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So a few days back a Chelsea statement was posted withthe non - interesting part of it bolded. The interesting part was her claiming Bernie's health care plan was poorly written and would let GOP governors gently caress it up like they did the Medicaid expansion. That is a very scary claim. So what is she basing this claim on? I didn't address it last night because I wanted to know more before commenting on it. Step one: read Bernie's proposed UHC bill. I hit a snag right of the bat. He doesn't have a set written plan. He's been promising to release one but hadn't yet. What he has is a collection of high level vision statements and the assertion that his actual plan will be based on a bill he sponsored in 2013 - S. 1789. Step two: read S. 1789 in its entirety. https://www.congress.gov/bill/113th-congress/senate-bill/1782/text I was eight paragraphs in when I began to see Chelsea's point. quote:
That's certainly bodes ill ... But it's high level. In the intro. What are the actual provisions of state powers and responsibilities? Reading on ... Good, good, weird, good, not sure what that even means, very good - keeping federal control of coverage minimums, oh. I think I found it. quote:
His plan would let the states set the reimbursement rates for doctors. So let's say you live in Kansas and Brownback set the reimbursement to $1 per service, with you being responsible for the remaining bill. Can you rely on any other program to help out? quote:
Looks like no. Pretty much all other forms of government assistance at the state and federal level are prohibited from covering anything in the uhc. There is one carve out though: quote:(d) Treatment Of Benefits For Veterans And Native Americans.—Nothing in this Act shall affect the eligibility of veterans for the medical benefits and services provided under title 38, United States Code, or of Indians for the medical benefits and services provided by or through the Indian Health Service. So the troops still get theirs. But you'll have to get private insurance to get your heart checked out ... Wait ... Wtf? Why is this even here? quote:
So if Brownback decides to add abortion coverage to the Kansas state plan with a plan pay of one penny, now all private insurers in Kansas are prohibited by federal law from offering abortion coverage. Wonderful. That'll take some rear end in a top hat all of 20 minutes to figure out. And I'm only a quarter of the way through. Need to read the rest, maybe something later mulligans and fixes this. Back in I go .... Ok, I started skimming. But then I saw this, this could fix it ... quote:
This could be an upward pressure on the state controlled payment schedule. It's draconian as hell but if doctors are forced to charge only the state mandated amount for covered care then you can't stick people with copays ... You can still do shenanigans like set the fee so low for certain items that doctors can't afford to offer the service at all but it would blunt things somewhat ... Never mind. This is in the participating providers section. Participation by doctors isn't mandatory. They have to opt in. If they don't then they can charge whatever they want. So we have a two tiered system of UHC in Kansas with poors who can't find doctors willing to accept the state reimbursement pennies and middle class+ people paying out of pocket ( since private insurance isn't allowed to cover anything on the list ). Moving on ..., stuff that seems ok, no brainers, how on earth would you even enforce that, good, general administration provisions ... Huh. So at the federal level you have a six member board determined by presidential appointment running this. They each have six year terms and one comes up for replacement every year. So in the fourth year of any presidential term the president has a majority. I wonder if Bernie has considered the potential for abuse ... Yes he seems to be aware of it: quote:
That's a lovely sentiment. But like several other much less relevant sentences, how the hell do you even enforce that? There is no DNA test for party affiliation. Blah blah blah, pay scales and titles. New section, cost containment. Huh. quote:
So ... Instead of tying it to inflation and putting in a floor by which it [b]must increase every year, Bernie put in a ceiling past which it may not increase every year. This, basically, loads a gun and puts it to the laws head. In the year of our trump 4 the trunpanista majority board members vote to reduce the plan budget to a pittance paid out to the states in quarterly installments of a fraction of a pittance. The democratic president who follows can't fix it because his board can only increase it 4% due to gdp growth. Brilliant. Moving on. Block grant wankery, boring , so tired, should I just stop? No. Next section is regulating state payment to providers. Maybe there are payment floors here. If there are and I don't read it I'll look really stupid when someone else point ms them out. Sigh. Ok, a lot of this is unworkable but not in a short quote way. Basically it attempts to resolve the conflict of interest between a fee per service model and wanting to save money by asking doctors pretty please not to abuse the fee per service model. It then continues to recommend that states increase the fees per service to address shortages .. Like if you need more pediatrician a increase pediatric fees. But it permits them to adjust the fees quarterly while it takes years to train a new doctor. So not really workable but whatever. Next section, prescription drugs! Yay! I used to work in this field. So Bernie's plan is we figure out what a drug should cost and strong arm the pharmacy into selling it for that much on pain of not covering them if they overcharge. quote:
There was a test case in my drug utilization review code for approving a liquid medication that cost 5x what a pill did. Same active ingredients. But the patient had injuries such that she couldn't swallow a pill but could swallow a liquid. So this "overpriced" drug was covered in her specific case because the cheap version physically couldn't be administered. If the margin on the liquid form was large enough to classify it as price gouging, but the patient needs that variant, then refusing coverage entirely is wrong. At least cover what you would cover if they weren't gouging. And making determinations like "better" or "available" isn't something a board can do in Washington. That's very much a physician on the scene call. Which is why our system allowed physician overrides of cost saving restrictions. That flexibility should be put in here. Ok, a bunch more stuff. None of it interesting. The payment section is actually pretty fleshed out but he took that transaction tax and is using it for a different promise so he can't re-use it in his final draft of this bill. Done. I rate the Chelsea's charge that this thing - as written - can't handle bad actors, "true". Uhc is good but this bill is poorly written.
