals and doctors the insurer got contracts with in your vincinity.
Also you can add things to your basic policy, which every insurer has to comply with and they cannot refuse to accept you.

 

Sorry. No you didn’t. The when was determined by the surgeon and acute care facility. The where was determined by your insurance provider. You got to choose amongst their pre defined list. Or you would have paid out of network for that “choice”. The how you got to choose. The Who (great band) was determined by your insurance company unless you chose to pay out of network.

with single payer, there is zero incentive for any doctor to choose another patient over you. It is the ultimate in absolute total choice in who what when and wear. It is everything you want and think you have.

 

This is a great read for those who think that somehow there are magical unicorns running the market. It is short, direct an enlightening:

https://dimosioshoros.files.wordpress.com/2010/09/23_things.pdf

Basically, a lot of the things we assume are done "naturally" by free markets, are set up by either government or a powerful part of society. All in all, there's nothing that prevent us from changing what goods or services are on a freer market or on a more controlled market, only our own willingness to change the framework.

Once you accept that there are not really naturally free markets, you can then change a lot of things.

 

ASF, my SO worked for the local hospital as a medical tech, and needed a knee replacement and back surgery. She held out until retirement and Medicare specifically because she knew exactly which surgeons she wanted to do the surgeries, because her job was showing her the outcomes people were getting from them. Her hospital insurance did not give her the option of using either specialist.

Medicare did. And also both paid the surgeon better and charged her a smaller deductible. The right wing fear stories do not seem to be true for her, me or a raft of friends and colleagues in ether theory or practice; they grossly underestimate both the economies of scale involved and the constriction of choice.

In my time in the state education finance system, I dealt with state insurance for teachers and administrators. The state self insures them, with the nuts and bolts contracted out to BCBS for the routine stuff and Lloyd's backstopping the catastrophic, and state contracted coverage through private vendors for vision and dental.

A bunch of longstanding local, quality practitioners reached retirement in about a five year period, in my time there, and sold their practices-- which then went through a completely predictable cycle. They would be bought by youngish extremely competent docs who wanted to come to Taos for the skiing, fishing, or both. They would settle in for a brief overlap period, be shocked at the levels of payment their predecessors would accept from the State of NM system and its vendors, and withdraw from its networks the instant they had control.

Then to their further shock, they would find that their core employees, who had all seen this cycle before and knew where it went, began jumping jobs to other practices, particularly the Indian Health Services.

And then they found out why people are jumping ship.

The NM State Educators insurances are the absolute backbone of medical finance in the state. They pay on time or early, and exactly what they promise; the state insists on this before it issues the annual charters, and they don't reup anybody out of routine or momentum. If practices are complaining about any vendor, they drop them. Docs who drop out of network experience lumpy cash flow and have difficulty in amortizing their practices. Those who work with the system find that they get the days of fishing and skiing they expected-- and so do their employees... and not because there's any improper compulsions involved...just because it actually works.

 

As many have explained here, what you think of as the public option has nothing to do with limiting your options. You have been misinformed. Please listen, instead of continuing to blame others for not understanding your point. I just read 4+ very long and well explained posts that point out quite clearly that your fear is unfounded.

Seeing that you can't see or don't even try to understand this point is an example of what makes it so frustrating for anyone believing in trying to give people more health care options.

 

Since I don’t think you noticed....none of the bolded have anything to do with insurance. They have to do with the actual healthcare you received, not your insurance plan.

it’s not that we can’t see something. It’s that we refuse to allow you to debate x when the discussion is about Y.
Your argument is as dumb as saying regulations of the auto loan industry would limit the types of cars automotive companies sell. While they both have auto in the names, and they’re somewhat related, one has zero affect on the other.

on a side note...I’m glad we can go back to debating the stupid policies and bullshit put forth from the right instead of wondering about the end of our republic.

 

The government won’t deny you the right. Private health insurance will be the buggy whip of this century. If you really want to keep your buggy whip....have at it.

 

????

 

Medicare has been around since 1966 and it is already more efficient than private insurance... So.. Problem solved. Your fear is entirely unfounded.

 

"Senator from Vermont. If elected president, he’d push for a single-payer plan that would eliminate private insurance, be free of copays and deductibles and give Americans the right to chose their doctor and hospital." (Esquire)

I had forgotten that he was proposing to chase private insurance away, both because he wasn't going to be the nominee, and because he wouldn't have the power even if elected.

If his system worked well enough private insurance would mostly die on the vine, but it is just not possible either that Congress would vote to outlaw it or that the courts would not overturn such a law...

I'm not finding anywhere that Warren actually proposed ''getting rid of" private insurance; just a sort of conciousness that it would dwindle because it would only be able to find niches of the market to survive in. Which would itself be classic free market evidence of superiority

Williamson? Cant even remember who that is/was...

And again-- my personal experience has been that private insurance well above average has been way more restrictive of choice than Medicare or Medicaid (which i was on for several months.) It is probably worth mentioning that my MS doc is pretty much the guy in my time zone, and the specialist who handles my other serious issue is successor to the guy in my state and excellent (I got a little bit lucky to draw their attention in each case)-- and again neither Medicare nor Medicaid has had the slightest question about their bills or my qualification for the frequency of them...

 

let’s talk about health care. I’ll define it so we can discuss it.

Healthcare is prevention, diagnosis, treatment and recovery.

in that continuum of healthcare, can you provide me one example where insurance, even that fantastic amazing insurance you apparently have, provides patient value and improves their health?

 

Again.. Medicare has been providing health insurance for the most unhealthy group of Americans since 1966 and it has been doing so with good results based on the health of its patients. Your point is largely one based on wild speculation that is entirely unfounded.