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Ze Pollack posted:ill people... might not drag themselves into work? No, even better, the author is implying that people would choose to not work because they'd have healthcare either way. It has nothing to do with sick days.
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Aug 29, 2017 18:31
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WampaLord posted:Yes, people would just not work, because you can afford shelter and food by using free healthcare instead! He's actually correct on this, though I disagree that it's much of a problem. Our current healthcare system creates incentives to extend your career for health benefits, even if you're otherwise financially secure (not most Americans). Generally I'm in favor of turning over the older end of our workforce, but the effects of doing so should be analyzed more deeply than "less Olds in jobs means more jobs for the young". Thank you for quoting the nuance-challenged bit though  KillHour posted:It also ignores the fact that progressive tax systems are intentionally structured to place the largest burden on the people who can afford it. This isn't going to raise your taxes if you're working part time at McDonalds. Creating Single Payer without a broadbased tax is fantasy. If structured correctly, any tax increase on your part time burgerflipper would be dwarfed by the decrease in premiums/deductibles - but again, that requires work and thought being put into the creation of the bill. Aumanor posted:Do you actually need to kill private market? Out here in Poland we have universal healthcare and extensive private healthcare, often provided by employers. [Page long derail about what SP actually is, because words don't have meaning and goalposts don't have anchors]
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Aug 29, 2017 18:33
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Aumanor posted:Do you actually need to kill private market? Out here in Poland we have universal healthcare and extensive private healthcare, often provided by employers. No, you could have UHC and/or Single Payer and not kill the private market. The current insurers would no longer be liable for claims, but retain their health plan administrator functionality.
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Aug 29, 2017 18:38
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KillHour posted:It also ignores the fact that progressive tax systems are intentionally structured to place the largest burden on the people who can afford it. This isn't going to raise your taxes if you're working part time at McDonalds. payroll taxes are generally not all that progressive because they don't tax capital gains. they tax the working class at the expense of the investing class. this is true even of the income tax, which is progressive: the ultra-wealthy do not pay much, if any, of the ordinary income tax
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Aug 29, 2017 18:39
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evilweasel posted:payroll taxes are generally not all that progressive because they don't tax capital gains. they tax the working class at the expense of the investing class. this is true even of the income tax, which is progressive: the ultra-wealthy do not pay much, if any, of the ordinary income tax Re-classify all capital gains as income. Problem solved!
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Aug 29, 2017 18:48
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Paracaidas posted:Creating Single Payer without a broadbased tax is fantasy. If structured correctly, any tax increase on your part time burgerflipper would be dwarfed by the decrease in premiums/deductibles - but again, that requires work and thought being put into the creation of the bill. Considering part time burger flippers don't currently have health insurance on their own and by and large just die or go into bankruptcy, I highly doubt that. evilweasel posted:payroll taxes are generally not all that progressive because they don't tax capital gains. they tax the working class at the expense of the investing class. this is true even of the income tax, which is progressive: the ultra-wealthy do not pay much, if any, of the ordinary income tax That's why I didn't say payroll tax. I'm assuming the legislation would be well-designed, but maybe I'm giving too much credit.
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Aug 29, 2017 18:50
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KillHour posted:That's why I didn't say payroll tax. I'm assuming the legislation would be well-designed, but maybe I'm giving too much credit. yeah but aren't we arguing about how to design it well 
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Aug 29, 2017 18:53
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Dems learned from the losing end how an unworkable healthcare policy that only appeals to the base can be a powerful tool to win elections. Even if the wonks give it an honest try, the actual politicians might not see it as in-their-interest to put forward anything resembling good policy.
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Aug 29, 2017 18:56
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esquilax posted:Dems learned from the losing end how an unworkable healthcare policy that only appeals to the base can be a powerful tool to win elections. Even if the wonks give it an honest try, the actual politicians might not see it as in-their-interest to put forward anything resembling good policy. yes but republicans are learning that once you get into office you better deliver or there's going to be consequences the point of having wonks put forward solutions while the politicians run on more generic stuff is that once they get into office, they crib from the wonks republicans never had any intention on delivering on their plans of "replace" but democrats do actually want to improve health care
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Aug 29, 2017 19:00
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KillHour posted:I'm assuming the legislation would be well-designed, but maybe I'm giving too much credit. I really don't know how anyone looks at the US government after 2010 and believes that good policy just happens. This is putting a ton of faith in a broken system that has done fuckall to justify it (see:California). It's also why I don't understand the reticence towards crafting policy now. Trying to do it while the healthcare industry is fighting for its life seems way harder.