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Jan 15, 2016 11:39
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McAlister posted:too many words Dude enough already just admit this is a bad tack for a democratic candidate to take against another dem candidate and move on. It's that simple. You don't have to twist yourself into knots to support every move this long term politician is going to make to try to win.
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Jan 15, 2016 12:48
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Its a bad idea to point out that one canidate has no real idea as to how to implement the policy that they have proposed? Or how to fund it? It as if one canidate is a back bench senator from a state with a population smaller than most major cities and near zero legislation under his belt that has risen to popularity spouting the same populist rhetoric espoused by the occupy Wallstreet crowd with a with a similar myopic view as to how these institutions operate. This poo poo is complicated. Acting as if anything can be solved in broad strokes is incompetence boarding on negligence. Its near the same as the addage of playing chess with a pigeon.
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Jan 15, 2016 13:09
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Bad actors are why 50+% of people have given up on voting altogether. I think the time for a constitutional convention is coming.
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Jan 15, 2016 13:11
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bird cooch posted:Its a bad idea to point out that one canidate has no real idea as to how to implement the policy that they have proposed? Or how to fund it? It as if one canidate is a back bench senator from a state with a population smaller than most major cities and near zero legislation under his belt that has risen to popularity spouting the same populist rhetoric espoused by the occupy Wallstreet crowd with a with a similar myopic view as to how these institutions operate. No, it's a bad idea to do it in such a way where the narrative in america is that: the ACA is enough and just needs tweaking what do we need that silly ol' single payer for. And mcalister is annoying. McDowell posted:Bad actors are why 50+% of people have given up on voting altogether. Not until the state governments actually get fixed or at least more even. Joementum made a very good case against it.
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Jan 15, 2016 13:19
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The aca is something we have to bulid upon vs. Pie in the sky ideals crusades. Tilting at windmills slays no dragons and gets us no better healthcare than we have currently. Improving and expanding the aca is a vastly more more realistic goal than wishing hard enough to make single payer happen when the aca could only get passed with both chambers and a boat load of concessions resulting in millions still without heathcare. The sanders campaign is vapor-ware in needs to be exposed as such as soon as possible. He has no healthcare plan, no tax plan, no politcal coalition and no party backing. All he has is a stump speach that is purpose built for a generation that grew up in the rubble of the bush administration but has no political memory of the time before with the battle cry of 'Lifes not fair!'. Its not and that sucks, but you dont fix anything by throwing the baby out with the bathwater. bird cooch fucked around with this message at 13:36 on Jan 15, 2016 |
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Jan 15, 2016 13:34
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The day we have enough Democrats in congress to improve the ACA is the day we have enough Democrats to pass Medicare-for-All.
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Jan 15, 2016 13:36
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No? You can tell by the aca exsisting.
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Jan 15, 2016 13:37
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bird cooch posted:No? You can tell by the aca exsisting. A good number of people who voted for it are gone or on the way out.
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Jan 15, 2016 13:39
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Healthcare should not be a thing that people can profit from, hth.
