Obamacare Lite: Tastes Great If You’re Rich, Less Filling If You’re Not

Republican congressman Mo Brooks, of Alabama, was on CNN this morning railing against his party’s new health insurance plan, which some are calling “Obamacare-lite.” His appearance came just after Speaker Paul Ryan was on television lying about the “collapse” of the real Obamacare and how this new “conservative” plan was his “dream” and that it will certainly pass Congress because, well, just because. Ryan confirmed that Tr-mp was mo brooks on cnn.jpgfully on board and it looks like Agent Orange’s new assignment will be to fan out across the country’s rural districts and tell the folks who foolishly placed their faith in him that this is good medicine, even if it will surely kill some of them.

Congressman Brooks is one of those conservatives who wants Obamacare repealed—period. He doesn’t give a damn about replacing it with anything short of offering people who are poor, sick, and old an unsubsidized aspirin today and suggesting their next of kin call a local undertaker in the morning. Brooks said that the Ryan-Tr-mp plan was “the largest welfare program ever proposed by Republicans in the history of the Republican party.” He said, without irony since he is a Tr-mp supporter, that the new plan will ultimately lead to “the demise” of the country.

Like most Republicans, Brooks seems to have an obsession with how government programs affect the behavior of people he apparently considers too lazy to go to work and get their bleeping insurance from their bleeping employer. He specifically highlighted his objection to the new GOP plan by saying it “undermines the work ethic; it increases greater reliance on welfare from the federal government…” He was talking about the stingy tax credits that are part of the “subsidization” contained in the bill. This is what makes people like Brooks call it welfare. But just what is it that bothers Republicans so much about people who need help? Why do they assume everyone who needs some assistance is a low-life who just wants free stuff?

Infamously now, Rep. Jason Chaffetz, who like Brooks can get his health insurance courtesy of taxpayers, defended the new GOP plan by saying it gives more “access” to health coverage for low-income Americans. When CNN’s Alisyn Camerota challenged him by saying that “access for lower-income Americans doesn’t equal coverage,” out came the real spirit that motivates these people:

CHAFFETZ: Well, we’re getting rid of the individual mandate. We’re getting rid of those things that people said that they don’t want. Americans have choices, and they’ve got to make a choice. So rather than getting that new iPhone that they just love and want to go spend hundreds of dollars on that, maybe they should invest in their own health care.

It’s really pretty simple. Poor folks, and sick and disabled folks, and elderly folks who don’t yet qualify for Medicare just need to forgo the bling and fork out $10,000 or so a year for health insurance and then, as Vox points out, “the wealthiest 0.1 percent of Americans” can enjoy tax cuts that amount to “$200,000 each in a single year,” as a result of the provisions in this new GOP healthcare “reform.”

Of course, if poor, sick, disabled, and elderly folks had ten grand under their mattresses (at least those who have mattresses) that they could spend on health insurance, then we wouldn’t need Obamacare or Obamacare-lite. But they don’t. Perhaps they should invest the few dollars they do have in the lottery. Maybe they could win and then they could buy insurance. But even if they were so fortunate, even if they beat the odds, Republicans have that covered, too. So suspicious are right-wingers of needy people that these asshole legislators, unbelievably, devoted a substantial part of their new bill to addressing the pressing issue of “letting states disenroll high dollar lottery winners.” From Slate:

A full six pages of the 60-plus page bill were devoted to lottery winnings. Lottery winnings! Essentially, the GOP bill’s big idea on this—to which it devoted nearly 10 percent of its attention—is figuring out ways to make sure lottery-winners on Medicaid can’t cheat the system. Seriously. The bill goes on and on and on to stipulate under which circumstances the state can declare you no longer in need of—nor entitled to—Medicaid.

This absurdity merely illustrates what is in the minds of these people. There is something twisted about spending this much time on something so remote, so ridiculous. There is something perverted about worrying whether an infinitely small number of people will game the system for a few dollars, while real grifters run the White’s House. Yet, none of us who have paid attention to politics, at least since the rise of the Tea Party, should be surprised. This is who they are. This is what they do when given power.

You can go to many neutral and liberal sites to find an analysis of how cruel the new Republican plan is (including how cruel it is to defund Planned Parenthood). And, as cruel as it is, you can go to many right-wing sites and find out that it isn’t nearly cruel enough. They want more blood from the poor and the sick. They want to put more money into the pockets of those whose pockets are already stuffed with cash. Again, I can’t stress this enough: this is who they are.

