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  #51  
Old 09-17-2019, 12:24 PM
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Originally Posted by bump View Post
FYI, just to put some numbers down, 91.2% of people as of 2017 had health insurance.

So we're talking about 8% of people, which might be valid for certain values of "quite a few" or "lots".
Just in case there are people who look at that, and say, "8% isn't that many":
- It means that 28 million Americans have no health insurance at all
- It means that more than one out of every twelve Americans has no health insurance at all
  #52  
Old 09-17-2019, 03:30 PM
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Originally Posted by kenobi 65 View Post
Just in case there are people who look at that, and say, "8% isn't that many":
- It means that 28 million Americans have no health insurance at all
- It means that more than one out of every twelve Americans has no health insurance at all
So what? That doesn't mean they don't have access to health care. They might lack that access, or they might not.

What infuriated me about the Democrats and the ACA was, they said, effectively, "Oh no, people don't have health insurance! Maybe if we have a monetary penalty for not having health insurance, that will inspire more people to have insurance!" And sure enough, it worked.

Now if they had said that every American was going to be charged 10% of their income, and that this money was going to fund health care for everyone, that might have worked. Maybe not; there's still the problem that people in rural areas are definitely underserved when it comes to health care, and those people might balk at paying the same amount to cover everybody when they themselves are 40 miles from the nearest ER and are not going to get the same level of care. So they would vote against it. And they did.
  #53  
Old 09-17-2019, 05:12 PM
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Originally Posted by KidCharlemagne View Post
The optics (not the reality) of this issue, reparations, and decriminalizing illegal immigration are going to put Trump in office for another 4, possibly 8 years. I can't believe my fellow progressives don't see that.
There is no way in hell Trump can get EIGHT more years without breaking the constitution... in which case we've got more problems than just health insurance coverage.
  #54  
Old 09-17-2019, 05:37 PM
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Originally Posted by Kent Clark View Post
I'm on Medicare, and I'm 10x more satisfied with it than any private insurance I ever had.

Or you could ask my daughter, who couldn't even get health insurance before Obamacare.

Or my daughter-in-law, who couldn't afford health insurance before expanded Medicaid.
Indeed. I live in a country with single-payer health care, and any politician who even hinted at undermining it would be utterly destroyed in an election. Americans who think their private health insurance is doing a good job for them simply have no understanding of the alternative, which as implemented in other countries is actually far more generous and less onerous than even Medicare in the US. I've also had private insurance for dental coverage, and it closely followed the American model for general health care: usually paid by the employer, out-of-pocket co-pays for everything -- sometimes substantial amounts, limits on payouts, annoying paperwork, denials and arguments, etc. I shudder to think of my critically important general health care being managed in such a mercenary manner. It's astounding that the OP thinks that any private company could provide better coverage than a universal public program that simply pays for all necessary health care services.

That said, I think that promising to abolish private health insurance is bad politics because of all the existing misconceptions out there, like those of the OP. Private health insurance should just be reduced by attrition over time from lack of demand, as it has in other countries.
  #55  
Old 09-17-2019, 05:46 PM
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Originally Posted by kenobi 65 View Post
Just in case there are people who look at that, and say, "8% isn't that many":
- It means that 28 million Americans have no health insurance at all
- It means that more than one out of every twelve Americans has no health insurance at all
Quote:
Originally Posted by Hilarity N. Suze View Post
So what? That doesn't mean they don't have access to health care. They might lack that access, or they might not.
Having been without health coverage a couple times in my life let me clarify something for you.

The ONLY treatment you are guaranteed access to in the US is the ER. Which MUST treat you IF your life is in danger. If your life is not in immediate danger they don't have to do jack for you. (Many still try to help you, but they don't have to do that.) And by "imminent" I mean "you're going to die right now is something isn't done". Have cancer? Hope you have insurance because if you don't you're fucked. NO ONE has to treat you. Go to the ER? Well, you're not dying right now so too bad. No insurance and you don't get chemo, you don't radiation, you don't get surgery, you don't get rehab, you don't get jack. You might not even get painkillers.

If you don't have health insurance by and large you don't have access. There is a thread on this forum from a decade and change back about the utter bullshit I had to go through to get a fucking tetanus shot when I had no insurance. I was denied access even when I could prove I could afford to pay. As in, as soon as I said I had no insurance and was paying out of pocket the office drone would hang up the phone. It was an exhausting marathon of weeks to get a fucking tetanus booster, eventually requiring me to cross state lines to get it.

Is that clear enough for you? If you don't have insurance you are a non-entity.

We have diabetics dying in this country because they can't get insulin.

Please, stop deluding yourself. Those 8% of Americans don't have healthcare coverage. That's 20+ million people.

Waiting lists? If you don't have insurance you don't even get onto the list. Your wait is forever.
  #56  
Old 09-17-2019, 05:53 PM
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Originally Posted by Linden Arden View Post
Your argument is "You should not get to choose FedEx because the US Post Office is all you really need"

I should get to choose what is best for my family.
No, you should get to choose the health care you want and need for yourself and your family, and the hospitals and practitioners who provide it, without any limitations on who you may choose. The government's only role here is to unconditionally pay for it. That's exactly how single payer works, and it's exactly NOT how private insurance works. None of the stipulations in that first sentence are true for private insurance. Single payer is what brings you real choice where it matters.
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Originally Posted by Linden Arden View Post
I know that if everyone is on Medicaid then Medicaid will suffer more than it already does.
How do you know that? Where I live every citizen has what is in effect a version of Medicaid, and it works just fine.
  #57  
Old 09-17-2019, 06:34 PM
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Originally Posted by Hilarity N. Suze View Post
What infuriated me about the Democrats and the ACA was, they said, effectively, "Oh no, people don't have health insurance! Maybe if we have a monetary penalty for not having health insurance, that will inspire more people to have insurance!" And sure enough, it worked.

Now if they had said that every American was going to be charged 10% of their income, and that this money was going to fund health care for everyone, that might have worked. Maybe not; there's still the problem that people in rural areas are definitely underserved when it comes to health care, and those people might balk at paying the same amount to cover everybody when they themselves are 40 miles from the nearest ER and are not going to get the same level of care. So they would vote against it. And they did.
The issue with healthcare is that there is a significant group of people who have long-term expenses that they simply would not be able to pay for themselves, and will never be profitable for an insurance company. Insurance is supposed to be about pooling risk, but healthcare costs are so long-term that it essentially amounts to pooling certainty. I have no idea if I'm more likely to total my car than anyone else with my car insurance, but I know I'm hundreds of times less likely to have to pay for expensive chemo in two months than someone who is in the middle of a multi-year chemo regimen. If I don't either take it as an article of faith that I need to pay because it's just part of living in our society to pay for their chemo, or get some sort of coercion to do it, I'm not going to do it, because it saves me money.

Since the ACA tax was eliminated we're now living in a world where the insurance companies can't discriminate based on preexisting conditions, but there will always be a large marginal group that loses money on average by buying non-discriminatory health insurance.

Unfortunately, this means that actually trying to make a rational justification for any universal healthcare proposal forces politicians to actually admit that they need to either force or incentivize you into paying for someone else's care. I think Sanders/Warren have essentially taken the strategy of shouting their slogans (at varying volumes) in the hope that single-payer will become the norm and people will just like life better on the other side and not want to go back, rather than actually make the case which forces them to admit that they have to take freedom from people in order to make it work.

Last edited by str8cashhomie; 09-17-2019 at 06:34 PM.
  #58  
Old 09-17-2019, 06:39 PM
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Originally Posted by Hilarity N. Suze View Post
So what? That doesn't mean they don't have access to health care. They might lack that access, or they might not.

What infuriated me about the Democrats and the ACA was, they said, effectively, "Oh no, people don't have health insurance! Maybe if we have a monetary penalty for not having health insurance, that will inspire more people to have insurance!" And sure enough, it worked.

Now if they had said that every American was going to be charged 10% of their income, and that this money was going to fund health care for everyone, that might have worked. Maybe not; there's still the problem that people in rural areas are definitely underserved when it comes to health care, and those people might balk at paying the same amount to cover everybody when they themselves are 40 miles from the nearest ER and are not going to get the same level of care. So they would vote against it. And they did.
The irony is that the ACA did more to provide better access to health care for rural areas through the Medicaid expansion (Healthcare Dive), among other things, than anything else. What most people don't appreciate is that rural access to health care has been a growing problem for a very long time. The problem predates the ACA.

___

I am very heartened to see how aware people are of the true state of American health care as evidenced by the responses in this thread. Folks are much more aware than they were pre-ACA. Wonderfully encouraging!

