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-   -   Biden vs Bernie on healthcare (https://boards.straightdope.com/sdmb/showthread.php?t=891050)

Sterling Archer 03-03-2020 02:34 PM

Biden vs Bernie on healthcare
 
Biden says he supports a public Medicare option, plus increasing tax credits for those who choose it (or choose a plan on the gov exchange, I’d guess), and further expanding Medicaid so states can’t just turn it down and screw their people over. He has referred to it as ACA+ in the past, but that Medicare option is the big game changer. The insurance industry is gonna fight like hell to prevent that.

Bernie supports Medicare for all... or does he? I thought in the past he wanted full coverage single payer, which would go way beyond M4A and work more like the UK where you never see a bill at all.

My concern is: which plan actually has a chance to get through Congress?

Wesley Clark 03-03-2020 02:51 PM

There is about a 0% chance of Bernies plan getting through a democratic congress. They couldn't even pass single payer in Vermont where democrats and progressives control almost 80% of state legislature seats. If Vermont (one of the most liberal states in the nation) can't pass it, then there is no chance national congress would pass it.

Bidens plan may pass, but all the aspects that make wealthy corporations angry will be taken out.

A medicare buy in makes hospitals, pharma and insurance companies mad. So it will either be taken out, or the reimbursement rate will be hiked so much that it costs the same as private insurance.

Bernies plan has an actuarial value of 92% or something like that.

Here is Biden's plan.

https://joebiden.com/healthcare/

What will probably pass (assuming the democrats win congress) Is most of Bidens plan, minus all the things that make medical companies mad.

So a medicare buy in, buying Rx from overseas, making it easier for generic manufacturers to make drugs, antitrust efforts, medicare negotiation of prescription drugs, etc will all be taken out.

Sterling Archer 03-03-2020 02:55 PM

Well that’s depressing. That sounds like nothing would improve from the ACA, for most of us. I have hope that a public option could become reality but it’s going to take willingness to kick the insurance industry in the teeth.

Wesley Clark 03-03-2020 04:48 PM

Quote:

Originally Posted by Sterling Archer (Post 22170433)
Well that’s depressing. That sounds like nothing would improve from the ACA, for most of us. I have hope that a public option could become reality but it’s going to take willingness to kick the insurance industry in the teeth.

Some things will improve, but my guess/impression is best case scenario what will happen is this.

The subsidies in the ACA will increase. Instead of premiums maxing out at 10% of gross income they'll max out at 8%. Also subsidies will be tied to a gold plan (80% actuarial value) instead of a silver plan (70%). Plus they'll eliminate the 400% FPL cap on subsidies.

Biden may also pass some subsidies so people who get insurance through work pay lower deductibles.

And hopefully there will be some consumer protections regarding balance billing and out of network charges.

other than that, all the other reforms make rich people mad so the democrats aren't going to pass them. Same thing happened with the ACA, pretty much everything that made powerful corporations mad was taken out.

The 'problem' with a strong public option is that medicare costs less than private insurance. It has lower reimbursement rates and lower overhead costs. So private insurance can't compete with it. People won't pay $500/month for private insurance when medicare is $400 a month and a superior plan. But also hospitals and doctors don't want a public option since reimbursement rates are lower than private insurance.

If we do get a public option, they'll probably hike the reimbursement rates to 200% or so so that it costs the same as private insurance.

Sterling Archer 03-04-2020 11:16 AM

Maybe that’s the ticket to getting a public option. Build a little profit into it to pay for all the other healthcare improvements, and STILL undercut the private insurance plans’ costs.

The republicans should love that plan, it’s basically a regressive tax.

Boycott 03-04-2020 11:19 AM

Ask Joe Manchin which he prefers. The answer he gives is the plan we get.

DrDeth 03-04-2020 12:13 PM

Quote:

Originally Posted by Sterling Archer (Post 22170386)
Biden says he supports a public Medicare option, plus increasing tax credits for those who choose it (or choose a plan on the gov exchange, Iíd guess), and further expanding Medicaid so states canít just turn it down and screw their people over. He has referred to it as ACA+ in the past, but that Medicare option is the big game changer. The insurance industry is gonna fight like hell to prevent that.

Bernie supports Medicare for all... or does he? I thought in the past he wanted full coverage single payer, which would go way beyond M4A and work more like the UK where you never see a bill at all.

Bernie has NAMED his UHC socialized medicine plan "Medicare for all" altho is has nothing whatsoever to do with Medicare.


Bidens plan could pass. It's pretty minimal.

Bernies plan is the cadillac plan, and can't possibly get thru congress.

Hari Seldon 03-04-2020 02:00 PM

It looks like SCOTUS is about to scuttle ACA. But of course they will wait till after the election to do it. So all these discussions are irrelevant. Then it will be up to the individual states.

JohnT 03-04-2020 02:09 PM

Raise your hand if you didn't know, prior to reading this post, that Medicare has been administered from Day 1 by none other than Blue Cross Blue Shield.

Knowing that the nations largest private health insurer is also its largest public health insurer, can't we, you know, just put M4A in the hands of BCBS? It's already there anyway!

