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Reik posted:I agree, but this also creates enough ambiguity to allow healthcare providers to knowingly bill incorrect amounts with the fallback of the system being complicated. another issue with this example is so many medications come in single use vials ( go knows how much lidocaine/bupivacaine) i've seen throw away. Its possible inexperiences staff don't know that while 8 vials they use are single use but this one isn't and just use the whole vial. Certainly could be intentional fraud but there is probably a little bit of just plain error.
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Sep 2, 2017 23:23
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Paracaidas posted:The evil house in CA killed the senate UHC bill*. Bastards. Legislating is hard, who knew, well let's just not write any laws ever then* *Only applies to potential laws that corporations don't like VitalSigns fucked around with this message at 15:27 on Sep 4, 2017 |
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Sep 4, 2017 15:25
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Writing good laws is actually really hard, especially when you're making what the Cali legislative analyst called, "unprecedented changes to a mature health care system." Activists aren't interested in the details of making good policy, because it turns out some of what they want is impossible or unpopular once people find out what it will cost them. This "I want you to support giving me everything I want and I expect someone else to figure out how to do it" behavior is one of the reasons the Tea Party is so destructive to the normal function of government.
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Sep 4, 2017 19:44
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Dead Reckoning posted:Writing good laws is actually really hard, especially when you're making what the Cali legislative analyst called, "unprecedented changes to a mature health care system." Activists aren't interested in the details of making good policy, because it turns out some of what they want is impossible or unpopular once people find out what it will cost them. strategy works pretty well for police unions, DR why not let other people have a taste
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Sep 4, 2017 20:39
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VitalSigns posted:Legislating is hard, who knew, well let's just not write any laws ever then* Hey, I'm in total support of CA writing Single Payer legislation (which they're finally getting down to business on). The flaming pile of poo poo that 'passed' the Senate avoided the constitutional supermajority requirement by not actually doing... anything. A fine example of the charlatans and shitheads coming out of the woodwork to bandwagon and claim progressive momentum without providing value or creating progress. See also: the litany of Conyers cosponsors who don't support and wouldn't vote for the bill they're sponsoring. I'd prefer UHC not continue down the path of Repeal We'll know California's serious when they include a funding mechanism (and actually serious when they push to either conform to or amend the constitution). In the meantime, my post was in response to Ze Pollack complaining that the House killed the Senate's "bill", apparently under the common misconception that the legislation from Atkins and Lara bore any resemblance to an actual effort.
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Sep 4, 2017 21:40
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Ze Pollack posted:strategy works pretty well for police unions, DR I literally have no idea what you're talking about or its relevance to crafting workable UHC policies.
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Sep 4, 2017 22:01
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Ze Pollack posted:strategy works pretty well for police unions, DR lol, just admit you don't understand that making laws is hard, and move on.
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Sep 4, 2017 22:10
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UHC activists should be pushing for the next step which would be either Medicare expansion or opt in Medicaid on the state level. Let businesses decide if the want to pay for their own healthcare or for a small pay roll tax have their employees take a state plan.
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Sep 4, 2017 22:55
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Paracaidas posted:Hey, I'm in total support of CA writing Single Payer legislation (which they're finally getting down to business on). Yes we're all well aware that the Senate shoved an incomplete bill out the door with a simple majority and then both chambers started blaming the other for not working on the bill ("We passed the bill, it's the house's job", "the bill wasn't complete, it's the senate's job"). We don't give a poo poo whose "fault" it is because both houses have a responsibility to govern, not wallow in inaction and whine that someone else should be doing it for them. Coincidentally, this is the exact inaction that donors want, while all the politicians blocking the effort can just answer any question about it by pointing the finger at someone else. Fortunately, after a massive public outcry and recall threat the Assembly Speaker has changed his tune and will hold hearings on the bill, no thanks to everyone who has spent the last month telling everyone that single payer is just impossible and everyone needs to shut up and stop demanding legislators do the jobs they were elected to do rather than whine that their jobs are hard okay and they shouldn't have to do things. Dead Reckoning posted:Writing good laws is actually really hard, especially when you're making what the Cali legislative analyst called, "unprecedented changes to a mature health care system." Activists aren't interested in the details of making good policy, because it turns out some of what they want is impossible or unpopular once people find out what it will cost them. Writing good policy is actually really hard you're right, which is why the answer should be "we will assign this bill to a committee and hold hearings in order to navigate the problems and write the best legislation we can" (what they're doing now after public rage made them fear for their seats in recall elections), and not "oh gee writing laws is hard someone else needs to do it, not us, we the