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  #101  
Old 08-06-2019, 03:50 PM
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Wait, “doing the opposite” as in encouraging black folks to move into what for them could be an oppressive hellhole?
Fallacy of the excluded middle. Not gonna dignify it. Way off topic from OP, at any rate.

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  #102  
Old 08-11-2019, 09:25 AM
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Universal healthcare doesn't have to mean MFA. Germany (I think?), Switzerland (I think?) and some other northern European countries have achieved universal coverage using private insurers.

As far as I can tell, there are three ways to achieve universal coverage:

Government as provider (UK's National Health, US's VA hospital system)
Single Payer (Canada, Medicare)
Private health insurance, with mandates, coverage requirements, and subsidies (Obamacare if done right, some European countries)

They all have pluses and minuses, but if implemented properly, can all provide universal coverage with better outcomes for less money than our mess of a system.

Moving from private coverage mostly through employers to MFA would be a giant move and Sanders shouldn't require purity on that -- he and Biden can argue why their method is better without implying or saying outright that it's their way or the highway. I could see boosting Obamacare rules, while adding a public option (optional buy-in to Medicare, for example) and if people prefer that, they can go that way. If MFA really would be better, then more and more people could choose the public option and the final transition would be easier. However, if employers and unions continue to provide better coverage, as long as people are covered, it's better than we had a few years ago.
Good post. Getting to universal coverage doesn't require the abolition of private insurance. There are many ways to get to UC. But all ways to get to UC do require a government presence. There's no way to get to UC unless our government is willing to do the things that are known that can get us there.
  #103  
Old 08-11-2019, 10:05 AM
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Just to correct some misconceptions ...
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I was surprised in the debate last night how everyone was talking about MFA would "ban" private insurance. Maybe I haven't been paying attention but that can't possibly be part of the proposal, right? Other countries with single payer systems still have private insurance for those who want to pay extra for extra coverage, right?
That's not typically how it works, although sometimes private supplemental insurance does cover some (usually minor) items that aren't part of the public system. More typically, though, the co-existence of public and private insurance is in the form of a two-tier system where you're either in the public system or the private system on an all-or-nothing basis, one or the other. In most countries, as in Canada and the UK, the public system offers comprehensive coverage without co-pays and no limitations for all medically necessary procedures.
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Universal healthcare doesn't have to mean MFA. Germany (I think?), Switzerland (I think?) and some other northern European countries have achieved universal coverage using private insurers.
Switzerland, yes, and it's one of the reasons that their per-capita health care costs are among the highest in the world, though completely dwarfed by the astronomical costs in the US. Still, the Swiss system is universal, highly regulated, and subsidized when necessary.

But the German public system uses a network of tightly regulated "sickness funds" which are non-profit and community-rated, and all offer basically the same benefits, the net effect of which is that it operates much like single-payer, and the network of different payers is more historical happenstance than anything else. This system is completely distinct from the private insurance tier, which operates much like the commercial American system and is only available to those above a certain income threshold and is utilized by just a little over 10% of the population.
  #104  
Old 08-11-2019, 12:36 PM
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Which is still quite different from the 0% Warren and Sanders would allow. In the U.S., 11% is almost 40 million people.
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Old 08-11-2019, 01:02 PM
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Which is still quite different from the 0% Warren and Sanders would allow. In the U.S., 11% is almost 40 million people.
That's a totally bizarre and utterly distorted interpretation of the facts I just laid out. The 10% or so who choose to go with the private insurance tier do so voluntarily and basically because they can afford superficial amenities, like coverage for private rooms in hospitals that look more like hotels. But everyone is entitled to choose the public system which offers unconditional and unlimited coverage of all medically necessary procedures. Canada has seen no need for a private insurance tier at all.

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  #106  
Old 08-11-2019, 01:38 PM
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Yours is the “totally bizarre and utterly distorted interpretation”, at least insofar as I can even make out what you are saying at all. What you are describing in Germany sounds like the “Medicare for all who want it” approach that all the other top- and middle-tier candidates support, and which Warren and Sanders would not allow. What is “distorted” about that? Maybe you didn’t understand what I was saying?
  #107  
Old 08-11-2019, 03:11 PM
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Which is still quite different from the 0% Warren and Sanders would allow. In the U.S., 11% is almost 40 million people.
That's right. And 11% is much less than the US population share who have private insurance (over half the US is on private insurance). As best I can tell, Sanders would not allow private insurance at all. I haven't studied Warren's plan - if it's any different than Sanders.

So, it would be very disruptive to go to Sanders' version of M4A. Some other versions aren't as absolutist in getting rid of Private insurance, but still achieve UC.

See the link for a look at some countries and how they use different means to achieve UC. The Netherlands and Switzerland seem to use what I would call "doing Obamacare right" approach and they achieved UC, and seem happy with it. We could do the same in the US and get to UC via an "ACA done right" option:

https://www.commonwealthfund.org/blo...ight-countries
  #108  
Old 08-11-2019, 03:21 PM
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That's right. And 11% is much less than the US population share who have private insurance (over half the US is on private insurance). As best I can tell, Sanders would not allow private insurance at all. I haven't studied Warren's plan - if it's any different than Sanders.

