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call to action posted:Is there anywhere I can read about why we apparently need to raise taxes to fund UHC (per this thread) and yet we already spend more public-only dollars on healthcare per capita than any country in the world, tia There's lots of places, but the basic reasons are: - Economies of scale (its easier to do in denser and more urban countries in Europe) - The U.S. does not force price controls on all service providers through monopsony or monopoly powers - The U.S. does not conscript doctors into being government employees and apply much lower salaries to them - U.S. costs subsidize medical device manufacturers and prescription drug manufacturers prices in other parts of the world - The U.S. consumes more services (scans, tests, and procedures) than other countries https://www.theatlantic.com/business/archive/2014/07/why-do-other-rich-nations-spend-so-much-less-on-healthcare/374576/
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Apr 5, 2017 20:53
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skull mask mcgee posted:As a young person with multiple preexisting conditions, I'd like to contest this. Don't lose your insurance for more than 6 months, don't live in a red state, make more money, and don't have any major medical issues until you are 65 and you'll be fine (and probably come out ahead financially) under the AHCA.
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May 5, 2017 14:29
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ISeeCuckedPeople posted:So what's the easiest way to get a job that pays over $75,000 a year? Depends on where you live. If you live in America? Hard work, intelligence, and strength of character.
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May 5, 2017 15:14
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Brookings did a study a couple of years ago and came to the conclusion that the higher rate Americans pay for healthcare boils down to three big things. 1) Private insurance 2) Higher compensation for pharmaceutical manufacturers, medical device manufacturers, and medical professionals (especially specialists) 3) Geographic and Lifestyle issues (the US is much less densely populated than every European country, 90% of Canada lives in about 10% of the land mass, high obesity rates, income inequality leads to a small subgroup of people that have tons of health needs that compound costs) Private insurance was responsible for about 18% of the increased costs that Americans pay. Geographic and lifestyle issues were about 20%. Costs for medical professionals, pharma, and medical devices was close to 50%. If the US wants to get per-capita medical spending down to Canadian levels, then they have to accept the fact that doctors are going to be compensated less, some people in the insurance and medical professions will lose their jobs, and that spending money to get the 10% of people that recieve 80% of the US healthcare spending early will save money in the long-run. Those are all politically unpopular things to say and doctors have a very strong lobbying influence and enjoy a very high level of public trust, so it is difficult to get done. The insurance companies promote a ton of waste and perverse incentives, but they are not the primary drivers of cost compared to Canada/Europe. Leon Trotsky 2012 fucked around with this message at 18:24 on May 9, 2017 |
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May 9, 2017 18:22
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Ze Pollack posted:Man, that one was sneaky. "Medical professions, pharma, and medical devices." I wasn't pretending doctors are. But if you break it down, then getting doctor salaries in the US down to the ratio they are in the most efficient European countries would reduce total healthcare costs by about 10%. Doctors would still be making 6-figures in this scenario. It is also highly concentrated in certain fields that make some procedures almost 8x more expensive in the US. That ain't nothing. It has to be a part of the solution. The vast bulk of increased costs to US consumers comes from the excess margin various people in the chain collect. Doctors aren't un-involved. Everyone knows that pharmaceuticals in the US are sold at a crazy markup and it isn't a secret.
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May 9, 2017 19:07
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Mr. Nice! posted:Specialists are what you're after, not doctors. Your average GPs in America aren't making vastly more now than what they are anywhere. Specialists are the major source of doctor price gouging. GPs in the US actually do make much more than doctors anywhere else in the world. quote:So do we simply use more expensive technologies? Are doctors murdering our pocketbooks with their tests? In fact, Americans get less MRI scans per person than Japan, and have fewer hip and knee replacements and cardiac catheterizations than many European countries. The distribution of our spending among various sectors—basic medical care, diagnostics, hospitals, pharmaceuticals, and nursing homes—is not actually very different from European countries (we actually spend far less of our healthcare expenditures on nursing homes, at only 6.2% as compared to 20% in Switzerland, and slightly more than European countries on basic care). The highest cost technologies don’t seem to be disproportionately used by us. esquilax posted:Do you have a link to the study? Sounds neat The quote above is the nugget from The Commonwealth Fund that the Brookings used as a guide. The full study is here: http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective I don't have a link to the Brookings study, but it was released in late 2014 or early 2015 and I have a copy at home I can post later. Leon Trotsky 2012 fucked around with this message at 19:17 on May 9, 2017 |
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May 9, 2017 19:15
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Mr. Nice! posted:You're right, but it's not much more. Australia is lower than pretty much all of europe. https://journal.practicelink.com/vital-stats/physician-compensation-worldwide/ That chart you posted says that the average U.S. GP makes 206% more than the average non-US doctor. How does that jive with the idea that they don't "make much more" than other countries?
