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KillHour posted:Ah, that makes sense. I kind of think a flat 4% surcharge is oddly regressive though. Every country with UHC funds it with regressive taxes. You need a very wide tax base to get a stable funding mechanism. That 4% surcharge is actually wildly low compared to other countries.
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Sep 14, 2017 18:55
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Ahhhhhhhhhhhhhhhhh https://twitter.com/realDonaldTrump/status/908413134196572161
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Sep 14, 2017 21:26
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EugeneJ posted:Ahhhhhhhhhhhhhhhhh Call it Trumpcare instead and watch him go "GOP won't make deal for Trumpcare. Sad! Need good deal now!"
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Sep 14, 2017 21:28
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EugeneJ posted:Ahhhhhhhhhhhhhhhhh boo hiss Someone get him out of his Twitter feed / Fox News bubble! If he passed UHC, he'd be a hero for generations -- no matter what else he's done. It could be a worst-case scenario where the Russians have him on tape sawing the head off a prostitute and he'd still go down in history for UHC. He's pretty narcissistic. He should want this, right?
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Sep 14, 2017 21:47
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I have a bad feeling Pelosi and Schumer made Trump promise to kill single-payer if it ever comes to his desk
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Sep 14, 2017 22:02
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EugeneJ posted:I have a bad feeling Pelosi and Schumer made Trump promise to kill single-payer if it ever comes to his desk I know, right? He's been so supportive of government run healthcare until that meeting. makes you think.
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Sep 14, 2017 22:15
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EugeneJ posted:I have a bad feeling Pelosi and Schumer made Trump promise to kill single-payer if it ever comes to his desk You are criminally stupid.
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Sep 14, 2017 22:18
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EugeneJ posted:I have a bad feeling Pelosi and Schumer made Trump promise to kill single-payer if it ever comes to his desk yeah that is definitely a reasonable concern that it is trump that stops the republican majorities in the house and senate from voting for single payer
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Sep 15, 2017 01:26
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http://nymag.com/daily/intelligencer/2017/09/could-the-gops-final-push-to-kill-obamacare-actually-pass.html The final GOP attempt to repeal Obamacare - Graham-Cassidy - is now out. It's very, very bad: it essentially abolishes medicaid within 10 years, significantly cuts medical spending, and will certainly lead to 20m+ uninsured. Graham and Cassidy are talking up their chances and although it's still a very long shot (there are no indications that Paul/Murkowski/Collins would go for this, and Cassidy is optimistically saying he thinks they have 48 votes), it's worth keeping it a long shot. Especially after what happened in the House, and that there are only 15 days left. So health care activists are gearing up and if you've got a senator that may be one of the key votes to kill it, it's worth making it clear to them you haven't stopped paying attention: https://twitter.com/AngelRafPadilla/status/908482059500388353 https://twitter.com/AngelRafPadilla/status/908483851541975040
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Sep 15, 2017 14:03
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I like Bernies bill because I'm willing to tax the hell out of the rich to give health insurance to the poor. Call me crazy.
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Sep 15, 2017 14:21
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EugeneJ posted:I have a bad feeling Pelosi and Schumer made Trump promise to kill single-payer if it ever comes to his desk Do you smell burnt toast mate
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Sep 15, 2017 14:32
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EugeneJ posted:I have a bad feeling Pelosi and Schumer made Trump promise to kill single-payer if it ever comes to his desk Do you really believe that if they had sworn Trump to a secret pact that he wouldn't either forget it immediately or brag about it on Twitter within a few hours? Possibly both?
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Sep 15, 2017 14:36
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thankfully rand paul is continuing his strategy of "do the right thing, but say it's for evil reasons not good ones" https://twitter.com/RandPaul/status/908675484493516800 my feeling is that with three apparent hard nos that it's going to be a hard sell to the other senators who have wavered that what they really need to do is take ANOTHER hard vote that is just going to hurt them one way or another and keep the bill from getting close to 50
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Sep 15, 2017 15:11
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Do they even have time to rewrite the bill into something that could sway any of the 3 hard nos + get it scored by the CBO?
