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Ardennes posted:If Medicaid paid Medicare +5%-10% rates, it wouldn't be an issue. Most providers would take patients without a fuss, but the system low-balls providers to the point that Medicaid patients have become a target. Some providers still take some in order to get Medicare patients but put as many barriers to entry as possible to keep them out of the office. Calling a representative is fine and everything, but people often can't wait to see how the entire situation shakes out when they have a serious health issue. Right, right, I'm just saying that design is deliberate because it's seen as serving poor and minority populations. In my Republican-run state, it's seen as a program for "Democrats", i.e., black people. So it's kept underfunded for that reason.
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Dec 21, 2017 21:23
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Ardennes posted:There are a bunch of issues with Medicaid though including open discrimination by providers who often do anything to not to see a Medicaid patient if they have to. In addition, even in relatively "blue states" like Oregon, there is a ton of hoops you have to go through and there are real limits to your coverage. In contrast, if your above 138% of the poverty line, you often get very high subsidies, enough to make at least high-end Silver plans affordable and usually you skip the open discrimination that Medicaid patients face. I don't actually have a problem with Medicaid as a concept, but once you start actually picking apart how Medicaid patients are treated...it is something else. Also, there is a point where is may simply just make more sense to pay a little more to protect your health. States have pretty much bucketed most Medicaid recipients into managed-care plans, though--which face the same narrow networks as individual Obamacare plans but shield recipients from balance billing and other out-of-pocket costs. While you might have to wait a few months to get an appointment with a Medicaid managed-care PCP, it's not like the pre-ACA days when you couldn't find providers to take Medicaid across entire counties. And reimbursement parity with Medicare is moot if providers are being paid per capitation. And "enough to make Silver plans affordable" sort of obscures stuff like balance billing, or the fact that once you get into the 3x multiplier for olds the cost difference in (even subsidized) premiums between Bronze and Silver makes high-deductible Bronze plans more attractive for lower-middle-income people. Eg: When I was scoping out plans for 2017 the premium differential for a Silver Plan with cost-sharing reductions made the high-deductible Bronze plans pretty much a wash with Silver plans. As far as reimbursement levels, I remember that back when the Obamacare plans rolled out in 2014 many private insurers were only paying around 70 percent of Medicare's provider reimbursement levels in California. To some degree, Obamacare has had the dubious distinction of having private insurance take on the worst features of Medicaid while Medicaid has become a fairly well-working single-payer model in the states that have expanded it. Willa Rogers fucked around with this message at 21:29 on Dec 21, 2017 |
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Dec 21, 2017 21:27
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Willa Rogers posted:States have pretty much bucketed most Medicaid recipients into managed-care plans, though--which face the same narrow networks as individual Obamacare plans but shield recipients from balance billing and other out-of-pocket costs. While you might have to wait a few months to get an appointment with a Medicaid managed-care PCP, it's not like the pre-ACA days when you couldn't find providers to take Medicaid across entire counties. And reimbursement parity with Medicare is moot if providers are being paid per capitation. Btw, I am talking about people that are making just above 138%, in Oregon you can get very decent plans where most of the out of pocket costs are restrained and premiums costs are pretty limited. It is going to be higher than Medicaid, but it also gives you more flexibility even if you choose an HMO (then you get to at least choose the HMO you want). Age is also a factor, but once you are just across the 138%, there are actually quite a few higher tier Silver options. I agree that the farther you move up income, the subsidies pretty much disappear and affordability is far far more of an issue. I am taking the experience of Oregon in mind, and over here the CCOs have limited choice pretty severely and if you want to have better care you still have to run the gauntlet. The OHP also has some severe cost containment which honestly is fairly worrisome. Ardennes fucked around with this message at 21:51 on Dec 21, 2017 |
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Dec 21, 2017 21:46
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It's really hard to compare the subsidized plans this year with Medicaid, because Trump's holding back the cost-sharing subsidies has upended the individual market. Silver plans in IL are pretty dirt-cheap for 2018 (at least in IL) but as I said for 2017 the age differential ironed out the difference in costs for high out-of-pocket Bronze plans and CSR-impacted Silver plans.