Last night I watched Donald Berwick on MSNBC’s All In with Chris Hayes. Berwick was once the Administrator of the Centers for Medicare and Medicaid Services, appointed by President Obama. As I like to do before quoting such knowledgeable folks, here are some of his credentials, as listed on Wikipedia:

Berwick began his career as a pediatrician at Harvard Community Health Plan; in 1983 he became the plan’s first Vice President of Quality-of-Care Measurement.[14] In that position, Berwick investigated quality control measures in other industries such as aeronautics and manufacturing, in order to consider their application in health care settings.[10] From 1987 to 1991, Berwick was co-founder and Co-Principal Investigator for the National Demonstration Project on Quality Improvement in Health Care, designed to explore opportunities for quality improvement in health care. Based on this work, Berwick left Harvard Community Health Plan in 1989 and co-founded the IHI (Institute for Healthcare Improvement).

Berwick is Clinical Professor of Pediatrics and Health Care Policy in the Department of Pediatrics at the Harvard Medical School and Professor of Health Policy and Management at the Harvard School of Public Health.[15] He is also a pediatrician, Adjunct Staff in the Department of Medicine at Children’s Hospital Boston, and a Consultant in Pediatrics at Massachusetts General Hospital.

Berwick has published over 129 articles in professional journals on health care policy, decision analysis, technology assessment, and health care quality management.

As you can see, he knows more about the American healthcare system than ten thousand ideologues like Paul Ryan and Mo Brooks will ever know. Keeping Berwick’s credentials in mind, below is a quickly produced transcript of what he said to Chris Hayes about the Ryan-Tr-mp health insurance plan. I’m sure we will visit this issue again and again, but let this serve as the introduction to policy discussions in the bizarre political world we are living in:

BERWICK: The proposal destabilizes insurance markets…You’ll see that premiums will go up. Under the proposals here, people aren’t going to have enough money to buy insurance, and the only ones that will are going to be the sicker people because they have to, leaving the people who are “well” outside the system. That unravels insurance premiums. Premiums will soar.

And costs will soar because the safety net will get weakened over the trajectory of this proposal. Medicaid gets severely weakened. A lot of very vulnerable people are going to be back in emergency rooms and getting sicker instead of getting the care they need…And it’s not just the poor who are going to pay. The middle class is going to find they have a lot less support for buying their insurance.

HAYES: So…”support” meaning that the sort of subsidy structure has been altered in ways that folks are going to be out-of-pocket paying more, you think?

BERWICK: Yeah. The Affordable Care Act expanded Medicaid for the poorest people, but for those in the kind of lower middle class—forty, fifty thousand dollars—these people got help buying their policies with subsidies, tax rebates, and those were progressive so don berwick on msnbcthat the less money you had, the more help you got. Under this [new] proposal, the amount of subsidization is…the same across income categories up to $75,000 a year for an individual, $150,000 for couples. So that people at lower levels of income don’t get more help and the amount of help that everyone’s getting isn’t enough to buy insurance. People are going to find themselves really out in the cold. This is going to be really painful. And more painful for older people because this is really a transfer of assistance from older people back to the young healthy people.

HAYES: So, this is a key point. It was interesting to me, AARP comes out right away and says it’s got an “age tax” in it. I just asked congressman Buddy Carter [R-GA] about this and he really wouldn’t defend it. He basically said, “Well, this is just a starting point.” You’ve got a provision in there that allows insurance companies to charge a lot more based strictly on age. Do you think  you’re going to see an older cohort paying more out-of-pocket out of this?

BERWICK: Oh, definitely. It goes two ways. First of all, the amount of subsidy doesn’t rise enough with age. The figures I just got, in Mobile, Alabama, a 60-year-old who makes $40,000 a year, under the Affordable Care Act is getting about $10,000 in subsidies to buy their health insurance. Under the proposal it would be $4,000.

HAYES: So, just to be clear. You’re talking about a 60-year-old in Mobile, Alabama, who in this plan is losing $6,000 in purchasing power?

BERWICK: Right. Exactly. The government is going to hand them a check for $4,000 and say “Go buy your insurance” instead of the subsidy they’re now getting of $10,000. This is going to be a big takeaway for people in the upper age brackets before they’re eligible for Medicare.

