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Hieronymous Alloy posted:There is only one winning strat right now in health care politics, it is Medicare for All/ public option Medicare, and it is politically impossible until after the Republicans fall on their faces. The party in power does not own the status quo in any real sense. That's the problem: they own any change from the status quo, and (as the last 8 years have taught us) mostly own only the downsides while people with the upsides think voting trump is the way to save their healthcare  So yeah, public option medicare is the way to go, provided that you make sure that nobody is forced into it because even if they're entirely better off forced into it they will hate you for it and blame every little thing that goes wrong on you.
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Mar 10, 2017 19:27
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evilweasel posted:So yeah, public option medicare is the way to go, provided that you make sure that nobody is forced into it because even if they're entirely better off forced into it they will hate you for it and blame every little thing that goes wrong on you. Would GOP support single-payer if it was entirely funded by the insured? Bernie's plan made it a payroll tax that was split between an employee and the employer (2.2% for employee and 6.7% for employer). If you made it just 9% across the board for all working Americans - would that be enough? Someone making 20k/year would pay $150/month to the single-payer tax Someone making 50k/year would pay $375/month to the single-payer tax Someone making 100k/year would pay $750/month to the single-payer tax That sounds completely reasonable to me, and dependents would be covered regardless of what you pay
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Mar 10, 2017 19:39
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if you're asking whether the GOP would support a large payroll tax increase to fund literally any form of health insurance administered by the federal government, the answer is "never in a million years"
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Mar 10, 2017 19:42
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EugeneJ posted:Would GOP support single-payer if it was entirely funded by the insured? No. Because this isn't entirely funded by the insured, it's funded by the wealthy. The core conservative problem* with Obamacare is that it taxes the rich to help the poor which is why their repeal bill is a massive upper-class tax cut. Fundamentally what conservatives want is that the rich don't have to help pay for medical care for the poor. There's some Republicans who don't share this randian dogma but the randian dogma holds the whip hand. *they pretend to care about a lot of things for political reasons, but this is the core issue: Obamacare raised taxes on the rich to fund health care for the poor. They just needed better political attack lines than that. evilweasel fucked around with this message at 19:45 on Mar 10, 2017 |
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Mar 10, 2017 19:43
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What we really need is a cheaper, lesser tier of healthcare affordable to the poor. Maybe we could developer a 2nd tier healthcare system that allowed foreign medical graduates to practice without passing US medical boards? I know a lot of Caribbean and Indian doctors would be glad to come here and make 1/3 of what the median US doctor makes.
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Mar 10, 2017 19:48
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Twerk from Home posted:What we really need is a cheaper, lesser tier of healthcare affordable to the poor. Maybe we could developer a 2nd tier healthcare system that allowed foreign medical graduates to practice without passing US medical boards? I know a lot of Caribbean and Indian doctors would be glad to come here and make 1/3 of what the median US doctor makes. Labor cost of doctors is only 10% of the total cost of healthcare though. Cutting doctors' wages by 25% or even 50% would be a much greater savings than having health insurance companies run at cost and changing nothing else about running their businesses, but it still wouldn't be a great cost savings for Americans. silence_kit fucked around with this message at 20:43 on Mar 10, 2017 |
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Mar 10, 2017 19:58
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silence_kit posted:Labor cost of doctors is only 10% of the total cost of healthcare though. Cutting doctors' wages by 50% would be a much greater savings than having health insurance companies run at cost, but change nothing else about running their businesses, but it still wouldn't be a great cost savings for Americans. Then also let them import drugs from developing countries that don't have to conform to FDA regulations, boom 2 tier healthcare system completed!
