Affordable and Quality Health Care

[rmnka447]

There's a 900 lb. gorilla that no one advocating universal healthcare has addressed as yet. How do you expand the availability of healthcare to make healthcare receivable in a timely fashion by all the millions of additional people to be covered under the system? Right now, our healthcare delivery systems have a finite capacity and adding millions more individuals vying for that care will cause cost increases and scarcity resulting in rationing. Inevitably, that rationing will result in increased fatalities resulting from inability to receive timely care. How do we prevent that?

[barmar]

Single payer sounds good in principle, but since something like 76% of healthcare in this country is delivered under employer supplied plans, the question is whether you can convince all those people covered under those plans that it's better to be covered by a single payer government plan. I suspect that will be a very tough sell with some severe political ramifications if jammed down people's throats.

Why would they care? Either way, someone else is paying for it. And unless you get the most basic plan your employer offers, you often have to contribute to the premium.

 

Presumably the government would raise corporate taxes to pay for this. So whatever the corporations were paying to insurance companies, they would instead pay to the government, but it ends up being a wash.

[Winstonm]

There's a 900 lb. gorilla that no one advocating universal healthcare has addressed as yet. How do you expand the availability of healthcare to make healthcare receivable in a timely fashion by all the millions of additional people to be covered under the system? Right now, our healthcare delivery systems have a finite capacity and adding millions more individuals vying for that care will cause cost increases and scarcity resulting in rationing. Inevitably, that rationing will result in increased fatalities resulting from inability to receive timely care. How do we prevent that?

 

I worked in healthcare so I've seen some of this up close and personally. Prior to the ACA, hospital emergency rooms were the only places the working poor could go to seek care - this led to emergency rooms having to prioritize which patients to see first and led to long waits for the less emergent patients.

 

For the well-to-do, there is no reason they cannot continue as they have. There are doctors who have very private practices and they do not accept medicare or medicaid and limit the size of their practices.

 

You are right that supply and demand will take time to balance - and it will be a difficult adjustment. But something needs to be done to help hold down costs and get more people treated. Eliminating care in order to cut taxes for the wealthy has not been shown to be effective in generating jobs or economic growth, so why not admit that supply-side is not the sole answer but only a part of a greater economic system that is driven by demand, followed by supply-side savings that add to growth.

[Zelandakh]

So when did this bill get signed into law by Obama?

Did you bother to click on the link I provided?

The House and Senate established a conference committee to agree on amendments to the bill. The committee met on June 24, 2014. The House voted to agree to the conference report on July 30, 2014 with a vote of 420-5 in Roll Call Vote 467.[6] The Senate voted to agree to the conference report on July 31, 2014 with a vote of 91-3 in Roll Call Vote 254.[6] President Barack Obama signed the bill into law on August 7, 2014.[6]

 

Provisions of the bill

The bill costs nearly $2 billion.[1] Approximately $500 million would be used for hiring more doctors and nurses to work for the VA.

Veterans who live over 40 miles away from the nearest VA health clinic or who are unable to get an appointment in a reasonable time frame would be able to receive "choice cards" allowing them to seek treatment from a non-VA facility.[1] This would be a pilot program lasting for two years.[19] Veterans would be allowed to go to other providers that accept Medicare, the military's health program TRICARE, or at facilities run by the United States Department of Defense.[19]

The Secretary of Veterans Affairs would have increased power to fire senior executives.[19] The executives could be removed immediately from the payroll and would only have a week to appeal being fired.[19] Three weeks later, a merit board would make a final decision in that person's case.[19]

The bill would authorize the VA to build 26 new facilities.[19]

The bill would require public colleges and universities to grant veterans in-state tuition.[19]

The bill would improve the medical care that victims of military sexual assault receive.[19]

The Act shifts the cost of the medical treatment and care to the veteran's private insurance plan[20] and the Veterans Administration now requires joining the Choice program as a condition of receiving medical care[21], although this change has not been published, evidently prompted by the dismal failure of the Act. Congressman Jeff Miller's House Committee report[22] anticipated a $200,000,000 recovery from veterans' private health plans, but with only 84,386 appointments made through the first six months of 2015[23], shifting the cost to the private sector has not been successful.