HAYES: Final question. One of the things that Donald Tr-mp said throughout the campaign always was, “We gotta take care of everybody. I don’t want anyone out on the street. We gotta take care of everybody.” It’s been this sort of reverse refrain, “I’m compassionate, unlike these other Republicans.” I mean, is this compassionate? Will this, quote, take care of everybody, particularly the most vulnerable folks?

BERWICK: No! This man came into office with a law in place that increased coverage in this country by over 20 million people. That’s expanding coverage. If you really want to make things better, build on that. No, this is a takeaway. It’s going to go backward. And I think we’re going to have a lot of people, as the president [sic] put it, on the street without the kind of care they need. It’s bad. It’s bad for America. It’s bad for the poor. It’s bad for the middle class.

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15 Comments

  1. ansonburlingame

     /  March 8, 2017

    Duane, again,

    Is ACA really “imploding” as claimed by the right. By that I mean premiums are going through the roof with no end in sight? I say yes. What say you, Duane, today?

    ACA was placed into law with zero support from GOP during the last “single party” government we experienced in America for two short, but seemed very long years.

    Will we now see another “single party” HC plan rammed through Congress and passed into law? Maybe but I hope not, I say. What say you, Duane?

    Should we all sit down at a table and not leave until a compromise bill is concocted and ultimately passed into law with say 70% of House and Senate voting for approval and President signing into law. I really hope so. What say you, Duane?

    When all those politicians sit at the suggested table what should be their “guiding principles”? Try this on for size: “Every American that wants to pay “something” for HC insurance must have the access and ability to do so and all their HC needs deemed appropriate by a “good” physician must be met, without further cost to the insured American”. BUT, any such plan so produced must not rely of deficit spending by the federal, state or local governments and thus must be sustainable, financially to all concerned, governments and the insured.

    How to get there to that utopia? Jokingly I offer this approach. REPEAL ACA, Medicare and Medicaid Laws, all of them, start over while America screams and thus FORCE Congress and the President to compromise with the solution. While everyone dithers force the federal government to pay for ALL HC rendered to anyone until that law is past. Ha, right, no way.

    Why not? You and yours will get “single payer HC” for a while at least and you can then filibuster every compromise attempt to pass a new law, bankrupt the federal government in a few months and say the “GOP did it”!!

    Anson

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    • Anson,

      I explained in other comments to you about your claim that Obamacare was “rammed through Congress and passed into law.” Suffice it here to say it was a very conservative plan that took the better part of a year to get passed, was amended by Republicans in committees who had no attention of ever voting for it, and is not on the verge of collapse, as claimed by a Lyin’ Ryan. 

      There are places where the law isn’t working well and fixes need to be made. But a big part of the reason it isn’t working well in those places is because younger, healthier folks aren’t signing up for insurance. The penalty for not doing so is too low and Republicans spent years telling these people the whole thing was a sham anyway. Don’t bother, was their message. The truth is that what is wrong with Obamacare could be fixed by a bipartisan effort. But because Republicans have spent more than 7 years demonizing the law, and the effort to “nationalize” healthcare, they have to repeal it and put in place something that almost no American wants and will most certainly result in millions of folks losing their insurance and, sadly, access to necessary healthcare. Nor does the American Medical Association or the American Hospital Association want it, not to mention the AARP.

      I point you to a recent poll in which only 7% of people want the law changed “to do less” than it is doing now (which is what Tr-mp and the GOP are proposing officially). Almost two-thirds want the law left as is or changed “to do more.” Count me in that latter category. And I say that as someone who has no personal stake in the law, outside of what it has done to bring down overall healthcare costs. I will have affordable health insurance outside of the exchanges until my end comes. But I don’t want to live in a country where that is not true for everyone. To use your question, what say you on that?

      As for getting 70% of Congress to agree on an adequate plan, come on. I wish it were possible. But we both know it isn’t. And you will probably equally blame “both sides” for that reality. But you would be wrong. As I said and will say again, Obamacare was a goddamned compromise to start with. Maybe Obama should have started with something much more radical and we would have ended up with something, as a legitimate compromise, that looked a lot like what we ended up with, but he didn’t do that. He assumed good faith on the part of his political adversaries. And that, above all else, is the biggest domestic mistake he made as president. He assumed John Boehner and Mitch McConnell were something more than ideological, my-way-or-the-highway partisans.