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Aug 29, 2017 19:06
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evilweasel posted:yes but republicans are learning that once you get into office you better deliver or there's going to be consequences I agree, I just expect there to be a big pushback against it based on the reason I gave and all the ones that Yglesias identified in his article. A lot of dems really are not going to like it when a pro-single payer organization comes out and says that they recommend a $15 trillion tax increase.
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Aug 29, 2017 19:06
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The people on the left who are focused on purity are also the same sort to say 'Well, just implement UBI, easy!' and 'Just do Medicare-for-all, easy!' and will usually freak out at any suggestion that an actual plan is made for anything.
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Aug 29, 2017 21:21
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Could you quote Mr. Man, Straw saying something like that?
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Aug 29, 2017 21:29
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Yadoppsi posted:Could you quote Mr. Man, Straw saying something like that? the entirety of the democrats are a waste thread
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Aug 29, 2017 21:44
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The only people who work for healthcare only are people who really shouldn't. Maybe they are sick and should really be resting. Maybe they have a sick or disabled dependent and need the health insurance for them, even though they would prefer to be looking after them directly. Maybe they have enough money for early retirement (freeing up a job for a younger person) but have pre-existing conditions. Actual layabouts couldn't care less about health insurance. Can you imagine a basement-dwelling video game addict thinking "Well... I would like to play Overwatch 16 hours a day at my mom's expense while smoking weed. But what if I get CANCER? Gosh! I need to be more sensible, shape up and get a job."
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Aug 29, 2017 21:53
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BarbarianElephant posted:The only people who work for healthcare only are people who really shouldn't. Maybe they are sick and should really be resting. Maybe they have a sick or disabled dependent and need the health insurance for them, even though they would prefer to be looking after them directly. Maybe they have enough money for early retirement (freeing up a job for a younger person) but have pre-existing conditions. this only became true in 2014 when the obamacare exchanges went online: before that if you didn't work for a company that provided health insurance, you didn't have health insurance. you don't need to be sick to be worried about the impact that a health problem could have on your family or your life, and you didn't have any other way to get insurance
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Aug 29, 2017 21:55
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evilweasel posted:this only became true in 2014 when the obamacare exchanges went online: before that if you didn't work for a company that provided health insurance, you didn't have health insurance. you don't need to be sick to be worried about the impact that a health problem could have on your family or your life, and you didn't have any other way to get insurance Yeah, if they never lost their job and looked up what a COBRA payment actually was, the average person pre-Obamacare had no idea what the healthcare market actually looked like, which was a big part of the problem. It was hyper-hosed. I ended up throwing half my unemployment benefits directly into insurance when I was transitioning jobs just so I'd stay covered at all times because of a pre-existing condition, and that was as a healthy 25 year old non smoker. Old Kentucky Shark fucked around with this message at 22:08 on Aug 29, 2017 |
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Aug 29, 2017 22:05
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evilweasel posted:this only became true in 2014 when the obamacare exchanges went online: before that if you didn't work for a company that provided health insurance, you didn't have health insurance. you don't need to be sick to be worried about the impact that a health problem could have on your family or your life, and you didn't have any other way to get insurance If you could make it through medical underwriting, you could buy an individual plan pre-ACA.
