What is wrong with this idea?

[Ponca Dan]

Currently an insurance company figures out how much they can squeeze from the consumer and how much they can squeeze out of the health care provider and then keep as much as possible. You can't do shit about their pricing -- everything they offer you is an adhesion contract. You either accept or you do not. I don't want to do business with them but I must, or I can't get health care. I can go without a diamond or spayed cat or buick, but not health care. There's your choice -- pick one of their profitable (for them) adhesion contracts or go without health care. I don't see some virtuous vindication of "choice" in that scenario.

Single payer is where you, the taxpayer are also the insurance company. Hopefully it has some eligibility restrictions for smokers, obese, and whatever makes sense from an underwriting perspective. Fine with me if you want to hire a Dr. to do it himself. The European models are successful and they also have great medical innovation. The European voters will throw anyone out on their ass that messes it up, too. The opponents of it also constantly lie and mislead.

If someone is defending the current system I'll just say it: They either don't pay for their own insurance or they are employed by health insurance companies. We are allowing a middle man to profiteer and skim and for no reason. The health insurance industry is an economically dominant, invincible tapeworm that - watch! - will be lovingly protected by the GOP.

Thank you for your reply. I must confess there was a lot about it I didn't quite understand. I don't know what you mean, for example, when you say single payer is where I, a taxpayer, am the insurance company. What does that mean?

I get the impression you see only two ways that health insurance can be provided: socialized (single payer, with the government deciding how much will be paid for any procedure, and which patients will be eligible for the procedure in the first place), or the current economically fascist system under which we find ourselves today (insurance is provided by supposedly private companies, but those companies work hand in hand with government bureaucrats to set rates and decide who qualifies for the insurance based on their health and ability to pay the premiums). You obviously - and quite rightly, I might add - abhor the second option, the fascist one, and that leaves the socialized option as the only viable plan by default.

What I don't understand about your way of thinking has a lot to do with your understanding of human nature. You decry the greed and immorality of the people who work for insurance companies (and, I suppose, you feel the same way about the insurance commissioners and other government employees who get bought wholesale by the insurance companies). You may be right, I don't know the hearts and minds of insurance executives. Maybe every one of them are masochistic monsters that think of nothing but themselves. What I don't understand is why you think the insurance commissioners and government employees that today are being bought by the insurance executives will suddenly turn benign altruists when you hand them complete control of an industry that literally can determine what happens to your life. Could you explain that seeming discrepancy to me?

I have many more questions. I'm pretty sure I have OCD issues. But I had better stop for now. I've written a long form essay!

 

[anon_xl72qcu5isp39]

Good discussion.

For those of you in favor of single payer, @Been Jammin, @syskatine, what would a single payer system look like if you could design it? Hypotheticals in regards to how it is funded and how it pays providers, what it covers, what it doesn't, and should there even be an option for any private insurance?

For those not in favor, let's say for discussion sake that it is going to become reality and you get to design it, what would it look like to you?

There's so much disinformation and spin about this issue from so many vested interests that it's hard to even get a set of reliable facts to work from.

Coburn was asked once when he was ripping TF out of everything that any dem proposed (Dr. No) and was asked by someone for a solution. He said a national catastrophic policy that covers big medical issues 99% of the country can't really pay for without financial ruin. 1. Sounds pretty good and cheap to me, 2. This is what I'm talking about. He never politically advanced that ball, and neither has the GOP. When squeezed, he had a solution but he's not interested in solutions.

My personal preference is that 1. everyone that doesn't smoke and exhibits some degree of health awareness (No 300 lbs x 5'8") be in a federally underwritten policy. Basically cut out the middle man. Bend over the health insurance industry (the entire skim-and-produce-nothing insurance industry while you're at it) 2. Huge federally-underwritten and guided STEM curriculum and requirements for primary education, and some type of universal education beyond. A lot of very smart kids aren't gonna get a shot. I understand we Okies value lower taxes above all ($), but at some point we have to be a smart country, so require and fund a first class primary education. We just have to do it. This country would have superpower status in 30 years that dwarfs anything we've ever seen. 3. Greatly expand med school admissions.