It was obvious that the OP was not reading my responses in even a cursory fashion, since s/he didn't acknowledge that I clearly stated I support Biden's approach to add a public option to the existing ACA (that s/he claims to support) and strengthen its weaknesses through full participation via Medicaid expansion.

TruCelt, one of my sidelines is to send out COBRA Election Notices to employees who have terminated employment with their companies. The notices feel like a cruel joke to advise them of the premium amounts they must now bear in order to continue their coverage. For an average family, $3,200/month is not an unusual amount. For people out of work.

galen ubal, my late husband was Australian/Kiwi. He suffered the same culture shock at the American health care system as you did. Ours is an embarrassment when compared to many systems abroad.

survinga, I remember reading something long ago that outlined Singapore's research into how best to set up a national health care system. Someone asked the relevant official if the American system was under consideration, and he replied it was. As an example of how not to do it.

Buck Gudot, I agree with your post #15, there is zero chance that Medicare for all will become a reality irrespective of who is in the White House come 2021. And if Warren does not temper her commitment to an instant conversion, she will lose either the primary if we're lucky or the general election if we're not. We can make a fair guess where the health industry oligarchs will throw their financial weight given a choice between Warren, who scares all oligarchs, and Biden, who doesn't. Better the devil you know and all that.

Like it or not, this is the system we currently have, and making a successful common sense argument is often entirely different from making a successful political argument. Medicare for all suffers for being a common sense argument.
  #59  
Old 09-17-2019, 06:51 PM
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Originally Posted by Broomstick View Post
Having been without health coverage a couple times in my life let me clarify something for you.
Thank you, Broomstick. I hadn't been able to get back to the thread to reply to Hilarity N. Suze (because, ironically enough, I was busy with work for one of my clients, a health insurance company), but your reply was far more articulate and relevant than mine would have been.
  #60  
Old 09-17-2019, 06:51 PM
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We also need to remember that the candidates may have their plans but no plan survives contact with the enemy and progress, in this country, has some very, very determined enemies. Any plan offered by any of these candidates is likely to be signed by any other of them should it pass the House and Senate. Anti-Buttigiegcare ads, anybody?

But seriously, politics in this country is like the weirdest kind of baseball game where you have to swing for the fences simply to get on base. A good thing to remember when talking about MFA or O'Rourke's gun proposals.
  #61  
Old 09-17-2019, 07:12 PM
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I'm afraid that a lot of voters feel the same way the OP does and pushing universal health care or medicare for all will bring us four more years of Trump. I know it will.

Regardless if it's a better approach, people do not like the government taking over something that works OK for most people. That scares them, and this fear will be massively inflamed by the republicans during the general election. It WILL be enough to sway the election.
  #62  
Old 09-17-2019, 07:19 PM
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Originally Posted by Hilarity N. Suze View Post
the costs of health care have gone up because of insurance. Not medical professionals, not medical equipment companies, and certainly not illegal immigrants. Insurance companies.
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Originally Posted by kirkrapine View Post
Per capita health care costs are twice in the USA what they are in Canada -- and the only reason for that is that we still have a private health-insurance industry, which Canada has long since socialized/marginalized. That extra cost is going entirely to the insurance-company execs and shareholders.
This is a hijack of the thread, but I'd like to call out the above as the bullshit that it is. Medical costs have gone up because the medical establishment charges a shit-ton of money. Insurance companies aren't wonderful, but they're not driving up the costs solely. I recently went to see a specialist for a 5-minute appointment and they billed insurance $3000, with $500 out of my pocket, and insurance paid up the rest. I once was billed $3400 for a four mile ambulance ride, and the insurance company protected me (yes and themselves) by refusing to pay such a crazy sum. The medical establishment gets rich by bilking insurance, with the costs passed to us. Nobody is a hero here, but insurance companies aren't the only villain.

If health costs are to go down, it's not only insurance companies that need to feel some pain. Specialists, GPs and the whole industry will need to make less off of all of us to bring down costs, period. This is what's different in UHC countries.

Last edited by squeegee; 09-17-2019 at 07:21 PM.
  #63  
Old 09-17-2019, 09:16 PM
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Originally Posted by squeegee View Post
This is a hijack of the thread, but I'd like to call out the above as the bullshit that it is. Medical costs have gone up because the medical establishment charges a shit-ton of money. Insurance companies aren't wonderful, but they're not driving up the costs solely. I recently went to see a specialist for a 5-minute appointment and they billed insurance $3000, with $500 out of my pocket, and insurance paid up the rest. I once was billed $3400 for a four mile ambulance ride, and the insurance company protected me (yes and themselves) by refusing to pay such a crazy sum. The medical establishment gets rich by bilking insurance, with the costs passed to us. Nobody is a hero here, but insurance companies aren't the only villain.

If health costs are to go down, it's not only insurance companies that need to feel some pain. Specialists, GPs and the whole industry will need to make less off of all of us to bring down costs, period. This is what's different in UHC countries.
You need to educate yourself about health care economics because most of this is quite wrong. The last paragraph isn't entirely wrong but the logic leading up to it is.

There are two main reasons health care in the US costs so much more than anywhere else in the world. One is that each and every individual claim is adjudicated by an insurance company. When you consider the amount of paperwork and administration required to do this, not just in terms of insurance company staff but in every doctor's office and every clinic and hospital and imaging center and medical lab in the country, it's an enormous administrative burden that has to be paid for. This simply does not happen in public UHC because it isn't really insurance in the normal sense of the word, but operates more like a public service whose job is to pay for health care services. But with private insurance, each patient is in effect paying an enormous premium for the "privilege" of having insurance bureaucrats coming between him and his doctor, scrutinizing every claim, in some cases questioning the doctor's advice, and seeking to reduce or deny every claim. It may be medically counterproductive and barbaric, but it still costs money.

The second reason health care in the US costs so much is that there are virtually no controls over the amount of health care billings, because there's no one to control them. Insurance companies don't care much because they just pass the costs on to their captive customers, and indeed insurance companies benefit from high costs because in effect their take is a percentage. The simple way to say this is that doctors and hospitals charge enormous amounts both because to some extent they have to, as in the previous paragraph, and because they can, since there's no one to stop them. There is also absolutely zero transparency in the process, with crazy variations in fees for the same procedure from the same practitioner, and crazy variations across different parts of the country.
  #64  
Old 09-17-2019, 10:04 PM
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Originally Posted by wolfpup View Post
You need to educate yourself about health care economics because most of this is quite wrong.
I've had cancer surgery, thankyouverymuch, and my employer HDHP is a constant source of education.

Look, I'm not defending insurance companies, I'm scoffing at the notion that they are entirely the whole problem, as asserted in those posts. The medical establishment itself is complicit at best in the cost of medical services and especially prescription costs.

I'm sure you've heard of surprise balance billing, or facility fees. These are scams against the consumer, not perpetuated by insurance but by the medical establishment.

Hell, did Martin Shkreli make coin selling health insurance? He did it by gaming pharmacy prices, something that happens on less-ridiculous scales daily. By the medical establishment, not insurance companies.

Again, no heroes here, but arguing this is solely an insurance problem is nuts. It is systemic.

Last edited by squeegee; 09-17-2019 at 10:05 PM.
  #65  
Old 09-17-2019, 10:43 PM
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Regardless if it's a better approach, people do not like the government taking over something that works OK for most people.
I think the effective and accurate message would be to emphasize how much it doesn't "work OK" for most people when they actually need it. Drawing people's attention to headlines like "Cancer forces 42% of patients to exhaust life savings in 2 years, study finds" would help them realize how not-OK that's working.

Most Americans know that healthcare expenses for any serious condition can easily turn anyone into a pauper. Bankruptcy for medical bills, spending a lifetime's worth of accumulated assets in order to qualify for Medicaid, stress of recovery exacerbated by massive debt: Americans are frightened of these prospects, and with good reason.

Remind them of how much they really have to be scared of in the inadequacy of their health "insurance" plan---even a plan that they think "works OK"---and they'll be less focused on nebulous fears of their plan being "taken away" in favor of one that does a better job of really protecting them.
  #66  
Old 09-17-2019, 10:43 PM
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Again, no heroes here, but arguing this is solely an insurance problem is nuts. It is systemic.
Yes, the problem is systemic, but insurance companies are the proximate cause of the systemic ills. That should be the takeaway from what I described: that the health care system is structured the way it is because it has to be in order for private businesses to provide health care coverage as a business under the insurance model, which, as I have frequently said, is fundamentally the wrong model for health care so it's broken right from the get-go. The big cost drivers simply do not exist in public UHC systems. When I receive health care services under single payer, my financial responsibility begins and ends when I present my health card. That's the end of it. There are no forms, no claims processing in the conventional insurance sense, no arguments, no denials, no chasing after insurance companies for payment, and from my POV there are no claims at all and no money is exchanged. The doctor or institution just needs to know what account number to bill, and is assured of full payment. It's absurdly simple.