She doesn’t have her own plan. She endorses Bernie’s. And she and Bernie were the only major candidates to raise their hands and say they would outlaw private health insurance.
  #109  
Old 08-11-2019, 04:37 PM
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She doesn’t have her own plan. She endorses Bernie’s. And she and Bernie were the only major candidates to raise their hands and say they would outlaw private health insurance.
OK thanks for the clarification. I didn't watch the debate.

Here's a report by the US Census Bureau that lays out a lot of stats on health coverage in the US. It says that 67% of Americans with health coverage has a type of private health insurance - either through their employer, their union, or purchased individually on-exchange or off-exchange.

https://www.census.gov/content/dam/C...mo/p60-264.pdf
  #110  
Old 08-11-2019, 04:51 PM
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At the place where I got my IVAPS machine, the woman in charge of billing pulled up my insurance and exclaimed “Wow, you have such a low deductible! I wish mine was this low.”
IVAPS. So you mean Internal Vapor Application Penumbra Slicer? Or maybe Index of Venal Ambulance Potash Succubi? Or is it something else? Don't keep us in suspense!

Do you think it's cute or hip to only offer initialisms? Like some teenaged Leetspeaker with her teenaged friends? Are you just lazy? Do you have no wish for people to understand what you're saying? You've done this several times already in this thread. Say what you mean. Don't try to make us look it up. Just fucking write it out. WTF? (That stands for Whiskey Tango Foxtrot).

Last edited by I Love Me, Vol. I; 08-11-2019 at 04:53 PM. Reason: You know... for kids!
  #111  
Old 08-11-2019, 05:04 PM
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I was just calling it the word the doctor used. It’s for a rare type of central sleep apnea produced in some patients by therapy with a less expensive BiPAP machine. This is the machine Blue Cross/Blue Shield bought for me after titration via my third sleep study (also expensive, also covered by BC/BS): https://helpmedicalsupplies.com/prod...caAmksEALw_wcB

Last edited by SlackerInc; 08-11-2019 at 05:07 PM.
  #112  
Old 08-11-2019, 05:10 PM
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I was just calling it the word the doctor used. It’s for a rare type of central sleep apnea produced in some patients by therapy with a less expensive BiPAP machine.
[Bolding mine]

Bilevel Positive Airway Pressure.

See how easy that was? Maybe someone can tail behind after every post of yours to write out what you seem unwilling to. Why are you unwilling? It's not like I'm suggesting you spell out what USA or SDMB means. Why not be reasonable and mature?

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  #113  
Old 08-11-2019, 05:36 PM
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Originally Posted by I Love Me, Vol. I View Post
IVAPS. So you mean Internal Vapor Application Penumbra Slicer? Or maybe Index of Venal Ambulance Potash Succubi? Or is it something else? Don't keep us in suspense!

Do you think it's cute or hip to only offer initialisms? Like some teenaged Leetspeaker with her teenaged friends? Are you just lazy? Do you have no wish for people to understand what you're saying? You've done this several times already in this thread. Say what you mean. Don't try to make us look it up. Just fucking write it out. WTF? (That stands for Whiskey Tango Foxtrot).
Quote:
Originally Posted by I Love Me, Vol. I View Post
[Bolding mine]

Bilevel Positive Airway Pressure.

See how easy that was? Maybe someone can tail behind after every post of yours to write out what you seem unwilling to. Why are you unwilling? It's not like I'm suggesting you spell out what USA or SDMB means. Why not be reasonable and mature?
Dial back the hostility. There is no rule against using acronyms. There is a rule against insults so if you feel you must, the Pit is right around the corner.

[/moderating]
  #114  
Old 08-11-2019, 05:38 PM
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Yours is the “totally bizarre and utterly distorted interpretation”, at least insofar as I can even make out what you are saying at all. What you are describing in Germany sounds like the “Medicare for all who want it” approach that all the other top- and middle-tier candidates support, and which Warren and Sanders would not allow. What is “distorted” about that? Maybe you didn’t understand what I was saying?
Your confusion is mystifying to me, as the health care options in Germany and most other countries are very easy to understand: everyone is entitled to health care, whether or not they can afford it. Period. In many countries, those with ample means can choose a private option, but to directly quote what I said earlier, "the 10% or so who choose to go with the private insurance tier do so voluntarily and basically because they can afford superficial amenities, like coverage for private rooms in hospitals that look more like hotels."

But, unlike US Medicare, the public option doesn't exhibit the ruthless savagery of limiting access to medically necessary care, such as throwing a patient out of hospital simply because a set number of days have expired and that's all they're going to pay for. I live in Canada and, like the citizens of most of the countries in the civilized world, I can just take it for granted that if I'm sick, I will get the health care I need, without conditions, co-pays, co-insurance, forms, certifications, or any other bullshit, regardless of what it costs. Maybe you didn't understand what I was saying? Maybe you don't understand how health care really works in the rest of the world?
  #115  
Old 08-11-2019, 05:52 PM
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It looks like you don’t understand what I am saying, or what the other Democratic candidates are saying. All of them advocate going to universal healthcare for everyone, as a human right. That does not mean banning private insurance.