100 years ago in law school there were very compelling arguments made by the OU law faculty that medical school admissions being so limited is kind of the medical outrage of the millenium. There's no reason to have such restricted training of that profession. It's classic frustration of free market supply and demand. The con$ervative and libertarian professional media plainly doesn't have that agenda or beat that drum though, so @MegaPoke @ThorOdinson13 @Ponca Dan you @CowboyJD and every single other free market devotees are okay with it. That's its own thread, imo. Medical industry has kept government bought and intimidated to expand med school admissions.

We need to completely overhaul our federal dietary guidelines. Unfortunately, some private corporate interests, enabled by @Marshal Jim Duncan , were allowed to infiltrate our national government back in the day and push interests of private enterprise over public health.

 

[Marshal Jim Duncan]

 

[Medic007]

There's so much disinformation and spin about this issue from so many vested interests that it's hard to even get a set of reliable facts to work from.

I completely agree.

Coburn was asked once when he was ripping TF out of everything that any dem proposed (Dr. No) and was asked by someone for a solution. He said a national catastrophic policy that covers big medical issues 99% of the country can't really pay for without financial ruin. 1. Sounds pretty good and cheap to me, 2. This is what I'm talking about. He never politically advanced that ball, and neither has the GOP. When squeezed, he had a s

There's always been talk from both sides with no real solutions except the status quo. I had hoped Obamacare would actually create some changes in the system but instead was largely an expansion of Medicaid and a pile of taxpayer bailout provisions to guarantee profits of big insurance to get them to play.

My personal preference is that 1. everyone that doesn't smoke and exhibits some degree of health awareness (No 300 lbs x 5'8") be in a federally underwritten policy. Basically cut out the middle man.

What happens to the fatties, smokers, alcoholics, etc? Those are the ones who can least afford healthcare and insurance and are over represented in the costs to provide care.

We need to completely overhaul our federal dietary guidelines.

Agreed, except every time that's done, the food industry runs wild exploiting what the government recommends. I really wonder what it would look like if the government quit telling us what we should eat.

Medical industry has kept government bought and intimidated to expand med school admissions.

Not sure I completely agree here. Medical schools do need to expand enrollment, but it was the federal government that in 1997 capped CMS funding of residency programs due to a fear of producing a physician surplus. Even as medical school enrollment has began to expand, residency slots have stayed fairly stagnant. The feds need to increase funding for physician training so residencies can afford expansion and also attract new programs. Right now, our own ER residency is capped at 6 residents per year. Six. They could easily take many more but there aren't dollars available to do it.

Med schools obviously have to be selective since student failure is very costly, but there should be an increased focus on recruiting minorities into the field and including selection based on the ability to become a successful physician, not just award winning GPAs. Some of the best physicians I know weren't 4.0 college kids. The costly application process coupled with the difficulty getting in, and overall cost of the post graduate education, turns many capable folks away before anyone has a chance to see what they have to offer.

 

[Medic007]

@syskatine, here are two really good articles to read when you get time.

https://www.theatlantic.com/magazine/archive/2014/11/doctors-tell-all-and-its-bad/380785/

https://www.google.com/amp/www.marketwatch.com/amp/story/guid/364FAB8A-F81E-11E5-8305-EA3A5160826F

I planned on going to medical school until I began working in the medical field. Screw that. My best friend is an ER doctor and he said if he had a do over, he wouldn't choose medicine again.

 

[anon_xl72qcu5isp39]

What happens to the fatties, smokers, alcoholics, etc? Those are the ones who can least afford healthcare and insurance and are over represented in the costs to provide care.

I don't know. Personal responsibility needs to kick in but I'm all ears re how to handle them. I don't think ANY underwriting or scheme works when a segment of insureds are actively exploding the costs.

Agreed, except every time that's done, the food industry runs wild exploiting what the government recommends. I really wonder what it would look like if the government quit telling us what we should eat.

You have a point. If they simply repeatedly allow business interests to doctor the rec's it defeats the purpose.

Medical schools do need to expand enrollment, AND it was the federal government that in 1997 capped CMS funding of residency programs due to a fear of producing a physician surplus.

Fify.

 

[Medic007]

Fify.

It doesn't do any good to have 50,000 attend medical school and only have 42,000 residency spots (hypotheticals). CMS funding for expansion of residency programs needs to be a simultaneous thing. Physicians who don't have residency training aren't very marketable.