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Mar 10, 2017 19:59
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Twerk from Home posted:Then also let them import drugs from developing countries that don't have to conform to FDA regulations, boom 2 tier healthcare system completed! You are truly a brilliant policy wonk. But yeah, medicine is too important and medical costs are getting too high to allow doctors to cartelize the profession and jack up costs. We need to admit more people into medical schools and residencies, and medical schools should be structured so that you can enter after high school and not have to pay for four years of college for like maybe one and a half years' worth of pre-med education. It's wasteful. silence_kit fucked around with this message at 20:37 on Mar 10, 2017 |
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Mar 10, 2017 20:33
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silence_kit posted:You are truly a brilliant policy wonk. Most require 2-3 years of chemistry. I guess you could complete a full ochem and pchem sequence in 2 years if you get the general chem courses knocked out from AP credit or the like It seems like med school should be able to be setup like pharmacy school where you don't necessarily need the bachelors first just the curriculum. The problem however is not a lack of qualified candidates for medical school, it's that med schools don't want to graduate doctors that cannot be placed in residencies. The number of residencies available has been staying flat because the overwhelming majority of funding for it is from the federal government. hobbesmaster fucked around with this message at 21:06 on Mar 10, 2017 |
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Mar 10, 2017 21:03
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hobbesmaster posted:The number of residencies available has been staying flat because the overwhelming majority of funding for it is from the federal government. This doesn't make that much sense to me--why are residents a net drain on hospitals? It seems to me that there could be a lot of useful work that they could be doing at hospitals and so they'd be a net benefit to them and not a hindrance. Also, I'm sure that the doctors' lobby had absolutely nothing to do with writing the laws that seriously limit residencies and ensure high salaries and incredible job security for doctors . . .
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Mar 10, 2017 21:11
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A MD that has completed residency is not allowed to do anything on their own until completing their residency. They are considered a drain because everything they do is supposed to be checked by an attending. This is different from a PA or NP who is allowed to operate independently within certain guidelines.
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Mar 10, 2017 21:15
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hobbesmaster posted:A MD that has completed residency is not allowed to do anything on their own until completing their residency. They are considered a drain because everything they do is supposed to be checked by an attending. Is being a doctor really like an episode of House, M.D. where you are constantly making judgement calls on esoteric diseases and oddball symptoms that only a veteran would be able to diagnose, or is there a lot of stuff that residents could do on behalf of the veteran doctors that would greatly enhance the veteran doctors' productivity? I suspect that reality is more like the latter than the former. silence_kit fucked around with this message at 21:25 on Mar 10, 2017 |
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Mar 10, 2017 21:23
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silence_kit posted:Is being a doctor really like an episode of House, M.D. where you are constantly making judgement calls on esoteric diseases and oddball symptoms that only a veteran would be able to diagnose, or is there a lot of stuff that residents could do on behalf of the veteran doctors that would greatly enhance the veteran doctors' productivity? I suspect that reality is more like the latter than the former. And on the rock of "it seems to some rando on the internet," we shall rebuild our health care system. To lay this one out simply, silence_kit, when you gently caress up a diagnosis, people die. The difference between "take some aspirin and call me in the morning" and "that aspirin will in fact kill you because important bits of you have hosed up pH" is a series of small details that you have to know to look for, because the patient's unlikely to volunteer them. Courtesy of this, there is no doctor in primary care who has not, through making a mistake, killed a patient, whether through missing something critical or actively prescribing a course of treatment that kills someone. Seriously, they don't exist. It's a business where gently caress-ups are measured in human lives and nobody is perfect. You are correct in your guess that residents could do a lot of stuff without being checked by veteran doctors! For that matter, four times out of five, a reasonably bright high schooler could handle a primary care patient by dressing "eh, don't worry about it, you'll be fine" up in medicalspeak! That remaining 20%, you need someone who knows what the gently caress they are doing, or people die. And you don't know who that 20% are until you're talking with them. For understandable reasons, the principle "try not to kill patients" is kind of foundational to the design of medical education.
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Mar 10, 2017 21:46
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otoh people surviving medical emergencies is clearly not one of the current administration's priorities, so now's the time to change the rules!
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Mar 10, 2017 21:52
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evilweasel posted:I don't think it's happening. I was already feeling vaguely hopeful but if Senator Cotton, noted piece of poo poo and fervent Trumpenstaffel sturmgrenadier, is saying its a stupid piece of poo poo that will make health care worse, I don't see it getting anywhere in the Senate. When did cotton start rocking the Paul Ryan Muslim beard
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Mar 10, 2017 21:57
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I checked with a local pharmacy and I can get a subsidized prescription when I lose health insurance. Not sure how.long that will last though.