I am truly mystified as to where you are getting this. Did you read the whole thread?

Last edited by SlackerInc; 08-11-2019 at 05:53 PM.
  #116  
Old 08-11-2019, 05:56 PM
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It looks like you don’t understand what I am saying, or what the other Democratic candidates are saying. All of them advocate going to universal healthcare for everyone, as a human right. That does not mean banning private insurance.

I am truly mystified as to where you are getting this. Did you read the whole thread?
Actually Sanders plan does effectively plan private Insurance. Altho he calls it medicare for all, it bears little relation to actual Medicare. It's simply pure socialized medicine. I think Warren likes the same plan.

Others want Medicare for all, which means of course lots of private insurance- Medicare Parts C &D, and of course some will want cadillac plans.
  #117  
Old 08-11-2019, 06:22 PM
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It looks like you don’t understand what I am saying, or what the other Democratic candidates are saying. All of them advocate going to universal healthcare for everyone, as a human right.
That's because health care **is** a human right, and therefore should be universal.
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That does not mean banning private insurance.
Correct, it obviously does not mean banning private insurance. Almost no country has done that. Canada has done so (for medically necessary coverage) for specific reasons having to do with the proximal influence of the US insurance lobby and the massively profitable private hospital industry, but most other countries continue to offer private insurance as an available tier for those people who want that option and can afford it. I never said otherwise. But if they don't choose that option, or can't afford it, they are still fully covered for all essential health care.
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I am truly mystified as to where you are getting this. Did you read the whole thread?
Getting what? I think your reading comprehension is seriously deficient here. Go back and carefully read my factual statements. If there's something you still don't understand or find mystifying, please be specific about exactly what it is so I can explain it.
  #118  
Old 08-11-2019, 07:16 PM
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That's because health care **is** a human right, and therefore should be universal.
According to whom? And what if others disagree?
  #119  
Old 08-11-2019, 07:39 PM
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According to whom? And what if others disagree?
Ayn Rand.
  #120  
Old 08-11-2019, 07:42 PM
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Getting what? I think your reading comprehension is seriously deficient here.
Let's not cast aspersions about others' reading comprehension.

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  #121  
Old 08-11-2019, 08:08 PM
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Okay, since it’s my thread I will try to calmly untangle this in the face of what seems like unprovoked hostility.


You started by saying:


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Originally Posted by wolfpup View Post
Just to correct some misconceptions ...

Presumably this means you think the people you quoted below that have misconceptions. The second quote was the following:


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Originally Posted by RitterSport View Post
Universal healthcare doesn't have to mean MFA. Germany (I think?), Switzerland (I think?) and some other northern European countries have achieved universal coverage using private insurers.

To which you responded:


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Originally Posted by wolfpup View Post
Switzerland, yes, and it's one of the reasons that their per-capita health care costs are among the highest in the world, though completely dwarfed by the astronomical costs in the US. Still, the Swiss system is universal, highly regulated, and subsidized when necessary.

But the German public system uses a network of tightly regulated "sickness funds" which are non-profit and community-rated, and all offer basically the same benefits, the net effect of which is that it operates much like single-payer, and the network of different payers is more historical happenstance than anything else. This system is completely distinct from the private insurance tier, which operates much like the commercial American system and is only available to those above a certain income threshold and is utilized by just a little over 10% of the population.

What “misconception” did you clear up? You added some interesting details and context, but I don’t see the misconception.


Then I responded to the “little over 10% of the population” part with:


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Which is still quite different from the 0% Warren and Sanders would allow. In the U.S., 11% is almost 40 million people.

This is just math, based on current estimates of the US population, combined with the fact that Warren and Sanders have clearly stated that they would not allow private health insurance at all.


You responded to this very straightforward extrapolation with:


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Originally Posted by wolfpup View Post
That's a totally bizarre and utterly distorted interpretation of the facts I just laid out. The 10% or so who choose to go with the private insurance tier do so voluntarily and basically because they can afford superficial amenities, like coverage for private rooms in hospitals that look more like hotels. But everyone is entitled to choose the public system which offers unconditional and unlimited coverage of all medically necessary procedures. Canada has seen no need for a private insurance tier at all.

What’s “totally bizarre and utterly distorted” about it? What was the point of saying “everyone is entitled to choose the public system which offers unconditional and unlimited coverage of all medically necessary procedures”? This would also be true for all the other major candidates like Biden and Buttigieg, who would offer a public plan for anyone who wants or needs one, but also allow people to stay on their private health plan if they prefer.


The only way any of your combative posts make sense is if you think that RitterSport and I are arguing that healthcare is not a right and that there shouldn’t be universal coverage, that people should either not get treatment or go bankrupt from the cost of their treatments. But we haven’t said that, and have pretty directly said otherwise. Sooo...wot’s the deal?