      Well, Republicans won using the methods of obfuscation, obstruction, and sabotage. And it would be politically stupid if Democrats let them get away with that without putting up a fight now. You’re right that this is a sick system. But it wasn’t Democrats who made it that way. It was the very same people who are now ignoring the mental illness of their “president,” ignoring his entanglements with our Russian adversaries, ignoring his fondness for authoritarian killers, all to get what they have always wanted: power to roll back the gains we have made, gains that invalidate their religion-like ideology.

      Duane

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  2. Healthcare insurance premiums under the ACA have risen significantly, about 20% in a year I seem to recall, principally because GOP opposition has been so fierce and effective in rejecting ObamaCare and the Medicaid buy-in. Insurance is a purely statistical thing wherein a group of people share risk. If the healthy decline to participate, if they choose to play healthcare roulette hoping something big doesn’t happen to them, then the scheme doesn’t work.

    Although I, like you, Anson, have excellent insurance as retired military (socialism!), I get an occasional insight into the medical costs borne by the other 97%. One of the meds I take is Armour Thyroid for hypothyroidism. It’s been around for a long time and common for the elderly. (I seem to recall that Hillary takes it.) Anyway, although I get it from a mail order pharmacy, I had occasion to check the price people without insurance pay. It was $240. Another of my wife’s meds was over $600. I have several times seen elderly people at the pharmacy walk away without their meds after learning the price. This is not how a first-rank country should be run, i.e., with healthcare costs driven by profits. Big Pharma is the most profitable industry in America. Do they deserve it? No, they do not. Yes, they do run extensive trials, but most basic research is done by the government. (Hmm. I wonder if Trump is going to cut the budget for that too?)

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    • Jim,

      You are exactly right about the GOP’s role in the problems with Obamacare. Sabotage, it turns out, even works in the healthcare delivery sector. You can, if you are callous enough, put people’s lives in jeopardy by urging young healthy people to not sign up, changing the composition of the risk pool, and driving out insurers. You can, also if you are callous enough, try to prevent the government, through a provision in the original law (called “risk corridors”), from subsidizing insurers who found they had underpriced their insurance in certain markets. In fact, Marco Rubio tried to take credit for essentially destroying this part of the law, claiming he slipped a counter-provision into an omnibus spending bill in, I think, 2013. 

      These assholes, when it comes down to it, rejected their own “reform” plan that was, essentially, Obamacare. And most of them did so for one of two reasons. They were ideologically opposed to an entitlement of health coverage for all Americans, or they didn’t like the idea of Obama and the Democrats doing something so important as guaranteeing more Americans access to the health system. Either way, they have earned my eternal loathing, for whatever that is worth. And if Democrats play ball in any way with them, when it comes to bailing them out of the mess they have created for themselves on this issue, they will earn my eternal loathing, too.

      Duane

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  3. ansonburlingame

     /  March 10, 2017

    Duane and Jim,

    The problem with HC is really simple. Jim and I (both retired military) have the utopia (almost) of HC. I and I suspect Jim (both wives included) pays about $2400 per year (about $100 per month for me and my wife thru SS deduction for each of us). That is it, as long as our problems are “covered by Medicare” (no face lifts allowed, etc.) Tricare for Life then pays ALL the Medicare deductible (20% of Medicare allowed costs). No other deductibles, no co-pays, etc. Just go in, get “fixed” and walk out as healthy (even pain free sometimes) as possible.

    Certainly Jim and I are in a single payer system of HC and that payer is anyone paying taxes to the federal government, most of you flamethrowers herein included I suppose. I would also explain that all those benefits were not fully provided until Jim, me and our wives reached the age of 65. Before that age we still had “great HC” but the personal costs were somewhat higher (supplemental insurance, copays, etc.) but still very affordable to both families.

    I would FULLY support that exact same system for every American, from cradle to grave. Certainly such universal, single payer system is “fair”, “equal for all Americans”, you name it. So why not do it?

    Well just since my wife and I reached the age 65 (about 10 years ago) I can just scan the costs to all of “you” (taxpayers). Over those 10 years we have “paid in” around $24,000, total for “our HC”. My very rough approximation of the costs we have charged the federal government are at least in the range of $150,000 plus of minus $25K, maybe.

    I won’t bother to do the math to approximate the cost to the federal government (all you tax payers) if such a HC system (universal, single payer) was the law for all Americans. But I would suggest such costs would be higher, just for HC, than all the government paid social benefits combined plus a large chunk of defense spending as well.