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Jan 15, 2016 13:58
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the_paradigm_shift posted:No, it's a bad idea to do it in such a way where the narrative in america is that: the ACA is enough and just needs tweaking what do we need that silly ol' single payer for. I think thats closer to the party narrative, it doesn't really square with the narrative I've observed over the past 7 years. The narrative in America in general seems to be split between considering the ACA a disappointment that amounted to nothing that would help anyone versus considering it as tyrannical overreach that has gutted the economy and destroyed heathcare system and killed tons of people. In my personal experience it's a cumbersome annoying program and I wish it could have been a lot better but it still managed to save my life and kept me insured when I was between jobs for a month (which was the difference between paying maybe 500 bucks for insurance covering my epilepsy medication vs. $10,000 per bottle) which is nice. So I'm pretty out of step with either side of this narrative, which is fine because both sides of that narrative are totally out of touch with reality.
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Jan 15, 2016 14:04
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Tight Booty Shorts posted:Healthcare should not be a thing that people can profit from, hth. So you're against doctors making a living, then?
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Jan 15, 2016 14:09
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Eschers Basement posted:So you're against doctors making a living, then? yes, just like all the doctors in all the other industrialized nations! 
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Jan 15, 2016 14:12
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Eschers Basement posted:So you're against doctors making a living, then? I'm sure majority of doctors got in their field to make money instead of saving/improving lives. 
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Jan 15, 2016 14:24
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Thankfully they can do both.
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Jan 15, 2016 14:25
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Typical Pubbie posted:Thankfully they can do both. And when you do both, you get the state of healthcare in America. Which is abysmal. Hope this helps 
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Jan 15, 2016 14:31
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bird cooch posted:No? You can tell by the aca exsisting. You could just admit that you don't understand politics instead of making such a statement.
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Jan 15, 2016 14:33
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Tight Booty Shorts posted:yes, just like all the doctors in all the other industrialized nations! so in other words, you're not actually against healthcare being a thing that people can profit from, hth
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Jan 15, 2016 14:34
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McAlister posted:bernie health plan breakdown yikes. turns out bonzai buddy does know a thing or two
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Jan 15, 2016 14:35
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Eschers Basement posted:So you're against doctors making a living, then? today I learned that employees of a non-profit draw no salary
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Jan 15, 2016 14:40
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WhiskeyJuvenile posted:so in other words, you're not actually against healthcare being a thing that people can profit from, hth What? In other industrialized nations, doctors still make a living even though they are part of a UHC system. Hth
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Jan 15, 2016 14:44
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https://twitter.com/Heminator/status/687993363828621317 The Business Wing of the GOP ladies and gentlemen.
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Jan 15, 2016 14:56
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Can state stuff go in here too? Because Brownback just released his governor proposed budget and most Disney villains would be too ashamed to have it attached to their names. http://www.kansascity.com/news/government-politics/article54451360.html Highlights include: Defunding Early Headstart. Privatizing the Bioscience Authority. Partially defunding the Parents as Teachers program if you're salary is 200% above poverty levels. Stealing $50.6m from the "Children's Initiative Fund" which is paid for by tobacco settlement money. $25.5m cut to SCHIP which provides healthcare to children in low income households and pretending it's fine because federal dollars increased. Eliminating the KanCare Health Homes which provides long term care for the chronically ill (both physical and mental health) on medicare/medicaid. These were created as a safety measure when the state previously privatized medicaid so that the chronically ill wouldn't be completely thrown out on the street to die. 
Anubis fucked around with this message at 16:39 on Jan 15, 2016 |
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Jan 15, 2016 15:06
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Taerkar posted:You could just admit that you don't understand politics instead of making such a statement. Thats funny. You are funny. Good job. McDowell posted:A good number of people who voted for it are gone or on the way out. This is true and not necessarily a good thing. bird cooch fucked around with this message at 15:13 on Jan 15, 2016 |
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Jan 15, 2016 15:07
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the_paradigm_shift posted:Won't they just keep appealing the settlement down to almost nothing like Chase did? No. You typically can't appeal a settlement or consent judgment (and the MBS settlements have included explicit appeal waivers). JPMC appealed a judgment (actually appealed a decision about how to allocate responsibility for WaMu, which they had purchased.)
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Jan 15, 2016 15:11
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Kalman posted:No. You typically can't appeal a settlement or consent judgment (and the MBS settlements have included explicit appeal waivers). JPMC appealed a judgment (actually appealed a decision about how to allocate responsibility for WaMu, which they had purchased.) Excellent I was really curious what made this different so thank you. At least they have to actually pay this money.
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Jan 15, 2016 15:15
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Anubis posted:Can state stuff go in here too? Because Brownback just released his governor proposed budget and most Disney villains would be too ashamed to have it attached to their names. Yeesh. This goes beyond typical callous douchebaggery into the realm of child hating supervillainy.
