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so for certain versions of "you" not including anyone who was not aware of this and missed the window, who had financial difficulties that half-year and missed the window, and the like
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Oct 23, 2017 22:33
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Medicare-for-All, or at least the Bernie Sanders proposal under that name:quote:
So fixating on the name and complaining that Medicare doesn't cover XY and Z or that Part B has ruinous coinsurance rates isn't really a criticism of Bernie's proposal at all. The name is just branding, to associate a single payer plan with a very popular existing public payer system, although I wouldn't put it past us to  "Well actually Medicare isn't as good as you think, here's why Medicare is awful and anything called that is terrible, probably" this thing right into the ground.
VitalSigns fucked around with this message at 06:28 on Oct 24, 2017 |
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Oct 24, 2017 06:25
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evilweasel posted:so for certain versions of "you" not including anyone who was not aware of this and missed the window, who had financial difficulties that half-year and missed the window, and the like Sure. Seems like a pretty easy gap to close though when writing Medicare for All "extend 6 month window to entire period of eligibility".
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Oct 24, 2017 15:51
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"Single payer" polls about the same as "Medicare For All" at least according to the polls I've seen. It's not really some silver bullet. The real messaging issue is how to explain to people why their taxes are going up. That's what killed ColoradoCare which otherwise had very good messaging. You don't have to worry about your insurance company declining to pay your claim or dropping coverage because you couldn't afford your premiums. You don't have to shop around for different insurers or worry that your coverage will change because your boss changed plans or providers; you don't have to worry about losing coverage because you switched jobs or lost your job. Most people would save money on the plan, etc. All very good stuff that explained why single payer made life more convenient and helped to save you money. But then people saw the tax increases and it died horribly at the polls. The advertising blitz against it from private insurers didn't help either, but really people in the US have a very strong hatred of taxes. That's why politicians shy away from actually discussing any implementation details.
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Oct 24, 2017 16:22
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Reik posted:Sure. Seems like a pretty easy gap to close though when writing Medicare for All "extend 6 month window to entire period of eligibility". this is not my area of expertise so take this with a grain of salt, but I think you're missing a key issue there: that insurance for the gap is private insurance. simply allowing signups at any time without underwriting (i.e., figuring out how sick they are and charging appropriately) would have the same effect as abolishing the obamacare mandate and opening up the enrollment period to the entire year - you'd quickly get a death spiral where some people got the insurance only when they needed it, making the pool sicker overall, raising the costs of the insurance, which pushes a few more people to get it only when they need it, making the pool sicker overall... right now, that six months basically acts as an open enrollment period for the rest of your life, with the penalty for missing it being that you probably have to pay more when you get it. you would want to just eliminate the gap and the need for that extra insurance, not do these sort of half measures which probably won't work well because there's too many moving parts.
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Oct 24, 2017 16:41
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VitalSigns posted:Medicare-for-All, or at least the Bernie Sanders proposal under that name: yes, that's what everyone is saying. we're explaining why these supposed "medicare for all" plans aren't actually medicare for all, by explaining why that would cause issues. these aren't attacks on bernie's proposal (or other similar proposals), they're explaining why medicare for all is just branding and not the actual substance of the bill. it's not obvious to a bunch of internet posters because the vast majority of us are not old enough to know the ins and outs of medicare 
evilweasel fucked around with this message at 16:45 on Oct 24, 2017 |
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Oct 24, 2017 16:43
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I think you'll find that as long as the plan's name is Medicare, then it is Medicare, regardless of what the plan actually does. And that's a fact.
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Oct 24, 2017 17:11
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Ceiling fan posted:I think you'll find that as long as the plan's name is Medicare, then it is Medicare, regardless of what the plan actually does. And that's a fact. Hahaha quote:"In terms of creating a national conversation about fiscal reform, the last thing we need is demagoguing attacks against people who have put forward serious policy proposals," said Jason Peuquet, a policy analyst with the bipartisan Committee for a Responsible Federal Budget. "It’s very worrying." quote:Under the current Medicare system, the government pays the health care bills for Americans over age 65. Under the Ryan plan, future beneficiaries would be given a credit and invited to shop for an approved plan on a Medicare health insurance exchange.
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Oct 24, 2017 17:58
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evilweasel posted:it's not obvious to a bunch of internet posters because the vast majority of us are not old enough to know the ins and outs of medicare Public perception of health policy is pretty interesting. Medicare is still really popular even among people who are using it, but like nine times out of ten when an older patient is complaining about Medicare (or their Medicare Advantage plan) screwing them or their family over they will blame it entirely on Obamacare.