To be sure, the US health care system is large and very complex and many specific causes for high costs can be identified, but ultimately they can all be broadly categorized in the manner I described: the high administrative costs of processing claims (and, from the medical provider's point of view, high costs of collecting payments and of non-payments), and the absence of any meaningful cost controls -- all ultimately ascribable to the way private insurance has to operate.

I don't have the time or patience to re-litigate this whole issue again and, as you say, it's rather a hijack from the main topic anyway.
  #67  
Old 09-17-2019, 10:45 PM
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Look, I'm not defending insurance companies, I'm scoffing at the notion that they are entirely the whole problem, as asserted in those posts. The medical establishment itself is complicit at best in the cost of medical services and especially prescription costs.
That's exactly what wolfpup says in the very post you replied to:
Quote:
The second reason health care in the US costs so much is that there are virtually no controls over the amount of health care billings, because there's no one to control them. Insurance companies don't care much because they just pass the costs on to their captive customers, and indeed insurance companies benefit from high costs because in effect their take is a percentage. The simple way to say this is that doctors and hospitals charge enormous amounts both because to some extent they have to, as in the previous paragraph, and because they can, since there's no one to stop them.
  #68  
Old 09-17-2019, 10:51 PM
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That's exactly what wolfpup says in the very post you replied to:
OK, fair enough. wolfpup, sorry if I was haranguing you.

Last edited by squeegee; 09-17-2019 at 10:54 PM.
  #69  
Old 09-18-2019, 02:43 AM
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I'm on Medicare, and I'm 10x more satisfied with it than any private insurance I ever had.
Do you also have a Medicare supplement? Otherwise I dont see how it's better than most private insurance plans. Which also kind of segues into my broader question...

Namely, why is the word "Medicare" used is all these UHC proposals? I have Medicare myself, and while I'm satisfied with it, it only covers 80% of my health care costs, that remaining 20% is left to me to pay for out of pocket. Clearly, when the term "Medicare For All" is used, it's not referring to any health care system which leaves the individual needing to pay 20% of their health care costs out of pocket. So what gives? "Medicare" is the term being used when Universal Health Care is what is being discussed. Why?

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Originally Posted by Aspenglow View Post
I think Pete Buttegieg is correct when he said at the debate on Thursday that people will figure it out for themselves if we simply add a public option. It will cost less and provide better access to care.

Medicare for all would fulfill that better and faster than a gradual transition. However, because many people don't understand this, I support the gradual transition -- so you can think you're choosing what's best for your family.
You seem conflicted about us muricans j/k

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Originally Posted by Linden Arden View Post
It is this smug attitude (that individuals don't know what is best for them
Walk into any Walmart and there are myriad examples that support the idea that people dont always know what is best for them. It's not even necessarily a criticism of those people. Sometimes it can be truly difficult to figure out just what *is* the best choice to make and which ones are best avoided.

The predatory low-cost "insurance" plans that Chronos detailed in his excellent post upthread are a perfect example. I can understand how a person in the right life circumstances might rationally determine that a very low cost health plan, but one that *did* still cover some basics, would be the perfect fit. And, if what they bought actually *was* what they believed it was, they most likely would have indeed made the best selection for themselves. But thats the problem, for many of these people, what they thought they were getting was a cheap, no frills health care policy. What they *got* was a big fat nuttin. Denied, rejected, unapproved, whatever. They bought garbage.

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Originally Posted by Grrr! View Post
Just one anecdotal data point.

I know TWO liberal friends who have expressed the same feelings as the OP.


People are scared of the public health care.

Let others be the guinea pig and if they do alright maybe the rest will come around.
You think *we* would be the guinea pig?? Well, if so, we'd be the *last* guinea pig to join the rodentfest.

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Originally Posted by Kimstu View Post
No, it's this smug attitude (namely, your attitude that a knowledgeable experienced professional explaining what the average layperson doesn't know about a complicated subject is just being "smug", and should be threatened with electoral failure instead of being listened to) that is making the Dems' job a whole lot harder than it needs to be.

Our health insurance system can definitely be improved, but not if we refuse to acknowledge that there's a lot that most of us don't understand about it, and that our lack of understanding can be exploited for profit by those running the system.
Kimstu, as superior at communicating than me as normal.

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Originally Posted by Budget Player Cadet View Post
You deserve better, and if it's smug of me to say so, I'm very sorry, but I'll be Smuggy McSmuggerson when it comes to this issue, because in aggregate, you, and the people who think like you, are just simply wrong.
It would seem to me just flat out telling people they are wrong and feeling no compunction with being smug about the issue, would be counterproductive to reaching your ostensible goals of seeing UHC become a reality here (yes i know you dont live in U.S. but you obviously have an interest in its state of affairs).



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Originally Posted by Chronos View Post
Before the ACA, the vast majority of Americans didn't even have health insurance at all. They thought they did, and they paid significant amounts of money to companies that claimed they were insurance companies, but if anything ever happened to make them unprofitable, the "insurance" companies would drop them instantly without paying out a dime. If you've got a plan that will drop you the moment they have to pay out, then what you had was never actually an insurance plan; it's a Mafia-style protection racket that was somehow legal. But most people didn't realize it, because they hadn't yet gotten to that point, and so they thought they were satisfied with insurance they didn't even have.
This. Perfectly stated.

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Originally Posted by squeegee View Post
This is a hijack of the thread, but I'd like to call out the above as the bullshit that it is. Medical costs have gone up because the medical establishment charges a shit-ton of money. Insurance companies aren't wonderful, but they're not driving up the costs solely. I recently went to see a specialist for a 5-minute appointment and they billed insurance $3000, with $500 out of my pocket, and insurance paid up the rest. I once was billed $3400 for a four mile ambulance ride, and the insurance company protected me (yes and themselves) by refusing to pay such a crazy sum. The medical establishment gets rich by bilking insurance, with the costs passed to us. Nobody is a hero here, but insurance companies aren't the only villain.

If health costs are to go down, it's not only insurance companies that need to feel some pain. Specialists, GPs and the whole industry will need to make less off of all of us to bring down costs, period. This is what's different in UHC countries.
I was all primed and ready to respond until i read wolfpup say just what i was going to say, only in a way infinitely more erudite and eloquent than what i would have offered up. I agree with his bottom line tho, *insurance companies* are the reason why medical establishments charge exorbitant prices. Those aren't prices charged to the patient (well, they aren't set up to be anyway and typically arent), they are prices charged to a large corporate entity that feels absolutely no pain or suffering, pretty much no matter what they are charged. They just spread those costs out across the millions of their customers in the form of higher premiums. But since the cost is so diffuse among such a large number of premium payers, the "hit" felt by the consumer doesnt stand out as anything other than the reality of what having insurance means.

For example, i have a cushion that i sit on when in my wheelchair. I have an extremely skinny butt and legs, so its a cushion specifically intended to prevent pressure sores (I'd never get a typical pressure sore but thats a different thread). The *cushion* alone, not including the casing it is housed in, "costs" $650. For a motherfucking cushion. I should be getting top of the line Shiatsu ass massages every time i sit down for that kind of value. The casing for the damn thing is another $100!

But *I* dont pay for it. My insurance gets billed. They dont give a flying fuck. Heck, it probably behooves them in some way to pay more for things worth much less. It opens the floodgates for gouging the consumer in small, repetitious, untraceable to its source (these overinflated bills of others) ways.

So thanks all you nameless, inadvertent Good Samaritans. You dont know it, but your private insurance helped pay for my ass being comfy when i sit all day errday in my wheelchair. And don't get me started on my useless standing chair that "cost" $13,000. Thats a lot of money for anyone, insurance company or not, to pay for yet another thing for me to accumulate random crap on. And once again, wolfpup says it so much better.

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Originally Posted by wolfpup View Post
You need to educate yourself about health care economics because most of this is quite wrong. The last paragraph isn't entirely wrong but the logic leading up to it is.

There are two main reasons health care in the US costs so much more than anywhere else in the world. One is that each and every individual claim is adjudicated by an insurance company. When you consider the amount of paperwork and administration required to do this, not just in terms of insurance company staff but in every doctor's office and every clinic and hospital and imaging center and medical lab in the country, it's an enormous administrative burden that has to be paid for. This simply does not happen in public UHC because it isn't really insurance in the normal sense of the word, but operates more like a public service whose job is to pay for health care services. But with private insurance, each patient is in effect paying an enormous premium for the "privilege" of having insurance bureaucrats coming between him and his doctor, scrutinizing every claim, in some cases questioning the doctor's advice, and seeking to reduce or deny every claim. It may be medically counterproductive and barbaric, but it still costs money.