 

As already pointed out, Trump extended the bill entered into law by Obama:

On April 19, 2017, President Donald Trump signed a bill into law extending the act.[27]

 

Everything clear now? :blink:

[Winstonm]

I wonder if it is due to lack of a civics class in our education system or the product of poor history training that leads people to view the political landscape as us verses them where everything one side has ever done is "wrong".

 

Facts are that both Republicans and Democrats have done their share of good things and bad things. Looking for the reality of situations will help anyone escape from the trap of being a victim of one-sided propaganda.

[Zelandakh]

I wonder if it is due to lack of a civics class in our education system or the product of poor history training that leads people to view the political landscape as us verses them where everything one side has ever done is "wrong".

The link I just gave in the Trump thread touches on this subject somewhat. I found it an interesting read.

[Winstonm]

The link I just gave in the Trump thread touches on this subject somewhat. I found it an interesting read.

Thx

[barmar]

I wonder if it is due to lack of a civics class in our education system or the product of poor history training that leads people to view the political landscape as us verses them where everything one side has ever done is "wrong".

I suspect it's a combination of lack of good civics education in schools, and the rise of social media and cable TV news networks. People who used to read major newspapers, which were not so heavily partisan (there were some biases, but nothing close to the extreme leanings of Fox News) now just watch and read networks and web sites that feed their beliefs. They only see alternatives in "us vs them" settings.

 

NPR has an annual tradition of reading the Declaration of Independence on the 4th of July. When they did it this year they were inundated with responses that didn't recognize it, and thought they were advocating overthrowing the Trump administration (the DoI never mentions King George by name, and only briefly mentions Great Britain -- it's mostly written in generalities that could easily be misinterpreted in light of current politics).

[Winstonm]

I suspect it's a combination of lack of good civics education in schools, and the rise of social media and cable TV news networks. People who used to read major newspapers, which were not so heavily partisan (there were some biases, but nothing close to the extreme leanings of Fox News) now just watch and read networks and web sites that feed their beliefs. They only see alternatives in "us vs them" settings.

 

NPR has an annual tradition of reading the Declaration of Independence on the 4th of July. When they did it this year they were inundated with responses that didn't recognize it, and thought they were advocating overthrowing the Trump administration (the DoI never mentions King George by name, and only briefly mentions Great Britain -- it's mostly written in generalities that could easily be misinterpreted in light of current politics).

 

I think you have it. Neil Postman wrote Amusing Ourselves To Death and hit on a similar theme - the changes in the way we receive information and how that changes our points of view. He points out that prior to telegraph, reading was the primary way we gathered information, and most of that was of the local variety. Now we have instantaneous information from just about anywhere in the world.

[mike777]

posters continue to fail to consider things such as innovation

 

crispr

robots

 

AI see Kurzweil

 

I fully understand these gains depend on at the very least innovation in nano tech.

[PassedOut]

posters continue to fail to consider things such as innovation

No, we don't.

[kenberg]

I suspect it's a combination of lack of good civics education in schools, and the rise of social media and cable TV news networks. People who used to read major newspapers, which were not so heavily partisan (there were some biases, but nothing close to the extreme leanings of Fox News) now just watch and read networks and web sites that feed their beliefs. They only see alternatives in "us vs them" settings.

 

NPR has an annual tradition of reading the Declaration of Independence on the 4th of July. When they did it this year they were inundated with responses that didn't recognize it, and thought they were advocating overthrowing the Trump administration (the DoI never mentions King George by name, and only briefly mentions Great Britain -- it's mostly written in generalities that could easily be misinterpreted in light of current politics).

 

Yes, and other factors. I will pick something from health care to illustrate my thoughts, since this is the health care thread.