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Dec 21, 2017 21:54
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Willa Rogers posted:It's really hard to compare the subsidized plans this year with Medicaid, because Trump's holding back the cost-sharing subsidies has upended the individual market. Silver plans in IL are pretty dirt-cheap for 2018 (at least in IL) but as I said for 2017 the age differential ironed out the difference in costs for high out-of-pocket Bronze plans and CSR-impacted Silver plans. Well, every state market is going to be different, I don't think the Oregon market has been that affected but I guess we will see. Admittedly, part of it literally takes "gaming" out a scenario to see what is worth it. Btw, I absolutely don't think Medicaid doesn't have a point, especially if you really just can't afford even subsidized Silver plans.
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Dec 21, 2017 22:07
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Hieronymous Alloy posted:Column A, Column B, etc. I've had the conversation several dozen times with people irl. It always ends the same way: If we lose Obamacare, we need true universal healthcare. This conversation is normally with people the "Do you even left, bro? " crowd would sneer at as centrists. I'm not sure the right realizes how they'll gently caress themselves if they gently caress it (Obamacare) up. Thing is... atleast three years... that's a long time and a lot of harm.
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Dec 21, 2017 22:53
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BrandorKP posted:I've had the conversation several dozen times with people irl. It always ends the same way: If we lose Obamacare, we need true universal healthcare. This conversation is normally with people the "Do you even left, bro? " crowd would sneer at as centrists. If it is enough harm for people to back a inquisition. Then that is good. We can then purify America.
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Dec 21, 2017 22:56
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I'm not a fan of accelerationism but we're already in hellworld so I might as well have something to look forward to.
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Dec 21, 2017 23:03
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https://twitter.com/AngelRafPadilla/status/943971504315920386
ded redd fucked around with this message at 00:01 on Dec 22, 2017 |
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Dec 21, 2017 23:58
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Tweet's gone, what did it say?
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Dec 22, 2017 01:17
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https://twitter.com/NumbersMuncher/status/943636459428483072
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Dec 22, 2017 01:34
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sirtommygunn posted:I'm not a fan of accelerationism but we're already in hellworld so I might as well have something to look forward to. It is all there is now.
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Dec 22, 2017 01:53
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Good Dogge.
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Dec 22, 2017 01:54
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Ardennes posted:Well, every state market is going to be different, I don't think the Oregon market has been that affected but I guess we will see. Admittedly, part of it literally takes "gaming" out a scenario to see what is worth it. The problem is for older, low-income-but-not-medicaid-poor people who can't afford a silver plan and are stuck with $7,000/year deductibles under whopping incomes of, say, $18k-$20k/year. Otoh, Trump's screwing around with the CSRs has made a lot of silver plans cheap with very low deductibles. But the Murray-whoever plan that McConnell has promised to restore the CSRs will bring us back to those horrible bronze plans again.
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Dec 22, 2017 04:31
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Majorian posted:Tweet's gone, what did it say? You probably know this already but for the record it was supposedly a list of D reps who advanced the budget rather than go full opposition for DREAMers. Apparently it was wrong.
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Dec 22, 2017 04:44
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The US/Israel are still completely isolated on the legality of Israel's occupation https://twitter.com/ggreenwald/status/943902006141472769 https://twitter.com/spectatorindex/status/943926960937299968
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Dec 22, 2017 05:47
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Guess we’re not even going to pretend the F-35 isn’t just some bizarro jobs project. https://twitter.com/GDouglasJones/status/943953177002553344?ref_src=twcamp%5Eshare%7Ctwsrc%5Em5%7Ctwgr%5Eemail%7Ctwcon%5E7046%7Ctwterm%5E1
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Dec 22, 2017 06:20
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Hieronymous Alloy posted:Right, right, I'm just saying that design is deliberate because it's seen as serving poor and minority populations. In my Republican-run state, it's seen as a program for "Democrats", i.e., black people. So it's kept underfunded for that reason. This is so true. Medicaid might as well not exist in my state because it's so underfunded. It's a convoluted, bureaucratic nightmare just to get on a year-and-a-half long waiting list (that is IF you qualify). The only reason I have any healthcare at all is because I qualified for one of the ACA exchanges, and who knows how long that will last with Trump's congress gutting everything in sight with tax cuts.