The second reason health care in the US costs so much is that there are virtually no controls over the amount of health care billings, because there's no one to control them. Insurance companies don't care much because they just pass the costs on to their captive customers, and indeed insurance companies benefit from high costs because in effect their take is a percentage. The simple way to say this is that doctors and hospitals charge enormous amounts both because to some extent they have to, as in the previous paragraph, and because they can, since there's no one to stop them. There is also absolutely zero transparency in the process, with crazy variations in fees for the same procedure from the same practitioner, and crazy variations across different parts of the country.
I would guess that a bigger percentage of the expense of our system is attributable to reason #2. But that's a guess based mostly on personal anecdote.
  #70  
Old 09-18-2019, 03:01 AM
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To answer your original question directly ("Are there?"), yes there are ways to get UHC without outlawing private insurance.
I agree that there are ways to get UHC with private insurance, and that many countries have perfectly serviceable systems with private options.

I question whether there are ways to get UHC while keeping private insurance as it works today, where the vast majority is unilaterally assigned (or removed) by one's boss and paid for with otherwise-worthless company scrip. Any real UHC system with private options would seem to require a conversion of that scrip to cash. But if you do that that, you're "taking away" half the country's insurance because employers will just remove themselves from the picture entirely, which is a perfectly good thing but it would be extremely disruptive, and the disruption is what will cause the controversy.

Last edited by Lord Feldon; 09-18-2019 at 03:06 AM.
  #71  
Old 09-18-2019, 03:15 AM
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Regardless if it's a better approach, people do not like the government taking over something that works OK for most people. That scares them, and this fear will be massively inflamed by the republicans during the general election. It WILL be enough to sway the election.
I really, really feel like I'm beating my head against a wall.

Health care coverage in the US does NOT "work OK for most people". It's terrible. The actual care is fine - once you access it. What you have to go through to GET it should be criminal.

It "works OK" because most people are healthy. Some might need something long term for high blood pressure or high cholesterol or mild anxiety, but those are cheap to treat and if you have to skip the meds for a week or three due to loss of job/changing medical plan/whatever it's not going to kill you.

But as all too many people find out, if you have something MAJOR you are screwed. US health insurance is inadequate for cancer, large burns, major trauma... as someone else pointed out, Go Fund Me is full of people with insurance financially broken by out-of-pocket costs. If you're too sick to work you lose your access to the system.

That is NOT "working OK". That is horribly cruel, stupid, and broken.

Let me illustrate how US health "coverage" has nothing to do with helping people, and hasn't for decades.

In the late 1990's I went to work for a Very Large Health Insurance Company in their long term disability administration area. LTD is an area health insurance companies don't really like, because it involves paying out money every month for as long as someone lives. Some genius, with an idea the bean-counters loved because the aim was to reduce the caseload and costs, decided to make continuing to receive LTD long-term contingent on all of these people having "90 day plans" for rehabilitation and a road map for how they were all going to get well, go back to work, and no longer cost the VLHIC money.

One letter from a physician stands out in my memory. It was about a blind woman. The doctor was pretty furious, because the VLHIC demanded to know the 90 day plan for restoring her sight and getting her back to work. The doc was pissed because, as he pointed out her eyes had been removed for medical reason. She no longer had eyes. At all. And therefore it was IMPOSSIBLE to restore her sight by any means, the question was stupid and ridiculous, and even cruel. Yet there was paperwork in place to end this woman's disability check due to failure to comply with a plan for rehabilitation. Which was impossible. It wound up in court, which I'm sure cost the VLHIC more than continuing to issue the woman's disability checks without the stupid drama.

Because it's NOT about helping people. It's about making money. The health insurance companies only make money when they're "covering" healthy people. If you're sick they'll look for any possible way to drop you, or to avoid paying because that's how they stay in business.

All of you people who think you have "good" coverage, who "like" your current plan - you're fooling yourselves. You have SHIT coverage compared to most of the rest of the world. We really, really do have terribly ACCESS to the good healthcare that exists in this country. The only reason you don't know that is because you've never had a big health crisis/injury.

No, the average American DOES NOT "know what's best" in this situation. The average American has been lied to for decades, misled, propagandized, and told black is white. And the average American will never know until it's too late.
  #72  
Old 09-18-2019, 03:45 AM
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I really, really feel like I'm beating my head against a wall.

Health care coverage in the US does NOT "work OK for most people". It's terrible. The actual care is fine - once you access it. What you have to go through to GET it should be criminal.

It "works OK" because most people are healthy. Some might need something long term for high blood pressure or high cholesterol or mild anxiety, but those are cheap to treat and if you have to skip the meds for a week or three due to loss of job/changing medical plan/whatever it's not going to kill you.

But as all too many people find out, if you have something MAJOR you are screwed. US health insurance is inadequate for cancer, large burns, major trauma... as someone else pointed out, Go Fund Me is full of people with insurance financially broken by out-of-pocket costs. If you're too sick to work you lose your access to the system.

That is NOT "working OK". That is horribly cruel, stupid, and broken.

Let me illustrate how US health "coverage" has nothing to do with helping people, and hasn't for decades.

In the late 1990's I went to work for a Very Large Health Insurance Company in their long term disability administration area. LTD is an area health insurance companies don't really like, because it involves paying out money every month for as long as someone lives. Some genius, with an idea the bean-counters loved because the aim was to reduce the caseload and costs, decided to make continuing to receive LTD long-term contingent on all of these people having "90 day plans" for rehabilitation and a road map for how they were all going to get well, go back to work, and no longer cost the VLHIC money.

One letter from a physician stands out in my memory. It was about a blind woman. The doctor was pretty furious, because the VLHIC demanded to know the 90 day plan for restoring her sight and getting her back to work. The doc was pissed because, as he pointed out her eyes had been removed for medical reason. She no longer had eyes. At all. And therefore it was IMPOSSIBLE to restore her sight by any means, the question was stupid and ridiculous, and even cruel. Yet there was paperwork in place to end this woman's disability check due to failure to comply with a plan for rehabilitation. Which was impossible. It wound up in court, which I'm sure cost the VLHIC more than continuing to issue the woman's disability checks without the stupid drama.

Because it's NOT about helping people. It's about making money. The health insurance companies only make money when they're "covering" healthy people. If you're sick they'll look for any possible way to drop you, or to avoid paying because that's how they stay in business.

All of you people who think you have "good" coverage, who "like" your current plan - you're fooling yourselves. You have SHIT coverage compared to most of the rest of the world. We really, really do have terribly ACCESS to the good healthcare that exists in this country. The only reason you don't know that is because you've never had a big health crisis/injury.

No, the average American DOES NOT "know what's best" in this situation. The average American has been lied to for decades, misled, propagandized, and told black is white. And the average American will never know until it's too late.
Jesus fuck-mothering christ. That's obscene. Thanks for sharing, and I cannot cosign that last paragraph hard enough. American health care is a disgraceful joke.
  #73  
Old 09-18-2019, 05:20 AM
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I really, really feel like I'm beating my head against a wall.

Health care coverage in the US does NOT "work OK for most people". It's terrible. The actual care is fine - once you access it. What you have to go through to GET it should be criminal.

It "works OK" because most people are healthy. Some might need something long term for high blood pressure or high cholesterol or mild anxiety, but those are cheap to treat and if you have to skip the meds for a week or three due to loss of job/changing medical plan/whatever it's not going to kill you.

But as all too many people find out, if you have something MAJOR you are screwed. US health insurance is inadequate for cancer, large burns, major trauma... as someone else pointed out, Go Fund Me is full of people with insurance financially broken by out-of-pocket costs. If you're too sick to work you lose your access to the system.

That is NOT "working OK". That is horribly cruel, stupid, and broken.

Let me illustrate how US health "coverage" has nothing to do with helping people, and hasn't for decades.

In the late 1990's I went to work for a Very Large Health Insurance Company in their long term disability administration area. LTD is an area health insurance companies don't really like, because it involves paying out money every month for as long as someone lives. Some genius, with an idea the bean-counters loved because the aim was to reduce the caseload and costs, decided to make continuing to receive LTD long-term contingent on all of these people having "90 day plans" for rehabilitation and a road map for how they were all going to get well, go back to work, and no longer cost the VLHIC money.

