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My personal opinion, is that the biggest mistake was passing the healthcare act congress did in 2009 instead of national single payer Medicare/Medicaid for all.

My personal opinion, is that the biggest mistake was passing the healthcare act congress did in 2009 instead of national single payer Medicare/Medicaid for all. Socialize it all; call in the military doctors to provide care that's missing. Train up more. Break the education cartel and '(evil/dark) company' style hazing of new grads in grueling 12-36 hour deathmarch shifts. Train enough doctors to fulfill society's needs.

silisili 2y ago
I'm a pretty conservative person, and this is the one view I break with hardliners completely with - I agree completely. The funny thing is, most people you talk to on either side of the aisle are for it. The healthcare lobby is so large as to buy politicians to make it seem like a wedge issue, but even a ton of conservatives agree with single payer in principle. I'd wager if you put it to a national vote, it'd break something like 80-20 for.
- chefandy 2y ago
  I think the core ideas of the ACA with the public option was originally Gingrich, in response to Hillary Clinton’s much more aggressive proposal for single payer, right? And then before the federal ACA, “Romneycare” was implemented in Massachusetts (without a public option, but with preexisting condition protection and not allowing separate high risk pools) by Republican Governor Mitt Romney. I think the discourse ended up polarized because Obama presented it that it seemed really partisan but the person that killed the public option in a Herculean commitment to insurance company profiteering was none other than liberal centrist Senator Joe Lieberman. This is not a partisan issue. There are obviously going to be ideological pockets in the extremes but outside of that, for the most part, the only people that are stepping up to defend the insurance companies are in their goddamned pockets.
  - silisili 2y ago
    You're right, but there are people on both sides who toe the party line blindly(and stupidly, if I might add). I'll never forget Trump being cornered, and him saying he's not going to let people die in the streets, and his audience booing. He claimed they were all donors and lobbyists taking the audience seats, and despite his typical theatrics, I now believe that to be the truth. Either way, today it is a leftist idea I think, so there will exist some people who oppose it out of spite. I don't know a single person happy with the system today, which is damning. Just look at the reaction from recent events...
    - chefandy 2y ago
      Fair enough. It is rather telling and should be extremely concerning to the insurance industry that in our extremely polarized political culture of late, this has been a the largest patch of common-ground many of us have stood on in a long time. Obviously not a total common ground issue, but I can’t think of anything bigger recently.
- nojvek 2y ago
  I disagree with Medicare for all and single payer. The role of govt is a catch 22 - it is by design a monopoly, and monopolies are usually inefficient, so too much govt power gets monopoly capture but too little means govt can’t break the monopolies. The largest issue with US healthcare is lack of price-quality transparency and competition. This means tons of middle player monopolies e.g PBMs. I can’t go shop around for a procedure on a marketplace and pay out of pocket, the same rates an insurer would. I can’t deal directly with service provider or the labs. It has to be intermediaries. The # of medical licenses are capped, they’re not growing in proportion to population. Demand-supply dynamics, the basis of capitalism is wildly inefficient in US. Get rid of employer given insurers, make a law that insurers cannot negotiate a lower price than out of pocket price. Every procedure price should be openly put on an easily searchable marketplace. Make it easy to start new practices, more doctors and nurses and hospitals. The prices will come down. Single payer is a bandaid fix. It does nothing to fix the supply problem.
  - hellotheretoday 2y ago
    this argument comes up every time and it always ignores a critical aspect of medicine: not all procedures can be “shopped for”. If I have cancer and I need to start treatment as soon as possible I’m not going to waste precious time comparing rates of infusion centers, especially given that one may be able to take me in for treatments 2 weeks sooner. That two weeks could make all the difference If I have a heart attack, stroke, car accident, etc, that incapacitates me, I am simply incapable of shopping around for the best price. I am going to be taken in for emergency care and treated to the point of stabilization (or better, depending on whether I have a guardian who can approve more. Said guardian could theoretically shop around at this point but it is difficult given the potential emotionality involved and danger in moving someone who is critically injured) Increasing provider supply is certainly a huge part of fixing things, if it’s done correctly. If you merely lower standards you just increase supply with substandard practitioners that overall worsen outcomes