lawmaking body are just too busy to make laws maybe u should have stapled a fully-realized draft bill to ur ballot if u wanted us to actually do what we said" (what they were doing which rightly prompted the public rage). Dead Reckoning posted:This "I want you to support giving me everything I want and I expect someone else to figure out how to do it" behavior is one of the reasons the Tea Party is so destructive to the normal function of government. Lol no, hiring someone else to figure out how to do achieve the policy goals that we want is the entire purpose of representative government, that's what we elect representatives to do. When representatives campaign on an issue like single payer, vote to pass it a million times when they have a safe veto from a governor of the opposing party, and then sit on their hands when they get power and say "oh turns out the thing we promised to do if you voted for us is hard, not gonna try, sorry" then that's destructive of representative government because it destroys the people's faith in representative democracy and the ability of the franchise to translate voter will into public policy. This is not comparable to the Tea Party btw because Single Payer actually is possible and works and does what its proponents claim it will do, unlike the Tea Party's laissez-faire horseshit which can't and doesn't work. The Tea Party by definition can only function by gumming up the works while someone else is in power so all the blame falls on the other guy, when the Tea Party gets power they're hosed because all their promises were lies and at least some of them know that if they actually, e.g. default on the debt, it will be bad and not good like they said. Single Payer doesn't have this problem because the obstacles are tactical questions of practical implementation or political problems like lack of will and stacks and stacks of donor cash opposing it, and not any fundamental disagreements with reality in the underlying theory itself. E: niceness VitalSigns fucked around with this message at 03:58 on Sep 5, 2017 |
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Sep 5, 2017 02:34
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VitalSigns posted:Yes we're all well aware that the Senate shoved an incomplete Saying single payer "works" is like saying lower taxes work; it's basically a platitude at this point unless paired with a substantive proposal that spells out how care will funded, apportioned, and rationed. Single payer advocates insist that everything will be better under their proposed system, but without defining better for whom, without a solid description of how the system will work, and with no road map to get from here to there. In its current form, it's as much an aspirational fantasy as "smaller government."
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Sep 5, 2017 04:30
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No it's not because we have evidence from other countries that have successfully implemented single payer that it achieves better medical outcomes at lower costs than a free market system, whereas we know austerity does not work because again we have evidence from here and from other countries that the cuts in public spending required to pay for the tax cuts shrink the economy and result in larger deficits in a spiral of self-defeat and economic destruction until the people finally put a stop to it by electing socialists in the good timeline or turn to fascists in the bad one. The rest of what you said is just strawmanning. Single payer advocates very much want to have those conversations about costs, benefits, and implementation in order to create a description and a solid proposal, that's why there was so much public outrage when the Assembly tabled the issue and so much public pressure which finally succeeded in getting the speaker to agree to hold committee hearings. The obstacle to those legislative hearings at state and federal levels is not single payer advocates blocking them from happening, it is from the politicians in leadership positions fighting tooth and nail to keep those hearings from ever occurring, from the Gang of Six in the federal government in 2009 to Rendon tabling the measure in 2017 until public outcry forced his hand. VitalSigns fucked around with this message at 04:40 on Sep 5, 2017 |
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Sep 5, 2017 04:37
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Dead Reckoning posted:Saying single payer "works" is like saying lower taxes work; it's basically a platitude at this point unless paired with a substantive proposal that spells out how care will funded, apportioned, and rationed. Single payer advocates insist that everything will be better under their proposed system, but without defining better for whom, without a solid description of how the system will work, and with no road map to get from here to there. In its current form, it's as much an aspirational fantasy as "smaller government." That's only partly true because we have fairly good half-implementations in place already; Medicare and Medicaid. The apportionment and rationing questions are answered by saying "medicaid / medicare for all," ; Medicaid and Medicare have systems for both of those things. Therefore, in order to have a functioning single payer system, we only really need to do two things: 1) pass a law removing the eligibility thresholds for the Medicare and Medicaid programs, and 2) figure out a way to fund it (this is the part where you have a point, any proposal would have to figure out a way to pay for the expansion of those programs). The framework is there though and plenty substantive, and there are plenty of ways that the expansion could be funded -- for example, a tax on millionaires could cover a lot of the costs, as could a cut in military spending. The costs aren't as extreme as they might seem because Medicaid and Medicare are so much more efficient, cost-wise, than other health care funders, and the programs already cover most of the most expensive patients (sick children, the disabled, the elderly). The more those programs are expanded the more their cost efficiencies will grow as they cover less and less demanding patients. Honestly the bigger issue is the one you don't mention -- the displacement of health-care-insurance-industry workers by the single-payer system. That's actually a real problem, especially since it's a source of a lot of the aforementioned cost savings.