One letter from a physician stands out in my memory. It was about a blind woman. The doctor was pretty furious, because the VLHIC demanded to know the 90 day plan for restoring her sight and getting her back to work. The doc was pissed because, as he pointed out her eyes had been removed for medical reason. She no longer had eyes. At all. And therefore it was IMPOSSIBLE to restore her sight by any means, the question was stupid and ridiculous, and even cruel. Yet there was paperwork in place to end this woman's disability check due to failure to comply with a plan for rehabilitation. Which was impossible. It wound up in court, which I'm sure cost the VLHIC more than continuing to issue the woman's disability checks without the stupid drama.

Because it's NOT about helping people. It's about making money. The health insurance companies only make money when they're "covering" healthy people. If you're sick they'll look for any possible way to drop you, or to avoid paying because that's how they stay in business.

All of you people who think you have "good" coverage, who "like" your current plan - you're fooling yourselves. You have SHIT coverage compared to most of the rest of the world. We really, really do have terribly ACCESS to the good healthcare that exists in this country. The only reason you don't know that is because you've never had a big health crisis/injury.

No, the average American DOES NOT "know what's best" in this situation. The average American has been lied to for decades, misled, propagandized, and told black is white. And the average American will never know until it's too late.
Thank you for you anecdotal evidence. Now, let me offer some different anecdotes. I have family members with type 1 diabetes and seizures. We have private insurance through my employer, and we've been managing these conditions for years. I have no problems with access to a doctor. The co-pays have been reasonable. I've been able to see specialists no problem, and meds have been reasonable. We're probably a high-cost family. We have had to do a lot of tests over the years. But unlike what is often discussed around here, I've had no issues that would cause me to complain.

People in the US who complain about private insurance often tend to ignore the polling around it. And those of us who like our private insurance are not just a bunch of ignorant rubes. We have our own experiences which count just as much as your experiences.

Related to your employement with an LTD company: I would note that LTD is a different type of insurance from basic medical. I'm aware that some LTD companies play games, and it's disgusting. But it's not the same as a blue-cross/blue-shield plan, etc. Many of those blues plans, BTW, are non-profits. When people get angry about profit-seeking health insurers, they're often ignoring the many non-profits that operate in this space.
  #74  
Old 09-18-2019, 05:22 AM
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Originally Posted by kenobi 65 View Post
Just in case there are people who look at that, and say, "8% isn't that many":
- It means that 28 million Americans have no health insurance at all
- It means that more than one out of every twelve Americans has no health insurance at all
Yes, that is a lot of people. Some can't afford it. Some think they're invincible and don't need it. Some don't know they can qualify for it. Some are illegal immigrants.

I think however that we need to remember that there are multiple ways to achieve UHC. Some of them are single-payer. Others are not. They have all been demonstrated world-wide. The US can achieve UHC without doing away with private insurance, and these 28 million people would be covered. The issue isn't something structural with private insurance (as has been proven in other countries). The issue is politics, and particularly the Republican party.
  #75  
Old 09-18-2019, 05:29 AM
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......
It was obvious that the OP was not reading my responses in even a cursory fashion, since s/he didn't acknowledge that I clearly stated I support Biden's approach to add a public option to the existing ACA (that s/he claims to support) and strengthen its weaknesses through full participation via Medicaid expansion.

TruCelt, one of my sidelines is to send out COBRA Election Notices to employees who have terminated employment with their companies. The notices feel like a cruel joke to advise them of the premium amounts they must now bear in order to continue their coverage. For an average family, $3,200/month is not an unusual amount. For people out of work.

......
survinga, I remember reading something long ago that outlined Singapore's research into how best to set up a national health care system. Someone asked the relevant official if the American system was under consideration, and he replied it was. As an example of how not to do it.

Buck Gudot, I agree with your post #15, there is zero chance that Medicare for all will become a reality irrespective of who is in the White House come 2021. And if Warren does not temper her commitment to an instant conversion, she will lose either the primary if we're lucky or the general election if we're not. We can make a fair guess where the health industry oligarchs will throw their financial weight given a choice between Warren, who scares all oligarchs, and Biden, who doesn't. Better the devil you know and all that.

Like it or not, this is the system we currently have, and making a successful common sense argument is often entirely different from making a successful political argument. Medicare for all suffers for being a common sense argument.
A few comments. Yes, I also support something that builds on our current system. The ACA was actually structured well, and it's survived incredible attacks by Trump. It's too light on subsidies, though. We need stronger subsidies in the exchanges, and we need to reinstate a mandate penalty. If we did all this, more people would come into the exchanges and prices would come down, as it would be a healthier group. Also, it would make it easier for someone who lost their job, as a subsidized policy on the exchange would be available to more people.

As for Singapore, I agree they didn't want the US system. But they didn't mind keeping Private Insurance either. They achieved their own version of UHC without going to single-payer.
  #76  
Old 09-18-2019, 06:10 AM
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[QUOTE=survinga;21867278]Thank you for you anecdotal evidence. Now, let me offer some different anecdotes. I have family members with type 1 diabetes and seizures. We have private insurance through my employer, and we've been managing these conditions for years. I have no problems with access to a doctor. The co-pays have been reasonable. I've been able to see specialists no problem, and meds have been reasonable. We're probably a high-cost family. We have had to do a lot of tests over the years. But unlike what is often discussed around here, I've had no issues that would cause me to complain./QUOTE]

"My Brother Has Cancer, Has Been Fired. Advice?"

Just what i saw on my way back to this thread. I thought this was the appropriate post to plunk it down in, for some reason. (Altho i didnt actually look at the thread itself, im just commenting on the title and timing). Whats the surety that this couldnt be you?

Last edited by Ambivalid; 09-18-2019 at 06:11 AM.
  #77  
Old 09-18-2019, 06:25 AM
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Thank you for you anecdotal evidence. Now, let me offer some different anecdotes. I have family members with type 1 diabetes and seizures. We have private insurance through my employer, and we've been managing these conditions for years. I have no problems with access to a doctor. The co-pays have been reasonable. I've been able to see specialists no problem, and meds have been reasonable. We're probably a high-cost family. We have had to do a lot of tests over the years. But unlike what is often discussed around here, I've had no issues that would cause me to complain./QUOTE]

"My Brother Has Cancer, Has Been Fired. Advice?"

Just what i saw on my way back to this thread. I thought this was the appropriate post to plunk it down in, for some reason. (Altho i didnt actually look at the thread itself, im just commenting on the title and timing). Whats the surety that this couldnt be you?
Or have a look at my earlier post about Maggie the Ocelot. "Insurance through your employer" is great until you get really ill and either your employer decides you are too much of a drain on the insurance pool to keep around or you simply get too sick to do your job anymore. Ice is never too thin to skate on, until suddenly it is.

Last edited by Gyrate; 09-18-2019 at 06:26 AM.
  #78  
Old 09-18-2019, 09:19 AM
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Maybe not; there's still the problem that people in rural areas are definitely underserved when it comes to health care, and those people might balk at paying the same amount to cover everybody when they themselves are 40 miles from the nearest ER and are not going to get the same level of care. So they would vote against it. And they did.
And the flip side is that a lot of people who already have health care are going to balk at the cost of building out and providing health care infrastructure in underserved parts of the country; that's a big piece of this pie nobody's really talking about. What's the maximum distance someone is expected to travel in order to avail themselves of universal health care? What about the elderly in small towns who can't just hop in a car and travel 30 miles? Are we going to require/provide health care providers to go to them?

There's a lot of downstream consequences people haven't really thought out about this yet- and a lot of it is somewhat unique to the US- somewhere like a European country rarely has to deal with the sort of wide-open spaces that the US has west of the Mississippi.

I'm not at all against universal healthcare, but I do think it needs to be approached from a rational and pragmatic perspective, not a frantic bunch of appeals to emotion and sympathy.
  #79  
Old 09-18-2019, 10:55 AM
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And the flip side is that a lot of people who already have health care are going to balk at the cost of building out and providing health care infrastructure in underserved parts of the country; that's a big piece of this pie nobody's really talking about. What's the maximum distance someone is expected to travel in order to avail themselves of universal health care? What about the elderly in small towns who can't just hop in a car and travel 30 miles? Are we going to require/provide health care providers to go to them?

There's a lot of downstream consequences people haven't really thought out about this yet- and a lot of it is somewhat unique to the US- somewhere like a European country rarely has to deal with the sort of wide-open spaces that the US has west of the Mississippi.