 

The CBO predicts that 22m will lose health insurance coverage. OK, what are the details? I have seen that for 15m, this will be because while they were required to have coverage under the aca, they will not be required to do so under the new (and of course ever changing) plan. But surely more details are needed here as well. Will they be opting out because the price will go up or will they be opting out at the same price because the only reason they are carrying ot ow is because they are required to? And, of course, are the numbers correct?

 

 

Now people losing their health insurance is a big deal, no doubt about that. But (a) having something taken away, (b) having something become considerably more expensive, and © having the coverage remain available at the same cost but allowing people to opt out are three very different things. One could well imagine someone disapproving of taking something away, but approving of allowing a person the option to not participate. Then there are the practicalities. These 15m people are going to get sick, some very seriously, whether they have insurance or not. We will do what? I think at one point the Senate plan was that they would have to wait six months and then they could get insurance even with pre-existing conditions. So heart attacks were probably death, but a slow growing cancer could maybe be handled.

 

The world has always been complex, that is not really new, but there was a time when people were thought to be reasonably good citizens if they new the general outline of things. People like simplicity, I like simplicity, but care is needed. Our president has now discovered that health care is complicated. Who knew, he asked. Well, just about everyone. But there are some things we could think about without becoming experts on the economics of medicine. How do we divide up our responsibility to our fellow man as opposed to the view that people are responsible for themselves? No doubt I lean more in the direction of having government help for healthcare than some do, but it is not completely open-ended. Maybe someone who smokes two cartons of cigs a week could stop? It seems to me such things can be rationally discussed, but instead often people grab isolated pieces of data and start shouting.

 

Here is another way of describing the difference between now and then. The Korean War started when I was 11, and I followed it closely. I did not expect MacArthur to call me for advice.

[Winstonm]

Yes, and other factors. I will pick something from health care to illustrate my thoughts, since this is the health care thread.

 

The CBO predicts that 22m will lose health insurance coverage. OK, what are the details? I have seen that for 15m, this will be because while they were required to have coverage under the aca, they will not be required to do so under the new (and of course ever changing) plan. But surely more details are needed here as well. Will they be opting out because the price will go up or will they be opting out at the same price because the only reason they are carrying ot ow is because they are required to? And, of course, are the numbers correct?

 

 

Now people losing their health insurance is a big deal, no doubt about that. But (a) having something taken away, (b) having something become considerably more expensive, and © having the coverage remain available at the same cost but allowing people to opt out are three very different things. One could well imagine someone disapproving of taking something away, but approving of allowing a person the option to not participate. Then there are the practicalities. These 15m people are going to get sick, some very seriously, whether they have insurance or not. We will do what? I think at one point the Senate plan was that they would have to wait six months and then they could get insurance even with pre-existing conditions. So heart attacks were probably death, but a slow growing cancer could maybe be handled.

 

The world has always been complex, that is not really new, but there was a time when people were thought to be reasonably good citizens if they new the general outline of things. People like simplicity, I like simplicity, but care is needed. Our president has now discovered that health care is complicated. Who knew, he asked. Well, just about everyone. But there are some things we could think about without becoming experts on the economics of medicine. How do we divide up our responsibility to our fellow man as opposed to the view that people are responsible for themselves? No doubt I lean more in the direction of having government help for healthcare than some do, but it is not completely open-ended. Maybe someone who smokes two cartons of cigs a week could stop? It seems to me such things can be rationally discussed, but instead often people grab isolated pieces of data and start shouting.

 

Here is another way of describing the difference between now and then. The Korean War started when I was 11, and I followed it closely. I did not expect MacArthur to call me for advice.

 

The issue here is not who is in or who is out...it is about insurance and the state's right to compel coverage.

 

The whole idea of insurance is to spread risk among many. Imagine if liability insurance on automobiles were treated like health insurance under the Republican plan - do we really want any groups to opt out?