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Sep 5, 2017 04:38
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I'm glad DR is posting though because his brand of dishonest argumentation and strawmanning is typical: block committees from holding hearings and debates necessary to draft a single payer bill, then use the fact that no committees have written a bill to justify continuing to block the hearings necessary for the bill's creation. "But Rendon is agreeing to hold hearings now!" yeah he is after a month of public outcry and a recall threat which you fought against the entire time, fortunately no one listened to people like you.
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Sep 5, 2017 04:50
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Also worth pointing out that the month of public pressure for UHC which you're dismissing as meaningless aspirational platitudes that will never amount to anything just forced the Assembly Speaker to put healthcare on the agenda for this year and assign it to a committee, greatly increasing the chances that positive legislation will come out of this whole thing compared to when it was declared dead a month ago, so you are in demonstrable disagreement with reality here. Although I suppose you must be used to disagreeing with reality by now, it's a wonder you still haven't tired of it.
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Sep 5, 2017 05:05
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VitalSigns posted:No it's not because we have evidence from other countries that have successfully implemented single payer that it achieves better medical outcomes at lower costs than a free market system, whereas we know austerity does not work because again we have evidence from here and from other countries that the cuts in public spending required to pay for the tax cuts shrink the economy and result in larger deficits in a spiral of self-defeat and economic destruction until the people finally put a stop to it by electing socialists in the good timeline or turn to fascists in the bad one. Evidence from other countries cuts both ways. Nationalized Healthcare systems have historically struggled to handle minority healthcare well. Taking longer to approve experimental treatments for diseases like aids, forcing trans people to wallow on years long wait lists and get through multiple layers of gatekeepers to get life saving hormone treatment, and leaving the very poor with no way to get second opinions or seek better care at facilities outside their primary care whole the rich can still buy their way into private hospital suites and better doctors. If you don't want uhc to be super regressive toward the most vulnerable it's not as easy as just "look at Europe". There's real problems there. For trans people specifically I can give you horror stories from nearly every uhc country but there's problems for every minority group.
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Sep 5, 2017 05:06
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I never meant to imply that Europe is perfect and that we just need to copy them without looking at what they do right versus what they still do wrong. I merely disputed DR's claim that "single payer is good is as meaningless as tax cuts are good", because there is piles of evidence that austerity is bad policy with no benefits, and the same is not true for single payer which has plenty of evidence of outcomes which can be discussed but which he is not interested in discussing, preferring to pretend it doesn't exist and we can just never know what UHC could look like or what would happen. Of course the NHS has had trouble with treating unpopular and misunderstood minorities with decades and decades of pseudoscientific and pseudomedical opposition to them, but of course private systems are no better in this regard for everyone except the ultra-rich (but then the ultra-rich in nationalized health care countries also have no problem getting whatever care they want/need either, and in UHC countries when medical thinking on minority issues progresses then those minorities benefit alongside it whereas here poverty continues to lock out many members of those groups). I'm always interested in discussions about models in foreign countries and how we can improve upon them, as long as the discussion is in good faith and isn't just a cynical device to shut down discussion before it begins which is bad enough in public forums like this and of course much much worse when politicians do it to block any debates or hearings from even happening in the first place like California tried to do before caving to public pressure. VitalSigns fucked around with this message at 05:37 on Sep 5, 2017 |
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Sep 5, 2017 05:30
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cis autodrag posted:Evidence from other countries cuts both ways. Nationalized Healthcare systems have historically struggled to handle minority healthcare well. Taking longer to approve experimental treatments for diseases like aids,]forcing trans people to wallow on years long wait lists and get through multiple layers of gatekeepers to get life saving hormone treatment, and leaving the very poor with no way to get second opinions or seek better care at facilities outside their primary care whole the rich can still buy their way into private hospital suites and better doctors. Did you just suggest that UHC systems are worse than the American system when it comes to treating poor folks and minorities because uh...