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May 9, 2017 19:22
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Flip Yr Wig posted:So how long do we think it will be between the Senate passing their bill and the conference bill coming to a final vote? Once the Senate votes on their AHCA, I have to assume the media silence will end and it will dominate the news and finally get people angry. Depends on how quickly the two houses agree to the changes and if they have planned/negotiated beforehand. They could theoretically do it all in a day or the conference committee could kill the bill.
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Jun 15, 2017 18:42
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Shimrra Jamaane posted:Yeah I thought that they were trying to make it so the public only had a matter of hours to review things. They are going to limit floor debate and amendments with that tactic, not keep the text of the bill secret.
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Jun 20, 2017 01:15
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Sir Kodiak posted:So I take it you disagree with the guy who said they would use "gerrymandering, a police state, and voter suppression to make sure anyone who might give a poo poo is too disenfranchised to do anything about it", which is what I was asking about? They have (correctly) determined that: - They need to pass a bill to fulfill their promise to "repeal and replace Obamacare" to their base - That if they are going to do it, then a long drawn out public debate over the bill is bad politically - They can delay most of the provisions in the bill to not kick in for 2-7 years and hope that by then most voters will have forgotten about it. - This minimizes the political damage from passing it and makes it the responsibility of individual states to make it work.
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Jun 20, 2017 02:37
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The hot new trend for medical device companies since ~2005 is to partner with certain clinics and get old people to sign up for exercise or lifestyle classes with Medicare Advantage and then bill them for a service that they never use or use once a year until they die. This has the advantage of not having to actually pay for shipping or any actual products.
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Jun 20, 2017 15:55
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BarbarianElephant posted:Not really, if run like most first world countries. You think Canadians would put up with that? There are edge cases where it is lower, such as if you want a transplant ASAP and have infinite cash. But for the experience of most people, single payer is the same experience or better. "Lower standards of care" obviously scares the poo poo out of Americans, but it doesn't work that way. In fact, in UHC countries, the rich can usually skip the line by ponying up stacks of cash. Rich people can currently pay piles of cash for premium healthcare without paying an additional 6% of their income in taxes.
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Jun 20, 2017 16:29
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BarbarianElephant posted:The truly rich don't tend to have health insurance, because they would never need to use it. They just pay cash. Not true at all in America. The uninsured rate for people who make more than 200k per year is less than 1.5% And you would not get a net benefit if you were high-income and healthy.
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Jun 20, 2017 16:35
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The average salary increase and tax treament of doctors in the U.S. outweighs the total debt they accrue after about 2.5 years. That is an extremely good trade-off. If you drop out of your last year of medical school, then you're boned. But pretending that student debt is the reason doctors get paid so much and justifies their groaning is silly.
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Jun 20, 2017 17:09
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Lote posted:All the doctors in the US just agreed with you and decided to cut their income to $100,000 from the average of $200,000. Reducing the cost of healthcare in the U.S. by 2.3% would save more money than the entire annual budget of the NHS in England, Scotland, Ireland, and France.
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Jun 20, 2017 17:12
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empty whippet box posted:What the gently caress? Cruz? Paul? No, he's just one of the 13 Senators who is allowed to view the bill in the working group. Nobody knows which of those 13 are actively drafting it (Mike Lee is in the group and claims to not know all the details of what is in the bill) or how much each person is contributing.
