5 ms·

Obamacare, the proposed trump care, its all a failure. Get rid of the employer sponsored plans, that makes no sense at all and makes me hesitant to lose my job

Obamacare, the proposed trump care, its all a failure. Get rid of the employer sponsored plans, that makes no sense at all and makes me hesitant to lose my job because my health relies on it? That is simply absurd. Get rid of this. I'm so frustrated with the healthcare here and I don't understand how Washington can't come up with any real solutions

coldpie 9y ago
Single payer has been proposed many times and works well in the rest of the first world. Edit: Don't forget to vote every November.
- ClassyJacket 9y ago
  It works so well in Australia that entire elections are basically predicated on who will protect it the best.
- avs733 9y ago
  Single payer works well in the US. Despite claims and the continuously driven narrative of government inefficiency and waste, Medicare and Medicaid are easily the most efficient and effective health care options in America. It would take a one line act of congress...removing the income cap...to make America a defacto single payer state. The only problem is that it would disrupt a huge capitalist market, and our society has judged the protecting markets is more important than protecting people.
  - creaghpatr 9y ago
    Medicaid and Medicare are heavily subsidized in practice by private insurance covered patients. Hospitals that have too high of a proportion of Medicare patients get a bonus subsidy from the government to cover up the fact that the coverage alone can't financially sustain the provider. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/dsh.html https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen... If we implemented single-payer in the form of Medicare as it is now, the healthcare industry would quickly collapse.
    - chimeracoder 9y ago
      > Medicaid and Medicare are heavily subsidized in practice by private insurance covered patients. If we implemented single-payer in the form of Medicare as it is now, the healthcare industry would quickly collapse. In addition to everything you said (which is true), Medicare's apparent success is also boosted by the portion of Medicare patients who receive their non-pharmaceutical Medicare benefits through a private insurer. Original Medicare (which is the part of Medicare that is purely government-run[0]) has dramatically lower ratings for both medical outcomes and patient satisfaction scores[1] than Medicare Advantage, which is privately run. Medicare Advantage also consistently outperforms Original Medicare on cost as well. Unfortunately, when statistics are cited for Medicare as a whole by laypeople and in mass-media, Original Medicare and Medicare Advantage are lumped together, giving the impression that Original Medicare is much more effective and well-liked than it actually is. The same applies to Medicaid, but because that's state-run, the exact details vary from state-to-state. Overall, though, nearly ever state has some form of private management for Medicaid plans, and those consistently outperform the state-run counterparts, for reasons which are immediately clear to anybody who's experienced both firsthand. [0] except for drug benefits under Part D [1] In 2015, Original Medicare's patient satisfaction scores were lower than the very worst Medicare Advantage provider - they were literally the bottom of the rung.
    - avs733 9y ago
      I agree my comment was an oversimplification but I think it is fairer to say that "the health care industry as we know it would change" I think you are unlikely to see immedaite adoption but over time you would have many other/new/different problems to address just as we have many problems now. It is worth mentioning that it would like cause significant employment reductions in the non-governmental insurance providers which are not without an impact. But for starters, both medicare and medicaid are effectively a concentration of very high risk/high cost customer pools (the elderly and the low income). Opening it up would likely positively impact that cost calculation as well
    - kaitai 9y ago
      But this is because Medicare reimbursement rates are set by a panel of specialists (I believe there is one internal medicine doc and then every specialty is represented, so getting a stent sure does get reimbursed well while counseling a diabetic about keeping that A1c down or working on the toe of a homeless guy get reimbursed approximately not at all) who don't necessarily care if Medicare is that fair. Tangentially, note Medicare spends about 3% on overhead, compared to private industry's previous 30%. (There are now caps on overhead expenditures -- trying to keep it to 20% or less.)
- shard972 9y ago
  What about drug R&D in those countries? For all the issues of the US healthcare system, one thing it has going for it is most of the new developments in medicine comes from the US.
  - toomuchtodo 9y ago
    Great for pharma stockholders, terrible for American citizens. Let's stop subsidizing drug R&D for the world on the backs of US citizens who are being squeezed to death by Washington and a for profit healthcare system.
    - shard972 9y ago
      That's a fair argument but I'm more interested in how much R&D happens under single payer systems.
      - toomuchtodo 9y ago
        Does the NIH and NSF not provide a pipeline for drug research in the US? Did you know the CEO of Mylan, the company that makes epipens made $98 million last year? Is that reasonable? http://money.cnn.com/2017/05/31/investing/epipen-mylan-chairman-98-million/index.html http://money.cnn.com/2017/05/31/investing/epipen-mylan-chair...