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Dec 22, 2017 07:08
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Chomskyan posted:The US/Israel are still completely isolated on the legality of Israel's occupation Why did the countries who abstained, abstain?
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Dec 22, 2017 07:32
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Lightning Knight posted:Why did the countries who abstained, abstain? They didn't want to vote "No", but for whatever reason, they thought voting "Yes" might be politically risky. I'm sure each country that abstained had their own individual reasons...but note that most of them are poor and need a lot of foreign aid, are particularly deep in the US's sphere of influence, or both.
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Dec 22, 2017 08:17
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I've always thought it would be best if Jerusalem became a city-state like the Vatican, but there's no way Palestine or Israel would let that happen.
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Dec 22, 2017 08:40
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Chomskyan posted:The US/Israel are still completely isolated on the legality of Israel's occupation There is no question on the legality of Isreal's ownership/annexation of East Jerusalem. There is disagreement about whether anything should be done about it, which basically boils down to the UN and most of the worlds position of "We don't like it, but we're not going to do anything about it either." The UN Two-State solution is a internationally preferred solution to prevent conflict, not a legal question. Just throwing that out there because framing the issue as a legal question is not only misleading but also serves a narrative that dismisses the original source of this problem and the double standard with Isreal by the UN major powers.
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Dec 22, 2017 09:29
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Main Paineframe posted:They didn't want to vote "No", but for whatever reason, they thought voting "Yes" might be politically risky. I'm sure each country that abstained had their own individual reasons...but note that most of them are poor and need a lot of foreign aid, are particularly deep in the US's sphere of influence, or both. Also NAFTA is being renegotiated. Trump's a petty gently caress and Canada and Mexico know it.
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Dec 22, 2017 09:33
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The logical thing is to re-divide it, but that will absolutely never happen while the US backs Israel.
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Dec 22, 2017 09:42
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Lycus posted:The logical thing is to re-divide it, but that will absolutely never happen while the US backs Israel. Why is that the logical thing? The authority granted to make the resolution was granted by the British under the mandate, and neither party it supposed to represent agreed to it. On top of that, both subsequently declared independence anyways. From an international standpoint they're just two rebel governments that took hold and established themselves. In all other cases across the world where that's happened conflict happens, life goes on, and the winner gets invited into the UN where there are several former illegitimate governments serving today. Based on past history and the examples used literally everywhere else in the world the most logically thing to do would be for everyone to pull let, let the Palestinians and Isreali's do what they want to each other until one side comes out on top permanently or they're so exhausted they finally come up with a tenative solution. Which is almost what we've got now except for the UN constantly pushing their resolution like it has some sort of legitimacy. Edit: To be fair, there is also the few times when the "UN" did actually intervene such as the Korean War or Yugoslav Wars, so I suppose I can't say literally every example and by that token it would be logically for the UNSC to vote to do a full on military campaign as another option. But in either case just sitting back and trying to tell Isreal and Palestine to live by the resolution is most certainly the least logical thing to do. nessin fucked around with this message at 10:07 on Dec 22, 2017 |
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Dec 22, 2017 09:51
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The logical thing is for the European colonizers to gently caress right back off to Europe and stop genociding whomever sits on land they want, hth.