 

[Ponca Dan]

It doesn't do any good to have 50,000 attend medical school and only have 42,000 residency spots (hypotheticals). CMS funding for expansion of residency programs needs to be a simultaneous thing. Physicians who don't have residency training aren't very marketable.

I'm trying to make sense out of what you and sys are saying. On one hand there's a shortage of doctors because medical schools don't get enough taxpayer money, because the government capped how much it was going to pay. More taxpayer money would result in more doctors, but the way medical students are selected needs reforming by the government. In the meantime single payer insurance would be a good thing as long as smokers and obese people were somehow accounted for by the program that would be run by the government. One way to account for smokers and the obese would be to have federal government guidelines on food. Somehow if you smoke or eat in a way the government disapproves then you will be lowered in status. (What would that mean? They would have to pay more?). But if the government establishes food guidelines the food industry would take advantage (Of what? Loopholes?). So doctors supplied by government administered schools will practice medicine in which the insurance will be administered by government guidelines, to people who will be mandated to eat according to government dictates or face dire consequences. Is that what you are proposing? What could possibly go wrong with that scenario?

 

[Medic007]

I'm trying to make sense out of what you and sys are saying. On one hand there's a shortage of doctors because medical schools don't get enough taxpayer money, because the government capped how much it was going to pay. More taxpayer money would result in more doctors, but the way medical students are selected needs reforming by the government. In the meantime single payer insurance would be a good thing as long as smokers and obese people were somehow accounted for by the program that would be run by the government. One way to account for smokers and the obese would be to have federal government guidelines on food. Somehow if you smoke or eat in a way the government disapproves then you will be lowered in status. (What would that mean? They would have to pay more?). But if the government establishes food guidelines the food industry would take advantage (Of what? Loopholes?). So doctors supplied by government administered schools will practice medicine in which the insurance will be administered by government guidelines, to people who will be mandated to eat according to government dictates or face dire consequences. Is that what you are proposing? What could possibly go wrong with that scenario?

Not even close.

 

[Ponca Dan]

Not even close.

Phew!!! There for a minute I thought you and sys were proposing a situation in which I would have no say in how I conducted my life. I'm so thankful I misunderstood!

 

[Medic007]

Phew!!! There for a minute I thought you and sys were proposing a situation in which I would have no say in how I conducted my life. I'm so thankful I misunderstood!

I'll help where I can...

On one hand there's a shortage of doctors because medical schools don't get enough taxpayer money, because the government capped how much it was going to pay.

Medical schools are paid tuition by the student, most often in the form of federal student loans. Residency programs are funded by CMS. The residency program has to pay the residents, faculty, and other associated costs, and if hospitals didn't receive federal funding, there would be no residency programs.

More taxpayer money would result in more doctors, but the way medical students are selected needs reforming by the government.

Nope. Outside of the usual applicable laws regarding discrimination, the government has no say in the selection of medical students.

One way to account for smokers and the obese would be to have federal government guidelines on food.

The government has had recommendations on that kind of stuff forever.

Somehow if you smoke or eat in a way the government disapproves then you will be lowered in status. (What would that mean? They would have to pay more?).

Neither syskatine or I presented an answer for this, but obviously obese people and smoker have higher overall healthcare costs, so something would need to be done to address it whether it's them paying more or better reimbursement for patients with those comorbidities. Right now Medicare pays on DRG, so if that pneumonia patient also has type 2 diabetes and smokes 2 packs per day and that complicates things, the hospital eats that cost.

But if the government establishes food guidelines the food industry would take advantage (Of what? Loopholes?).

The food industry latches on to government recommendations and runs with them. See the "low fat" diet phenomenon of the past few decades. The food industry gave us low fat in exchange for massive amounts of carbohydrates, and the incidence of heart disease and diabetes skyrocketed in response. Are they to blame? No, again they are often just producing products that represent what the government has recommended. My suggestion is to maybe stop making recommendations if they aren't supported by good scientific evidence, like what happened with "low fat." The latest guidelines do a much better job addressing sugar intake, but are still piss poor when it comes to meat consumption.

So doctors supplied by government administered schools will practice medicine in which the insurance will be administered by government guidelines, to people who will be mandated to eat according to government dictates or face dire consequences.

