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  #101  
Old 09-18-2019, 07:05 PM
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Originally Posted by survinga View Post
Your horror story plays out differently today to a degree, and tweaks to the ACA would mostly fix it.
Uh-huh. And the Republicans tried their best to kill ACA. Because they're that cruel.
  #102  
Old 09-18-2019, 07:26 PM
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The ACA was a big step in the right direction, but even beefed-up subsidies won't resolve the crisis because most of the marketplace plans have high OOP maximums. Case in point: My friend V. , who was diagnosed with breast cancer last year. She got insurance through the marketplace because she works for a business with fewer than 50 employees. She hit her OOP maximum, $6,000, but she didn't have $6000. She arranged to make payments. This year she again reached the OOP maximum, $6000. She hadn't finished paying off the first $6000, so now she owes $10,000 she doesn't have.

There were plans that had lower OOP maximums, but she couldn't afford the higher monthly premiums. She lives frugally, but it's still going to take her 5 years to pay off her medical debt, and that's assuming she doesn't accumulate more.

A lot of employers offer plans with high OOP maximums, so it's not the ACA that's the problem, but the ACA isn't the fix, either.
  #103  
Old 09-18-2019, 08:16 PM
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Originally Posted by bump View Post
That's awfully optimistic to assume they'd up people's pay if they discontinued a benefit.
I don't think so. Most employers use health insurance as a tool to attract and retain employees. If this were not true, they would offer the least expensive plan they could get away with.

Particularly in this economy with low unemployment, employers want to do what they can to get and keep good employees while minimizing the cost to them. That means that if competitors are offering decent health insurance and underwriting 3/4 of the cost, they have to offer something else to make it as good or better deal for employees to buy MFA.

Since they can pay more in salary and reduce their own administrative expense, I think some will do so. Remember too that health care costs have of late increased more rapidly than salaries.
  #104  
Old 09-18-2019, 08:59 PM
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That's awfully optimistic to assume they'd up people's pay if they discontinued a benefit.
Yeah, that's why I'm pretty pessimistic about anything good actually happening. Any real reform is going to require the conversion of the company scrip into something like a payroll tax, whether that goes to the state directly or to the employee's choice of insurer (as in Germany and other places). And that's going to be crazily disruptive to the entire system. And the disruption is what's actually controversial; the maximalist version of Medicare For All doesn't really take away many people's choices, since most people only have one choice, but it would mean change for everyone, and the change is what people don't want.

People's Stockholm Syndrome about "their" insurance is so strong that my preference for a hypothetical Democratic trifecta is to just skip healthcare this time, or do something fast and mediocre like throw subsidies at the exchanges and create a federal Medicaid program for the states that didn't expand Medicaid.

Last edited by Lord Feldon; 09-18-2019 at 09:03 PM.
  #105  
Old 09-18-2019, 09:09 PM
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Non-profits make profits, and they pass them along as reinvestment in the organization, massive payouts to executives and shareholders.
Incorrect. Obviously, you're not an accountant. Non-profit accounting doesn't even include the term "profit" on the statement of statement of activities, since there isn't any.

Also, there aren't any shareholders since the organization has no equity.

Your cites are b.s.

https://www.accountingtools.com/arti...ccounting.html
  #106  
Old 09-18-2019, 09:09 PM
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Originally Posted by nelliebly View Post
The ACA was a big step in the right direction, but even beefed-up subsidies won't resolve the crisis because most of the marketplace plans have high OOP maximums. Case in point: My friend V. , who was diagnosed with breast cancer last year. She got insurance through the marketplace because she works for a business with fewer than 50 employees. She hit her OOP maximum, $6,000, but she didn't have $6000. She arranged to make payments. This year she again reached the OOP maximum, $6000. She hadn't finished paying off the first $6000, so now she owes $10,000 she doesn't have.

There were plans that had lower OOP maximums, but she couldn't afford the higher monthly premiums. She lives frugally, but it's still going to take her 5 years to pay off her medical debt, and that's assuming she doesn't accumulate more.