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Mar 10, 2017 21:57
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Azhais posted:otoh people surviving medical emergencies is clearly not one of the current administration's priorities, so now's the time to change the rules! Fun fact: the major change in provider mechanics over the last several years has been a shift away from focus on highly specialized doctors- cardiologists and the like- back towards primary care. As it was charmingly summed up to me, having the biggest cardiology department in the state doesn't make you any money if all your prospective patients die of their heart attacks at home.
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Mar 10, 2017 21:59
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hobbesmaster posted:Most require 2-3 years of chemistry. I guess you could complete a full ochem and pchem sequence in 2 years if you get the general chem courses knocked out from AP credit or the like There is also a limit on the number of cadavers for students to practice on.
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Mar 10, 2017 21:59
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Hollismason posted:I checked with a local pharmacy and I can get a subsidized prescription when I lose health insurance. Not sure how.long that will last though. Most drug manufacturers offer their drugs for free or almost free in the US to those who make under a certain amount because if they didn't, the FDA would be all over them about abusing drug patents I'm on a drug that should have had a generic available over a decade ago, but the manufacturer keeps coming up with bullshit "therapeutic uses" every few years to extend the patent - I get it for free through their charity program As long as they can still bill insurance companies for the brand name meds at full price, they're happy
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Mar 10, 2017 22:05
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EugeneJ posted:Most drug manufacturers offer their drugs for free or almost free in the US to those who make under a certain amount because if they didn't, the FDA would be all over them about abusing drug patents One of their cleverer scams is charities that pay the co-pay for people on insurance who can't afford the co-pay.
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Mar 10, 2017 22:08
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How is that a scam?
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Mar 10, 2017 22:09
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evilweasel posted:One of their cleverer scams is charities that pay the co-pay for people on insurance who can't afford the co-pay. How does this work anyway - Pfizer just dumps a million dollars into their "charity fund" and is able to write that money off?
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Mar 10, 2017 22:11
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Hollismason posted:How is that a scam? The drug company pays a small amount for the co-pay in exchange for getting the full drug price from the insurance company. That its "charity" is the scam part, it's naked self-interest and highly profitable.
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Mar 10, 2017 22:11
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Hollismason posted:How is that a scam? Because ultimately they're paying themselves to justify their own insane prices. Patients can't even afford a 10% coinsurance on their drugs, so rather than give up that huge 90% they're getting from the insurance, they just write off that 10% that they're covering for the patient. They make more money overall that way rather than by just setting prices people can afford. It's a shell game.
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Mar 10, 2017 22:14
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Ah I see what your saying. Yes, that makes sense and is scammy. I remember recently that there was a article stating that after ACA drug companies were doing real well. Here's another Forbes on it https://www.forbes.com/sites/brucejapsen/2013/05/25/obamacare-will-bring-drug-industry-35-billion-in-profits/#2c25cf4d34a5 The more I see the impacts of ACA and Medicaid the more I think that if Republican's get their way they'll crash the healthcare industry with their changes.
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Mar 10, 2017 22:16
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Ze Pollack posted:You are correct in your guess that residents could do a lot of stuff without being checked by veteran doctors! This sounds like you are agreeing with me, and you are saying that residents aren't a cost center for hospitals. By having residents doing the more menial work and having veteran doctors check it, you are increasing the productivity of the veteran doctors. So the argument that 'we can't have more residents because it would be too expensive' doesn't make sense to me at all. It is more likely IMO that we don't have more residents because it would threaten doctors' paychecks.
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Mar 10, 2017 22:19
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It is like the current systems for training doctors are setup to protect the interests of established doctors and not to efficiently train doctors.