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Sep 5, 2017 05:37
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Ohthehugemanatee posted:Did you just suggest that UHC systems are worse than the American system when it comes to treating poor folks and minorities because uh... For 1percenters who happen to be gay or trans or some other minority, yeah our system is better for them personally because their wealth allows them to buy whatever they need even if say it's the 1960s and the medical establishment says they're mentally ill and need to be electrocuted into being normal sure, whereas in the UK where all doctors are employed by the government you can't get unapproved treatment without leaving the country for it.
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Sep 5, 2017 05:41
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Ohthehugemanatee posted:Did you just suggest that UHC systems are worse than the American system when it comes to treating poor folks and minorities because uh... America had the informed consent model for trans people and multiple clinics that provide hormone therapy for free no questions asked. Being trans is still awful here but you don't have to wait on a list for 3 years just to talk to the gatekeeper who refers you to the next gatekeeper who will question every aspect of your identity and then deny you care if you don't fit the traditional binary trans narrative to a T. Don't disingenuously act like it saying that it's worse abroad means it's perfect here. I just don't want to see access to care move backwards because informed consent is antithetical to the existing models of uhc we have. And to the guy calling me a 1 percenter, loving lol. I starred transitioning while I was still living on credit and selling poo poo in my house to pay bills (with insurance that covered nothing and required all sorts of arcane legal maneuvering to get anything covered at all). I didn't have it as bad as a trans person of color in like Alabama but I certainly didn't have it easy.
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Sep 5, 2017 06:55
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Okay so the private insurance system you're defending hosed you over for being not-rich, and it was free clinics that gave you the care you needed? Were the clinics by any chance funded by Medicaid, which was (along with Medicare) barred from withholding hormone therapy from trans people by the new HHS regulations under the ACA, or by a federally funded charity like Planned Parenthood also affected by the same rule? Because I see no reason to believe that expanding Medicaid or Medicare for All would also somehow roll back those protections. Democrats wouldn't support that and Republicans sure as gently caress wouldn't be the ones passing Medicare/aid for All so why do you think that rule would be reversed by Democratic legislation? If such a rollback is proposed by all means let's fight it, but I see no reason to assume it will happen. Gender reassignment is such a tiny drop in the bucket of healthcare costs that there's no inherent fiscal reason that single payer would put up barriers to access; the barriers are purely ideological. It's also why I don't think pointing to the history of the NHS in the UK is a good analogy for what trans rights would be under a theoretical single-payer system here, first because the ideological battle for trans people's care has already been won within the US Democratic Party and among the medical profession at large and second because the history is complicated by a legacy of anti-LGBT institutional prejudice in every Western country but recently activism has been forcing the NHS to make changes to better care for trans people as the movement for transgender rights has progressed in the UK. The government-run parts of our healthcare system are the best when it comes to access for poorer trans people because they're required to be by law, it's the private part that's garbage for the poor and continues to be in poo poo states that didn't expand Medicaid into single payer without qualification for everyone under the federal poverty line. VitalSigns fucked around with this message at 10:08 on Sep 5, 2017 |
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Sep 5, 2017 10:04
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Hieronymous Alloy posted:That's only partly true because we have fairly good half-implementations in place already; Medicare and Medicaid. The apportionment and rationing questions are answered by saying "medicaid / medicare for all," ; Medicaid and Medicare have systems for both of those things. Therefore, in order to have a functioning single payer system, we only really need to do two things: Medicare is not a single payer system. Medicaid is more like a single payer system, but not always. The implementation varies by state.
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Sep 5, 2017 14:20
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Xae posted:Medicare is not a single payer system. Medicaid *generally* covers the Medicare gaps, though yeah, there are differences state to state and and there have been privatization inroads. Still if you're asking for a universal care model for the US the two programs combined get us 95% of the way there and the rest could be accomplished by incremental reform. I kinda view the focus on "single payer" as more shibboleth than goal; the goal is universal free / negligible cost coverage for health needs, how we get there isnt nearly as.important Not every developed world nation has single payer.
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Sep 5, 2017 14:47
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Dead Reckoning posted:I literally have no idea what you're talking about or its relevance to crafting workable UHC policies. it turns out that unceasingly demanding that other people work out the details on why, precisely, you should get everything you want is an effective advocacy strategy. now imagine that strategy was being used to call for providing health care to people, rather than explain why an eight-year old had his summary execution on tape coming.
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Sep 5, 2017 16:17
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Ze Pollack posted:now imagine that strategy was being used to call for providing health care to people, rather than explain why an eight-year old had his summary execution on tape coming. 