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Oct 24, 2017 18:23
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The Phlegmatist posted:"Single payer" polls about the same as "Medicare For All" at least according to the polls I've seen. It's not really some silver bullet. "Your taxes will go up some, but your insurance premiums you constantly bitch about increasing will go away completely.".
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Oct 24, 2017 19:59
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Khisanth Magus posted:"Your taxes will go up some, but your insurance premiums you constantly bitch about increasing will go away completely.". There's trust issues there. You need to expect people to trust that they won't have to pay both increased taxes and insurance too. Americans are too used to being hosed over that way. Plus, it's also a way of saying "All you people who work in the health insurance industry/healthcare billing? Vote us for unemployment." And that's a lot of people. Hillary got in trouble for being slightly hostile to coal mining, which employs 3 guys and a robot. Healthcare bureaucracy employs a LOT of people.
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Oct 24, 2017 20:09
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Khisanth Magus posted:"Your taxes will go up some, but your insurance premiums you constantly bitch about increasing will go away completely.". most people who care about their taxes don't bitch about insurance premium that much because they're taken out of their paycheck and a good chunk is contributed by their employer: it's the people who don't get insurance through their work who have a real close idea what they pay but there's not that many self-employed people who care about their tax rates. what people mostly hate about insurance companies is fighting with them over what's covered or not covered.
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Oct 24, 2017 20:19
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The company I work for has come up with a creative plan for preventing increasing insurance premiums. It is a private pool that is managed by BCBS, so the company has lots of say in the plans. So, instead of increasing premiums in recent years to keep up with increasing medical costs, they have just been making the insurance plans worse. Copays and deductibles going up. We got our benefits summary for next year and they've somehow taken the traditional HDHP, where it has a high deductible but it pays 100% of costs after you hit that deductible for doctor visits and prescriptions, and made it even worse by making it so you have a 15% coinsurance on prescriptions AFTER the deductible. Then in 2019 they are eliminating the HMO plan, leaving only HDHP. Frankly HDHPs should be illegal, because they are the biggest loving rip offs ever. If you don't have health issues, you are literally paying premiums towards a plan that will pay nothing for the times you do have to go to the doctor. If you do have health issues...well, enjoy paying several thousand out of pocket each year. Its sadly getting to the point where I'm going to have to move on to a new job just because I cannot afford my wife's medical care on my salary that is well under the average in my area for my job, with no expectation of a decent raise, and looming changes to the health insurance to make it so I'm paying even more. I actually kind of like this job sometimes.
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Oct 24, 2017 20:28
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I'm on an HDHP which has coinsurance after deductible, but the out of pocket max is comparable to the annual premiums on the HMO and the difference is made up with a contribution to an HSA. Medical insurance in this country is nuts.
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Oct 24, 2017 23:51
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I get the cheapest plan my employer offers and then never go to the doctor so I don't have to put effort into figuring this poo poo out. Yeah, our system is hosed.
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Oct 25, 2017 00:57
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BarbarianElephant posted:There's trust issues there. You need to expect people to trust that they won't have to pay both increased taxes and insurance too. Americans are too used to being hosed over that way. This. Pretty much the only way it's going to work is creating a universal public system and keeping the private, employer sponsored model around simultaneously so rich/white people can double dip whenever it is convenient. See how it works in brazil
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Oct 25, 2017 01:12
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Peven Stan posted:This. Pretty much the only way it's going to work is creating a universal public system and keeping the private, employer sponsored model around simultaneously so rich/white people can double dip whenever it is convenient. See how it works in brazil I want to be clear that I am not being a dick here and am bringing this up just as an important talking point: Pretty much everyone else has some form of universal or semi-universal coverage and they do not have massive unemployment. The British NHS was established in 1948 during the Great Reconstruction after the devastation of the war and I know of no massive unemployment. I believe that Canada's system began in the province of Saskatchewan in 1962 and I also know of no massive employment problem there. Why, then, is it impossible for the US system to transition without putting millions and millions out of work? After all, giving people better coverage will increase the number of people taking advantage of it, which will increase the need for health services, both medical and administrative, would it not? Even if you totally abolished private insurance, which even I am not sure is the best route, the need for health services will grow and, like any sector, a growing need for a service means more jobs in that field.
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Oct 25, 2017 03:11
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If you wanna get real macro level about it: having free healthcare for your population helps cut down medical costs due to preventative care, helps cut down on bankruptcy costs. Healthy populations are smarter and more productive. Like you said more jobs to help cover the whole populations needs. Plus a bunch of things I’m sure I’m forgetting. These would also make rich people richer but gently caress minorities and poor people I guess.