    As well when you implement such a federal government only run HC system each and everyone of all Americans would line up in hospitals looking very much like today’s VA HC hospitals and clinics. How many Americans would put up with that kind of HC, with no other “choices” available?

    One ;last point. Note the cost of HC for me alone is about

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  4. ansonburlingame

     /  March 10, 2017

    Duane,

    Not sure what happened when I posted my last comment (it is incomplete). Delete it if you can and put in place what I paste below. Here is the full comment:

    Duane and Jim,

    The problem with HC is really simple. No one knows how to pay for it.

    Jim and I (both retired military) have the utopia (almost) of HC. I and I suspect Jim (both wives included) pays about $2400 per year (about $100 per month for me and my wife thru SS deduction for each of us). That is it, as long as our problems are “covered by Medicare” (no face lifts allowed, etc.) Tricare for Life then pays ALL the Medicare deductible (20% of Medicare allowed costs). No other deductibles, no co-pays, etc. Just go in, get “fixed” and walk out as healthy (even pain free sometimes) as possible.

    Certainly Jim and I are in a single payer system of HC and that payer is anyone paying taxes to the federal government, most of you flamethrowers herein included I suppose. I would also explain that all those benefits were not fully provided until Jim, me and our wives reached the age of 65. Before that age we still had “great HC” but the personal costs were somewhat higher (supplemental insurance, copays, etc.) but still very affordable to both families.

    I would FULLY support that exact same system for every American, from cradle to grave. Certainly such universal, single payer system is “fair”, “equal for all Americans”, you name it. So why not do it?

    Well just since my wife and I reached the age 65 (about 10 years ago) I can just scan the costs to all of “you” (taxpayers). Over those 10 years we have “paid in” around $24,000, total for “our HC”. My very rough approximation of the costs we have charged the federal government are at least in the range of $150,000 plus of minus $25K, maybe.

    I won’t bother to do the math to approximate the cost to the federal government (all you tax payers) if such a HC system (universal, single payer) was the law for all Americans. But I would suggest such costs would be higher, just for HC, than all the government paid social benefits combined plus a large chunk of defense spending as well.

    As well when you implement such a federal government only run HC system each and everyone of all Americans would line up in hospitals looking very much like today’s VA HC hospitals and clinics. How many Americans would put up with that kind of HC, with no other “choices” available? As well how many physicians would accept the salaries of VA physicians? Try that and watch the AMA “revolt”!!

    One last point. Note the cost of HC for me alone is about $1200 per year and thus such costs must be paid by EVERY American, every month, cradle to grave. Have a baby and your monthly costs go up $100 every month (just for HC) in your family. How many Americans could never support that increase. How will the homeless man pay such costs, etc. So when you implement that new system consider as well the government subsidies to pay that $100 a month to ……… (How many millions would or must so qualify?)

    Morally of course such utopia is the “right thing to do”, “Christ would say do it” and that list goes on forever. And of course there is the “Europe does it” argument. Will you join me in laughter at that point of view??

    I conclude with this point (actually two of them). If you want to impeach Trump then show me a way to do so, legally, and with the support of 60-70% of the “American people” and I will support you. For HC, implement such a HC system AND pay for it on a sustainable basis (no defict spending), AND get the support of some 60-70% of the same group and I will support it. As well, you better put “no tax increases” into your bill, except of course the $100 a month for EVERY American!!!

    Until then, compromise between both parties today is the only path forward in my view. If you and yours think you can get it and keep it when the other party regains power, well go for it. But if the only way forward towards such utopia is single party power only, then I say again, not while I have a vote, for either side’s approach, today.

    I will give you one point. Today, in regards to ACA, it should be Replace and then Repeal, OR just modify ACA (rather drastically however). But we all know that won’t happen no matter how many mobs take to the streets, today or tomorrow.

    Anson

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  5. Anonymous

     /  March 10, 2017

    Anson,

    Let’s talk about your home state. In Manchester in Clay County population 21,000 people there were 2.2 MILLION prescriptions for opioids last year. Hillbilly heroin had infected your home state, West Virginia, and the entire US. In Clay county 60% of the population is on Medicaid, which Trump plans to eliminate federal funds by 2020. Follow the money, big pharma, pharmacies, are all lining their pockets at the expense of human life.

    Medicaid paying for mental illness treatment for citizens? Not on the GOP’s watch, but hey they will allow them to purchase and carry a concealed weapon. Your party’s reverse Robin Hood approach to health care by not taxing the rich to help the poor support to buy healthcare is disgusting. Millions will lose coverage under the GOP plan, contrary to what the orange monkey said during the campaign.