Last edited by SlackerInc; 08-11-2019 at 08:09 PM.
  #122  
Old 08-11-2019, 08:25 PM
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That's because health care **is** a human right, and therefore should be universal.
According to whom? And what if others disagree?
Others are entitled to disagree, and to let themselves be governed accordingly. To paraphrase Joseph de Maistre, in a democracy people get the government -- and the society -- they deserve.

It's a pretty ruthless law of nature, actually, because social systems have no more forgiveness for the consequences of ignorance and bad policy than the physical laws of nature. If you choose to pay far more for health care than other nations while being content to get far less for it, while some of your fellow citizens die from lack of it altogether, then that's a choice you collectively made and that's the fundamental quality of the society you have to live in.
  #123  
Old 08-11-2019, 08:30 PM
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So I take it you have now concluded that your beef was not with RitterSport and me after all?
  #124  
Old 08-11-2019, 09:25 PM
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So I take it you have now concluded that your beef was not with RitterSport and me after all?
No, I've been looking at the board intermittently and didn't see your post #121 with its various strange circumlocutions the last time I posted. And I still have no idea what you're on about, but I'll respond to the best of my ability to follow your strange line of argument. To wit:

Quote:
What “misconception” did you clear up? You added some interesting details and context, but I don’t see the misconception.
I cleared up the misconception that "Medicare for all" necessitates the banning of private insurance, and the additional misconception that private insurance is used to "pay extra for extra coverage". In most systems, private insurance is a different form of coverage altogether when it comes to medically necessary health care, not an "add-on", though it is that for sure in US Medicare. But that's not how most systems work, which provide all medically necessary health care regardless of ability to pay and without conditions or limits, making "add-on" coverage redundant for medically necessary procedures. Instead of being "combative" -- to use your term -- you should strive to understand how other systems actually work, like that one that I've lived with all my life.

Quote:
Then I responded to the “little over 10% of the population” part with: ... This is just math, based on current estimates of the US population, combined with the fact that Warren and Sanders have clearly stated that they would not allow private health insurance at all ... You responded to this very straightforward extrapolation with: ... What’s “totally bizarre and utterly distorted” about it? What was the point of saying “everyone is entitled to choose the public system which offers unconditional and unlimited coverage of all medically necessary procedures”?
I still have absolutely no idea what the relevance of some percentage of the population choosing private vs. public health insurance is. The main point is that everyone gets health care, and those who can afford it get better amenities (more luxurious accommodations, better food). Your "little over 10% of the population" comment seemed to imply that 10% of the population would be left without health care benefits or something. Whether it's 5%, or 10%, or 50% who choose that option is irrelevant. Who cares? They're just the ones willing to fork out their own money to get more luxurious amenities and, possibly -- for non-critical elective procedures -- quicker access. That situation already exists in the US, in a rather extreme and horrifying example of mercenary medicine.
  #125  
Old 08-11-2019, 09:49 PM
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I cleared up the misconception that "Medicare for all" necessitates the banning of private insurance

There was no such misconception in the posts you quoted. In fact, if anyone in this entire thread has had that misconception, I don’t recall it. However, Bernie’s single payer plan does in fact ban private health insurance, and Elizabeth Warren raised her hand to say she also supports eliminating private health insurance. (So did Kamala Harris, but she later walked it back.)

Other Democrats running do not want to ban private health insurance, but they do want to fill in the gaps so that everyone is covered. In polls, Americans favor that more moderate patchwork approach to achieve universal coverage, but do not support the banning of private health insurance that Warren and Sanders are advocating.


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Instead of being “combative” —to use your term — you should strive to understand how other systems actually work, like that one that I've lived with all my life.

I have been studying this issue since I was in college and the “Hillarycare” proposal crashed and burned. Additionally, my sister became a naturalized Canadian citizen in the ‘90s, and so did my mother a few years ago.


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I still have absolutely no idea what the relevance of some percentage of the population choosing private vs. public health insurance is.

The relevance is that Warren and Sanders want to ban Americans from having that option, which clearly works perfectly well in Germany.



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Originally Posted by wolfpup View Post
The main point is that everyone gets health care, and those who can afford it get better amenities (more luxurious accommodations, better food). Your "little over 10% of the population" comment seemed to imply that 10% of the population would be left without health care benefits or something. Whether it's 5%, or 10%, or 50% who choose that option is irrelevant. Who cares? They're just the ones willing to fork out their own money to get more luxurious amenities and, possibly -- for non-critical elective procedures -- quicker access.

The whole point of this thread is that it is crucial politically to have a system like that where people who are more well off can have precisely those advantages. Warren and Sanders do not want to allow anyone to have that option. I’m repeating myself, but it really seems like you aren’t aware of the distinction between their proposal and what other Democrats are advocating.
  #126  
Old 08-12-2019, 09:06 AM
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And as I know both anecdotally (because my mother and sister are Canadian) and from reading on the subject, Canada has lengthy delays that would cause riots if they happened here.
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Meanwhile I have been consuming lots of long-deferred medical care in the past two years after a couple decades of being either uninsured or underinsured. Blue Cross/Blue Shield has taken great care of me.
As they say on Sesame Street, "One of these things is not like the other".