The government isn't going to run medical schools. We didn't suggest that the government mandate what you eat, but they might find cause to have a more vested interest if they are the lone insurer. Some cities already have taxes on soft drinks and limits on the size you can buy. We all already pay more for our own healthcare to subsidize the piss poor life choices of others. At what point can we expect that those folks bear the totality of the consequences, if ever? If so, what does that look like? There is only so much the government can do, even through mandates, to make you live a healthier lifestyle, short of looking like North Korea, and we know our fat folks and cigarette lovers won't ever go for that. Thus, our discussion of what to do about those folks.

Is that what you are proposing?

So in conclusion, not even close.

 

[Ponca Dan]

I'll help where I can...


Medical schools are paid tuition by the student, most often in the form of federal student loans. Residency programs are funded by CMS. The residency program has to pay the residents, faculty, and other associated costs, and if hospitals didn't receive federal funding, there would be no residency programs.


Nope. Outside of the usual applicable laws regarding discrimination, the government has no say in the selection of medical students.


The government has had recommendations on that kind of stuff forever.


Neither syskatine or I presented an answer for this, but obviously obese people and smoker have higher overall healthcare costs, so something would need to be done to address it whether it's them paying more or better reimbursement for patients with those comorbidities. Right now Medicare pays on DRG, so if that pneumonia patient also has type 2 diabetes and smokes 2 packs per day and that complicates things, the hospital eats that cost.


The food industry latches on to government recommendations and runs with them. See the "low fat" diet phenomenon of the past few decades. The food industry gave us low fat in exchange for massive amounts of carbohydrates, and the incidence of heart disease and diabetes skyrocketed in response. Are they to blame? No, again they are often just producing products that represent what the government has recommended. My suggestion is to maybe stop making recommendations if they aren't supported by good scientific evidence, like what happened with "low fat." The latest guidelines do a much better job addressing sugar intake, but are still piss poor when it comes to meat consumption.


The government isn't going to run medical schools. We didn't suggest that the government mandate what you eat, but they might find cause to have a more vested interest if they are the lone insurer. Some cities already have taxes on soft drinks and limits on the size you can buy. We all already pay more for our own healthcare to subsidize the piss poor life choices of others. At what point can we expect that those folks bear the totality of the consequences, if ever? If so, what does that look like? There is only so much the government can do, even through mandates, to make you live a healthier lifestyle, short of looking like North Korea, and we know our fat folks and cigarette lovers won't ever go for that. Thus, our discussion of what to do about those folks.


So in conclusion, not even close.

Medic, sometimes I love you

 

[anon_xl72qcu5isp39]

I'm trying to make sense out of what you and sys are saying. On one hand there's a shortage of doctors because medical schools don't get enough taxpayer money, because the government capped how much it was going to pay. More taxpayer money would result in more doctors, but the way medical students are selected needs reforming by the government. In the meantime single payer insurance would be a good thing as long as smokers and obese people were somehow accounted for by the program that would be run by the government. One way to account for smokers and the obese would be to have federal government guidelines on food. Somehow if you smoke or eat in a way the government disapproves then you will be lowered in status. (What would that mean? They would have to pay more?). But if the government establishes food guidelines the food industry would take advantage (Of what? Loopholes?). So doctors supplied by government administered schools will practice medicine in which the insurance will be administered by government guidelines, to people who will be mandated to eat according to government dictates or face dire consequences. Is that what you are proposing? What could possibly go wrong with that scenario?

Your second sentence, "On one hand" has nothing to do with taxpayer dollars.

 

[NZ Poke]

 

[JonnyVito]

 

[NZ Poke]

Flashback:

 

[aix_xpert]

If I created a medical health care plan, here are the primary items I would implement:

1) Medical care needs to be separated into two tracks: Critical/Emergency care and elective care. Anything deemed elective care should be excluded from government run healthcare. Sorry, vision care is elective. Contraceptives are elective.

2) Medical costs for non-elective procedures should be approved and documented by a government commissioner. If we truly believe that medicine is a right for all, then it should be managed like a utility is managed. The power company can't just raise its prices as it deems fit. It can have multiple tiers of pricing, but all of these need to have been documented and approved. In addition, profits for clinics and hospitals will be capped to a % of revenue as well as a specific percentage of expenses must have been allocated towards patient care. Those hospitals and medical clinics whom choose to receive government payments must adhere to the above rules. Like I said, treat hospitals just like you treat OG&E.