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Mar 10, 2017 22:20
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Oh yeah - I worked as a pharmacy tech and we got "coupons" for certain drugs. So let's say Pfizer gave you a coupon that says "brand name Viagra $10 copay", the coupon actually has insurance information (RX Group, RX Bin) that you would bill just like any other insurance provider - but that "provider" is the manufacturer. So yeah - any claims that are run to those accounts are written off as "donations" by the manufacturer
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Mar 10, 2017 22:21
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silence_kit posted:This sounds like you are agreeing with me, and you are saying that residents aren't a cost center for hospitals. By having residents doing the more menial work and having veteran doctors check it, you are increasing the productivity of the veteran doctors. You misunderstand. If you go to an ER at a teaching hospital, you will be asked the same questions by: 1. The triage nurse 2. Your "real" nurse 3. A 4th year med student 4. A resident MD 5. The attending MD The resident is doing redundant work
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Mar 10, 2017 22:26
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It's sort of weird seeing people defend PPACA as a jobs program when they'd never do the same for the F-35 program.
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Mar 10, 2017 22:32
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call to action posted:It's sort of weird seeing people defend PPACA as a jobs program when they'd never do the same for the F-35 program. unsuprisingly your view on government spending money on things to create jobs tends to vary with your view on the value of the things being made
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Mar 10, 2017 22:33
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call to action posted:It's sort of weird seeing people defend PPACA as a jobs program when they'd never do the same for the F-35 program. Are we going to use the F-35 to get poor people to the hospital faster? Is that how it's comparable to the PPACA and not a ridiculous comparison?
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Mar 10, 2017 22:34
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Wouldn't the often-talked about cap on/elimination of Public Service Loan Forgiveness dissuade people from choosing med school? That seems like it could be in GOP crosshairs soon
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Mar 10, 2017 22:37
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evilweasel posted:unsuprisingly your view on government spending money on things to create jobs tends to vary with your view on the value of the things being made There's also the idea - and I don't know if it's true or not - that once the F-35 orders are complete, that's it, you've made the planes, goodbye, but PPACA's effects on hospitals, doctor's offices, insurance companies, etc, are perpetual because people are perpetually being born, getting sick, getting hurt, and so forth.
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Mar 10, 2017 22:38
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Sundae posted:Are we going to use the F-35 to get poor people to the hospital faster? Is that how it's comparable to the PPACA and not a ridiculous comparison? Nah, you completely missed the point, which was that defending PPACA purely on the basis that it creates jobs and that changing it will put people out of work is pretty silly. Mostly because that line of work can be used triply so to discount single payer, which inherently will put A LOT of insurance and administrative people out of work.
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Mar 10, 2017 22:38
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call to action posted:defending PPACA purely on the basis that it creates jobs and that changing it will put people out of work is pretty silly It definitely would be if anybody did this.
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Mar 10, 2017 22:40
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Sir Kodiak posted:It definitely would be if anybody did this. It's happened in this thread.
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Mar 10, 2017 22:42
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call to action posted:It's happened in this thread. I'd love to see a quote of the post defending the PPACA purely on the basis that it creates jobs, rejecting all other defenses for the law, rather than a post that merely points out that the PPACA created jobs.
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Mar 10, 2017 22:44
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call to action posted:It's happened in this thread. you'll be able to quote it then, no doubt
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Mar 10, 2017 22:50
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silence_kit posted:Labor cost of doctors is only 10% of the total cost of healthcare though. Cutting doctors' wages by 25% or even 50% would be a much greater savings than having health insurance companies run at cost and changing nothing else about running their businesses, but it still wouldn't be a great cost savings for Americans. Net Profit Margin from: https://biz.yahoo.com/p/522conameu.html Aetna: 0.8% Anthem: 1.7% Cigna: 3.84% Humana: -3.11% UnitedHealthCare: 3.54% I'm not sure how much savings there is available there, however: https://biz.yahoo.com/p/510conameu.html https://biz.yahoo.com/p/515conameu.html https://biz.yahoo.com/p/521conameu.html AbbVie: 20.47% AstraZeneca: 32.98% Bayer: 10.54% Bristol-Meyers: 17.04% Merck & Co: 11.64% Amgen: 32.44% Gilead Sciences: 42.46% Abbott Laboratories: 14.96% Medtronic PLC: 15.18% There may be some room there.
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Mar 10, 2017 23:04
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