You're saying that there would be riots in the US if there were wait lists like in Canada (eg - some months to get an MRI), and yet Americans put up with no health care for decades because they aren't insured or uninsured.

Why weren't you rioting in the streets when you were denied health care for decades?
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  #127  
Old 08-12-2019, 09:46 AM
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Reduced and non-service are OK if they happen to other people, and you can rationalize it by finding a way to say they just aren't as deserving as you. You only protest when it starts to happen to you too. Medical care is just one example.
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Old 08-12-2019, 12:42 PM
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If 2nd place Bernie starts taking the lead over Biden I bet the Medical industry and Big Pharma will be out rioting in the streets. Or more like throwing tons of money around to advertise against Bernie. No more billions in profits for them if M4A becomes law.
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  #129  
Old 08-12-2019, 02:56 PM
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If 2nd place Bernie starts taking the lead over Biden I bet the Medical industry and Big Pharma will be out rioting in the streets. Or more like throwing tons of money around to advertise against Bernie. No more billions in profits for them if M4A becomes law.
If the government is footing the bill, I am sure that medical costs will become much lower.
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  #130  
Old 08-13-2019, 06:28 PM
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Reduced and non-service are OK if they happen to other people, and you can rationalize it by finding a way to say they just aren't as deserving as you. You only protest when it starts to happen to you too. Medical care is just one example.

Did you even read the post you seem to be responding to, right above yours?


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As they say on Sesame Street, "One of these things is not like the other".

You're saying that there would be riots in the US if there were wait lists like in Canada (eg - some months to get an MRI), and yet Americans put up with no health care for decades because they aren't insured or uninsured.

Why weren't you rioting in the streets when you were denied health care for decades?

Because I was not a privileged, affluent swing voter with good insurance who had that suddenly changed by politicians. I was working hard to support Democrats, though, and I was bitterly disappointed when Obamacare did not cover me.

And it’s not just about waiting for MRIs. My sister has twice had to wait months for surgery on her knee and foot that meant she had to use crutches in the interim. It was only non-critical in the sense that she would not die while waiting.

The wound care red tape my mother ran into OTOH could have killed her since she is a diabetic.
  #131  
Old 08-13-2019, 06:51 PM
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And it’s not just about waiting for MRIs. My sister has twice had to wait months for surgery on her knee and foot that meant she had to use crutches in the interim. It was only non-critical in the sense that she would not die while waiting.
I'm one of the guys with good health care paid for by my employer and me.
The surgeon to do my hip replacement planned to go on vacation with a friend, and I had to wait a month. His friend died (I wonder what health insurance he had) and the surgeon sat around the house or played golf while I walked on crutches and waited for a month.

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Old 08-14-2019, 08:39 PM
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Other Democrats running do not want to ban private health insurance, but they do want to fill in the gaps so that everyone is covered. In polls, Americans favor that more moderate patchwork approach to achieve universal coverage, but do not support the banning of private health insurance that Warren and Sanders are advocating.
That's right. When polled about private coverage ceasing, people don't like it so much.

Let's keep in mind that most Americans like their health care (about 80%), and their insurance (about 70%).

https://news.gallup.com/poll/245195/...ositively.aspx

People tend to like their own situation pretty good, even if they think the overall US situation is bad. And honestly, most people know their own situation better than they know the macro-situation...kind of like I know my own car better than I know the entire auto industry. And in my own experience, I like my healthcare and my insurance. I have private insurance through my employer, and it's worked well for me and my family (including some family members with serious chronic conditions). I'd hate to lose it.

Anyway, in the face of most polling, whatever Democrat gets nominated, I hope they keep Private Insurance around. If they try and get rid of it, I think they'll lose a lot of support in the general election. We can get to UC without throwing out private insurance.
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Old 08-15-2019, 05:56 AM
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That poll is very instructive about the danger. I showed it to several friends, including some who are generally pragmatic and not on the left edge of the party, and they were genuinely surprised by those results. They really believed that almost everyone hated their health insurance company.

In a weird way, I see the greatest threat to people’s health care being what might happen within a decade if Warren wins fairly comfortably thanks to massive disgust with Trump, and perhaps a burgeoning recession.

She claims a mandate, gets this law passed, and consumers get kicked off their private insurance while millions of people who now work in the health insurance industry suddenly find themselves out of jobs. Actually, not just them but benefit advisors at workplaces, clerical staff at hospitals and doctors offices who sort out insurance claims, etc. A great improvement in economic efficiency to be sure, but also a massive economic and social shock to the system. Who’s to say other jobs get created for them right away, as opposed to this being the jumpstart of the automation economy Yang warns of (which I started a thousand-post thread about back in 2012), with fewer net jobs available?

So we get a huge Republican backlash wave election sometime in the 2020s, and they repeal MFA. But wait: Medicaid and Obamacare were already repealed when that law was put into place. Oops. So now we go back to the 1950s? Maybe Republicans put something barebones back into play for the very poorest, but it won’t be much, especially for adults in their 30s/40s/50s..

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  #134  
Old 08-15-2019, 09:13 AM
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That poll is very instructive about the danger. I showed it to several friends, including some who are generally pragmatic and not on the left edge of the party, and they were genuinely surprised by those results. They really believed that almost everyone hated their health insurance company.