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Jan 15, 2016 15:15
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Adding hth to the end of your sentence is snide and condescending as gently caress, hth
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Jan 15, 2016 15:16
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Lotka Volterra posted:It's meaningless in the same way a speeding ticket is meaningless. It makes me sad and makes me somewhat more aware of how I'm driving (for a time) but doesn't mean I will never speed again, or even rarely. You're in nouveau D&D where Republicans aren't largely motivated by racism and where Banks can regulate themselves and where fines actually matter to financial institutions. Moderation in all things. Let's not be too hasty. If we get too riled up a socialist may get in White House! If you want anything to change regarding the financial institutions then people need to actually go to prison. Fines just don't matter in the long term since they punish institutions rather than individuals. Individuals make decisions within organizations and those individuals need to have harmful decisions dis-incentivized with harsh individual punishments. Until the folks who make these kinds of harmful decisions and implement these harmful practices at these financial institutions have to fear individual punishment nothing will change - in the same way that us peasants avoid committing crimes, if we're the type to want to in the first place, because we fear punishment. It's pretty basic human psychology, risk vs. reward stuff. Something anyone working in finance understands completely. The short term rewards of doing shady but profitable poo poo far outweigh any future fine the company you work for may have to pay. The risks have to be more likely and be more punishing for folks to avoid going after the reward.
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Jan 15, 2016 15:17
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Geostomp posted:Yeesh. This goes beyond typical callous douchebaggery into the realm of child hating supervillainy. Republicans in 2016. Yep, checks out. Edit: Doesn't China execute crooked bankers?
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Jan 15, 2016 15:20
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Quorum posted:Adding hth to the end of your sentence is snide and condescending as gently caress, hth some people deserve to be condescended to, hth
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Jan 15, 2016 15:29
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Eschers Basement posted:So you're against doctors making a living, then? lol ITT goons don't understand that people in non-profits still get paid
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Jan 15, 2016 15:35
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this_is_hard posted:lol ITT goons don't understand that people in non-profits still get paid Never mind med school being a giant pit you shovel money and coffee into.
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Jan 15, 2016 15:36
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I don't think doctor salaries are the primary cost driver for healthcare. But I wonder if docs would take smaller salaries if we subsidized the cost of med school.
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Jan 15, 2016 15:45
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In case anyone wants to keep track of super delegates, Paul Kirk endorsed Bernie Sanders this week. He was DNC Chairman from 1985-89, making him a delegate-for-life at the DNC.
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Jan 15, 2016 15:59
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zoux posted:I don't think doctor salaries are the primary cost driver for healthcare. Probably for many. But how would you deal with all the doctors currently practicing who would need to make a pay cut and didn't get their school subsidized?
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Jan 15, 2016 16:01
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zoux posted:I don't think doctor salaries are the primary cost driver for healthcare. My fiance will pay about $400,000 once it's all said and done so yeah if it was cheaper that'd be good. Also if residents got paid a fair wage that would be nice too. $44k a year for 80 hour weeks after 8 years of school is hosed.
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Jan 15, 2016 16:01
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zoux posted:I don't think doctor salaries are the primary cost driver for healthcare. Probably. My bro is looking for a job out in the sticks because it pays better than in places where people actually want to live because those places 'only' pay around 160k/yr. This matters when your loans are over a quarter million at usurious interest rates.
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Jan 15, 2016 16:02
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MasterSlowPoke posted:My fiance will pay about $400,000 once it's all said and done so yeah if it was cheaper that'd be good. Also if residents got paid a fair wage that would be nice too. $44k a year for 80 hour weeks after 8 years of school is hosed. I've always heard that the punishing residency stays around because if all the old docs had to do that, by god you will too. May be apocryphal, I guess. Shifty Pony posted:But how would you deal with all the doctors currently practicing who would need to make a pay cut and didn't get their school subsidized? You're going to have to fight docs, nurses and institutional inertia if you want a sweeping reform of the US healthcare system, so we should probably start preparing ourselves to deal with doctors' hurt feelings anyway.
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Jan 15, 2016 16:07
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MasterSlowPoke posted:Also if residents got paid a fair wage that would be nice too. $44k a year for 80 hour weeks after 8 years of school is hosed. Also true. Long hours in the medical profession also strikes me as unwise from a patient safely perspective as well.
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Jan 15, 2016 16:08
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