    - nradov 2y ago
      The vast majority of healthcare can be shopped for. Emergency care is only a few percent of total spending.
klipt 2y ago
The senate and house never had the votes for that. Obamacare was always a compromise between what the democrats wanted and what the centrists and republicans would allow.
ETH_start 2y ago
Socialized healthcare is also failing all around the world. Have you seen the situation in the UK recently? Or Canada? The cause of the malaise seems to be the same everywhere. See the biggest shift in the US healthcare system over the last 50 years for example: There was a 3,200 percent increase in the number of healthcare administrators between 1975 and 2010, compared to a 150% increase in physicians, due to an increasing number of regulations: https://www.athenahealth.com/knowledge-hub/practice-manageme https://www.athenahealth.com/knowledge-hub/practice-manageme... >Supporters say the growing number of administrators is needed to keep pace with the drastic changes in healthcare delivery during that timeframe, particularly change driven by technology and by ever-more-complex regulations. (To cite just a few industry-disrupting regulations, consider the Prospective Payment System of 1983 [1]; the Health Insurance Portability & Accountability Act of 1996 [2]; and the Health Information Technology for Economic and Clinical Act of 2009.) [3] In contrast, the fields of medicine in the US less affected by this surge in government intervention; cosmetic and laser eye surgery, have seen prices increase at below the rate of inflation. [4] [1] https://www.cms.gov/medicare/payment/prospective-payment-systems https://www.cms.gov/medicare/payment/prospective-payment-sys... [2] https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html https://www.hhs.gov/hipaa/for-professionals/privacy/laws-reg... [3] https://www.hhs.gov/hipaa/for-professionals/special-topics/hitech-act-enforcement-interim-final-rule/index.html https://www.hhs.gov/hipaa/for-professionals/special-topics/h... [4] https://healthblog.ncpathinktank.org/why-cant-the-m https://healthblog.ncpathinktank.org/why-cant-the-m
- atmavatar 2y ago
  A significant fraction of healthcare administrators are there to deal with insurers, both to negotiate pre-approval and then to get paid afterward. That's what happens when you have thousands of insurance companies, each negotiating their own individual prices for everything. On top of that, you have to deal with insurers that will deny pre-approvals for medically necessary treatments on first request as a matter of course, then deny the first claim afterwards despite acquiescing to the pre-approval. And finally, patients may have primary, secondary, tertiary, and even quaternary insurers to ensure they're fully covered, so you have to figure out which fraction of the procedure each will pay. Rather than doctors spending their entire days haggling with insurers, they've hired administrators to offload the work so they can get back to being doctors. Unfortunately, the byzantine structure which is privatized health insurance has only continued to grow in size and complexity, necessitating a growing number of administrators to handle the interface between the two.
downWidOutaFite 2y ago
The public option in 2009 would have helped, let the profit-skimmers compete with the government program and prove that they really can deliver better service while taking their 20-30% cut. But the "free market" captains of industry are liars, they say that they want competition but they don't, they want market manipulation and safe cozy profit margins. It's funny (not funny haha) how Democrats always seem to have a few undercover sabotagers in their ranks that get elected having lied to voters and then undermine Democrat's agenda, Lieberman, Manchin, Sinema, now Fetterman.
HDThoreaun 2y ago
We need to move to a capitated payment system. The current fee for service system incentivizes everyone to consume more than necessary. Doctors prescribe more because they get paid more, insurance gets a fixed percentage of revenue as profit so they want to spend more too. The systems has evolved into tons of make work bs because as the amount of money sloshing around grows so does profit for everyone. Capitated payment encourages everyone to save money as profit is just the left overs after everyone is treated. If you spend less than the provider next door without outcomes suffering you make more money, so innovation is encouraged and waste eliminated. Also fixes the "insurance denying coverage" issue as all prescription decisions are made by the provider.
wrp 2y ago
> national single payer Medicare/Medicaid for all. Barack Obama himself said in an interview that this option wouldn't be on the table, because it would kill millions of jobs. When there is great inefficiency in a system, remember that the "wasted" money is going to someone. Some voting districts in the eastern USA rely heavily on jobs in medical payment administration.
- emchammer 2y ago
  I don’t follow. What happens when they need care themselves? I read about layoffs in American auto manufacturers all the time. How does the value added by this paper-pushing bloc outweigh our collective health?