She claims a mandate, gets this law passed, and consumers get kicked off their private insurance while millions of people who now work in the health insurance industry suddenly find themselves out of jobs. Actually, not just them but benefit advisors at workplaces, clerical staff at hospitals and doctors offices who sort out insurance claims, etc. A great improvement in economic efficiency to be sure, but also a massive economic and social shock to the system.
I don't hate my insurance plan, I hate the amount of money the insurance and medical companies make.

I would hate to keep wasting this huge amount of money to keep clerks employed. A concept I've not heard mentioned is providing employment when an industry fires most of their employees, like coal mining. Such a plan should include any large number of workers for any industry. With health care, the loss of jobs will be expected. It would be much easier to move medical insurance workers to life, real estate or automotive insurance than retrain coal miners.
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Old 08-15-2019, 02:15 PM
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So we get a huge Republican backlash wave election sometime in the 2020s, and they repeal MFA. But wait: Medicaid and Obamacare were already repealed when that law was put into place. Oops. So now we go back to the 1950s? Maybe Republicans put something barebones back into play for the very poorest, but it won’t be much, especially for adults in their 30s/40s/50s..
That's one talking point in support of not going to a one-size-fits-all health coverage approach. If we do M4A, and there are no other choices, then a group of angry Republicans could wreck the whole system. Currently, they can only take potshots at smaller parts, and not the whole thing.
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Old 08-15-2019, 03:55 PM
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So we get a huge Republican backlash wave election sometime in the 2020s, and they repeal MFA. But wait: Medicaid and Obamacare were already repealed when that law was put into place. Oops. So now we go back to the 1950s? Maybe Republicans put something barebones back into play for the very poorest, but it won’t be much, especially for adults in their 30s/40s/50s..
Close parallell to removing the ACA, which hasn't happened for pretty much the same reasons. For the Republicans to take away the system without having a very clear and immediately available alternative would be flat out ballot box suicide. Think No Deal Brexit, but with no third party to try to shuffle the blame to.

Putting some input into the debate from a Norwegian's perspective; private insurance here is more about queue skipping, convenience and being able to second guess your doctor than anything else. (Frequently as banal as getting a doctor / office who grovel a bit / "are better at customer service".) Sometimes it might also get you access to - or at least the ability to purchase - prohibitively expensive or experimental drugs for rare diseases.

It doesn't really hurt the faith in the core system and I doubt it's going anywhere, but I can see the temptation for Sanders to kill it completely. Whatever remains after his reform has been amended to death in order to pass, will be what the Republicans will be trying to use to resuscitate its' corpse. Bigger remains = bigger wedge.

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Old 08-15-2019, 11:34 PM
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When Warren and Sanders want to suddenly zoom right past Norway, it’s clear we have a problem. All the elements you described of what role private insurance plays in Norway are precisely what we need to preserve in our country to avoid political catastrophe.

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With health care, the loss of jobs will be expected. It would be much easier to move medical insurance workers to life, real estate or automotive insurance than retrain coal miners.

And the people already working in those fields?


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That's one talking point in support of not going to a one-size-fits-all health coverage approach. If we do M4A, and there are no other choices, then a group of angry Republicans could wreck the whole system. Currently, they can only take potshots at smaller parts, and not the whole thing.

Exactly.
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Old 08-18-2019, 09:18 AM
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I don't hate my insurance plan, I hate the amount of money the insurance and medical companies make.

I would hate to keep wasting this huge amount of money to keep clerks employed. A concept I've not heard mentioned is providing employment when an industry fires most of their employees, like coal mining. Such a plan should include any large number of workers for any industry. With health care, the loss of jobs will be expected. It would be much easier to move medical insurance workers to life, real estate or automotive insurance than retrain coal miners.
OK, well keep in mind that the health insurance industry employs half a million people.

https://www.statista.com/statistics/...us-since-1960/

That's an awful lot of good jobs that potentially go out the door when we do M4A with no private insurance option. Now, I know some of them will find employment elsewhere. And government will absorb some of those jobs with more jobs needed for Medicare. But that's a big displacement, and some families will not adjust and will be hurt. Also, things like VA, TriCare, and Medicaid will also come to an end under the Sanders M4A. These represent additional jobs lost within the government & with private contractors. States governments lose employment as well, as they no longer have a role in regulating health insurance.

To avoid this displacement, I'm thinking that staying with the ACA and enhancing the subsidies, as well as beefing up the regs around insurers is a better option. As has been discussed earlier in this thread, we can get to full UC without getting rid of private insurance. Many countries have done that very thing, and are happy with their systems.
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Old 08-18-2019, 10:52 AM
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OK, well keep in mind that the health insurance industry employs half a million people.
... and not a single one of them actually provides health care, many of them actively work to block access to it by limiting or denying claims, and every single one of them adds to its cost. There may be valid arguments in favor of a private health insurance tier but that sure isn't one of them.
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Old 08-18-2019, 11:29 AM
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That's an awful lot of good jobs that potentially go out the door when we do M4A with no private insurance option.
I don't see why. The number of people covered would not go down, and every one of them would continue to need insurance workers to handle that coverage.
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Old 08-18-2019, 12:49 PM
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I apologize for not reading this whole thread (the sniping gets tiresome) so maybe this has already been discussed, but how does the promise to eliminate private insurance square with fact that over a third (and rapidly growing) of Medicare coverage is now Medicare Advantage, run by private insurance companies?