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Aug 29, 2017 22:06
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Reik posted:If you could make it through medical underwriting, you could buy an individual plan pre-ACA. for certain "technically correct" versions of "could", yes for practical purposes, your plan was not worth much if it was even possible to get one (and in some states it just plain wasn't) and the instant you had a serious condition you'd be fighting your insurance company that was trying to find any excuse to drop you and make you uninsurable forever
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Aug 29, 2017 22:13
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The "what health care policy should we propose" question is not nearly as important or interesting as it sounds because newsflash We already have two relatively well functioning models -- Medicare and Medicaid -- and, especially together, they're better than anything you're going to be able to come up with independently because 1) they're already partially adopted and their administrative infrastructure framework is already in place, and 2) they've already been tested and revised and re-revised for practical implementation for decades now, to a far greater degree than anything you'd be able to explicate in a goddam white paper, and 3) they're both stepping stones to true universal single payer if we just expand eligibility indefinitely So the answer to all these questions is just "expand Medicare and Medicaid eligibility" full stop The appropriate litmus test isn't single payer it's Medicaid for All. Support any policy or politician that results in expansion of the fee for service Medicaid model. Do that and your work is done here. Hieronymous Alloy fucked around with this message at 22:50 on Aug 29, 2017 |
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Aug 29, 2017 22:47
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edit: whoops
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Aug 29, 2017 22:54
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Hieronymous Alloy posted:The "what health care policy should we propose" question is not nearly as important or interesting as it sounds because hiya, public service announcement, the fee for service model is utterly loving broken in and of itself, and results in the worst kind of adversarial relationship between providers and insurers: providers trying to defraud insurers, insurers refusing to pay providers on grounds "this claim would be much cheaper for us not to pay out on," and the path of least resistance for any time neither side backs down being "well, gently caress the patient then." in a world where the hospital makes a couple hundred thousand off your heart attack and runs a net loss on giving you statins that will reduce the odds of that heart attack, it's amazing how stingy cardiologists are with statins before your first MI. famous study from a couple years back: the nation's rate of death from cardiac illness measurably drops during the American College of Cardiologists' annual meeting, because in their absence, their backups don't try any of the fancy expensive poo poo that kills people. capitation's the way you do this that incentivizes both sides to actually try to give a poo poo about their patients, because when you flip those financial incentives around it is amazing the lengths cardiologists will suddenly go to to avoid having to roll the dice on opening you up.
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Aug 29, 2017 23:14
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Peachfart posted:The people on the left who are focused on purity are also the same sort to say 'Well, just implement UBI, easy!' and 'Just do Medicare-for-all, easy!' and will usually freak out at any suggestion that an actual plan is made for anything. Nah, the point is that, "This is what we're doing," and, "This is how we're doing it," are two separate things. If you get up on stage and say, "it's hard so don't want UHC," then it comes across as feet-dragging because they want your votes but oppose your policy preferences. Edit: Long-term goals should guide short-term action. Edit: If you treat long-term goals as 'disprovable' (for lack of a better description) by short-term constraints, it comes across as disingenuous as hell. This happens often enough that stereotypes among progressives about centrists have been forming. Imagine what it would look like for a Democrat to hustle for UHC as vigorously as the GOP hustles over guns and abortion. How often have you ever seen that? Accretionist fucked around with this message at 23:29 on Aug 29, 2017 |
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Aug 29, 2017 23:15
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Ze Pollack posted:hiya, public service announcement, the fee for service model is utterly loving broken in and of itself, and results in the worst kind of adversarial relationship between providers and insurers: providers trying to defraud insurers, insurers refusing to pay providers on grounds "this claim would be much cheaper for us not to pay out on," and the path of least resistance for any time neither side backs down being "well, gently caress the patient then." In practice anything I've seen other than fee for service leads to payors (i.e., if you're talking capitation, MCO's) just trying to shuffle around who had to cover the least fortunate / highest expense patients, and/or denials of any expensive care based on pretextual grounds ("Yes you can't walk, but we don't think this wheelchair is medically necessary for you.") In the standard fee for service model Medicaid patients have much clearer rights and there's a much stronger established deference (at least in theory) towards the treating physician. Maybe in some sort of abstract world a capitation model could result in better care outcomes for patients but in practice all the moves I've seen so far away from fee-for-service have been backdoor cuts in care to the most in need (usually in the form of layering as many additional rounds of prior authorization review second-guessing as possible in between the patient and their choice of treating physician). That's the thing: standard basic fee-for-service Medicaid already works and outperforms just about everything else there is in America in terms of health outcomes. There might be some theoretical possible improvements on it, but from my perspective, those are all gilding the lily; get everyone onto standard Medicaid first, then we can improve from there. Basically, the efficiency gains you'd get from moving literally everyone in America onto standard fee for service Medicaid, by itself, eclipse any other potential gains in the system, even if there are other ways that could improve Medicaid as a whole. It's moving everyone off of horses and into cars vs. improving the internal combustion engine's efficiency. Hieronymous Alloy fucked around with this message at 00:42 on Aug 30, 2017 |
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Aug 30, 2017 00:26
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capitation is simply a different set of incentives that aren't aligned with patients, except it encourages providing cheaper/less service rather than more expensive/more service. there are cases where that's preferable, and there are cases it's not. it is not some magic bullet that aligns provider incentives correctly. you're always going to need much more thought put into how you do it.