I'm not at all against universal healthcare, but I do think it needs to be approached from a rational and pragmatic perspective, not a frantic bunch of appeals to emotion and sympathy.
If we fight this issue in bits and pieces we'll be another 50 years before we catch up with the rest of the industrialized world.
  #80  
Old 09-18-2019, 11:22 AM
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<snip>

Related to your employement with an LTD company: I would note that LTD is a different type of insurance from basic medical. I'm aware that some LTD companies play games, and it's disgusting. But it's not the same as a blue-cross/blue-shield plan, etc. Many of those blues plans, BTW, are non-profits. When people get angry about profit-seeking health insurers, they're often ignoring the many non-profits that operate in this space.
I'm afraid you've fallen for one of the biggest myths in the health care biz. I read a fantastic in-depth study some years ago about the profitability of non-profits and wish I could put my paws on it again. Basically the misunderstanding arises from the notion that being non-profit means they can't make any profits. Not true. In reality, it's merely a tax status designation. Non-profits make profits, and they pass them along as reinvestment in the organization, massive payouts to executives and shareholders. As someone in the article noted, "There's nothing more profitable than a non-profit hospital."

Here's a recent article that explain the situation, though not as well as that original one did: Non-profit Hospitals Can Be Extremely Profitable (American Council of Science and Health).

You might want to double-check on the non-profit status of Blue Cross Blue Shield. Most of that conglomerate hasn't been "non-profit" for years. (Wikipedia)

We agree the ACA was structured well and that it has survived incredible attacks by Trump. I'd go further: It survived despite having been implemented in a way not even close to how Obama envisioned it. Between the way health insurance companies whittled away the public option -- central to its ultimate success -- and the original failure of red states to accept the Medicaid expansion, plus the 63+ (I forget the actual number) efforts by Congressional Republicans to overturn it, the ACA remains standing. Barely.

I'd like to see the ACA fully implemented and agree it's a preferable approach to another major overhaul of our health care system -- even though I believe Medicare for all is the better system. I think we can merge the 2 ideas, but gradually. And I agree there is a role for private health insurance if they want it. It certainly works in other countries.
  #81  
Old 09-18-2019, 11:34 AM
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I'm afraid you've fallen for one of the biggest myths in the health care biz. I read a fantastic in-depth study some years ago about the profitability of non-profits and wish I could put my paws on it again. Basically the misunderstanding arises from the notion that being non-profit means they can't make any profits. Not true. In reality, it's merely a tax status designation. Non-profits make profits, and they pass them along as reinvestment in the organization, massive payouts to executives and shareholders. As someone in the article noted, "There's nothing more profitable than a non-profit hospital."

Here's a recent article that explain the situation, though not as well as that original one did: Non-profit Hospitals Can Be Extremely Profitable (American Council of Science and Health).

You might want to double-check on the non-profit status of Blue Cross Blue Shield. Most of that conglomerate hasn't been "non-profit" for years. (Wikipedia)

We agree the ACA was structured well and that it has survived incredible attacks by Trump. I'd go further: It survived despite having been implemented in a way not even close to how Obama envisioned it. Between the way health insurance companies whittled away the public option -- central to its ultimate success -- and the original failure of red states to accept the Medicaid expansion, plus the 63+ (I forget the actual number) efforts by Congressional Republicans to overturn it, the ACA remains standing. Barely.

I'd like to see the ACA fully implemented and agree it's a preferable approach to another major overhaul of our health care system -- even though I believe Medicare for all is the better system. I think we can merge the 2 ideas, but gradually. And I agree there is a role for private health insurance if they want it. It certainly works in other countries.
I appreciate your expertise and your willingness to repeatedly step up to put down misinformation. Keep up the thankless endeavour.
  #82  
Old 09-18-2019, 11:59 AM
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I'm afraid you've fallen for one of the biggest myths in the health care biz. I read a fantastic in-depth study some years ago about the profitability of non-profits and wish I could put my paws on it again. Basically the misunderstanding arises from the notion that being non-profit means they can't make any profits. Not true. In reality, it's merely a tax status designation. Non-profits make profits, and they pass them along as reinvestment in the organization, massive payouts to executives and shareholders. As someone in the article noted, "There's nothing more profitable than a non-profit hospital."

Here's a recent article that explain the situation, though not as well as that original one did: Non-profit Hospitals Can Be Extremely Profitable (American Council of Science and Health).

You might want to double-check on the non-profit status of Blue Cross Blue Shield. Most of that conglomerate hasn't been "non-profit" for years. (Wikipedia)

We agree the ACA was structured well and that it has survived incredible attacks by Trump. I'd go further: It survived despite having been implemented in a way not even close to how Obama envisioned it. Between the way health insurance companies whittled away the public option -- central to its ultimate success -- and the original failure of red states to accept the Medicaid expansion, plus the 63+ (I forget the actual number) efforts by Congressional Republicans to overturn it, the ACA remains standing. Barely.

I'd like to see the ACA fully implemented and agree it's a preferable approach to another major overhaul of our health care system -- even though I believe Medicare for all is the better system. I think we can merge the 2 ideas, but gradually. And I agree there is a role for private health insurance if they want it. It certainly works in other countries.
I think a lot of attacks on non-profits (be they hospitals or blue plans (yes, I know many have converted)) are driven by ideology more than reality of what those entities deal with.

I agree with you about Medicaid expansion and just about everything else on the ACA that you mentioned. I'm not as sold on the need for a public option. I think strong subsidies paired with a real mandate and full acceptance of the Medicaid expansion across the country would do the trick. But in the political situation we're in, I'm willing to go along with the public option on a state-by-state basis.

Keep an eye on the Medicaid expansion. Red states are trickling into it gradually. It might take another decade to get them all into it.....
  #83  
Old 09-18-2019, 12:07 PM
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Going back to the OP. Even if I thought that the Democratic nominee was going to destroy my family's health insurance (I don't) it would be a small price to pay to get rid of Trump. I guess I'm a patriot. I would pay any price, bear any burden, meet any hardship, support any friend, oppose any foe, in order to assure that motherfucker is gone by 2021.
  #84  
Old 09-18-2019, 12:46 PM
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Say it with me: MFA = Medicare For Anyone.
Like your employer-sponsored health plan? Keep it!

Lose your job, or want to strike out on your own as an entrepreneur? Welcome to MFA!
Yes, I realize this is just the "public option," but Medicare For Anyone is a much better brand, and it doesn't freak people out by abolishing private insurance or denying people the ability to choose what they think is best for themselves.

Since everyone will pay higher taxes to fund MFA, what if we made private insurance premiums partially tax deductible to slightly level the playing field?
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  #85  
Old 09-18-2019, 12:54 PM
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I'd like to see the ACA fully implemented and agree it's a preferable approach to another major overhaul of our health care system -- even though I believe Medicare for all is the better system. I think we can merge the 2 ideas, but gradually. And I agree there is a role for private health insurance if they want it. It certainly works in other countries.
That's probably the most realistic way to approach this.
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Old 09-18-2019, 01:14 PM
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The whole discourse on this seems a little misleading to me. The truth is that Medicare for Anyone is likely to seriously injure the private insurance market if it is anything like what Bernie and others are proposing it will be in terms of benefits and out-of-pocket costs. Moreover, by not eliminating private health insurance you do not get the kind of cost controls and benefit to the labor market that come from a single-payer system.

I see very little policy case for Medicare-for-all-who-choose. There is a political case for it because of people who feel inexplicably emotional about Aetna. But it isn't totally obvious to me that these hybrid approaches are more politically palatable in the long-term. There is a (false) simplicity to Medicare-for-all that I suspect means it will overtake the popularity of Medicare-for-all-who-choose within the time horizon of it actually mattering to actual policy--e.g., abolition of the filibuster.

The MFA discourse is also weird. They claim, for example, that doctors will no longer have to fill out insurance paperwork. Do they not understand how Medicare works? Still plenty of forms! Maybe marginally fewer, I guess, but it's not like doctors offices won't need all that administrative staff any more.

Anyway, voting for Trump because of a policy proposal that has 0% chance of becoming law seems like the sort of thing a Trump-voter would do.

Last edited by Richard Parker; 09-18-2019 at 01:15 PM.
  #87  
Old 09-18-2019, 01:48 PM
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I think a lot of attacks on non-profits (be they hospitals or blue plans (yes, I know many have converted)) are driven by ideology more than reality of what those entities deal with.

.
I don't see where it's an "attack" on non-profits by merely pointing out that the term "non profit" is a tax designation only, and these organizations still make profits which are then used for things like executive salaries and bonuses and payouts to shareholders.

This is not an "attack" in my view. It is more like "sharing relevant and accurate information"
  #88  
Old 09-18-2019, 02:04 PM
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I think that part of the reason people like their existing employer-provided health insurance is because most of them don't realize what it costs. Well, and there's not much reason for them to care what it costs so long as their part is small.

According to Kaiser Family Foundation, the average employee with family coverage paid $5,431 in 2018. Their employer paid $14,134. Both these shares of premiums were not taxable -- the employer deducted them as compensation expense, but the employee did not have to count them as compensation for tax purposes.