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Dec 22, 2017 13:01
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nessin posted:Why is that the logical thing? The authority granted to make the resolution was granted by the British under the mandate, and neither party it supposed to represent agreed to it. On top of that, both subsequently declared independence anyways. From an international standpoint they're just two rebel governments that took hold and established themselves. In all other cases across the world where that's happened conflict happens, life goes on, and the winner gets invited into the UN where there are several former illegitimate governments serving today. Based on past history and the examples used literally everywhere else in the world the most logically thing to do would be for everyone to pull let, let the Palestinians and Isreali's do what they want to each other until one side comes out on top permanently or they're so exhausted they finally come up with a tenative solution. Which is almost what we've got now except for the UN constantly pushing their resolution like it has some sort of legitimacy. Come on, pull out till a winner emerges is crazy talk. If everyone pulled out the Israelis would massacre the Palestinians in short order. It's also probably even worse if Israel somehow got close to losing because they're sitting on a nuclear arsenal that would allow them to end a lot of old grudges on their way out - Israel is like America is Christian Republicans actually got to enshrine the beliefs as inseparable from the government.
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Dec 22, 2017 13:32
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Chomskyan posted:The US/Israel are still completely isolated on the legality of Israel's occupation The Mexico/Canada abstentions don't look in any way like neighbors of a global bully trying not to gently caress up their trade deals. Nosiree!
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Dec 22, 2017 14:29
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Trump: "You gorgot
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Dec 22, 2017 14:44
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https://twitter.com/sunny_hundal/status/944158714835107840 As a Michigander, Pete Hoekstra is and has always been an rear end in a top hat.
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Dec 22, 2017 14:47
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Chilichimp posted:The Mexico/Canada abstentions don't look in any way like neighbors of a global bully trying not to gently caress up their trade deals. Canada would likely have abstained anyway, you'll note we went along with the US in rejecting the 2012 resolution giving Palestine observer status. Canada's interests are usually best served when the US forgets it exists. This means not rocking the boat or drawing attention through some act of defiance.
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Dec 22, 2017 15:29
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Also Australia might as well be two miles off the coast of Washington (and another two miles off the coast of London) as far as our politics goes.
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Dec 22, 2017 16:31
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Annnnd Tim Kaine rises from the oblivion that is his birthright to poo poo on DREAMers. 
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Dec 22, 2017 16:38
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Tim Kaine? Tim Kaine... Tim Kaine... Wasn't he the Democratic nominee for Vice President?
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Dec 22, 2017 16:53
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I read from someone that went to his event in Virginia this week and really put the current Democratic situation best. You had Dreamers yelling at Kaine while a bunch of people were trying to get selfie pictures standing with him.
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Dec 22, 2017 17:00
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Sephyr posted:Annnnd Tim Kaine rises from the oblivion that is his birthright to poo poo on DREAMers. specifically he is opposed to shutting down the government over daca or anything else but daca is next on the docket after chip
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Dec 22, 2017 18:15
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So this happened https://twitter.com/NaomiAKlein/status/943883222391382017 Sephyr posted:Annnnd Tim Kaine rises from the oblivion that is his birthright to poo poo on DREAMers. https://twitter.com/JayesGreenJ/status/944055829300465664
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Dec 22, 2017 18:41
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How do you vote against the dream act? Republicans have the majority, even if you are pragmatically trading them to keep government open just vote no and let the 51 republicans save you. It isn't hard. Just look at the 100000000 bills called "Obamacareisrepealedsaywhat" .
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Dec 22, 2017 18:45
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HootTheOwl posted:How do you vote against the dream act? Republicans have the majority, even if you are pragmatically trading them to keep government open just vote no and let the 51 republicans save you. It isn't hard. Just look at the 100000000 bills called "Obamacareisrepealedsaywhat" . Because it wasn't a vote against the dream act but instead a vote to fund the government for 1 month, stop cuts to medicare, and fund CHIP for 3 months?
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Dec 22, 2017 18:47
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Yeah the Dems were focused on funding CHIP which was just about to immediately run out. They accomplished that. You can debate on whether that was more important to push for than DACA or not but that's the reason why they put it to the side.
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Dec 22, 2017 18:50
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