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Sep 15, 2017 15:18
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Spiritus Nox posted:Do they even have time to rewrite the bill into something that could sway any of the 3 hard nos + get it scored by the CBO? Getting this scored by CBO in the first place in time is hard. They're trying to do it in a week but the CBO may simply not be able to move that fast. But it's possible that small tweeks, if they get a main score, can be scored quickly. But I don't think that's really the issue. Getting this rewritten to get 50 votes, well, nobody's managed to do that yet and it's hard to see how you get Paul (who has been the hardest no all along, apparently) who will always find something to make it Not Conservative Enough, and its hard to see how you get Murkowski/Collins after they received a hero's welcome for killing it last time and I'm sure this has the usual attacks on women's health. The only real way this passes is if it's put on the floor as a "take it or leave it, there's no time for any further negotiation" and that manages to get the 50 votes. They've horse-traded as much as they could and it didn't get them there.
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Sep 15, 2017 15:30
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I'm not going to be able to function until October at this rate. Any rumblings on the stabilization discussions? I think they're aiming to have a bipartisan agreement sometime early next week and I'm hoping that steals some oxygen from Graham-Cassidy.
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Sep 15, 2017 16:10
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Grammarchist posted:I'm not going to be able to function until October at this rate. Any rumblings on the stabilization discussions? I think they're aiming to have a bipartisan agreement sometime early next week and I'm hoping that steals some oxygen from Graham-Cassidy. other way around, the concern is now that graham-cassidy is stealing oxygen from those and that they might derail until oct 1 when trumpcare is finally finally dead
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Sep 15, 2017 17:21
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Hieronymous Alloy posted:disagree unless you mean "because it's too low" They're already doing it actually. I can't remember which but there are dem senators working on Medicare age lowering, Medicare buy in, and possibly Medicaid buy in bills.
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Sep 15, 2017 17:45
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Word is circulating that Bernie's bill relies on the Secretary of Health and Human Services to set the national health care budget and to set the fee/payment schedules for providers. (and I'm phone posting so can't dive in much deeper) Internally, this makes sense. Allow the entity in charge of setting up the overall budget do the research to estimate needed coverage for the following year, and then set the fee schedule accordingly to meet demand and constraints. When put into action, this is terrifying. We've all seen the damage that a hostile administration can do within the comparatively limited executive influence on Obamacare, a GOP administration could cause untold havoc with this bill. They're sabatoging Obamacare by making premiums jump across the board wherever they can by hurting recruitment. Ignoring the insane scenarios (cutting national health budget to $1, etc), they could set repayment to cripplingly low levels on women's healthcare (abortion, birth control, screenings, hpv vaccination) or racially/culturally coded care & procedures (sickle cell and malaria-ironically, STDs, HIV, psychiatric care for dysmorphia, etc) This would drive providers out of the arena and essentially kill care for anyone who can't afford to pay themselves or take advantage of charitable options. e: Can't confirm for myself until later tonight or in the weekend, so take with a grain of salt. Will redact and apologize if it's different with full context Paracaidas fucked around with this message at 19:55 on Sep 15, 2017 |
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Sep 15, 2017 19:46
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Paracaidas posted:Word is circulating that Bernie's bill relies on the Secretary of Health and Human Services to set the national health care budget and to set the fee/payment schedules for providers. (and I'm phone posting so can't dive in much deeper) It's not really word circulating. It's written right there in the bill and is on the one-page bullet point brief his office put out.
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Sep 15, 2017 19:48
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Paracaidas posted:Word is circulating that Bernie's bill relies on the Secretary of Health and Human Services to set the national health care budget and to set the fee/payment schedules for providers. (and I'm phone posting so can't dive in much deeper) No, you're right. Also the bill outlaws private insurers from covering benefits that are already covered by the government, and (if I'm reading it right, see section 202C) patients wouldn't be able to just pay for procedures out of pocket. So as long as the reimbursement rate isn't zero, critical services could be effectively cut off. This also makes it basically impossible for the CBO to score it. aware of dog fucked around with this message at 20:23 on Sep 15, 2017 |
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Sep 15, 2017 20:06
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Could they include a clause that disallows the system to be executively defunded or would that be unconstitutional?