silisili 2y ago

I'm a pretty conservative person, and this is the one view I break with hardliners completely with - I agree completely. The funny thing is, most people you talk to on either side of the aisle are for it. The healthcare lobby is so large as to buy politicians to make it seem like a wedge issue, but even a ton of conservatives agree with single payer in principle. I'd wager if you put it to a national vote, it'd break something like 80-20 for.

chefandy 2y ago
I think the core ideas of the ACA with the public option was originally Gingrich, in response to Hillary Clinton’s much more aggressive proposal for single payer, right? And then before the federal ACA, “Romneycare” was implemented in Massachusetts (without a public option, but with preexisting condition protection and not allowing separate high risk pools) by Republican Governor Mitt Romney. I think the discourse ended up polarized because Obama presented it that it seemed really partisan but the person that killed the public option in a Herculean commitment to insurance company profiteering was none other than liberal centrist Senator Joe Lieberman. This is not a partisan issue. There are obviously going to be ideological pockets in the extremes but outside of that, for the most part, the only people that are stepping up to defend the insurance companies are in their goddamned pockets.
- silisili 2y ago
  You're right, but there are people on both sides who toe the party line blindly(and stupidly, if I might add). I'll never forget Trump being cornered, and him saying he's not going to let people die in the streets, and his audience booing. He claimed they were all donors and lobbyists taking the audience seats, and despite his typical theatrics, I now believe that to be the truth. Either way, today it is a leftist idea I think, so there will exist some people who oppose it out of spite. I don't know a single person happy with the system today, which is damning. Just look at the reaction from recent events...
  - chefandy 2y ago
    Fair enough. It is rather telling and should be extremely concerning to the insurance industry that in our extremely polarized political culture of late, this has been a the largest patch of common-ground many of us have stood on in a long time. Obviously not a total common ground issue, but I can’t think of anything bigger recently.
nojvek 2y ago
I disagree with Medicare for all and single payer. The role of govt is a catch 22 - it is by design a monopoly, and monopolies are usually inefficient, so too much govt power gets monopoly capture but too little means govt can’t break the monopolies. The largest issue with US healthcare is lack of price-quality transparency and competition. This means tons of middle player monopolies e.g PBMs. I can’t go shop around for a procedure on a marketplace and pay out of pocket, the same rates an insurer would. I can’t deal directly with service provider or the labs. It has to be intermediaries. The # of medical licenses are capped, they’re not growing in proportion to population. Demand-supply dynamics, the basis of capitalism is wildly inefficient in US. Get rid of employer given insurers, make a law that insurers cannot negotiate a lower price than out of pocket price. Every procedure price should be openly put on an easily searchable marketplace. Make it easy to start new practices, more doctors and nurses and hospitals. The prices will come down. Single payer is a bandaid fix. It does nothing to fix the supply problem.
- hellotheretoday 2y ago
  this argument comes up every time and it always ignores a critical aspect of medicine: not all procedures can be “shopped for”. If I have cancer and I need to start treatment as soon as possible I’m not going to waste precious time comparing rates of infusion centers, especially given that one may be able to take me in for treatments 2 weeks sooner. That two weeks could make all the difference If I have a heart attack, stroke, car accident, etc, that incapacitates me, I am simply incapable of shopping around for the best price. I am going to be taken in for emergency care and treated to the point of stabilization (or better, depending on whether I have a guardian who can approve more. Said guardian could theoretically shop around at this point but it is difficult given the potential emotionality involved and danger in moving someone who is critically injured) Increasing provider supply is certainly a huge part of fixing things, if it’s done correctly. If you merely lower standards you just increase supply with substandard practitioners that overall worsen outcomes
  - nradov 2y ago
    The vast majority of healthcare can be shopped for. Emergency care is only a few percent of total spending.

klipt 2y ago

The senate and house never had the votes for that. Obamacare was always a compromise between what the democrats wanted and what the centrists and republicans would allow.