3) I think you either create government insurance options or subsidize private coverage for the low-to-no income folks, however, I do think that these need to have coverage limits. It doesn't make sense to spend 3 million in medical coverage for someone who's basically homeless. The caps should be high $2M+ but they should exist.

4) Once you are beyond the government subsidy/policy level, you are mandated to purchase a critical care policy (you must be insured for life-saving treatments that would be rendered in case of emergency) but risk pools for those policies should be defined as they were prior to Obamacare. Insurance companies can be free to offer policies that contain expanded coverage options, different deductibles, etc., however must offer a basic plan that meets the government mandated minimums. (Much like you are required to carry collision insurance for your car, but can choose to buy more comprehensive coverages).

5) Risk/Insurance pools be allowed to cross state lines to allow for larger and more efficient pooling of similar risk profiles and thus lower aggregate costs.

6) Tort reform that caps punitive damages to $50K times number of years left for life expectancy based on average age. or 100 times your income filed on your highest tax return in the past 5 years (whichever is greater). Basically, if you are 18 and have no income, life expectancy is 83, then you would be entitled to 65x50K= $3.25M in damages. If you are 25 and make $40K/year then you would be capped at $4M (40x100 is greater than 58*50). This better aligns damages to the societal impact of the mistake and not to the whims of juries who see all corporations as simply being greedy bastages. (Edit added here: I would set a $1M or $2M minimum cap otherwise you risk the older, retired individuals not being able to collect a reasonable settlement for malpractice based on my charts above). Also, measures should be inflation adjusted so it still works 20 years from now.

7) Those who go to a government-approved hospital or clinic (see #2) without insurance will be charged as normal. The emergency services will be rendered (we aren't without compassion) but the hospital will be allowed to resister a debt against the individual, and like student loans (and for the same reason), this debt is not dischargable via bankruptcy.

Obviously there a probably a number of details this doesn't address, but I think this moves us towards treating critical medical care more as a utility rather than as a capitalistic choice without moving directly to a single-payer model. Option #2 is a key component as it directly provides cost controls on the medical operations themselves rather than the only cost controls being applied to the insurance agencies as it stands today.

 

[Medic007]

@Been Jammin, preliminary report indicates this Bernie Medicare for All will cost at least $25 trillion over the first decade. Through increased taxes, including a 52% top bracket for income over $10 million, will only raise $11 trillion. The rest? Apparently borrow the money. One of the worst ideas of the plan is the stiff that comes with no copay. That lack of patient investment encourages misuse of resources and drives up costs just like we currently see with Medicaid.

Not looking workable.

 

[anon_xl72qcu5isp39]

@Ponca Dan wait and see -- these nationalist types will embrace single payer. It may have to be relabeled, but they will. Ditto for lots of conservatives. If conservatives had to pay for their own health insurance out of pocket they'd demand single payer.

@Been Jammin, preliminary report indicates this Bernie Medicare for All will cost at least $25 trillion over the first decade. Through increased taxes, including a 52% top bracket for income over $10 million, will only raise $11 trillion. The rest? Apparently borrow the money. One of the worst ideas of the plan is the stiff that comes with no copay. That lack of patient investment encourages misuse of resources and drives up costs just like we currently see with Medicaid.

Not looking workable.

Well fill in the other side of the equation. If you're gonna analyze the cost, let's look at the cost of the status quo, too. Insurance premiums don't just pay themselves.

 

[aix_xpert]

@Been Jammin, preliminary report indicates this Bernie Medicare for All will cost at least $25 trillion over the first decade. Through increased taxes, including a 52% top bracket for income over $10 million, will only raise $11 trillion. The rest? Apparently borrow the money. One of the worst ideas of the plan is the stiff that comes with no copay. That lack of patient investment encourages misuse of resources and drives up costs just like we currently see with Medicaid.

Not looking workable.

I wonder what the actual CBO estimated cost of implemening NHS (UK's single-payer system) would cost for the US. We see Bernie and others use that as an example of what it should look like, yet noone has actually simply recommended their already existing solution. I do find it interesting that for every Dem who talks single-payer, not one ever mentions actual cost for doing so.

BTW, where did you get the $25T number? I hadn't seen anything that actually dollar-figured Bernie's "free healthcare buffett" plan. Not even Bernie was stupid enough to put a dollar figure on his plan when he started circulating it. So I'm curious where (or who) did the estimate above.