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Sep 15, 2017 20:27
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Lightning Knight posted:Could they include a clause that disallows the system to be executively defunded or would that be unconstitutional? Congress can't pass a law that Congress can't undo. The only way to fully protect the funding is an amendment.
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Sep 15, 2017 20:34
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Lightning Knight posted:Could they include a clause that disallows the system to be executively defunded or would that be unconstitutional? If they wrote the law better, yes. Logically though you can't both ban defunding and let the secretary set whatever they want.
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Sep 15, 2017 20:36
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Xae posted:Congress can't pass a law that Congress can't undo. They're asking about the executive. Laws can be made that require the executive branch to spend money. It's entirely common.
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Sep 15, 2017 20:37
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evilweasel posted:If they wrote the law better, yes. Logically though you can't both ban defunding and let the secretary set whatever they want. Yeah this is kind of the problem. You could add a provision that says something like "the Secretary shall not set reimbursement rates below what is necessary to provide services" to make sure a hostile executive couldn't cut off access to services they don't like. However, that would basically undercut the entire argument for how single payer saves money. Doing so would give health care providers a lot more bargaining power to say "here's what I want to be paid for this service and if I don't get it, then I won't provide it," and by law HHS would have to go along with it.
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Sep 15, 2017 20:45
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Since this is all pipe dream anyways, I don't think that it would be too big of an issue. Say the secretary for a republican president did slash women's services payments to zero or effectively next to it. The secretary would then get sued in her official capacity and there's a better than not chance that the payment slashing will be tossed out by courts as discriminatory.
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Sep 15, 2017 20:54
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Paracaidas posted:Word is circulating that Bernie's bill relies on the Secretary of Health and Human Services to set the national health care budget and to set the fee/payment schedules for providers. (and I'm phone posting so can't dive in much deeper) Mr. Nice! posted:Since this is all pipe dream anyways, I don't think that it would be too big of an issue. Say the secretary for a republican president did slash women's services payments to zero or effectively next to it. The secretary would then get sued in her official capacity and there's a better than not chance that the payment slashing will be tossed out by courts as discriminatory. As unreasonable as it sounds in the current environment, we do kindof have to operate on the assumption that public officials will, on some level, act in good faith OR be punished when they don't. That's not happening now, but the reasons for that are larger scale failures in our system of government that we can't expect Bernie to address in a single health care bill.
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Sep 15, 2017 20:59
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Mr. Nice! posted:Since this is all pipe dream anyways, I don't think that it would be too big of an issue. Say the secretary for a republican president did slash women's services payments to zero or effectively next to it. The secretary would then get sued in her official capacity and there's a better than not chance that the payment slashing will be tossed out by courts as discriminatory. Given that we have a conservative majority on the SCOTUS and that it's likely to stay that way for a while, I'd rather not have to rely on them tbqh
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Sep 15, 2017 21:21
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More importantly doctors and healthcare in general are important contributors to congressional campaigns so in this hypothetical situation congress would have a strong interest in ensuring that payments continue come hell or high water.
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Sep 15, 2017 21:49
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Not to be entirely wonkish but doesn't this only solve one half of the health care equation? Will the bill address cost in any way?
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Sep 15, 2017 23:44
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Mooseontheloose posted:Not to be entirely wonkish but doesn't this only solve one half of the health care equation? Will the bill address cost in any way? There are detailed proposals to address costs explained above. "How do you pay for it" is just a talking point, not substantive. see, e.g. https://forums.somethingawful.com/showthread.php?threadid=3812639&userid=0&perpage=40&pagenumber=111#post476394644
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Sep 15, 2017 23:59
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Mooseontheloose posted:Not to be entirely wonkish but doesn't this only solve one half of the health care equation? Will the bill address cost in any way? Are you asking about how it pays for care or how it controls healthcare costs? If it's the former, Sanders released a paper with some suggestions for things that could pay for it, but there's no funding mechanism actually in the bill partially because we don't really know how much the thing would actually cost (re: the conversation a few posts above). The biggest things are a 7.5% payroll tax meant to shift money employers currently spend on health insurance to the government, more progressive income taxes, and a premium 4% of people's income. If it's the latter, the main way it addresses cost is through the single payer structure itself. If the government is the only one who can pay a provider for a service, then it can dictate the prices instead of just paying whatever ~the market~ decides.