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Sep 6, 2017 00:43
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So any chance GOP will try to sneak ACA repeal before Sept 30th? My impression is like a 10% chance, would love to hear less.
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Sep 6, 2017 02:38
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Mokelumne Trekka posted:So any chance GOP will try to sneak ACA repeal before Sept 30th? My impression is like a 10% chance, would love to hear less. I legitimately cannot imagine how that would work. I'm only giving them like a 60% chance of passing the bare minimum things they have to pass to avoid defaulting on our debt in that short time period. Harvey relief is maybe 50/50. Nobody wants to take another run at that field of rakes again. Even Trump has shut the gently caress up about healthcare.
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Sep 6, 2017 02:42
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Old Kentucky Shark posted:I legitimately cannot imagine how that would work. http://www.politico.com/story/2017/09/05/trump-obamacare-repeal-senate-242346 short version, graham is trolling him about it
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Sep 6, 2017 02:48
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Mokelumne Trekka posted:So any chance GOP will try to sneak ACA repeal before Sept 30th? My impression is like a 10% chance, would love to hear less. graham hasnt given up hope yet on his block grants but if its not in final scorable form in a week or so the cbo wont score it by 9/30 i also doubt mcconnell schedules a vote without blood oaths from 50 senators to vote yes
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Sep 6, 2017 02:49
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awesmoe posted:http://www.politico.com/story/2017/09/05/trump-obamacare-repeal-senate-242346 I'm pretty sure that Lindsey graham has been the source of every single article talking about how this time, for sure, Lindsey Graham's block grant proposal is definitely coming up for a vote.
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Sep 6, 2017 03:12
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I want to believe it's dead too, but we already thought that once and ended up thanking John loving McCain for saving the ACA. I'm not resting easy until we flip the House.
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Sep 6, 2017 06:58
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The Maroon Hawk posted:I want to believe it's dead too, but we already thought that once and ended up thanking John loving McCain for saving the ACA.
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Sep 6, 2017 22:45
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That's not news, he's been supporting that particular plan for a long time, and it doesn't have anything close to the kind of support it needs to even come to the floor. Not, of course, that John McCain doesn't deserve as much corn as you can go on him for only deigning to do one or two good things in the course of years in the Senate talking a big game. e: scorn, but you could probably throw a few corn cobs at him too if you wanted
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Sep 6, 2017 22:50
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Yeah, that isn't a flip, McCain was always for repeal. He objected to one particularly stupid plan for repeal, in which the Senate would pass a bill they all hated, just to move the process forward, and count on Paul Ryan not taking it and passing it through the House. There's no reason to think there's 50+ for Graham-Cassidy's brief outline of an idea, though, by all means, still yell at your senators about it.
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Sep 6, 2017 22:51
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Sir Kodiak posted:Yeah, that isn't a flip, McCain was always for repeal. He objected to one particularly stupid plan for repeal, in which the Senate would pass a bill they all hated, just to move the process forward, and count on Paul Ryan not taking it and passing it through the House. There's no reason to think there's 50+ for Graham-Cassidy's brief outline of an idea, though, by all means, still yell at your senators about it. mccain voted for BRCA, mcconnell's stab at it, which you might notice did not pass 
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Sep 6, 2017 22:56
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Jesus Fuuuuuick Eye of a hurricane slated to pass over my house and my senator's busy loving my health care
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Sep 6, 2017 23:00
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evilweasel posted:mccain voted for BRCA, mcconnell's stab at it, which you might notice did not pass Yeah, my recollection is that McCain's objection was purely to the skinny repeal, and that he'd happily vote for anything that was less fundamentally ridiculous than that.
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Sep 6, 2017 23:02
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https://twitter.com/TopherSpiro/status/905550209513652224 there is not enough time between now and 9/30 to go through regular committee process
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Sep 6, 2017 23:03
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Even if the Senate passes something, I doubt the conference negotiations can be completed by 9/30. The Republicans have tiny margins in both houses, and there are several other must pass bills that need to get done this month.
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Sep 6, 2017 23:22
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Konstantin posted:Even if the Senate passes something, I doubt the conference negotiations can be completed by 9/30. The Republicans have tiny margins in both houses, and there are several other must pass bills that need to get done this month. On the unlikely chance the Senate passes something, I'd expect the House to pass it unchanged, no conference committee.
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Sep 6, 2017 23:39
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If you know the secret bill the Senate will pass you should probably contact McConnell he'd be interested in it.
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Sep 7, 2017 03:33
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