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Jun 20, 2017 21:17
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Anubis posted:Yeah, there's a zero percent chance that provision would survive the courts. It's absolutely because it'll be a lot easier for a term limited or outgoing governor to make that decision than a more diverse group of state senators. It would actually be totally fine in the courts. The Federal Government has broad authority to attach strings to Federally-funded programs. Medicare and Medicaid themselves have a similar "permanent on switch" mechanic where they are implemented once a state accepts. That's why Arizona managed to resist implementing them for almost 20 years after it was passed. Additionally, there are some restrictions about allowing the federal government to make states spend money, but there is nothing really to stop a state from deciding not to spend money. The Obamacare exchanges themselves are administered by the Governor of each state unless the state legislature overrules them or the Governor defers to the legislature. Leon Trotsky 2012 fucked around with this message at 13:56 on Jul 5, 2017 |
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Jul 5, 2017 13:54
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Senate is voting on a motion to proceed on the full obamacare repeal with a 2-year delay. It is to gauge support for continuing the healthcare reform effort within the caucus and is expected to fail.
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Jul 24, 2017 13:42
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http://abcnews.go.com/Politics/democrats-open-single-payer-health-insurance-party-leader/story?id=48791105quote:Democrats open to single-payer health insurance, a party leader says
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Jul 26, 2017 19:58
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tekz posted:The Democrats have a supermajority in Califoria, a state that has the sixth largest economy in the world. Given these conditions, why have they not been able to table and pass a better bill? Single-Payer at the state-level in California requires a constitutional amendment because of Article 9. Half of all raised taxes for the general fund have to go to education, so any single-payer proposal has to either come after a constitutional amendment or has to raise taxes roughly 2x higher than needed to comply with Article 9.
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Sep 12, 2017 19:36
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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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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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KildarX posted:As with all of these polls. Who the gently caress are the Democrats going, "Yea, this is cool"? It's 1% of a subgroup in a poll with an overall MoE >3%. It's probably just some combination of: - 1 guy who actually believes it - Misheard the question - Just said whatever to get off the phone - Mentally ill
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Sep 25, 2017 15:25
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axeil posted:Using the fiscal 19 budget for healthcare seems uh...ambitious. Won't they potentially have lost the House and/or Senate at that point? No, FY19 would be in the middle of 2018. Also, there is no reasonable scenario where Democrats take the Senate in 2018.
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Sep 26, 2017 16:51
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Crashrat posted:Honestly the Forbes website is basically just a blog anyone can pay to have their poo poo posted on at this point. This is actually almost 100% literally true. Forbes still has staff writers for their magazine, and those writers are obligated to post a couple of their articles online. But in 2014, they fired almost all of their full-time columnists for the website and now they source their articles in two ways: - They buy access to a bunch of AP-style sites that let them post articles written by other people that are designed to be bought and fill up spaces. These are usually for when sites want to fill some space on a moderately esoteric topic and not assign a writer, but Forbes just does it for their entire entertainment, TV, politics, and lifestyle articles online. - They literally do what Huffington Post does, where they print articles from random contributors as long as the contributors agree to get paid for the articles in "exposure" and the ability to say "work featured in Forbes!"
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Oct 1, 2017 14:24
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JustJeff88 posted:I lost what tiny bit of respect I had for Forbes from a physical copy of the magazine that someone in the business department of the university for which I was working brought in. I was waiting on someone and was bored, and this was before I owned a tablet. I flipped it open and saw a statement that said, and I paraphrase: "We think that the US has the most fair and progressive tax structure in the world". I scoffed so loud that people stared at me and I dropped the magazine on the floor. I'd have burnt it had I had matches. The U.S. actually does have the most progressive income tax system in the world. That's because the bottom half of the country pays little to no income tax. Since we don't have an expansive welfare state, there isn't a budgetary need to. Most E.U. countries have higher income taxes on lower income citizens. That statement is true, but it's mostly just a result of the U.S. having low taxes in general because there isn't an expansive welfare state like Western European countries.
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Oct 1, 2017 18:36
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Mr. Nice! posted:I saw this yesterday. Koch bros. think tank has said medicare for all will save $2 trillion over 10 years. The Koch brothers just want the absolute maximum level of freedom and profit for businesses. Lots of businesses (that aren't the insurance companies or medical providers that make up 22% of US GDP) would love Medicare for All; if it wasn't funded through a payroll tax that the employer pays half of like Medicare/SS currently is.