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Aug 30, 2017 00:35
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Accretionist posted:Nah, the point is that, "This is what we're doing," and, "This is how we're doing it," are two separate things. I would be gung ho for any politician that pushed leftist policy while at the same time coming up with a realistic plan to implement it. I hate Republicans both because right-wing policies are poo poo and also because they have been dumbing down politics for the last 30+ years. Paul Ryan, is a 'policy wonk' because he releases his unworkable and terrible plans ahead of time. I guess I just want a strong left vision with a solidly reviewed and researched plan behind it. Going full 'populist' is what made the GOP the dumpster fire that it is today.(and yes I know that their policies aren't populist, but their 'know-nothing' approach is)
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Aug 30, 2017 00:41
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Peachfart posted:I guess I just want a strong left vision with a solidly reviewed and researched plan behind it. Same. quote:Going full 'populist' is what made the GOP the dumpster fire that it is today.(and yes I know that their policies aren't populist, but their 'know-nothing' approach is) Only thing I'd add is that I think there's a distinction to be made along lines of 'authoritarian populism' and 'egalitarian populism.' If you lump em' together, you're in the awkward position of both police reform and police militarization being populist, and both UHC and laissez faire healthcare being populist. Also, I'd chock the know-nothing approach up to anti-intellectualism more than populism as it pervades right-wing politics bottom-to-top and there's less of it among the left's populists/'bottom' than among the Republican establishment/'top'.
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Aug 30, 2017 00:54
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Accretionist posted:Same. You are correct, your phrasing of what I believe is probably more accurate. Anti-intellectualism is running rampant through the USA and it is the cause of many issues, on all political sides(but far worse on the right).
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Aug 30, 2017 01:05
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Hieronymous Alloy posted:The appropriate litmus test isn't single payer it's Medicaid for All. Support any policy or politician that results in expansion of the fee for service Medicaid model. Do that and your work is done here. A thousand times yes.
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Aug 30, 2017 01:15
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Hieronymous Alloy posted:In practice anything I've seen other than fee for service leads to payors (i.e., if you're talking capitation, MCO's) just trying to shuffle around who had to cover the least fortunate / highest expense patients, and/or denials of any expensive care based on pretextual grounds ("Yes you can't walk, but we don't think this wheelchair is medically necessary for you.") no disputes on the last paragraph, at least; it's just that from there step two is figuring out a viable capitation model, because in a world with a public option you are going to see hospital fraud go from an appreciable-but-relatively-minor issue to a significantly larger one. your experience matches up with mine; capitation systems run by private insurers operate on the principle of tying up all the expensive people and punishing hospitals you don't like with them, and capitation systems run by providers operate on the principle of trying very hard to pretend expensive people do not exist. as a result, the question "how do you design a payment model to minimize hospital fraud" turns out to be very important to answer, and a well-designed government-run one is in a position to sidestep the usual problems with private insurers maximizing payout by killing people. it turns out you have to put more thought into how to improve things than saying "you haven't thought enough about this" to the people who want to do more than you and calling it a day. who knew.
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Aug 30, 2017 15:29
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Fair points in the abstract; I just don't really care about step 2 or think it's worth discussing at any level detail until we've accomplished step 1, partly because it's premature and partly because when I do see capitation models pushed, it's usually in the form of incipient regulatory capture by privatization profiteers, not a sincere effort to stop medical fraud. I don't really care about medical fraud. In practice it is either negligible (almost nobody tries to get medical care they don't honestly believe they need, and those few who do have some other issue, like Munchausen's) or systemic and unprosecuted. You know what would reduce medical fraud? Rick Scott's head in the basket of a guillotine. Instead he's governor of Florida. Medical fraud is not a problem anyone actually cares about; it's just a stalking horse for privatization and regulatory capture.
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Aug 30, 2017 16:46
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Medical fraud is like $100+ billion per year? Like literally everyone in the insurance industry cares about it a lot, and spends a significant amount of their own resources to stop it
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Aug 30, 2017 16:55
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Hieronymous Alloy posted:Fair points in the abstract; I just don't really care about step 2 or think it's worth discussing at any level detail until we've accomplished step 1, partly because it's premature and partly because when I do see capitation models pushed, it's usually in the form of incipient regulatory capture by privatization profiteers, not a sincere effort to stop medical fraud. medical fraud is conducted by providers, not people getting the care, it's a very real thing and a very real problem it is also not limited to public insurance programs and it targets private insurance too
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Aug 30, 2017 16:58
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The insurance industry cares about "medical fraud" because that's their pretext for denying care they don't want to pay for. Actual criminal fraud is extremely rare. The supposedly common nature of medical fraud is a myth of the same kind as "welfare fraud."