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Oct 25, 2017 03:18
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It's not necessary, but "millions of people will be unemployed. forever" is a more effective argument than telling the truth "a private system that squeezes money from you and leaves you to die generates big profits for us"
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Oct 25, 2017 03:25
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Invalid Validation posted:If you wanna get real macro level about it: having free healthcare for your population helps cut down medical costs due to preventative care, helps cut down on bankruptcy costs. Healthy populations are smarter and more productive. Like you said more jobs to help cover the whole populations needs. Plus a bunch of things I’m sure I’m forgetting. These would also make rich people richer but gently caress minorities and poor people I guess. It works in the long run, but it would be potentially disruptive in the short run. It's not like a hospital administrator can become a nurse overnight. Also, today this thread prompted me to stumble across an article on the 1962 Saskatchewan Doctors Strike, so I learned something today!
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Oct 25, 2017 03:31
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JustJeff88 posted:I want to be clear that I am not being a dick here and am bringing this up just as an important talking point: Pretty much everyone else has some form of universal or semi-universal coverage and they do not have massive unemployment. The British NHS was established in 1948 during the Great Reconstruction after the devastation of the war and I know of no massive unemployment. I believe that Canada's system began in the province of Saskatchewan in 1962 and I also know of no massive employment problem there. Why, then, is it impossible for the US system to transition without putting millions and millions out of work? After all, giving people better coverage will increase the number of people taking advantage of it, which will increase the need for health services, both medical and administrative, would it not? Even if you totally abolished private insurance, which even I am not sure is the best route, the need for health services will grow and, like any sector, a growing need for a service means more jobs in that field. This plot from wikipedia might be relevant:  As you pointed out Canadian provinces started experimenting with public health care in the early 60s and the federa Medical Care act soon followed in 1966. This was close in time to when Medicare and Medicaid were established in the US. At this point Canadian and US health care costs were pretty comparable at ~6% of GDP. However despite a few attempts to pass UHC in the 1970s the US proceeded to do nothing in terms of public health care for 50 years, and the industry now accounts for ~17% of GDP. It's not unreasonable to think it will be more difficult for the US to transition to a UHC system now then Canada back in the 60s given that the industry is currently more than three times as large proportionally wrt the rest of the economy. edit: Honestly that plot is incredible. Health care costs were pretty similar across western countries in the early 1960s, but the US stubbornly doubled-down on privately insured healthcare for half a century and wound up with the most expensive and least amenable to reform system in the world. Was all the extra freedom worth it? Nocturtle fucked around with this message at 03:52 on Oct 25, 2017 |
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Oct 25, 2017 03:43
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The millions out of work myth is pretty well debunked by Matt Bruenig here: http://peoplespolicyproject.org/2017/09/19/single-payer-myths-redundant-health-administration-workers/ I'd recommend reading all of his Single Payer Myth articles as they show how bullshit so many of these "Yeah but what about" arguments are.
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Oct 25, 2017 03:44
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Khisanth Magus posted:Frankly HDHPs should be illegal, because they are the biggest loving rip offs ever. If you don't have health issues, you are literally paying premiums towards a plan that will pay nothing for the times you do have to go to the doctor. If you do have health issues...well, enjoy paying several thousand out of pocket each year. There is a huge range for HDHPs and they're not all terrible. The deductible can be as low as $1350 for individual plans and $2700 for a family and allow you access to an HSA. They can range up to the out of pocket maximum which is $6650 and $13300 respectively. I use a HDHP thst has a deductible of $1500 and an employer contribution of $500 to my HSA. Since I basically only need routine office visits my yearly costs are small so I van save a ton to my HSA that would otherwise be going towards a premium I wasn't benefiting from. And if something major does happen my out of pocket costs are manageable (and available from my HSA if absolutely necessary). They aren't great for everyone and it sucks your employer is limiting options to just it, but the ones with lower deductibles can actually be of good value.
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Oct 25, 2017 04:35
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Raldikuk posted:There is a huge range for HDHPs and they're not all terrible. The deductible can be as low as $1350 for individual plans and $2700 for a family and allow you access to an HSA. They can range up to the out of pocket maximum which is $6650 and $13300 respectively. I have a wife with health issues that ensures I will hit any deductable they set. An HSA does me absolutely no good because any money I put into it is going to be paid back out immediately. Actually I benefit more from and fsa because that is available immediately, where an HSA only has money you are putting into it. I have also never seen a HDHP where the employee part of the premium was less than $150, usually significantly more. If you have no ongoing health problems you are paying that $150 a month to receive nothing if you have to go to the doctor once or twice. It might as well be one of the "catastrophic health plans" that the PPACA made illegal. Basically if you are more or less healthy you are paying $150+ to be able to invest into an HSA.