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Aug 1, 2018 15:46
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Aumanor posted:Out of curiosity: what legislation is that? Social Security. Ryan has said in interviews that he was "a politics nerd" in college and spent "days in the dorm room thinking about social security reforms" and the national debt.
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Aug 27, 2018 14:13
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Zil posted:How long till the first lawsuit is filed to stop this? Who would sue someone for making saline bags? It's literally just mixing salt and water. There's no patent on it.
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Sep 7, 2018 14:42
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Big Mouth Billy Basshole posted:My company is offering a HSA for the first time this year. Anyone have much experience with those types of accounts? If you have very low fixed healthcare costs each year, then they are basically a tax shelter. I'd take it if you only go to the doctor once a year, are young, have no health issues, and already max out your IRA.
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Sep 11, 2018 15:32
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Rhesus Pieces posted:The ACA was developed by neoliberal wonk nerds who love filling out spreadsheets and they don’t care that the rest of society loving hates dealing with that poo poo. No, it's actually because of the Supreme Court decision in NFIB v. Sebelius severing mandatory Medicaid expansion from the bill. It was supposed to be: 1) You get Medicaid 2) If your income is too high for Medicaid, then you go to Healthcare.gov and get a subsidized plan. But the severing of Medicaid created a huge fuckup in states that didn't want to expand it. Because now, you have "donut holes" where people make too much for Medicaid, but too little to get a subsidized plan. And, states that don't expand can use their own formulas for Medicaid eligibility to knock even more people into that donut hole. If the bill was implemented as written, then you would still have issues with high-deductible plans (these were there by design), but there would not be these crazy situations where you have to stay under 13-17k income to maintain coverage. This was not a feature of the bill at all and you should probably not just throw random "de eleetz!" theories around if you don't know what you are saying.
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Sep 25, 2018 17:07
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Willa Rogers posted:In their infinite wisdom, the lobbyists and legislators never considered the possibility of states rejecting Medicaid expansion (and the federal money that came along with it), or going to court to block it. This is the silliest complaint I have ever seen. They did. That was why it was MANDATORY and crafted in compliance with every Supreme Court ruling up to that point. There is nothing you can do when a 5-4 majority on the court is okay with reversing 89 years of precedent and applying it to only one law. The other poster claiming that it was an intentional decision made by academics to punish people who don't go to college is crazy. There are a million things to actually complain about, but that is not it. Leon Trotsky 2012 fucked around with this message at 18:49 on Sep 25, 2018 |
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Sep 25, 2018 18:47
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hobbesmaster posted:But it requires additional money to be allocated by the states in the future, I thought that didn’t really break with precedent? If states couldn't be required to allocate money in the future, then the Civil Rights Act and Americans with Disabilities Act would be declared unconstitutional. The Sebelius decision was crazy and completely shattered all precedent in a way that even conservatives thought that they wouldn't do. The court went out of its way to say "Well, this only applies to this specific law and the civil rights act or the thousands of other laws in this scenario."
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Sep 25, 2018 18:53
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Willa Rogers posted:Wow, I didn't remember that so I just looked it up and Breyer & Kagan joined the conservative majority on that ruling. What was the two liberal judges' reasoning for that? No opinion on Medicaid expansion got a majority opinion. The court technically did not issue an official opinion on Medicaid expansion constitutionality. Breyer and Kagan voted that way as a sop to Roberts because of the severability clause. The conservatives wanted to get rid of the Medicaid expansion and use that to say that "one section of the law was ruled unconstitutional and it is inseverable from the main law, so the whole thing must be struck down - even the constitutional parts." That was how Roberts was wrangled to join the liberal judges to preserve most of the law: quote:The Affordable Care Act is constitutional in part and unconstitutional in part. The individual mandate cannot be upheld as an exercise of Congress's power under the Commerce Clause. That Clause authorizes Congress to regulate interstate commerce, not to order individuals to engage in it. In this case, however, it is reasonable to construe what Congress has done as increasing taxes on those who have a certain amount of income, but choose to go without health insurance. Such legislation is within Congress's power to tax. Leon Trotsky 2012 fucked around with this message at 02:01 on Sep 26, 2018 |
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Sep 26, 2018 01:58
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Willa Rogers posted:And then a few years later: boom, Congress passes a law zeroing out the mandate penalty, thus nullifying their reason to vote as a sop, lol. The vote was to preserve the overall law. There were 5 votes to get rid of Medicaid expansion and 4 to get rid of the law entirely. Roberts joined the 4 liberal judges in saying that inseverability didn't apply to the Medicaid expansion clause. So, you could remove the Medicaid expansion without removing the entire law. The 4 dissenters said that they had to strike down the whole law and allow congress to recraft a new law.