    My hope is that all the “rust belt” and rural voters like in your home state of Kentucky recall that it was the GOP that sad no to those afflicted by mental illness or opioids. I expect there to be a great deal of angry gullible citizens out for revenge against those who promised not to forget them when they watch their loved ones die from lack of assistance. Could you imagine the coal industry revitalized? It was promised to them.

    The ACA can work if not sabotaged at every turn by the opposition party. The surge in increases was directly related to the states that refused Medicaid expansion. It requires all to be covered in order for the insurance companies a fair platform, healthy workers as well as sickly. GOP lite is opposed by the American Medical Association, the American Hospital Association, and the AARP for valid reasons. The GOP motto, “Your on your own” is disturbing on so many levels.

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  6. ansonburlingame

     /  March 11, 2017

    Of course, Anonymous, I understand your points. In varied forms I have heard or read about most of them. Obviously the only solution to all those and many more $ issues related to HC can be resolved by a universal, single payer system. But two things prevent that.

    Give that system to the government and you have, at best, a VA like system. Look at that system today and tell me how many Americans would put up with it, much less pay for it out of pocket.

    But more important as pointed out above (and many times before) is the cost of such a system cannot be borne by any single payer. It is just too expensive unless you cut costs so far that only the “near dying” are provided HC with practioners (all HC workers) paid very average salaries. No doctor would have a chance at making say $300,000 per year for example.

    To even get well trained doctors, etc. who attend higher education (college, med school, internships, residency training, fellowships, etc.) that takes maybe 10 years after High School, that HC single payer would have to pay for all that education at a cost. No sane person would invest the time and $ required to become a doctor and only make a very average salary for the rest of their lives.

    I would love nothing better than the utopia of universal, single payer HC. But we the people must accept something less than that and there we go, if you have it I want it too. For sure one of my sons, making far more money that I ever did, thinks all my benefits are crazy. He is smart enough (and making enough money) to plan his own golden years today without any reliance on government benefits. But forget him as he is probably a 10%’er and a tightwad as well.

    I have seen the progression of health and its costs make the transition for the 50’s up to today. My father made a lower middle class income but we never suffered for the need of HC, paid for out of pocket more or less.

    Then society decided to pay for old age HC and Medicare began. A great system for sure, none better in the world probably but only for people over 64. Want good universal, single payer and Medicare for all would be a good starting point. Now pay for it.

    Then came Medicaid. Society decided that paying for HC for the poor was needed. Certainly anyone would prefer Medicare but at least there is now some safety net for the poor in terms of HC. OK lets keep Medicare for the old and expand Medicaid for everyone else, rich, poor, you name it.

    Then here comes ACA. Now pay for it as currently constructed. Can’t do it and soon some states will not have any private insurance companies willing to try to compete. Well fine, let them try to earn money elsewhere or better yet let’s just abolish private HC insurance lock, stock and barrel. With a stroke of a federal pen, we “outlaw” (or force out of business) any and all private insurance for HC and force every American to accept Medicaid only.

    But to do that the government must force all doctors, etc. to accept only Medicaid (or Medicare) allowed costs. Have you ever looked at a hospital bill showing hospital charges and in a different column the Medicare allowed charges? The difference is HUGE, at least on my wife’s Medicare statements. Force hospitals to operate on such payments for all patients and you will be lucky to see that hospital operating at least up to VA standards, but probably much lower.

    Well big government can fix that. It will implement really “good” (and very high) standards for care and sue the asses off any hospital or doctor that does not perform up to such demanded levels of care. Then let a doctor being paid maybe $100K per year find the money to pay a multi-million law suit payment. Do you know how much such insurance costs doctors today, insurance to pay medical law suits?

    Both of us can only touch the surface of examples of people desperately needing HC OR the inability of anyone (society) to pay for all those needs. The complexity of such issues is certainly beyond the reach of you and me or Left and Right. Simple solutions won’t work and no solution will meet all the needs anyone can demand be paid for.

    I can only say that morally, I will support a universal, single payer system, a Medicare for all system IF and only if it can be made sustainable AND still have money for the federal government to provide for reasonable needs in a host of other areas that always needs money as well.