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Aug 30, 2017 17:01
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evilweasel posted:medical fraud is conducted by providers, not people getting the care, it's a very real thing and a very real problem It happens -- there was a big problem a year or two back when a national medical scooter store got caught pushing people into care they didn't need, and of course Rick Scott -- but it's a problem that should be dealt with via the criminal justice system. I don't trust insurers to make the determination of fraud because they have a vested interest in denying legitimate claims.
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Aug 30, 2017 17:04
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Hieronymous Alloy posted:The insurance industry cares about "medical fraud" because that's their pretext for denying care they don't want to pay for. https://www.justice.gov/criminal-fraud/health-care-fraud-unit quote:The Criminal Division plays a critical role in HEAT. The Criminal Division’s Fraud Section has 40 prosecutors assigned on health care fraud matters across the country. Most of these 40 prosecutors are assigned to the Medicare Fraud Strike Force (MFSF). Partnering with nine U.S. Attorney’s Offices, the MFSF has filed almost 1000 cases, charging over 2100 defendants who collectively billed the Medicare program more than $6.5 billion. Almost 1500 of these defendants pleaded guilty and 200 others were convicted in jury trials; over 1200 defendants were sentenced to imprisonment for an average term of approximately 48 months. And that's just Medicare fraud that they could prove, for this one particular unit of the DOJ. You're in conspiracy theory territory
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Aug 30, 2017 17:07
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Hieronymous Alloy posted:The insurance industry cares about "medical fraud" because that's their pretext for denying care they don't want to pay for. http://www.washingtonpost.com/sf/national/2014/08/16/a-medicare-scam-that-just-kept-rolling/?utm_term=.932aa1b463ec Medicare and insurance fraud is large enough industry that you have probably seen ads form the scams. Xae fucked around with this message at 17:13 on Aug 30, 2017 |
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Aug 30, 2017 17:10
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Hieronymous Alloy posted:It happens -- there was a big problem a year or two back when a national medical scooter store got caught pushing people into care they didn't need, and of course Rick Scott -- but it's a problem that should be dealt with via the criminal justice system. I don't trust insurers to make the determination of fraud because they have a vested interest in denying legitimate claims. i don't even get what you're arguing anymore any private insurance is going to monitor claims for fraud, full stop. of course they are. they have a vested interest in detecting fraudulent claims and reporting them. they have a very vested interest in having the criminal justice system prosecute the fraud: they want attempted fraud deterred. they are also going to determine if claims made against their policies are legitimate as a basic part of what they do: that is the function of insurance. because insurers have vested interests, that is also why any form of insurance is a heavily regulated industry along with requirements on how they can deny claims and punishment for bad-faith denials. nobody's suggesting any kind of liberalization of those regulations, so I'm not sure what you're arguing against.
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Aug 30, 2017 17:11
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esquilax posted:https://www.justice.gov/criminal-fraud/health-care-fraud-unit No, that supports my point and is in line with what I expected. Statistically speaking a few billion dollars a year is a relatively trivial part of the overall health care.industry, and a few thousand convictions are not a reason to implement capitation models that will ultimately deny care to many thousands of times that many people because the insurer's medical reviewer (usually an out of state doc who has never seen the patient) decides to overrule the treating physicians. I've heard those reviewers talk and I've seen the regulations and court rulings that (theoretically) justify those prior authorization procedures. They base it all on the rationale that it's necessary to prevent "fraud, waste, and abuse." It isn't, and to the extent it is, the criminal justice system should be handling it (as you just documented).
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Aug 30, 2017 17:14
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if you modify how reimbursement works - from public or private insurance - if that reimbursement makes fraud easier or more profitable you will need to consider fraud detection and punishment systems, regulatory or otherwise. if you change from private insurance to mostly or purely public insurance you may change how seriously the insurer monitors and reports fraud because you may lose the direct financial incentive, so you need to make sure that you have well-funded fraud detection and punishment organizations in the doj. insurance fraud is a very real thing that exists, it is not a myth made up to allow insurers to deny care, and insurers mostly rely on other ways to deny care instead of claiming crimes are occuring those seem really standard and not generally disputed so i do not know what you're even taking issue with here
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Aug 30, 2017 17:15
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