        theseatoms 9y ago
        Reminds me of a good SSC post. > The problem with the pharmaceutical industry isn’t that they’re unregulated just like chairs and mugs. The problem with the pharmaceutical industry is that they’re part of a highly-regulated cronyist system that works completely differently from chairs and mugs. http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-drugs-vs-chairs/ http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-dr...
        pc86 9y ago
        Well the board felt it was reasonable, and I'd expect the board of a publicly traded company to know more about its finances than me. The question was about how much R&D happens in single-payer counties, not how much one particular CEO made. I am a proponent of single-payer health care in the US but responding to unrelated, valid questions with, "yeah, but this one person made a lot of money and that makes me mad!" is ridiculous.
- mbesto 9y ago
  It's a valid solution that will never happen. Why? https://www.google.com/finance?q=NYSE%3AUNH&fstype=ii&ei=QD1NWaCMMNf9jAG7zp7gCQ https://www.google.com/finance?q=NYSE%3AUNH&fstype=ii&ei=QD1... $184B in revenue and 230k jobs gets eliminated https://www.google.com/finance?q=NYSE%3AAET&fstype=ii&ei=Zj1NWeHxI4XqjAGGubGwBw https://www.google.com/finance?q=NYSE%3AAET&fstype=ii&ei=Zj1... $63B in revenue and 49.5k jobs get eliminated https://www.google.com/finance?q=NYSE%3AANTM&fstype=ii&ei=yj1NWaGkKIX82AaztZCIAg https://www.google.com/finance?q=NYSE%3AANTM&fstype=ii&ei=yj... $84B in revenue and 53k jobs get eliminated https://www.google.com/finance?q=NYSE%3AHUM&fstype=ii&ei=7j1NWevyBobyjAG0laD4Bw https://www.google.com/finance?q=NYSE%3AHUM&fstype=ii&ei=7j1... $54B in revenue and 51k jobs get eliminated That's just 4 companies that total $385B and 383,500 jobs. More broadly, healthcare spending is about 20% of the US's GDP.
deleted 9y ago
[deleted]
sjg007 9y ago
The issue is that the left wants single payer and the right wants tax cuts. Then there is the insurance lobby. Premiums increases can be mitigated by reinsurance. The ultimate payer of that should be the Feds (as it is with almost all catastrophic cases e.g floods/earthquakes/landslides).
mikeash 9y ago
The reasons Washington can't come up with real solutions are simple: ideology and money. A big chunk of Washington firmly believes that socialized medicine is evil, and they will fight it. It doesn't matter what the facts are, it's part of their identity at this point. For the rest, the desires of insurance companies and similar get in the way. For example, the main, perhaps only reason the ACA didn't include a public option is because Joe Lieberman, Senator from a state where the health insurance industry is huge, refused to vote for a bill that included it and his vote was required for passage. If lawmakers wanted to fix things, it would be easy: study the systems of other first-world countries and incorporate the things that work best into ours. But "something that works well" is way down on the list of priorities.
- humanrebar 9y ago
  > For example, the main, perhaps only reason the ACA didn't include a public option is because Joe Lieberman, Senator from a state where the health insurance industry is huge, refused to vote for a bill that included it and his vote was required for passage. ...there were 40 other senators who were not voting for the ACA. The bill didn't, and still doesn't, have enough popular support. You can't blame one play on a lost game and you can't blame one voter for a lost ballot. Doubling down on employer provided healthcare with additional mandates didn't help their case.
  - pc86 9y ago
    > you can't blame one voter for a lost ballot You can't do this in popular elections but you can absolutely do it in the legislature where everyone has a different constituency, policy portfolio, campaign contribution history, etc. Lieberman wouldn't vote for a bill with a public option, full stop. The math worked out such that Lieberman was necessary. Ergo, Lieberman killed the public option if there was no other Senator for whom the existence of a public option would have changed their Nay to a Yea. There was not, so you can absolutely lay the lack of a present day public option for health care in the US at his feet.
    - humanrebar 9y ago
GiorgioG 9y ago
It's easy to understand - the rich continue to get richer because that's how politicians stay in power. As a father of a chronically-ill 5 year old I can't tell you how frustrating it is. Should I change jobs? Depends on the healthcare plans they offer. What do I do if I lose my job? COBRA adds insult to injury. How will he take care of himself when he gets out of college (assuming he goes of course)? Will it consume half of his paycheck? Through me, my son will have citizenship in France...maybe it's time to teach him French and consider steering him to moving to France when he's done with school. We need to shift the conversation away from single-payer, insurance, etc and focus on either: universal healthcare or strict price controls. Until these options are shoved down the throats of our politicians, they're going to keep distracting us with b.s. 'solutions' like the ACA, its "replacement", etc.

coldpie 9y ago

Single payer has been proposed many times and works well in the rest of the first world. Edit: Don't forget to vote every November.