 

[Medic007]

I wonder what the actual CBO estimated cost of implemening NHS (UK's single-payer system) would cost for the US. We see Bernie and others use that as an example of what it should look like, yet noone has actually simply recommended their already existing solution. I do find it interesting that for every Dem who talks single-payer, not one ever mentions actual cost for doing so.

BTW, where did you get the $25T number? I hadn't seen anything that actually dollar-figured Bernie's "free healthcare buffett" plan. Not even Bernie was stupid enough to put a dollar figure on his plan when he started circulating it. So I'm curious where (or who) did the estimate above.

http://www.crfb.org/blogs/sanders-introduce-single-payer-bill-how-much-will-it-cost

They looked at the "details" of this plan and the 2016 campaign plan, which is where the $25 trillion was originally estimated. This proposed plan is much more generous than current Medicare. I'm sure it isn't a giant leap to assume this current proposal will be unaffordable as well.

 

[Medic007]

Well fill in the other side of the equation. If you're gonna analyze the cost, let's look at the cost of the status quo, too. Insurance premiums don't just pay themselve

Of course insurance premiums don't just pay for themselves. Medicare for All isn't going to magically pay for itself either.

Speaking in hypothetical, if the Medicare for All is going to cost $30 trillion over a decade, and the government only intakes $15 trillion to pay for it, who pays the remaining $15 trillion? Is the government going to get a second job? Last I checked, the government only has one method to raise money.

 

[anon_xl72qcu5isp39]

Of course insurance premiums don't just pay for themselves. Medicare for All isn't going to magically pay for itself either.

Speaking in hypothetical, if the Medicare for All is going to cost $30 trillion over a decade, and the government only intakes $15 trillion to pay for it, who pays the remaining $15 trillion? Is the government going to get a second job? Last I checked, the government only has one method to raise money.

I guess the same place BC/BS gets money if it needs more "intake" money - premiums. They don't get a second job, either. A tax or premium to provide the base/catastrophic/preventative/whatever federal policy comes out my pocket either way. Hopefully there's not a mafia health insurer making me pad their bottom line.

Any analysis of what the new taxes/premiums cost is fine, but it needs compared to the cost of the status quo. You'd think currently that health care is free, to listen to the dialogue about these projections. I'm sure a huge pool of insureds would have to pay more premiums over time, just like private insureds do.

I have yet to hear one rational explanation why the current, for-profit health insurance domination over health care should be protected. In particular from someone that actually signs a check for health insurance premiums.

I see lots of debate about what Bernie's plan would be. Anybody quanitified the cost of the status quo if it's projected forward?

 

[Medic007]

I guess the same place BC/BS gets money if it needs more "intake" money - premiums. They don't get a second job, either. A tax or premium to provide the base/catastrophic/preventative/whatever federal policy comes out my pocket either way. Hopefully there's not a mafia health insurer making me pad their bottom line.

Any analysis of what the new taxes/premiums cost is fine, but it needs compared to the cost of the status quo. You'd think currently that health care is free, to listen to the dialogue about these projections. I'm sure a huge pool of insureds would have to pay more premiums over time, just like private insureds do.

I have yet to hear one rational explanation why the current, for-profit health insurance domination over health care should be protected. In particular from someone that actually signs a check for health insurance premiums.

I see lots of debate about what Bernie's plan would be. Anybody quanitified the cost of the status quo if it's projected forward?

Cost of the status quo?

 

[anon_xl72qcu5isp39]

Cost of the status quo?

Yes. Or is health care free in lieu of Bernie's plan? Somebody's gonna pay for it, right?

 

[Medic007]

Yes. Or is health care free in lieu of Bernie's plan? Somebody's gonna pay for it, right?

Are you being intentially obtuse? Of course healthcare isn't free. It will never be free. Nobody but you has brought up that idea.

The question in regards to Bernie's plan is if the government is paying for everything via the taxpayer/insured, is there enough money coming in to pay for the money being spent. If the government is spending $2 for every $1 it collects (hypothetical), how could that be sustainable?

Since there is no cost/income currently available for this new plan, we have no idea if it's financially feasible. His previous plan looked like the government would be paying more than $2 for $1 it collected. How could that be financially feasible?