[barmar]

YThe CBO predicts that 22m will lose health insurance coverage. OK, what are the details? I have seen that for 15m, this will be because while they were required to have coverage under the aca, they will not be required to do so under the new (and of course ever changing) plan. But surely more details are needed here as well. Will they be opting out because the price will go up or will they be opting out at the same price because the only reason they are carrying ot ow is because they are required to? And, of course, are the numbers correct?

I haven't read the report, but I've been assuming that "lose health insurance" refers to people who have insurance under Obamacare only because the subsidies made it possible, but will not be able to afford it under Trumpcare. So it's not the difference in the number of insured people, but the number who can afford to be insured.

[kenberg]

The issue here is not who is in or who is out...it is about insurance and the state's right to compel coverage.

 

The whole idea of insurance is to spread risk among many. Imagine if liability insurance on automobiles were treated like health insurance under the Republican plan - do we really want any groups to opt out?

 

 

There was a sub-conversation about why there is so much intolerance for differing viewpoints and I was using this as an illustration. I was not arguing for or against a specific provision, I was saying that we coould start by observing that taking coverage away from someone is different from allowing them to opt out.

 

Barry, above, says "I haven't read the report, but I've been assuming that "lose health insurance" refers to people who have insurance under Obamacare only because the subsidies made it possible, but will not be able to afford it under Trumpcare.". I also am not sure of the details, but I do know of people who make too much to receive subsidy help but find the paynents burdensome. I think often they cope with tis by choosing a plan with very high deductibles, and they would surely drop it all together if this was an option. These folks are not in great shape with their high deductibles., I have seen this work out badly.

 

Of course this is a problem. I agree completely that it is a problem. My point was that if we hope to address the problem constructively and cooperatively, we need to look more carefully at the numbers. What is being said? This 22m predicted figure breaks down how? Having insurance denied is one ting, opting out is another. It seems fair to ask which it is. My guess is that in some cases it is one, in some cases the other, I don't know how the numbers break down.

 

Anyway, my intention was to look a little at how communication becomes unglued. There was reference to teaching more history and civics I assume in grades K-12. Perhaps. That would be another discussion, but no doubt history and civics are interesting and useful. Or they can be.

 

 

But to repeat, I was using this to illustrate how discussions become swamped by partisanship.

[Winstonm]

There was a sub-conversation about why there is so much intolerance for differing viewpoints and I was using this as an illustration. I was not arguing for or against a specific provision, I was saying that we coould start by observing that taking coverage away from someone is different from allowing them to opt out.

 

Barry, above, says "I haven't read the report, but I've been assuming that "lose health insurance" refers to people who have insurance under Obamacare only because the subsidies made it possible, but will not be able to afford it under Trumpcare.". I also am not sure of the details, but I do know of people who make too much to receive subsidy help but find the paynents burdensome. I think often they cope with tis by choosing a plan with very high deductibles, and they would surely drop it all together if this was an option. These folks are not in great shape with their high deductibles., I have seen this work out badly.

 

Of course this is a problem. I agree completely that it is a problem. My point was that if we hope to address the problem constructively and cooperatively, we need to look more carefully at the numbers. What is being said? This 22m predicted figure breaks down how? Having insurance denied is one ting, opting out is another. It seems fair to ask which it is. My guess is that in some cases it is one, in some cases the other, I don't know how the numbers break down.

 

Anyway, my intention was to look a little at how communication becomes unglued. There was reference to teaching more history and civics I assume in grades K-12. Perhaps. That would be another discussion, but no doubt history and civics are interesting and useful. Or they can be.

 

 

But to repeat, I was using this to illustrate how discussions become swamped by partisanship.

 

The written word can be a difficult communications medium. :D I didn't mean to challenge your beliefs but simply to point out at fallacy in the thinking of those who do think that way.

[cherdano]

I haven't read the report, but I've been assuming that "lose health insurance" refers to people who have insurance under Obamacare only because the subsidies made it possible, but will not be able to afford it under Trumpcare. So it's not the difference in the number of insured people, but the number who can afford to be insured.