ClassyJacket 9y ago
It works so well in Australia that entire elections are basically predicated on who will protect it the best.
avs733 9y ago
Single payer works well in the US. Despite claims and the continuously driven narrative of government inefficiency and waste, Medicare and Medicaid are easily the most efficient and effective health care options in America. It would take a one line act of congress...removing the income cap...to make America a defacto single payer state. The only problem is that it would disrupt a huge capitalist market, and our society has judged the protecting markets is more important than protecting people.
- creaghpatr 9y ago
  Medicaid and Medicare are heavily subsidized in practice by private insurance covered patients. Hospitals that have too high of a proportion of Medicare patients get a bonus subsidy from the government to cover up the fact that the coverage alone can't financially sustain the provider. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/dsh.html https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen... If we implemented single-payer in the form of Medicare as it is now, the healthcare industry would quickly collapse.
  - chimeracoder 9y ago
    > Medicaid and Medicare are heavily subsidized in practice by private insurance covered patients. If we implemented single-payer in the form of Medicare as it is now, the healthcare industry would quickly collapse. In addition to everything you said (which is true), Medicare's apparent success is also boosted by the portion of Medicare patients who receive their non-pharmaceutical Medicare benefits through a private insurer. Original Medicare (which is the part of Medicare that is purely government-run[0]) has dramatically lower ratings for both medical outcomes and patient satisfaction scores[1] than Medicare Advantage, which is privately run. Medicare Advantage also consistently outperforms Original Medicare on cost as well. Unfortunately, when statistics are cited for Medicare as a whole by laypeople and in mass-media, Original Medicare and Medicare Advantage are lumped together, giving the impression that Original Medicare is much more effective and well-liked than it actually is. The same applies to Medicaid, but because that's state-run, the exact details vary from state-to-state. Overall, though, nearly ever state has some form of private management for Medicaid plans, and those consistently outperform the state-run counterparts, for reasons which are immediately clear to anybody who's experienced both firsthand. [0] except for drug benefits under Part D [1] In 2015, Original Medicare's patient satisfaction scores were lower than the very worst Medicare Advantage provider - they were literally the bottom of the rung.
  - avs733 9y ago
    I agree my comment was an oversimplification but I think it is fairer to say that "the health care industry as we know it would change" I think you are unlikely to see immedaite adoption but over time you would have many other/new/different problems to address just as we have many problems now. It is worth mentioning that it would like cause significant employment reductions in the non-governmental insurance providers which are not without an impact. But for starters, both medicare and medicaid are effectively a concentration of very high risk/high cost customer pools (the elderly and the low income). Opening it up would likely positively impact that cost calculation as well
  - kaitai 9y ago
    But this is because Medicare reimbursement rates are set by a panel of specialists (I believe there is one internal medicine doc and then every specialty is represented, so getting a stent sure does get reimbursed well while counseling a diabetic about keeping that A1c down or working on the toe of a homeless guy get reimbursed approximately not at all) who don't necessarily care if Medicare is that fair. Tangentially, note Medicare spends about 3% on overhead, compared to private industry's previous 30%. (There are now caps on overhead expenditures -- trying to keep it to 20% or less.)
shard972 9y ago
What about drug R&D in those countries? For all the issues of the US healthcare system, one thing it has going for it is most of the new developments in medicine comes from the US.
- toomuchtodo 9y ago
  Great for pharma stockholders, terrible for American citizens. Let's stop subsidizing drug R&D for the world on the backs of US citizens who are being squeezed to death by Washington and a for profit healthcare system.
  - shard972 9y ago
    That's a fair argument but I'm more interested in how much R&D happens under single payer systems.
    - toomuchtodo 9y ago
      Does the NIH and NSF not provide a pipeline for drug research in the US? Did you know the CEO of Mylan, the company that makes epipens made $98 million last year? Is that reasonable? http://money.cnn.com/2017/05/31/investing/epipen-mylan-chairman-98-million/index.html http://money.cnn.com/2017/05/31/investing/epipen-mylan-chair...
      - theseatoms 9y ago
        Reminds me of a good SSC post. > The problem with the pharmaceutical industry isn’t that they’re unregulated just like chairs and mugs. The problem with the pharmaceutical industry is that they’re part of a highly-regulated cronyist system that works completely differently from chairs and mugs. http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-drugs-vs-chairs/ http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-dr...
      - pc86 9y ago
        Well the board felt it was reasonable, and I'd expect the board of a publicly traded company to know more about its finances than me. The question was about how much R&D happens in single-payer counties, not how much one particular CEO made. I am a proponent of single-payer health care in the US but responding to unrelated, valid questions with, "yeah, but this one person made a lot of money and that makes me mad!" is ridiculous.
mbesto 9y ago
It's a valid solution that will never happen. Why? https://www.google.com/finance?q=NYSE%3AUNH&fstype=ii&ei=QD1NWaCMMNf9jAG7zp7gCQ https://www.google.com/finance?q=NYSE%3AUNH&fstype=ii&ei=QD1... $184B in revenue and 230k jobs gets eliminated https://www.google.com/finance?q=NYSE%3AAET&fstype=ii&ei=Zj1NWeHxI4XqjAGGubGwBw https://www.google.com/finance?q=NYSE%3AAET&fstype=ii&ei=Zj1... $63B in revenue and 49.5k jobs get eliminated https://www.google.com/finance?q=NYSE%3AANTM&fstype=ii&ei=yj1NWaGkKIX82AaztZCIAg https://www.google.com/finance?q=NYSE%3AANTM&fstype=ii&ei=yj... $84B in revenue and 53k jobs get eliminated https://www.google.com/finance?q=NYSE%3AHUM&fstype=ii&ei=7j1NWevyBobyjAG0laD4Bw https://www.google.com/finance?q=NYSE%3AHUM&fstype=ii&ei=7j1... $54B in revenue and 51k jobs get eliminated That's just 4 companies that total $385B and 383,500 jobs. More broadly, healthcare spending is about 20% of the US's GDP.