    It has been a couple of years since I ran the numbers. But here is approximation of what I found when I did so Medicare alone causes deficit spending of about $300 Billion per year. Well cut the defense budget from (about) $600 Billion to $300 Billion per year and use that cut to make just Medicare sustainable, financially.

    When you do so we will finally pay just for old age HC. As well I will let you liberals figure out how to prevail in a new Cold War against Russia. We solve one big financial problem affecting old people but can’t be ready to keep Putin out of western Europe. And we haven’t even begun to fix HC for ALL Americans, either.

    I suppose that is called a dilemma or a Gordian Knot.

    Anson

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  7. Anonymous

     /  March 11, 2017

    Anson,

    The hypocrisy of your party is nauseating. Some claim everyone including indigent should have access, some claim maybe some tax credits to reimburse costs, and some claim that you’re on your own, get it if you can. The Governor of Kentucky comes to mind in his fevered opposition, but now begging Congress not to repeal before replacing, which they are doing. 10 million without insurance just to spite the black POTUS.

    http://talkingpointsmemo.com/livewire/matt-bevin-obamacare-repeal-replace

    Your own damn party cannot get together to offer an unified answer to HC or paying for it. The fact is the ACA was working, there were spikes due to the Republican governors refusing Medicaid expansion. Your party is destroying it by removing the individual mandate. The ACA has withstood SCOTUS challenges to its provisions. Your party will reward the rich taxpayers by destroying the ACA at the expense of addicts, and indigent, and struggling Americans everywhere.

    My worry is that the dilemma or Gordian Knot will be solved by president Cheeto, when his incompetent, psychologically defective, and self serving decisions either destroy our country’s citizens with his “counter-puncher” mentality in war, or his financial destruction of our country’s assets. If the citizens “conned” by the orange monkey do not remove these GOP prostitutes to the elite and business in 2018, it is just a matter of time before the EPA, OSHA, HUD, Department of Education, and many other agencies are destroyed by ineptitude or graft.

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  8. King Beauregard

     /  March 15, 2017

    The thing everyone needs to bear in mind is, the ACA ties premiums to medical costs: 80%-85% of all premium dollars have to go to paying medical bills. If premiums are going up year after year, the primary culprit is medical COSTS going up.

    The next step is not single payer or tweaking the ACA or whatever other remedy people have been reflexively pushing for years. The solution is to start regulating the medical providers directly. For example:

    – Hospitals: maybe 80% of all dollars charged have to go directly to treating patients. Payroll and administrative costs and profits come out of the remaining 20%.

    – Doctors: reduce allowable fees, in exchange for forgiveness on student loans and subsidized malpractice insurance.

    – Pharmaceutical companies: subsidize research, in exchange for capping the prices they can charge to production cost plus 10%. (The tricky thing with pharmaceutical companies is, they legitimately have to spend a ton on R&D, so they need a market (the US) where they can be guaranteed to recover R&D costs. We take away the problem of research costs, we take away the justification for price gouging.)

    These are just ideas I’m pulling out of my ass, so I’m sure the details are off. But something like this, in broad strokes, would bring medical costs down. Would it be a lot of work? Sure! We need to elect more Democrats to make it possible. But until such time as we do this, medical costs will keep going up and premiums will keep going up in tandem.

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    • You are right on target, King. The trouble all began when the government decided that under Medicare, doctors could charge by the procedure and not just the visit. (Sometimes they got paid in chickens.) Now it’s Katy bar the door on charges.

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  9. ansonburlingame

     /  March 15, 2017

    Not a bad idea, King and Jim, EXCEPT …….

    What you are calling for in “broad strokes” (only, which is fine with me) is “government price controls”. I am old enough to remember gas prices in the 70’s that were going through the roof along with real scarcity. Government price controls were debated but cast aside by and large. Hell communism itself is government price control, along with quantity control as well through government “planning”. Socialism is a milder form of that same “big brother” approach as well.

    The counter argument is the “market”, competition is the best way to control both quantity and price of goods and services. That is the best definition I have seen for “economics”, the “system” devised by humans to control the distribution of scarce goods and services. That is putting the discussion in the broadest strokes possible.

    Medical care in America is not scarce at all. It is all over the place and available to everyone. But the cost is far, far too high for almost anyone except the very rich. So let government put a lid on such costs. Then what happens? Scarcity becomes the dominant fact in providing HC. No one will “do it” because the pay is far too low. Put a government cap on physician earnings and see how many physicians will still practice after the new system settles into place. Wonder if the CBO can “predict that”, broad strokes only!!