This post is a bit strange. Why do you care about telling us your assumptions about the CBO report? Especially since writing this post probably took 5 times as long as googling and finding out that your assumptions are wrong?

[mike777]

At some point we will need to look at the hard numbers regarding Medicaid.

 

How much of the budget do we want it to consume...7 or 9 or 10%?

[Winstonm]

At some point we will need to look at the hard numbers regarding Medicaid.

 

How much of the budget do we want it to consume...7 or 9 or 10%?

 

Medicaid and Medicare would both be absorbed by a single payer system.

[Flem72]

The decision about Charlie Gard was not taken by bureaucrats, but by the medical team at his hospital. This decision was then affirmed by several courts. The view of the doctors and judges was that trying the suggested experimental treatment would be against Charlie Gards interests.

 

This case raises difficult questions that would be interesting to discuss. But that is hard to do while someone is spewing complete nonsense (bureaucrats???) about it, framing it as a fight between the free world and oppression under socialism.

 

In the traditional US medical system, doctors opine, they don't decide.

[kenberg]

Taking Cherdan's suggestion seriously I googled a bit and brought up

 

https://www.cbo.gov/...r1628senate.pdf

 

This is the CBO saying what it is saying. It's 49 pages, I have read some of it. An aside: Yesterday I was doing some home repair on a water softener and the company emailed me the manual. After some heavy reading I called them back to ask just what the hell the manual was saying. They were sympathetic and helpful. This CBO document has some similarities to the water softener manual.

 

I want to start with some assumptions.

1. For the moment at least, single payer is not on the table. This doesn't mean that we won't get there, but I want to skip over it for now.

2, The "repeal and replace" plan is in serious trouble. Maybe the Rs' will get together and ram something through but for now we should be looking to other possibilities.

3. There is at least some remote chance that sanity will prevail and there will be some agreement somewhere to the right of the middle to try to do something that is not embarrassingly stupid, cruel or both.

With that in mind I have a couple of thoughts, not really new.

 

 

We should think of Medicaid as being largely separate from the rest of the ACA. At least for most recipients, Medicaid is either very cheap or free for the participants. There is no reason we need to have an exchange to provide Medicaid, and there is no reason we need to penalize a person for not signing up for it. Presumably people will sign up for a program that provides them with free medical care. The question here would be how broadly to we wish to provide it, meaning both to how many people and what it would cover.

 

Yes, I understand it is not that simple. There is the fed-state collision on who decides what and who pays for what. And there are some people out there who are in such bad shape they can't manage to avail themselves of something that is free. Or they will refuse to do so. So yes, there are problems. But my main point is that with Medicaid, the first and foremost issue is how generous we wush to be and can afford to be. If that is agreed to, then I think the rest can be worked out.

 

Next, we need to think about what we should do with people who could afford health insurance but would rather spend the money elsewhere. These folks, some of them and eventually most of them, will have serious accidents or contract serious diseases. The plan is to do what? If they were all healthy one minute and dropped dead the next minute, there would be no problem. But that's not the way things go.

 

Now I want to think a bit about the phrase "Medicare for all". If we look a little closely, we might see an interesting point. When I turned 65, or maybe it was up to 66 by them, I became eligible for Medicare. There is more to it than that. Being 65/66 entitled me to something at no charge. I could also sign up for part B. Far better coverage, but at a price. I had to take it then or lose it (more precisely take it then or have it be far more expensive later). I signed up for B, as would anyone with even half a brain. I have a supplemental plan. I pay extra for this, it does more.

 

Now here is how this might relate. Let's look at Medicaid. Poor people need health care. No doubt about it.Quite possibly they need it more than the well off do. And certainly their kids need it. In analogy with Medicare, we could have something where if someone is at some level of poverty we give them free care at some level. A higher level plan would be available, but there would be a charge. And then they could supplement that if they wished, in this case it would be entirely a matter of market forces.