deleted 9y ago

[deleted]

sjg007 9y ago

The issue is that the left wants single payer and the right wants tax cuts. Then there is the insurance lobby. Premiums increases can be mitigated by reinsurance. The ultimate payer of that should be the Feds (as it is with almost all catastrophic cases e.g floods/earthquakes/landslides).

mikeash 9y ago

The reasons Washington can't come up with real solutions are simple: ideology and money. A big chunk of Washington firmly believes that socialized medicine is evil, and they will fight it. It doesn't matter what the facts are, it's part of their identity at this point. For the rest, the desires of insurance companies and similar get in the way. For example, the main, perhaps only reason the ACA didn't include a public option is because Joe Lieberman, Senator from a state where the health insurance industry is huge, refused to vote for a bill that included it and his vote was required for passage. If lawmakers wanted to fix things, it would be easy: study the systems of other first-world countries and incorporate the things that work best into ours. But "something that works well" is way down on the list of priorities.

humanrebar 9y ago
> For example, the main, perhaps only reason the ACA didn't include a public option is because Joe Lieberman, Senator from a state where the health insurance industry is huge, refused to vote for a bill that included it and his vote was required for passage. ...there were 40 other senators who were not voting for the ACA. The bill didn't, and still doesn't, have enough popular support. You can't blame one play on a lost game and you can't blame one voter for a lost ballot. Doubling down on employer provided healthcare with additional mandates didn't help their case.
- pc86 9y ago
  > you can't blame one voter for a lost ballot You can't do this in popular elections but you can absolutely do it in the legislature where everyone has a different constituency, policy portfolio, campaign contribution history, etc. Lieberman wouldn't vote for a bill with a public option, full stop. The math worked out such that Lieberman was necessary. Ergo, Lieberman killed the public option if there was no other Senator for whom the existence of a public option would have changed their Nay to a Yea. There was not, so you can absolutely lay the lack of a present day public option for health care in the US at his feet.
  - humanrebar 9y ago

GiorgioG 9y ago

It's easy to understand - the rich continue to get richer because that's how politicians stay in power. As a father of a chronically-ill 5 year old I can't tell you how frustrating it is. Should I change jobs? Depends on the healthcare plans they offer. What do I do if I lose my job? COBRA adds insult to injury. How will he take care of himself when he gets out of college (assuming he goes of course)? Will it consume half of his paycheck? Through me, my son will have citizenship in France...maybe it's time to teach him French and consider steering him to moving to France when he's done with school. We need to shift the conversation away from single-payer, insurance, etc and focus on either: universal healthcare or strict price controls. Until these options are shoved down the throats of our politicians, they're going to keep distracting us with b.s. 'solutions' like the ACA, its "replacement", etc.