So I propose that we start by changing this -- employee contributions will be made on an aftertax basis, and employer contributions will be included in the employees' taxable income. Thus an employee in the 12% tax bracket would see his federal tax increase by about $2,350 per year. This additional tax revenues generated by this would go to help underwrite MFA.

I have a theory that if we implemented MFA on a buy-in basis for whoever wants it, employers may well reconsider whether they want to supply health insurance at all. Suppose that the buy-in for Medicare for a family of 4 would cost $16,000 per year. (I have no idea how reasonable this number is.) The employer could say, "Look, if we stop our company-sponsored plan, we will increase the salary of those on family coverage by $12,000 per year. This, in addition to the $5,400 premium you're already paying would more than coverage your MFA premiums."

Employees will see a bonus of $1,400 per year. Employers will have compensation expense decline by $2,100 per year per employee PLUS they get to lose the headaches and additional expenses incurred with providing coverage.

MFA would become the standard by attrition.

(Sort of ninja'd by Akaj.)

Last edited by Anny Middon; 09-18-2019 at 02:06 PM.
  #89  
Old 09-18-2019, 02:27 PM
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Originally Posted by survinga View Post
Thank you for you anecdotal evidence. Now, let me offer some different anecdotes. I have family members with type 1 diabetes and seizures. We have private insurance through my employer, and we've been managing these conditions for years.
If you lose your job you lose your insurance. Hope you're never laid off.

Type I diabetes and epilepsy (outside some rare exceptions) are NOT the high cost illness/trauma I'm talking about. Cancer will dwarf those costs in a heartbeat. Major trauma. Long term care for someone permanently disabled.

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Originally Posted by survinga View Post
And those of us who like our private insurance are not just a bunch of ignorant rubes. We have our own experiences which count just as much as your experiences.
I'm glad your experiences have been positive. I hope you keep your job. I hope your employer keeps offering an insurance option.

The thing is, those under UHC in other countries NEVER have to worry about any of that. And the vast majority of them are just as satisfied with their coverage as you are with yours.

Quote:
Related to your employment with an LTD company: I would note that LTD is a different type of insurance from basic medical. I'm aware that some LTD companies play games, and it's disgusting. But it's not the same as a blue-cross/blue-shield plan, etc.
Actually, it was Blue Cross Blue Shield, not some random unknown LTD provider. That IS the "blue cross plan". All of the people on that LTD plan were former employees of Blue Cross and Blue Shield, and it was the BCBS LTD plan. The third-rate companies are even skeevier.

I was so disgusted I transferred to a different area of the company as soon as I could. But I couldn't quit working for them - my spouse had the distinction of maxing out a Blue Cross health insurance policy by the time he was 20, so outside of being the family member of an employee Blue wouldn't have him as a customer (which was perfectly legal in those days). Given how much he'd cost the Blues, no other insurer would touch him, either (which was perfectly legal in those days) or cranked up the premiums to impossible levels (we were quoted monthly premiums that exceed our gross income by 50%). The only way I could get health coverage for him was to work for the industry.

I was laid off in 2007. We lost our health insurance. We went 14 months without it, during which time my spouse's vision deteriorated and he started to suffer from peripheral neuropathy from untreated diabetes. His doctor cut his fees in half, and handed out samples, and there was some local charity help, but it was inconsistent and sometimes he went without. It was also during that period I needed a tetanus booster and that turned into a pile of stupidity. It wasn't until we were poor enough to get on a type of Medicaid we got any relief and then, ironically, the spouse could get his regular doctor visits, his needed medications, and so forth. Government health care was GREAT for him. For both of us, really. It paid for his cancer treatment and his last few weeks of care. With Obamacare adding vision and dental to Medicaid I could get new glasses, we both got our teeth fixed. I could get regular gyno visits, mammograms, and checkups. He got urinary "procedures" to keep his kidneys working.

The only thing we paid out of pocket during his terminal illness was one $25 ER co-pay.

So, from my experience, even the crappy US version of "government" healthcare was a crap-ton better than none at all, and better than some private policies I've had in my life. Bring it on. Let's go to UHC.
  #90  
Old 09-18-2019, 02:34 PM
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And the flip side is that a lot of people who already have health care are going to balk at the cost of building out and providing health care infrastructure in underserved parts of the country; that's a big piece of this pie nobody's really talking about. What's the maximum distance someone is expected to travel in order to avail themselves of universal health care? What about the elderly in small towns who can't just hop in a car and travel 30 miles? Are we going to require/provide health care providers to go to them?
30 miles? It is to laugh. 30 miles is is nothing in many places in the US. What do you think people do NOW?

My college roommate had her medical education paid for by the Federal government. In exchange, she went where they sent her for the first seven years out of medical school. We're talking about a woman who used to hike solo through places like Yellowstone and Yosemite and they put her somewhere so far outside civilization SHE could hardly stand it. 150 miles to get to the nearest store that sold basic groceries and 150 miles back. Ambulance rides were usually by helicopter, not ground vehicle. She delivered more babies by the side of the road than in the actual clinic.

Make it contingent that new doctors serve under served communities. A year or two of service. Make it an option for other people to provide support services in return for forgiveness of the costs of advanced education.
  #91  
Old 09-18-2019, 02:36 PM
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I'm afraid you've fallen for one of the biggest myths in the health care biz. I read a fantastic in-depth study some years ago about the profitability of non-profits and wish I could put my paws on it again. Basically the misunderstanding arises from the notion that being non-profit means they can't make any profits. Not true. In reality, it's merely a tax status designation. Non-profits make profits, and they pass them along as reinvestment in the organization, massive payouts to executives and shareholders. As someone in the article noted, "There's nothing more profitable than a non-profit hospital."
Also some damn fine salaries for the non-executives - when I worked for a non-profit health insurance company I was a secretary making enough money to fly airplanes as a hobby. I enjoyed it while it lasted.
  #92  
Old 09-18-2019, 02:48 PM
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I think that part of the reason people like their existing employer-provided health insurance is because most of them don't realize what it costs. Well, and there's not much reason for them to care what it costs so long as their part is small.

According to Kaiser Family Foundation, the average employee with family coverage paid $5,431 in 2018. Their employer paid $14,134. Both these shares of premiums were not taxable -- the employer deducted them as compensation expense, but the employee did not have to count them as compensation for tax purposes.

So I propose that we start by changing this -- employee contributions will be made on an aftertax basis, and employer contributions will be included in the employees' taxable income. Thus an employee in the 12% tax bracket would see his federal tax increase by about $2,350 per year. This additional tax revenues generated by this would go to help underwrite MFA.

I have a theory that if we implemented MFA on a buy-in basis for whoever wants it, employers may well reconsider whether they want to supply health insurance at all. Suppose that the buy-in for Medicare for a family of 4 would cost $16,000 per year. (I have no idea how reasonable this number is.) The employer could say, "Look, if we stop our company-sponsored plan, we will increase the salary of those on family coverage by $12,000 per year. This, in addition to the $5,400 premium you're already paying would more than coverage your MFA premiums."

Employees will see a bonus of $1,400 per year. Employers will have compensation expense decline by $2,100 per year per employee PLUS they get to lose the headaches and additional expenses incurred with providing coverage.

MFA would become the standard by attrition.

(Sort of ninja'd by Akaj.)
Not ninja'd at all -- you thought out the details far more than I did.

