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I'd be great with a baseline medicare for all system publicly funded across the board with the option to pay more for privately funded better options. Not going

I'd be great with a baseline medicare for all system publicly funded across the board with the option to pay more for privately funded better options. Not going to get that, or anything close to that, are we? I give up America, you get the health care you're willing to prioritize. Not my problem any more. That said, going out of network if you can and going to the places with the cases if you can are the only real current options for beating the odds. I speak from direct experience doing whatever it took to get my wife's cancer treated at MD Anderson. We won, at least for now, but it wasn't cheap.

deleted 3y ago
[deleted]
jmye 3y ago
Medicare for all is not a panacea and would cause dramatic breaks in care in other places. The fragmented private model sucks, but the belief that single-payer would fix much of anything is faulty. Reform should happen, but it shouldn’t be based on a bumper sticker, and it should be thoughtful about the vast differences between SF, NYC, West Texas and Southern South Dakota. “Fixing” things for people in major cities while crippling/destroying rural care (more than it already has been) is a bad solution.
- deleted 3y ago
  [deleted]
- fzeroracer 3y ago
  Rural healthcare is being crippled in part due to state politicians posturing for political clout. Major reforms like medicare for all shouldn't be held back because they're not perfect, because otherwise we're going to continue having the same problems we've been having where compromised half-assed bills make the system overall worse.
  - BeefDinnerPurge 3y ago
    [flagged]
  - jmye 3y ago
    I’m not saying we shouldn’t reform - I’m saying we should be careful about what that reform is, and what its goals are. I would generally suggest that CMMI and provider groups is/are more heavily involved than big city voters who know very little about a very, very complicated issue. Lastly, rural healthcare is in trouble because reimbursements are bad (especially Medicare reimbursements), FFS (fee-for-service) is a failed model, there’s a massive credential shortage, and given those, the credentials that exist would prefer to work in desirable places, not Pine Ridge, SD. If you’re serious about fixing healthcare, you should start by fixing education. State politics, specifically around Medicaid, are, generally, not driving the hospital closures and OB/GYN deserts.
    - fzeroracer 3y ago
      State politics absolutely are driving hospital closures and OB/GYN deserts because the 'desirable places' metrics includes places that won't prosecute doctors for routine prenatal care. That's literally why we're seeing Texas and Florida suffer from an increasing lack of OB/GYN care. I don't dispute the rest of your arguments about healthcare, but you cannot fix education and/or brain drain without fixing state politics.
      - jmye 3y ago
        These issues were occurring before Dobbs - suggesting that’s a major driver in the long term creation of care deserts is incorrect. Hospitals are not closing because of shitty prenatal laws. They’re closing because reimbursement rates are insufficient, in part, because we’ve allowed too much consolidation, in part, and because there aren’t doctors/nurses who want to live in the sticks and make peanuts.
    - op00to 3y ago
      Why is it Medicare’s problem to fix that educated people choose not to live in certain places?
      - jmye 3y ago
        So your solution to healthcare in this country is to light rural America on fire so that you, personally, can have cheaper care? That sounds workable.
  - Wytwwww 3y ago