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Oct 25, 2017 04:49
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JustJeff88 posted:I want to be clear that I am not being a dick here and am bringing this up just as an important talking point: Pretty much everyone else has some form of universal or semi-universal coverage and they do not have massive unemployment. The British NHS was established in 1948 during the Great Reconstruction after the devastation of the war and I know of no massive unemployment. I believe that Canada's system began in the province of Saskatchewan in 1962 and I also know of no massive employment problem there. Why, then, is it impossible for the US system to transition without putting millions and millions out of work? After all, giving people better coverage will increase the number of people taking advantage of it, which will increase the need for health services, both medical and administrative, would it not? Even if you totally abolished private insurance, which even I am not sure is the best route, the need for health services will grow and, like any sector, a growing need for a service means more jobs in that field. I'm not worried about insurance jobs- nobody outside of that middleman industry gives a gently caress about them. What I am worried about is taking away employer paid healthcare from a population conditioned for 3 generations to accept it as the only way things work. It's an insanely arbitrary and capricious system where people making $12/hr can suck down over 70k a year in humira infusions and stick with the job because the health plan literally is worth several times their salary. The system is also tinged with classism and racism- ESI predominantly benefits wealthy individuals and white individuals. Unlike the ACA exchanges, which allow anyone with money to buy a high tier metal plan if they have the cash for it, employer paid locks those benefits behind a corporate filter so only "people like me" get the good stuff. Khisanth Magus posted:
Depends on the size /health of the group, andhow much money your employer wants to shell out. My last employer only had a HDHP with a whopping 3300 USD deductible but the premium was $40 a month. My current employer offers one with a more managable deductible of $1500 a month but the premium is $55 a month. CAPS LOCK BROKEN fucked around with this message at 05:04 on Oct 25, 2017 |
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Oct 25, 2017 05:00
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Khisanth Magus posted:I have a wife with health issues that ensures I will hit any deductable they set. An HSA does me absolutely no good because any money I put into it is going to be paid back out immediately. Actually I benefit more from and fsa because that is available immediately, where an HSA only has money you are putting into it. I pay $30 a month for mine. Employer covers $300. As I mentioned in my first post for a single person HDHP ranges from $1350 to $6650 for the deductible which is quite the range. The ones closer to $6650 are going to be giving less value but they're also the cheapest plans. And you do get value from the plan prior to hitting the deductible with negotiated rates and essential health benefits such as annual exams. My employer also offers a low deductible PPO plan that covers basically everything from day one with low copays. It also would cost me $300 per paycheck. For someone with chronic health issues thst will be using the plan a lot this is a great value. For someone like myself who generally only needs an annual exam it makes no sense. Even if something major happens the extra cost wouldn't be worth it. Tldr lower end deductible HDHPs are fine and shouldn't be illegal and can actually be the most prudent choice for some.
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Oct 25, 2017 06:27
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I don't even know why my employer bothers with health insurance, they don't contribute and the plans look no different than the exchanges and are of similar price. This has the bonus effect of disqualifying me for subsidies.
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Oct 25, 2017 06:49
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Have you seen my apex seals? I seem to have lost them.
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 at people talking about HSA's like they benefit them. HSAs are entirely a tax shelter vehicle for the wealthy. If you're not making top 1-2% income HSAs are a joke if you actually get sick.
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Oct 25, 2017 10:00
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Not joking, if I had to choose between an HSA with a tax-free APR of 50,000% and having medicare/medi-cal I'd still have to go the latter route. Otherwise I could never squirrel away enough money to keep it from hitting 0 for the month.
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Oct 25, 2017 10:32
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Cactus Jack posted:The millions out of work myth is pretty well debunked by Matt Bruenig here: http://peoplespolicyproject.org/2017/09/19/single-payer-myths-redundant-health-administration-workers/ No you see it's okay, hundreds of thousands would be out of work. We'll just pay them for two years while they find a retail job because their skillset is entirely useless now. But 1.3 million people get laid off every month so it's like totally a drop in the bucket, who gives a poo poo about them anyway. Oh and we'll institute a payroll tax to prevent employers from clawing back their contributions to employer-sponsored health plans when we implement single payer. Well I guess all those people who work for Wal-Mart who didn't receive health insurance anyway will be real happy when the mass layoffs come and they're taking home 10-15% less every pay period. You might not be able to make rent but at least you have healthcare now! --signed with a very bourgeois "Bernie would have won"
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Oct 25, 2017 13:07
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If they'd just implement single payer nobody would care after the first few years.