Sterling Archer 03-04-2020 03:05 PM

Biden vs Bernie on healthcare
 
Well now that puts us in a bit of a pickle. *sheepishly raises hand*

BCBS can’t continue to exist if M4A comes to fruition... so who is going to administer it? Can the govt buy part of BCBS? What a mess.

Sterling Archer 03-04-2020 03:09 PM

*BCBS that is

JohnT 03-04-2020 03:19 PM

Quote:

Originally Posted by Sterling Archer (Post 22172129)
Well now that puts us in a bit of a pickle. *sheepishly raises hand*

BCBS canít continue to exist if M4A comes to fruition... so who is going to administer it? Can the govt buy part of BCBS? What a mess.

The history of American governance has a lot of private-government partnerships, so we can literally have a for-profit public health care system. We already do.

JohnT 03-04-2020 03:53 PM

To correct the above, BCBS is a non-profit organization.

Which makes opposition to M4A even dumber, but there it is.

Translucent Daydream 03-04-2020 04:26 PM

Sounds like no matter what, we are fucked for insurance? Is that what I'm hearing?

I am in the middle of trying to negotiate a group plan for my small business. The marketplace average for my employees was 800 bucks a month, with some stupid ass high deductible that they could never afford to meet in addition to their monthly premium. The only group plans I seem to be able to get through our independent broker aren't taken by any of the medical providers here in the county.

I was hoping for better news. My wife is going to need surgery soon and we can't afford the costs of it. No surgery, no 15 year wedding anniversary doctors are saying. We are on year 9.

I have an employee right now in the ER. I shudder to think what her bill is going to be.

Wesley Clark 03-04-2020 08:00 PM

Quote:

Originally Posted by Translucent Daydream (Post 22172286)
Sounds like no matter what, we are fucked for insurance? Is that what I'm hearing?

We spend almost 20% of GDP on health care. That is way too much, but I seriously doubt no matter who wins that anything is done to actually lower costs.

We know how to lower costs. Take on the hospital and pharma trusts, promote international competition, all payer rate negotiations for private insurance, open medicare and medicaid up to the general public, etc.

But I don't think the democrats will do any of that.

Best case scenario, they pass some increased subsidies so people have public funds to buy their expensive insurance, and hopefully we get a few consumer protections. I doubt we get much more than that no matter who wins the white house.

septimus 03-05-2020 04:49 AM

Quote:

Originally Posted by Sterling Archer (Post 22170386)
Biden ... Bernie ...
My concern is: which plan actually has a chance to get through Congress?

I don't see a smiley-face, so maybe you're serious. But Wesley Clark Ninja'ed me:
Quote:

Originally Posted by Wesley Clark (Post 22170425)
There is about a 0% chance of Bernies plan getting through a democratic congress....

Bidens plan may pass, but all the aspects that make wealthy corporations angry will be taken out.

Democrats won't pass any legislation that Moscow Mitch disapproves of. They'd first need to kill the filibuster but that ain't happening.

It's inspiring to see Young America so infatuated with Bernie's left-wing visions!! But also discouraging to learn that their civics education isn't enough to realize that, even if he's elected, they would still be a pipe-dream.

I hope AOC and BS stick around and keep pushing the "Overton window" leftward. Maybe America will be ready for their visions in the 2030's.

Lord Feldon 03-05-2020 05:32 AM

Quote:

Originally Posted by DrDeth (Post 22171783)
Bidens plan could pass. It's pretty minimal.

Is it? It seems pretty big to me. He specifically wants a public option that's open to people whose employers have insurance plans, which would require either massive subsidies or a big payroll tax hike, to replace the employer portion of their premiums.

Lord Feldon 03-05-2020 05:47 AM

Not that any of the candidates' plans are going to pass as-is, even with a Democratic Senate, but I'm a little surprised that, given how much oxygen was wasted between Obama and Clinton in 2008, not one word has been said about the candidates (including the newly-reanointed frontrunner) whose plans include a revival of the very unpopular individual mandate.

Wesley Clark 03-05-2020 07:37 AM

Quote:

Originally Posted by DrDeth (Post 22171783)

Bidens plan could pass. It's pretty minimal.

.

If Biden passed his plan as it is, that would be a meaningful increase in the quality of the health insurance system.

But Bidens plan calls for
  • A strong public option
  • Using anti-trust legislation to take on pharma and hospital monopolies
  • Let medicare negotiate pharma prices
  • Limiting price increases of pharma to the rate of inflation
  • Letting people buy pharmaceuticals from overseas
  • Increasing the supply of generics

All good ideas, and all of which would reduce costs. But I don't see congress passing them because the medical industry would fight these reforms tooth and nail. The medical industry doesn't want transparency, competition or price controls.

Democrats wouldn't even pass these reforms in 2009 when they had 60 senators.

I thought Biden had a plan to limit deductibles to $1000, but I'm not seeing that part of his plan anywhere right now.

DrDeth 03-05-2020 01:06 PM

Quote:

Originally Posted by Lord Feldon (Post 22172932)
Is it? It seems pretty big to me. He specifically wants a public option that's open to people whose employers have insurance plans, which would require either massive subsidies or a big payroll tax hike, to replace the employer portion of their premiums.

Yes it's a big step, as opposed to a giant leap, as sanders plan. I shoudl have said "compared to sanders...."


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