    Wouldn't proper regulation of the health-insurance industry be easier to achieve than Medicare for all? It's not like single payer is the only real option. A 100% privatized system can work just fine with proper regulation. US could more or less just copy paste the Dutch insurance system..
- BeefDinnerPurge 3y ago
  [flagged]
- op00to 3y ago
  You provide no examples of your statement. I say Medicare for all is a panacea and will cause no breaks in care. That was easy.
  - jmye 3y ago
    I didn’t realize you were looking for a sourced essay. Medicare-for-all extends a fee for service model that results in poor care, poorer outcomes, massively increases expense, and simultaneously lowers physician reimbursements. Given the increasing doctor shortage, that’s an issue that will be immediately exacerbated. Further, the FFS model incentivizes throughput, not quality of care. Your care won’t get better.
    - BeefDinnerPurge 3y ago
      So how do places like Hong Kong make this work? Because they do. My out of pocket expenses there uninsured are less than my copayments fully insured here. https://journals.lww.com/jcma/Fulltext/2015/10000/Overview_of_the_health_care_system_in_Hong_Kong.2.aspx https://journals.lww.com/jcma/Fulltext/2015/10000/Overview_o... I suspect every reason you will cite is something we could both address as a nation and we will refuse to do so because freedom or some other idiocy. I truly give up. I threw money at family's medical crisis and prevailed. Most can't. More should be able to do so. Even California is looking to places like Houston to mine ideas for improving their raging homeless problem. If you're not going to steal from the best, why bother doing anything?
      - jmye 3y ago
        Do you think there might be other differences between Hong Kong and the United States that could account for differing challenges in providing healthcare? I’m not clear why you’re giving up - it’s not an intractable problem. Some folks need to give up on “healthcare only for the rich/cities” and some folks need to stop having strong opinions about a very, very complicated industry they don’t understand at even a surface level (not directed at anyone specifically - it’s a common US problem with healthcare discussions/solutions). Cost/utilization/availability challenges are fully solvable, if one is committed to a solution and not a message.
underlipton 3y ago
The problem is that a public option must necessarily spend a lot more of its focus on preventative care that keeps people from developing serious chronic illness in the first place, for budgetary reasons. There are a lot of people staking their career prestige, high pay, and lifestyles on Americans having the freedom to get sick, seriously sick, on a regular and consistent basis. I'm happy to throw them under the bus, but I imagine some will be more than happy to defend them. EDIT: Geez, here's one now: https://news.ycombinator.com/item?id=38759502 https://news.ycombinator.com/item?id=38759502
- mdorazio 3y ago
  Every single study I have seen refutes your point, which was commonly brought up during the Obamacare discussion days and never had any merit to begin with. Here's the NIH itself estimating a 13% savings compared to today: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8572548/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8572548/ What you're missing is that the current "system" is so utterly wasteful and inefficient that even if we cover people's shitty lifestyle habits it would still be cheaper than what we have today. Which is basically what TFA's main point is about.
  - underlipton 3y ago
    Fair, though we're generally in agreement. My point is that there are many who don't want the savings, because the over-payment is what fills their bank accounts. I was trying to point out that their last refuge, even when things improve objectively and across the board for the vast majority of Americans, is that single-payer or even a public option would hurt their pocketbooks. Like I said, I'm happy to throw insurers under the bus.