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Oct 25, 2017 13:13
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Cactus Jack posted:The millions out of work myth is pretty well debunked by Matt Bruenig here: http://peoplespolicyproject.org/2017/09/19/single-payer-myths-redundant-health-administration-workers/ The "lots of people lose their jobs/get pay cuts" myth is a necessary corollary to the "health costs will be cut in half" myth. You can't have one without the other unless you think literally half of health spending is capital gains and dividends. There's certainly some rents that can be cut, but not that much.
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Oct 25, 2017 13:39
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lmbo at someone trying to argue health care is bad for the poor and they probably don't want it anyway. Your bill is dead, Lindsay Graham, shitposting on SA ain't bringing it back
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Oct 25, 2017 13:43
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PerniciousKnid posted:The "lots of people lose their jobs/get pay cuts" myth is a necessary corollary to the "health costs will be cut in half" myth. You can't have one without the other unless you think literally half of health spending is capital gains and dividends. There's certainly some rents that can be cut, but not that much. You could cut healthcare costs in half with a better system. There are problems at every level of the system that need to be addressed.
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Oct 25, 2017 16:21
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Reik posted:You could cut healthcare costs in half with a better system. There are problems at every level of the system that need to be addressed. You want to cut healthcare costs. To do this, you simplify the billing system. Admin staff gets laid off. You get rid of private insurers. All those people get laid off. You reduce reimbursement rates to providers and implement rationing. Providers reduce staffing requirements to save money. More people jobless. It's a very drastic realignment of our current healthcare system.
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Oct 25, 2017 16:55
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The Phlegmatist posted:You want to cut healthcare costs. To do this, you simplify the billing system. Admin staff gets laid off. You get rid of private insurers. All those people get laid off. You reduce reimbursement rates to providers and implement rationing. Providers reduce staffing requirements to save money. More people jobless. It's a very drastic realignment of our current healthcare system. That's not how to cut healthcare costs. You're starting at the end of the chain and working your way back, when you should be starting at the beginning and working your way forward. Profit margins of pharmaceutical and medical devices companies are astronomical. Also, the billing system is complicated because healthcare is complicated. Insurers would love a simpler billing system.
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Oct 25, 2017 17:04
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Regarding the medical jobs themselves, we're already going to lose a lot of those jobs anyway to automation. As is happening with contract law, human resources, freelance hiring. Jobs that won't come back because why would the companies willingly incur higher labor costs and lower efficiency? But that's a larger issue that exists across the world, across industries, and essentially independent of health care costs.
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Oct 25, 2017 17:11
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If the healthcare system is a makework project for office drones then fine but why should the poor and middle classes foot the bill. Do single payer and then pass an Office Works Program Tax on the wealthy to hire all those former billing people and pay them to write up meaningless statements and send them back and forth for no reason forever, at the end of the day it's the same thing but with 100% fewer families ruined by insane healthcare costs and no money wasted on corporate profits.
VitalSigns fucked around with this message at 17:53 on Oct 25, 2017 |
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Oct 25, 2017 17:49
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The reason medical costs have balooned so much is that both the medical providers and insurance both benefit from the increases. Insurance companies are only allowed to keep a certain % of the premiums they get, the rest must be paid in claims, and premiums are more or less automatically calculated as what is necessary to cover expected claims. So to increase premiums so that their flat % cut also goes up they need medical costs to go up. Which of course directly benefits the medical providers. The way single payer fixes the problem is by upsetting half of that agreement and having the power to back it up. By no longer having insurance companies that want prices to go up, and by giving what replaces them enough muscle, the government agency can directly tell the medical providers what they will pay for x thing, they can take it or shove off and not be covered by the new system, which would be a death blow.
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Oct 25, 2017 18:44
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Khisanth Magus posted:The reason medical costs have balooned so much is that both the medical providers and insurance both benefit from the increases. Insurance companies are only allowed to keep a certain % of the premiums they get, the rest must be paid in claims, and premiums are more or less automatically calculated as what is necessary to cover expected claims. So to increase premiums so that their flat % cut also goes up they need medical costs to go up. Which of course directly benefits the medical providers. This assumes there is no competition in insurance, which is false. Insurers already don't want healthcare costs to go up.
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Oct 25, 2017 18:51
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