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Sep 16, 2017 00:15
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aware of dog posted:If it's the latter, the main way it addresses cost is through the single payer structure itself. If the government is the only one who can pay a provider for a service, then it can dictate the prices instead of just paying whatever ~the market~ decides. This is why the AMA and other doctor groups will kill this if it even sniffs becoming a law.
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Sep 16, 2017 00:40
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Peachfart posted:This is why the AMA and other doctor groups will kill this if it even sniffs becoming a law. pssst guess who sets the prices right now hint: it's not the doctors
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Sep 16, 2017 00:43
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aware of dog posted:If it's the latter, the main way it addresses cost is through the single payer structure itself. If the government is the only one who can pay a provider for a service, then it can dictate the prices instead of just paying whatever ~the market~ decides.
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Sep 16, 2017 01:22
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PerniciousKnid posted:Would it basically copy-paste Medicare reimbursement rates, or is it more complicated than that? Much more complicated. Right now any shortfalls from the current formula can be offset by charging private payers more. Under single payer hospitals can't do this. So the formula needs to be updated to prevent any shortfalls. So you need a formula that can handle the huge difference in cost to provide services across the entire United States. It won't be easy. Hieronymous Alloy posted:There are detailed proposals to address costs explained above. "How do you pay for it" is just a talking point, not substantive. Its substantive until we see a score from the CBO or a spread from some decent think tanks. I'm really skeptical about his 4.2 trillion from ending Health care deductions from taxes. He is assuming that if an employer stops paying for private health insurance employers will increase wages by an equal amount. I think we can all agree that is bullshit, especially since they are getting hit with a new 7% payroll tax. They'll get some savings from eliminate HSAs and the assorted deductions but not much.
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Sep 16, 2017 01:34
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PerniciousKnid posted:Would it basically copy-paste Medicare reimbursement rates, or is it more complicated than that? Medicare doesn't really set reimbursement rates per se, it has a formula to determine a physicians fee for a particular service that takes into account their costs of running a practice, cost of malpractice insurance, and their time and effort, and weights those factors differently based on where the physician is located. Under the Sanders plan, as I understand it, the HHS secretary would set essentially a list of prices it will pay for different services, similar to what Japan does (though I believe it also would have different regional prices). E: Reading the bill it actually says "the Secretary shall establish, by regulation, fee schedules that establish payment amounts for benefits under this Act in a manner that is consistent with processes for determining payments for items and services under [Medicare]" so the process would be similar, but as stated above and below this post, it becomes a more complex consideration under single payer. aware of dog fucked around with this message at 02:38 on Sep 16, 2017 |
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Sep 16, 2017 01:44
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The reimbursement question is a huge one. We haven't even figured out if it's best to pay doctors for what they do, for what they diagnose, or for some nebulous quantification of "performance." How much should a PCP get reimbursed for spending fifteen minutes trying to maximize medical management of a known chronic condition in a patient with multiple social factors affecting compliance, versus an emergency physician doing an incision and drainage of an abscess in three minutes? Well, since the panel that determines physician reimbursement (by assigning "revenue value units," or RVUs, to every billable activity) is largely composed of physicians who perform procedures, primary care physicians get screwed. Tack in rules regarding medication reimbursement and physicians who administer certain medications can rake in obscene amounts of money. Throw in that you're going to get people arguing that US physicians make too much in the first place, countered by people who point out that medical education debt can be crushing, and you quickly find that the discussion is a quagmire. So: Much more complicated than a copy-paste.
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Sep 16, 2017 02:02
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Ze Pollack posted:pssst Okay? Medicare is famous for paying less than insurance. I would like single payer, but we have to realize that many many powerful groups will be against it.
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Sep 16, 2017 03:15
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