deleted 3y ago

[deleted]

jmye 3y ago

Medicare for all is not a panacea and would cause dramatic breaks in care in other places. The fragmented private model sucks, but the belief that single-payer would fix much of anything is faulty. Reform should happen, but it shouldn’t be based on a bumper sticker, and it should be thoughtful about the vast differences between SF, NYC, West Texas and Southern South Dakota. “Fixing” things for people in major cities while crippling/destroying rural care (more than it already has been) is a bad solution.

deleted 3y ago
[deleted]
fzeroracer 3y ago
Rural healthcare is being crippled in part due to state politicians posturing for political clout. Major reforms like medicare for all shouldn't be held back because they're not perfect, because otherwise we're going to continue having the same problems we've been having where compromised half-assed bills make the system overall worse.
- BeefDinnerPurge 3y ago
  [flagged]
- jmye 3y ago
  I’m not saying we shouldn’t reform - I’m saying we should be careful about what that reform is, and what its goals are. I would generally suggest that CMMI and provider groups is/are more heavily involved than big city voters who know very little about a very, very complicated issue. Lastly, rural healthcare is in trouble because reimbursements are bad (especially Medicare reimbursements), FFS (fee-for-service) is a failed model, there’s a massive credential shortage, and given those, the credentials that exist would prefer to work in desirable places, not Pine Ridge, SD. If you’re serious about fixing healthcare, you should start by fixing education. State politics, specifically around Medicaid, are, generally, not driving the hospital closures and OB/GYN deserts.
  - fzeroracer 3y ago
    State politics absolutely are driving hospital closures and OB/GYN deserts because the 'desirable places' metrics includes places that won't prosecute doctors for routine prenatal care. That's literally why we're seeing Texas and Florida suffer from an increasing lack of OB/GYN care. I don't dispute the rest of your arguments about healthcare, but you cannot fix education and/or brain drain without fixing state politics.
    - jmye 3y ago
      These issues were occurring before Dobbs - suggesting that’s a major driver in the long term creation of care deserts is incorrect. Hospitals are not closing because of shitty prenatal laws. They’re closing because reimbursement rates are insufficient, in part, because we’ve allowed too much consolidation, in part, and because there aren’t doctors/nurses who want to live in the sticks and make peanuts.
  - op00to 3y ago
    Why is it Medicare’s problem to fix that educated people choose not to live in certain places?
    - jmye 3y ago
      So your solution to healthcare in this country is to light rural America on fire so that you, personally, can have cheaper care? That sounds workable.
- Wytwwww 3y ago
  Wouldn't proper regulation of the health-insurance industry be easier to achieve than Medicare for all? It's not like single payer is the only real option. A 100% privatized system can work just fine with proper regulation. US could more or less just copy paste the Dutch insurance system..
BeefDinnerPurge 3y ago
[flagged]
op00to 3y ago
You provide no examples of your statement. I say Medicare for all is a panacea and will cause no breaks in care. That was easy.
- jmye 3y ago
  I didn’t realize you were looking for a sourced essay. Medicare-for-all extends a fee for service model that results in poor care, poorer outcomes, massively increases expense, and simultaneously lowers physician reimbursements. Given the increasing doctor shortage, that’s an issue that will be immediately exacerbated. Further, the FFS model incentivizes throughput, not quality of care. Your care won’t get better.
  - BeefDinnerPurge 3y ago
    So how do places like Hong Kong make this work? Because they do. My out of pocket expenses there uninsured are less than my copayments fully insured here. https://journals.lww.com/jcma/Fulltext/2015/10000/Overview_of_the_health_care_system_in_Hong_Kong.2.aspx https://journals.lww.com/jcma/Fulltext/2015/10000/Overview_o... I suspect every reason you will cite is something we could both address as a nation and we will refuse to do so because freedom or some other idiocy. I truly give up. I threw money at family's medical crisis and prevailed. Most can't. More should be able to do so. Even California is looking to places like Houston to mine ideas for improving their raging homeless problem. If you're not going to steal from the best, why bother doing anything?
    - jmye 3y ago
      Do you think there might be other differences between Hong Kong and the United States that could account for differing challenges in providing healthcare? I’m not clear why you’re giving up - it’s not an intractable problem. Some folks need to give up on “healthcare only for the rich/cities” and some folks need to stop having strong opinions about a very, very complicated industry they don’t understand at even a surface level (not directed at anyone specifically - it’s a common US problem with healthcare discussions/solutions). Cost/utilization/availability challenges are fully solvable, if one is committed to a solution and not a message.

underlipton 3y ago

The problem is that a public option must necessarily spend a lot more of its focus on preventative care that keeps people from developing serious chronic illness in the first place, for budgetary reasons. There are a lot of people staking their career prestige, high pay, and lifestyles on Americans having the freedom to get sick, seriously sick, on a regular and consistent basis. I'm happy to throw them under the bus, but I imagine some will be more than happy to defend them. EDIT: Geez, here's one now: https://news.ycombinator.com/item?id=38759502 https://news.ycombinator.com/item?id=38759502

mdorazio 3y ago
Every single study I have seen refutes your point, which was commonly brought up during the Obamacare discussion days and never had any merit to begin with. Here's the NIH itself estimating a 13% savings compared to today: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8572548/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8572548/ What you're missing is that the current "system" is so utterly wasteful and inefficient that even if we cover people's shitty lifestyle habits it would still be cheaper than what we have today. Which is basically what TFA's main point is about.
- underlipton 3y ago
  Fair, though we're generally in agreement. My point is that there are many who don't want the savings, because the over-payment is what fills their bank accounts. I was trying to point out that their last refuge, even when things improve objectively and across the board for the vast majority of Americans, is that single-payer or even a public option would hurt their pocketbooks. Like I said, I'm happy to throw insurers under the bus.