Medicare is currently increasingly subbed out to private companies. Would Medicare for All reverse the push to the Advantage products? (Which I understand have done a good job with increasing population health quality at lower costs. https://www.hlc.org/news/harvard-res...are-advantage/)
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Old 08-18-2019, 01:13 PM
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Let me get all "Bill Clinton-y": it depends what the meaning of "premium" is.



In the two provinces that charge "premiums" (Ontario and BC), they are means-tested. Only individuals who have incomes over a certain amount are required to pay the "premiums". And, everyone gets access to the same health care, whether they pay "premiums" or not. Heck, even if you're required to pay "premiums" but you fail to pay your taxes, you get the exact same coverage.

Contrast that with the private insurers in the States: if someone applies for coverage to a private insurer and says "I don't have the money to pay the premiums but you're required by law to give me coverage," would the insurance company give them coverage?

Or, if you're someone who has a private plan, and then you just stop paying premiums, will the insurance company keep you enrolled?

The government health plans in Canada use the language of insurance for reasons I don't understand, but it's not really an insurance plan. It's a public service, just like roads and public schools and police, and the "premiums" are just a fancy name for an income-progressive tax.
Correct. In Ontario the "premium" is collected as a tax and is deposited into the provinces general revenue fund along with all other provincial income taxes. It is not deposited into any specific fund, and there are no restrictions at all as to how it must or even should be spent. It could be spent on medically treating a person, or building a hospital, or paying a clerk to issue drivers' licences in the Ministry of Transportation, or to buy a police car.

In other words, it was a way of explaining a small increase in general income tax, but calling it a health premium made it a lot more palatable to the public.

And to preempt the naysayers, remember that when compared to Americans, Canadians live longer, live healthier for longer, pay less through their taxes for health care, and pay less out of their personal pockets for health care.
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Old 08-18-2019, 01:44 PM
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As far as medications outside the hospital go, in Ontario you are covered if you are 24 or under, or 65 or over, of if you spend more that 4% your net after-tax income. That 's a pretty sweet deal. Private insurance is also available for medications.
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Old 08-18-2019, 01:56 PM
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Sorry, I was not clear. That 4% qualifier to get into the plan is your deductible for the plan. After that, you pay the first $2 per prescription and the rest is covered.
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Old 08-18-2019, 04:08 PM
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I apologize for not reading this whole thread (the sniping gets tiresome) so maybe this has already been discussed, but how does the promise to eliminate private insurance square with fact that over a third (and rapidly growing) of Medicare coverage is now Medicare Advantage, run by private insurance companies?

Medicare is currently increasingly subbed out to private companies. Would Medicare for All reverse the push to the Advantage products? (Which I understand have done a good job with increasing population health quality at lower costs. https://www.hlc.org/news/harvard-res...are-advantage/)
The distinction between traditional Medicare and Medicare Advantage is part of the hugely complex quagmire that is US health care and is far from being as simple as the way you've presented it, but maybe I can provide -- to the best of my understanding -- a few insights into why this is not an argument for private insurance vs. direct public single-payer.

Traditional Medicare is so far removed from true comprehensive single-payer in terms of its limitations and inadequacies that it's not surprising that there can be better models, but that says nothing about the effectiveness of MfA in which those barriers are removed and you have a universal single-payer system like in Canada and many other countries in which no private insurers are involved. Secondly, MA is less a system "run by private insurance companies" than a government funded and regulated system that provides managed health care on a capitation basis rather than fee-for-service. Moreover, many of the plan providers, called sponsors, are various forms of non-profits and by no means necessarily traditional insurance companies. And to the extent that capitation can offer benefits over traditional fee-for-service, such models can be and have been developed within single-payer systems -- I know that we have them right here in Ontario within public single-payer where no private insurance is allowed for medically necessary services.

I would also note in passing that I have my suspicions about the impartiality of the Healthcare Leadership Council as it's largely made up of the CEOs of health insurers, pharma companies, medical manufacturers, and for-profit hospitals, and their objective is really the complete privatization of Medicare. My skepticism is also triggered by statements like that US health care is "already the best in the world" -- very far from true according to objective rankings like that of the OECD -- or that the key to making it better is "consumer choice and competition" -- a traditional mantra of free-market conservatives. And as I keep saying, no, when it comes to health care plans, consumers don't need "choice" -- they simply need a plan that will pay for all the essential health care they need, fully and unconditionally. The citizens of other advanced countries get this as a basic human right; Americans never have.
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Old 08-18-2019, 04:51 PM
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I don't see why. The number of people covered would not go down, and every one of them would continue to need insurance workers to handle that coverage.
No. 90% of those "insurance workers" wouldn't be needed in a single-payer system.