 

Maybe this would not fly. But what I think is needed is some preliminary thought as to just what it is we hope to accomplish. Right now the main goal appears to be to cobble together something that will fulfill a pledge to repeal and replace, and the issue of what the replacement will accomplish is of secondary importance, the goal is to have something, really anything, that can be sold as fulfilling the pledge.

[mike777]

Ken Just to be clear Medicaid is no longer just for the poor. I believe the cut off is now 140% of the poverty line. Medicaid has doubled its share of the federal budget the last few years. Which raises the question what if any limits to the budget are there?

 

Many posters here advocate to increase the eligibility to Medicaid. As usual the question is will evil Republicans vote to push millions off Medicaid while saintly Democrats vote to push millions more on.

 

My guess is in 2018 there will be more voters in favor of free health care

[kenberg]

Ken Just to be clear Medicaid is no longer just for the poor. I believe the cut off is now 140% of the poverty line. Medicaid has doubled its share of the federal budget the last few years. Which raises the question what if any limits to the budget are there?

 

Many posters here advocate to increase the eligibility to Medicaid. As usual the question is will evil Republicans vote to push millions off Medicaid while saintly Democrats vote to push millions more on.

 

My guess is in 2018 there will be more voters in favor of free health care

 

Well, it's not just for the very poor. But largely I think there is room for discussion here. I believe that as things stand now, Medicaid is binary. There is a line. Beneath it you have Medicaid and it is very good. Above it, just a little above it, and it is gone. And someone at 141 % of the poverty line is going to have a seriously tough time affording unassisted coverage at anywhere near that level. I think, but I am not at all sure, that there is some middle spade where the kisd are still eligible for Medicaid even if the parents are above the line and not eligible.

 

But my general thrust is that we need to think through as a country just what seems reasonable and what we can afford.

 

I have often posted that I believe this country has been very good to me. I could cite many examples, but I'll skip that. I think it is good for everyone to help people do better. I suspect that many of my fellow citizens agree with this. Obama once addressed some of this, but very clumsily, with his "You didn't build that" . This was an insulting and divisive way to get at a point that I think has merit. We all gain if we help people do better. I favor taking this view seriously, and I think that it would have broad support if presented correctly. Health care is certainly a part of this.

[Winstonm]

Well, it's not just for the very poor. But largely I think there is room for discussion here. I believe that as things stand now, Medicaid is binary. There is a line. Beneath it you have Medicaid and it is very good. Above it, just a little above it, and it is gone. And someone at 141 % of the poverty line is going to have a seriously tough time affording unassisted coverage at anywhere near that level. I think, but I am not at all sure, that there is some middle spade where the kisd are still eligible for Medicaid even if the parents are above the line and not eligible.

 

But my general thrust is that we need to think through as a country just what seems reasonable and what we can afford.

 

I have often posted that I believe this country has been very good to me. I could cite many examples, but I'll skip that. I think it is good for everyone to help people do better. I suspect that many of my fellow citizens agree with this. Obama once addressed some of this, but very clumsily, with his "You didn't build that" . This was an insulting and divisive way to get at a point that I think has merit. We all gain if we help people do better. I favor taking this view seriously, and I think that it would have broad support if presented correctly. Health care is certainly a part of this.

 

The ACA allowed states to expand Medicaid and many did, but not all. Without state expansion, a large group of working poor in these states neither qualify for Medicaid or have access to the subsidies of the ACA.

[barmar]

The ACA allowed states to expand Medicaid and many did, but not all. Without state expansion, a large group of working poor in these states neither qualify for Medicaid or have access to the subsidies of the ACA.

And Trumpcare rolls phases out this Medicaid expansion, and actually puts Medicaid on a budget.

 

This and the reducation in subsidies are presumably responsible for the vast majority of the people who would lose health insurance. Under Obamacare there were plenty of people who opted out of health insurance because the penalty was lower than the premiums.