ETH_start 2y ago

Socialized healthcare is also failing all around the world. Have you seen the situation in the UK recently? Or Canada? The cause of the malaise seems to be the same everywhere. See the biggest shift in the US healthcare system over the last 50 years for example: There was a 3,200 percent increase in the number of healthcare administrators between 1975 and 2010, compared to a 150% increase in physicians, due to an increasing number of regulations: https://www.athenahealth.com/knowledge-hub/practice-manageme https://www.athenahealth.com/knowledge-hub/practice-manageme... >Supporters say the growing number of administrators is needed to keep pace with the drastic changes in healthcare delivery during that timeframe, particularly change driven by technology and by ever-more-complex regulations. (To cite just a few industry-disrupting regulations, consider the Prospective Payment System of 1983 [1]; the Health Insurance Portability & Accountability Act of 1996 [2]; and the Health Information Technology for Economic and Clinical Act of 2009.) [3] In contrast, the fields of medicine in the US less affected by this surge in government intervention; cosmetic and laser eye surgery, have seen prices increase at below the rate of inflation. [4] [1] https://www.cms.gov/medicare/payment/prospective-payment-systems https://www.cms.gov/medicare/payment/prospective-payment-sys... [2] https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html https://www.hhs.gov/hipaa/for-professionals/privacy/laws-reg... [3] https://www.hhs.gov/hipaa/for-professionals/special-topics/hitech-act-enforcement-interim-final-rule/index.html https://www.hhs.gov/hipaa/for-professionals/special-topics/h... [4] https://healthblog.ncpathinktank.org/why-cant-the-m https://healthblog.ncpathinktank.org/why-cant-the-m

atmavatar 2y ago
A significant fraction of healthcare administrators are there to deal with insurers, both to negotiate pre-approval and then to get paid afterward. That's what happens when you have thousands of insurance companies, each negotiating their own individual prices for everything. On top of that, you have to deal with insurers that will deny pre-approvals for medically necessary treatments on first request as a matter of course, then deny the first claim afterwards despite acquiescing to the pre-approval. And finally, patients may have primary, secondary, tertiary, and even quaternary insurers to ensure they're fully covered, so you have to figure out which fraction of the procedure each will pay. Rather than doctors spending their entire days haggling with insurers, they've hired administrators to offload the work so they can get back to being doctors. Unfortunately, the byzantine structure which is privatized health insurance has only continued to grow in size and complexity, necessitating a growing number of administrators to handle the interface between the two.

downWidOutaFite 2y ago

The public option in 2009 would have helped, let the profit-skimmers compete with the government program and prove that they really can deliver better service while taking their 20-30% cut. But the "free market" captains of industry are liars, they say that they want competition but they don't, they want market manipulation and safe cozy profit margins. It's funny (not funny haha) how Democrats always seem to have a few undercover sabotagers in their ranks that get elected having lied to voters and then undermine Democrat's agenda, Lieberman, Manchin, Sinema, now Fetterman.

HDThoreaun 2y ago

We need to move to a capitated payment system. The current fee for service system incentivizes everyone to consume more than necessary. Doctors prescribe more because they get paid more, insurance gets a fixed percentage of revenue as profit so they want to spend more too. The systems has evolved into tons of make work bs because as the amount of money sloshing around grows so does profit for everyone. Capitated payment encourages everyone to save money as profit is just the left overs after everyone is treated. If you spend less than the provider next door without outcomes suffering you make more money, so innovation is encouraged and waste eliminated. Also fixes the "insurance denying coverage" issue as all prescription decisions are made by the provider.

wrp 2y ago

> national single payer Medicare/Medicaid for all. Barack Obama himself said in an interview that this option wouldn't be on the table, because it would kill millions of jobs. When there is great inefficiency in a system, remember that the "wasted" money is going to someone. Some voting districts in the eastern USA rely heavily on jobs in medical payment administration.

emchammer 2y ago
I don’t follow. What happens when they need care themselves? I read about layoffs in American auto manufacturers all the time. How does the value added by this paper-pushing bloc outweigh our collective health?