What does a health insurance company do? It needs a vast army of executives and their minions to creatively design a plethora of different insurance "plans" that will appear attractive to the public while generating maximum profit. It needs an army of actuaries to analyze risk factors and price the plans for every single individual. It needs an army of marketeers to flog these plans to the public. It needs any army of executives to set up and negotiate provider "networks". It needs an army of claims adjusters to scrutinize every claim with a view to reducing it or denying it. And on the other side of the fence, health care providers have to employ an army of accounting clerks to fight with the claims adjusters through the echelons of their bureaucratic hierarchy.

Not a single one of those functions exists in a single-payer system, which, as someone already noted, is not really "insurance" at all but, at its core, simply a tax-funded public service that pays for all essential health care.
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Old 08-18-2019, 07:36 PM
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The distinction between traditional Medicare and Medicare Advantage is part of the hugely complex quagmire that is US health care and is far from being as simple as the way you've presented it, but maybe I can provide -- to the best of my understanding -- a few insights into why this is not an argument for private insurance vs. direct public single-payer.

Traditional Medicare is so far removed from true comprehensive single-payer in terms of its limitations and inadequacies that it's not surprising that there can be better models, but that says nothing about the effectiveness of MfA ... <snip>
An interesting post but not one that has to do with the post it is supposed to be responding to. To be very clear: I was making no argument or any comment about the effectiveness of MfA.

It was an honest question. Medicare currently utilizes the private industry to no small degree. To what degree will a switch from private to Medicare coverage be a switch from one form of private to another by way of Medicare?
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Old 08-18-2019, 08:21 PM
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My apologies if I gave the impression I was arguing with you. I was really trying to respond to the proposition that Medical Advantage is "run by private insurance companies". That phrase gives a somewhat inaccurate impression as it's really run by so-called "sponsors" under contract to the federal CMS and operate according to their rules; many of those sponsors are insurance companies or their spin-off organizations but many are not. You can appreciate that this is a completely different situation than, say, the feds giving you some cash for buying an individual insurance plan for yourself on the open market, where the insurers really would dictate the terms of service.

Your restated question, "To what degree will a switch from private to Medicare coverage be a switch from one form of private to another by way of Medicare?" seems like a different question. I have no idea of the answer to that one, but frankly the MfA proposals at this point are so very, very far from any kind of realistic implementation that what finally emerges will likely be totally unrecognizable from the current political rhetoric, as usually happens with this stuff. The solid facts that I'm trying to bring to bear on the subject are about how health care actually works, as actually implemented, in other countries, and the general picture is that it either involves single-payer or a multi-payer system that is so tightly regulated that it's indistinguishable, and free-market private insurance is usually just a small component of the total health care system in terms of participation.

I'm sure that, regardless of political rhetoric, the US will eventually end up with such a two-tier public/private system. This has nothing to do with the capitation system of payment, which is the defining characteristic of Medicare Advantage, and to which both public and private systems are amenable. For example, here are the alternative payment methods to traditional fee-for-service in Ontario, which as about as pure a single-payer system as you'll find anywhere, and where the Family Health Network (FHN) and Family Health Organization (FHO) models are primarily capitation-based models.
  #149  
Old 08-18-2019, 09:01 PM
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I don't see why. The number of people covered would not go down, and every one of them would continue to need insurance workers to handle that coverage.
Wolfpup has already addressed this point, but I'll chime in: one of the areas where US health costs are way more than in other countries is the administrative cost. Single payer eliminates much of the administration costs, nameky the salaries of all those administrators.

A simple example is claims procedure. As I understand it, each US insurer has its own coding system for each procedure, and its own claims interface. That means doctors need to have staff to enter all those claims, each day, using different systems. It may all be computerised, but the multiplicity of systems means more people are needed.

That's not the case in single payer. There's one set of codes within the province, and one interface. That reduces the administrative cost, because your staff just needs to be proficient in one billing system.

And there's no need for pre-approvals, and no need to have someone to fight with the insurance company when they disallow the claim. That eliminates more administrative layers.
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  #150  
Old 08-18-2019, 09:01 PM
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No. 90% of those "insurance workers" wouldn't be needed in a single-payer system.

What does a health insurance company do? It needs a vast army of executives and their minions to creatively design a plethora of different insurance "plans" that will appear attractive to the public while generating maximum profit. It needs an army of actuaries to analyze risk factors and price the plans for every single individual. It needs an army of marketeers to flog these plans to the public. It needs any army of executives to set up and negotiate provider "networks". It needs an army of claims adjusters to scrutinize every claim with a view to reducing it or denying it. And on the other side of the fence, health care providers have to employ an army of accounting clerks to fight with the claims adjusters through the echelons of their bureaucratic hierarchy.

Not a single one of those functions exists in a single-payer system, which, as someone already noted, is not really "insurance" at all but, at its core, simply a tax-funded public service that pays for all essential health care.
I'll have to take your word for it. I don't know how the typical insurance company is organized. Just seemed to me that most of their workaday activity was enrolling new members and processing claims, both of which would still need to be done under single-payer.
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