    Anson

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    • Anson, to cast regulation of medical costs, as King suggests, as “price controls” would be to over-generalize. Pure capitalism works no better than pure socialism. Is the tight regulation of utility costs socialism? I suppose it’s a form of it, but would you want to do away with energy commissions?

      Free-market healthcare worked OK in the days before modern technology. Then, the doctor came to the house with most of what he needed in his bag. Nowadays, when you hurt you go to where they have the Xray, the IV monitor, the oxygen, the MRI, and the CAT scan. And when you hurt your are most always not in a mood to shop around, and that’s if you knew ahead of time just what procedure to shop for. There’s no meaningful public pricing list anyway. If you’ve ever looked at your Medicare EOB’s you will notice that the amounts billed to the government are often double or more than what the government actually pays. The amounts billed have no basis other than greed.

      The same problem applies to pharmaceuticals. Industry lobbyists have managed to loosen patent rules so much that many standard drugs keep getting a new life. The epi-pen story is a good example. Again, shopping around is made very difficult. I just got in the mail yesterday a big postcard from my seldom-heard-from senator, Roy Blunt, warning me against buying medicine from Canadian sources because they might be “tainted”. (Roy likes lobbyists – he knows a lot of them.) Gee, I wonder why busloads of Canadians aren’t pouring over the border to get the good stuff here?

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  10. P.S., Anson, there is proof that socialized medicine already works in Canada, the U.K., Germany, and Australia, among others. And, for some reason, the U.S. Public Health Service and Doctors Without Borders still seem to recruit good talent. Maybe, just maybe, there is more to the profession than just money.

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  11. ansonburlingame

     /  March 16, 2017

    Jim,

    I don’t disagree with much of what you write above. I wonder if we can both agree that pure socialized medicine or pure market medicine won’t work. There must be some form of blend in how HC is provided to all Americans. That is where it gets so hard, finding the balance.

    Ever since my wife and I became eligible for Medicare I have been astounded when I see hospital bills, $ charged, and government $ paid. I have spoken with HC professionals about that matter. First, they tell me (former President of Freeman for example) that everyone is charged the same, period. An X-ray in the Emergency room of a potentially broken arm is billed (costs) ……, for everyone. Payments depend upon “who pays”, the individual, a private insurance company, a state agency or the federal government. We all know who has to pay the most, the uninsured individual. When they default on such payments the federal (or state) government pays a portion of that bill (small) and the hospital “eats” the balance, thus driving up further $ charged for future X-rays for everyone.

    Who pays the lowest $ for such bills, actually pays $? Medicare (or maybe Medicaid but I never see such bills or payment). That happens because of the very large “client base” available to government. They can negotiate for lower payments because …… Take that to the extreme, socialized medicine and you find monopoly power, a single payer only. Same situation applies to $ billed/paid for drugs. Just look at you pharmacy bill for a bottle of pills showing “real cost” and “saved as a result of insurance” (Tricare for you and me) HUGE differences of course.

    Now take a different insurance situation, you have an automobile accident. Take it to the shop for repairs and the bill is the same no matter who pays, you or the insurance company. The difference is both must pay the same $, you OR the insurance company.
    “Somebody” must pay $1,000 to replace a fender, etc. and the “shop” could care less who pays the amount billed.

    Put the federal government in charge of car insurance and watch that “system” get turned on its ear!! Hell put a state government in charge of “car” insurance (which it is to a degree) and you see widely varying rates charged from state to state. That is why when you price shop for car insurance they first ask you “where do you live” and your quoted rates vary by that situation. Insure your car in CA as opposed to MO and see the difference, same car, same age, same milage driven, etc.

    One other thought. The problem with Medicare is everyone gets it after age 64. It is a safety net for ALL older Americans, Trump, me or the impoverished. Why? Same with SS. Big government has yet to really figure out how to means test a safety net is the underlying problem.

    I in no way can offer “THE” solution to find the right balance to pay for HC. I just know today that if Dems provide solution it will cost too much and if GOP provides it “someone” will be let hanging by a thread for their life that could be saved if ……… Compounding that situation today is Dems and GOP refuse to sit down and figure out the best, but still pragmatic solution (one that works for MOST).

    We are at a point now if Dems provide a bill NO ONE in GOP will vote for it, or the reverse as well.

    What’a Country, right!! (for a little while at least until the next “revolution”)

    Anson

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