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Sep 26, 2018 02:15
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Willa Rogers posted:Healthcare.gov has its 2019 plans & pricing online now, even though open enrollment doesn't begin till Thursday. Unless the restricted network is so burdensome to travel to as to make it not worth it, I don't really get the complaint about narrower networks. They are an option you can take to reduce your costs. There are certain instances where people might not want to go with that, but as a general rule "picking" your doctor has no impact on your health. I know people want to "pick their own doctor," but for a GP or Family Practice Doctor, it really doesn't make any difference for 99.9% of people. And most narrow networks will restrict you to a couple facilities that will have several doctors each, so you can still choose someone. Obviously, in an ideal world everyone would get exactly what they wanted in the exact amount and size they wanted. But, my insurance is significantly subsidized already and they will subsidize/lower the cost even more if you commit to their network. As a result, my roughly $110 per month health insurance costs about $35 per month in premiums, a $3,500 deductible, and the first $1,000 of the deductible is covered in certain circumstances.
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Oct 31, 2018 14:47
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SousaphoneColossus posted:Or it could be as absurd as an in-network hospital emergency room that assigns you an out-of-network surgeon with no advance notice, as I experienced with a family appendectomy two years ago. That is an issue with "surprise billing" and certain hospital practices rather than some intrinsic part of choosing a narrow network as an option to reduce your premiums. If they banned "surprise billing" in all 50 states the scenario you described would be impossible. If they banned narrow networks in all 50 states, then the scenario could still happen.
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Oct 31, 2018 19:23
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JustJeff88 posted:Basically, the only jobs I can take are PT ones with no benefits that pay almost nothing or wait until I find a job that actually pays a living wage and has decent benefits. I refuse to have anything to do with the exchange, which is an insult to human decency. You have a solution, but you are loving yourself here. Have you actually looked at the exchange? At the income level you cited, you would be eligible for a plan with a monthly premium of between $17.45 and $26.21 per month depending on what plan you got. The deductible is $100 per year for that plan as well. Paying $16 more per month for health insurance to get a $12,000 per year higher salary is obviously a much better situation. Take care of yourself, look into it, and stop turning down jobs until you know what your situation is. Leon Trotsky 2012 fucked around with this message at 00:22 on Nov 19, 2018 |
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Nov 19, 2018 00:17
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Lightning Knight posted:What is the difference between this and a theoretical NHS system, if any? I've seen that distinction made before but I'm not sure what the difference is. Single-Payer includes the (usually effective, but not de jure) abolishment of private insurance for most medical issues. Private insurance for cosmetic procedures, lowering wait times, or much more expensive/experimental treatment still exists.
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Nov 19, 2018 17:16
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Rhesus Pieces posted:Here’s a great example of the immorality of the profit motive in medicine: The other side of this is that a 100% public pharmaceutical industry would just not ever pursue the development of that medicine. No government would spend hundreds of millions of tax-payer dollars on research for long-shot drugs like that. People already flip out over "wasteful" spending and nobody is going to authorize hundreds of millions of dollars for research with a 5% chance of panning out. Especially, if you did it 500 times and spent trillions of dollars and only a handful panned out. Even when the NHS nationalized hospitals and employed all doctors, they left the pharmaceutical mostly untouched because of concerns about taxpayer black holes and hampering new research. Today, the pharmaceutical research and development sector is still the one area of medicine that the NHS has almost no direct participation in and instead partners with private companies to distribute pharmaceuticals, but doesn't direct research. It's a trade off and there isn't really an easy answer because you can't predict the exact chance of success or cost to completion for every potential research path in the future. Leon Trotsky 2012 fucked around with this message at 00:31 on Nov 20, 2018 |
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Nov 20, 2018 00:25
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