But wouldn't making employee and employer contributions aftertax be a double-whammy for those who want to stay with private insurance, since their taxes would also go up? This would definitely hasten the end of private insurance, but might be politically hazardous enough to prevent it from happening in the first place if there are enough people like the OP.
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  #93  
Old 09-18-2019, 03:18 PM
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The employer could say, "Look, if we stop our company-sponsored plan, we will increase the salary of those on family coverage by $12,000 per year. This, in addition to the $5,400 premium you're already paying would more than coverage your MFA premiums."
That's awfully optimistic to assume they'd up people's pay if they discontinued a benefit.
  #94  
Old 09-18-2019, 03:31 PM
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That's awfully optimistic to assume they'd up people's pay if they discontinued a benefit.
Some of our employees opt out of our plan, since they have a spouse with a better plan, or other reason. We pay them more, but not the whole amount we're saving. For employees on our plan, we pay 100% of the premium, and contribute to their HSA. I think it's about $18,000 per employee per year. (I'll never understand why the business community in this country isn't lobbying hard for some kind of government health insurance for all)
  #95  
Old 09-18-2019, 03:32 PM
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Originally Posted by Richard Parker View Post
The whole discourse on this seems a little misleading to me. The truth is that Medicare for Anyone is likely to seriously injure the private insurance market if it is anything like what Bernie and others are proposing it will be in terms of benefits and out-of-pocket costs. Moreover, by not eliminating private health insurance you do not get the kind of cost controls and benefit to the labor market that come from a single-payer system.
That can be true, but it simply depends on how big a component of the whole system the private insurance sector is and therefore how big its deleterious effects are. In the US, where private insurance is dominant, Medicare hasn't been able to do much to control costs. In countries that have single payer or its functional equivalent, the private insurance sector is invariably small, on the order of about 10%. The fact that they've been successful on controlling costs is self-evident from any comparative chart of health care costs.
Quote:
Originally Posted by Richard Parker View Post
The MFA discourse is also weird. They claim, for example, that doctors will no longer have to fill out insurance paperwork. Do they not understand how Medicare works? Still plenty of forms! Maybe marginally fewer, I guess, but it's not like doctors offices won't need all that administrative staff any more.
This is categorically false. I'm in Canada and I have never in my life seen a single form or other paperwork related to health care services, not in my doctor's office, not at any specialist, not during the course of a week-long hospital stay. If any of these providers have to deal with forms, they certainly keep them well hidden. I can tell you for a fact that my doctor's office has just two staff, a receptionist who answers the phone, and a nurse/technician who does everything else. For every consultation he does, the doctor just submits the procedure code(s) and insurance number electronically to the Ministry of Health, and receives the set fee by EFT. Done. Whereas doctors' offices in the US typically have accounting staff whose sole job is to deal with insurance paperwork. The difference is night and day. The reason Medicare in the US still involves paperwork is because it's an unholy mess that has to coexist with, and indeed in many cases depends on, the private insurance industry.

Of course it's always possible to implement single payer badly, which is what some fear the US government might do. Any good idea can have a bad implementation. But that's not been the case in other countries, and in the US, Medicare actually works pretty well, considering what a compromised mess it had to be in order to function at all in the present mercenary health care environment.
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Old 09-18-2019, 03:58 PM
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I'm sorry if it's a rudimentary question but could someone please shed some light on the reasoning for using the term "Medicare.." in all these UHC proposals? Do I just have a blind spot somewhere? I just dont get it. Is it because Medicare and Medicaid are the *only* recognizable terms for most Americans re single payer health care? And "Medicare" is less stigmatizing than "Medicaid" because Medicaid is a "hand out" to people who "refuse to work" while Medicare is "earned" after a lifetime of legitimate work?

If this is the reasoning, will this new meaning for "Medicare" supplant the old one? When/how will that transition proceed?
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Old 09-18-2019, 04:36 PM
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I'm sorry if it's a rudimentary question but could someone please shed some light on the reasoning for using the term "Medicare.." in all these UHC proposals? Do I just have a blind spot somewhere? I just dont get it. Is it because Medicare and Medicaid are the *only* recognizable terms for most Americans re single payer health care? And "Medicare" is less stigmatizing than "Medicaid" because Medicaid is a "hand out" to people who "refuse to work" while Medicare is "earned" after a lifetime of legitimate work?

If this is the reasoning, will this new meaning for "Medicare" supplant the old one? When/how will that transition proceed?
My guess is that it's just smart branding. People know what Medicare is and in general have a pretty positive perception of it, even if they lack firsthand experience. Whereas "universal healthcare," "single-payer" and other terms need to be explained, pretty much any idiot knows what's meant by "Medicare for All" -- even if the term is less than 100% accurate in describing various proposals.
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Old 09-18-2019, 05:07 PM
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Do you also have a Medicare supplement? Otherwise I dont see how it's better than most private insurance plans.
Yes, I have a supplemental policy, but like other baby boomers, I grew up in a time when the standard health insurance policy paid 80% with a 20% copay.

Those types of policies started to disappear in the 1980s, when healthcare costs started going through the roof, even though the typical health insurance policy still made us pay 20%. Yes, even back in those days, we healthcare consumers could see prices rise and still have no bargaining power.

And, just like now, the insurance companies played little games to deny coverage, or cancel you entirely when they decided you had been sick enough for long enough. Then they came up with ideas like "preferred providers" and "in network" vs. "out of network" coverage.

During those years, my parents navigated Medicare through my mother's long battle with cancer with relative ease, compared to my insurance company refusing to pay for my daughter's bronchitis.

So yeah, I'm delighted with plain vanilla Medicare compared to the private insurance I had - back in the good old days as well as back in the pre-Obamacare days when I paid $7,000+ per year for an individual policy and was scared shitless I'd be canceled when one of my colonoscopies showed polyps. The fact that I can afford a decent supplemental policy is just the cherry on top.
  #99  
Old 09-18-2019, 05:24 PM
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My guess is that it's just smart branding. People know what Medicare is and in general have a pretty positive perception of it, even if they lack firsthand experience. Whereas "universal healthcare," "single-payer" and other terms need to be explained, pretty much any idiot knows what's meant by "Medicare for All" -- even if the term is less than 100% accurate in describing various proposals.
Whatís more: some folks pitch, what, ďMedicare For All Who Want It,Ē right? As far as I can tell, thatís smart branding: you donít lead off, like Warren, with a line about not knowing anyone who likes their health insurance; and you donít bring up the idea of killing private-sector health insurance, because you donít need to say it; you force the other side to mouthily connect the dots on that.

(See, you just want to make it available to people whoíd find it useful, you say, and then you just smile and stop; and if the other side wants to introduce the idea that itíll be so great itíll soon put uncompetitive companies out of business ó well, hey, they can make that case, if they want, but you donít need to; you can even take the opposite position, innocuously saying, aw, shucks, I heard tell of plenty oí folks who sure do like their plans, and I done figured thereís enough satisfied customers to keep them corporations up and runniní; golly, are you sayiní it ainít so?)
  #100  
Old 09-18-2019, 05:38 PM
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Originally Posted by Broomstick View Post
If you lose your job you lose your insurance. Hope you're never laid off.

Type I diabetes and epilepsy (outside some rare exceptions) are NOT the high cost illness/trauma I'm talking about. Cancer will dwarf those costs in a heartbeat. Major trauma. Long term care for someone permanently disabled.


I'm glad your experiences have been positive. I hope you keep your job. I hope your employer keeps offering an insurance option.

The thing is, those under UHC in other countries NEVER have to worry about any of that. And the vast majority of them are just as satisfied with their coverage as you are with yours.


Actually, it was Blue Cross Blue Shield, not some random unknown LTD provider. That IS the "blue cross plan". All of the people on that LTD plan were former employees of Blue Cross and Blue Shield, and it was the BCBS LTD plan. The third-rate companies are even skeevier.

I was so disgusted I transferred to a different area of the company as soon as I could. But I couldn't quit working for them - my spouse had the distinction of maxing out a Blue Cross health insurance policy by the time he was 20, so outside of being the family member of an employee Blue wouldn't have him as a customer (which was perfectly legal in those days). Given how much he'd cost the Blues, no other insurer would touch him, either (which was perfectly legal in those days) or cranked up the premiums to impossible levels (we were quoted monthly premiums that exceed our gross income by 50%). The only way I could get health coverage for him was to work for the industry.

I was laid off in 2007. We lost our health insurance. We went 14 months without it, during which time my spouse's vision deteriorated and he started to suffer from peripheral neuropathy from untreated diabetes. His doctor cut his fees in half, and handed out samples, and there was some local charity help, but it was inconsistent and sometimes he went without. It was also during that period I needed a tetanus booster and that turned into a pile of stupidity. It wasn't until we were poor enough to get on a type of Medicaid we got any relief and then, ironically, the spouse could get his regular doctor visits, his needed medications, and so forth. Government health care was GREAT for him. For both of us, really. It paid for his cancer treatment and his last few weeks of care. With Obamacare adding vision and dental to Medicaid I could get new glasses, we both got our teeth fixed. I could get regular gyno visits, mammograms, and checkups. He got urinary "procedures" to keep his kidneys working.

The only thing we paid out of pocket during his terminal illness was one $25 ER co-pay.

So, from my experience, even the crappy US version of "government" healthcare was a crap-ton better than none at all, and better than some private policies I've had in my life. Bring it on. Let's go to UHC.
The ACA fixed many (not all) of the things you talk about, such as people maxing out on what their policy would pay, having to wait for Medicaid to get something subsidized by government. If the subsidies within the exchanges were beefed up across the country, then people losing their jobs wouldn't be that big a deal. If you lost your job, you could then go get a policy on the exchange and so forth, and they couldn't cut you off for having too much claims.

Your horror story plays out differently today to a degree, and tweaks to the ACA would mostly fix it.
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