4 ms·

There’s always room for critique, but millions of Americans need something to change. How can we get coverage to the poorest people effectively?

tptacek 7y ago
I think it's easy to misread what I wrote as saying that the current system is OK, or there aren't giant, urgent problems that need to be addressed. There are huge problems. The concern I have is that payer-side reforms are a sideshow.
- TaylorAlexander 7y ago
  Sorry, I didn’t mean to suggest that you had taken this position. I just really want to move the conversation forward. So there are problems with Medicare, but you seem to know about this so I’m curious what you would suggest we do to provide coverage to millions of poor Americans currently going without. I’m no policy expert and I thought M4A is a great idea. Thanks!
  - tptacek 7y ago
    I don't know. What I'm advocating is that any discussion of the US health care problem start with a breakdown of where the money is going in our system. There are competing breakdowns, but any of them would be better than the default presumption we seem to have that the problem with health care is "insurance companies and prescription drugs". No breakdown I've seen on any side of this debate shows that either of those things are the true driver of costs in our system. I'm not defending either the current private health insurance system, which I think needs drastic reform, or the market for prescription drugs, which is dysfunctional in a bunch of ways. But I am unconvinced that the public intuition about the overall health care problem is well informed.
    - TaylorAlexander 7y ago
      Ah I see. Thanks for sharing that. It’s all so vague to me. There’s so many different analyses and so many experts who will attest to competing facts. My priorities are just: 1) Ensure universal coverage for all Americans. 2) Structure it so costs are at least as reasonable as those in other countries with similar systems. So for me, universal coverage immediately is a hard requirement and of course it must be done as fiscally responsible as we can manage. But we can always refine the system to lower cost later. We can’t replace the lives lost due to inadequate coverage.
throwaway_law 7y ago
>How can we get coverage to the poorest people effectively? Reform the entire economy so there aren't 10s of millions of people who can't afford health care insurance. The current medicaid solution for the poor is a joke like all governmental welfare programs for the poor, they exist so that the rich can benefit from this distribution of taxpayer dollars (like snap/food stamps, section 8 housing, etc..), meanwhile it gives the politicians enough examples of success to point at and pat each other on the back. Meanwhile for the poor who need these services, because to these services often function more like a lottery which you may or may not get the benefits, rather than acting as a program you can depend on.
refurb 7y ago
The poorest people generally have public coverage, Medicaid.

tptacek 7y ago

I think it's easy to misread what I wrote as saying that the current system is OK, or there aren't giant, urgent problems that need to be addressed. There are huge problems. The concern I have is that payer-side reforms are a sideshow.

TaylorAlexander 7y ago
Sorry, I didn’t mean to suggest that you had taken this position. I just really want to move the conversation forward. So there are problems with Medicare, but you seem to know about this so I’m curious what you would suggest we do to provide coverage to millions of poor Americans currently going without. I’m no policy expert and I thought M4A is a great idea. Thanks!
- tptacek 7y ago
  I don't know. What I'm advocating is that any discussion of the US health care problem start with a breakdown of where the money is going in our system. There are competing breakdowns, but any of them would be better than the default presumption we seem to have that the problem with health care is "insurance companies and prescription drugs". No breakdown I've seen on any side of this debate shows that either of those things are the true driver of costs in our system. I'm not defending either the current private health insurance system, which I think needs drastic reform, or the market for prescription drugs, which is dysfunctional in a bunch of ways. But I am unconvinced that the public intuition about the overall health care problem is well informed.
  - TaylorAlexander 7y ago
    Ah I see. Thanks for sharing that. It’s all so vague to me. There’s so many different analyses and so many experts who will attest to competing facts. My priorities are just: 1) Ensure universal coverage for all Americans. 2) Structure it so costs are at least as reasonable as those in other countries with similar systems. So for me, universal coverage immediately is a hard requirement and of course it must be done as fiscally responsible as we can manage. But we can always refine the system to lower cost later. We can’t replace the lives lost due to inadequate coverage.

throwaway_law 7y ago

>How can we get coverage to the poorest people effectively? Reform the entire economy so there aren't 10s of millions of people who can't afford health care insurance. The current medicaid solution for the poor is a joke like all governmental welfare programs for the poor, they exist so that the rich can benefit from this distribution of taxpayer dollars (like snap/food stamps, section 8 housing, etc..), meanwhile it gives the politicians enough examples of success to point at and pat each other on the back. Meanwhile for the poor who need these services, because to these services often function more like a lottery which you may or may not get the benefits, rather than acting as a program you can depend on.

refurb 7y ago

The poorest people generally have public coverage, Medicaid.