A lot of employers offer plans with high OOP maximums, so it's not the ACA that's the problem, but the ACA isn't the fix, either.
Price points have to be set such that the costs are limited as a % of income. The main problem with the ACA is that it wasn't rich enough in making the exchanges a good deal for a broader group. If we had a cheaper premium for people who are buying richer plans, and we didn't cut off subsidies at 400% FPL, then I think we'd get a much larger risk pool, and healthier, in the exchanges. And it would actually compete with employer insurance, as more people would see it as valuable.

The main problem with the ACA right now (other than the attacks by trump/republicans, etc) is that middle-class people who don't have employer insurance are priced out of affordability on the exchanges. This has to be fixed in order to make the ACA what it could be. The second problem is that there's no mandate penalty, so healthy people don't have an incentive to join the exchanges. The third problem is the politics of red states that won't accept the medicaid expansion and that won't promote the exchanges to get more people aware and interested in exploring.
  #107  
Old 09-18-2019, 09:10 PM
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Originally Posted by D'Anconia View Post
Incorrect. Obviously, you're not an accountant. Non-profit accounting doesn't even include the term "profit" on the statement of statement of activities, since there isn't any.

Also, there aren't any shareholders since the organization has no equity.

Your cites are b.s.

https://www.accountingtools.com/arti...ccounting.html
Good post. As I said earlier, alot of the attacks on these non-profits (like insinuating that they're "really" profit in disguise) are ideological.
  #108  
Old 09-18-2019, 09:21 PM
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Originally Posted by Linden Arden View Post
And Senator Warren claims she doesn't know ANYONE who likes their health insurance?
To me, it is wrong framing to ask "do you like your insurance."

I have my quibbles with my employer-provided insurance, but overall the quality of service has been satisfactory.

What's never going to be satisfactory is that I can't contemplate changing jobs, or taking some time off, without the risk of changing doctors/hospitals/networks (or just going outright uninsured).

It's stupid the way the US impedes the free movement of capital and labor by making people afraid to change jobs because of insurance. We can do better.
  #109  
Old 09-18-2019, 09:31 PM
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Originally Posted by D'Anconia View Post
Incorrect. Obviously, you're not an accountant. Non-profit accounting doesn't even include the term "profit" on the statement of statement of activities, since there isn't any.

Also, there aren't any shareholders since the organization has no equity.

Your cites are b.s.

https://www.accountingtools.com/arti...ccounting.html
Well, except for the "massive payouts to executives” part.
  #110  
Old 09-18-2019, 09:36 PM
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Originally Posted by D'Anconia View Post
Incorrect. Obviously, you're not an accountant. Non-profit accounting doesn't even include the term "profit" on the statement of statement of activities, since there isn't any.

Also, there aren't any shareholders since the organization has no equity.

Your cites are b.s.

https://www.accountingtools.com/arti...ccounting.html
Nope, not an accountant, never claimed to be and I'm not looking at this through an accountant's lens. You are, but that doesn't compel anyone else to do so. Of course they never state a profit. That doesn't mean they don't make money.

Refute these cites, please, and we'll talk all about it.

These Hospitals Make the Most Money Off Patients and They're Mostly Non-Profits (WaPo)

Not-For-Profits Dominate Top 10 List of Hospitals With Biggest Surpluses (Modern Health Care)

You can view this through whatever lens you like, but non-profits can be and are used as pass through entities to distribute money to, for example, administrators, charities (some of which are questionable), parent companies and others that do have shareholders. They also use the funds to purchase real estate which they then hold in perpetuity. If you're an accountant, you know this to be true.

This whole discussion is off topic, so I won't address it further unless you offer something substantive.
  #111  
Old 09-18-2019, 11:17 PM
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Maybe I'm just being a bit, um, obtuse but why on earth would someone answer in the affirmative when asked if they like having their healthcare company?

"Do you enjoy the relationship you have with the corporate adversary you have been pitted against due to the hand your were dealt by your employer, whose sole reason for existence is to deny you as much legitimate, doctor ordered health care as possible, while simultaneously paying for as few legitimate claims of health care as possible?"

Who the fuck would answer in a positive way to that framing of the question?

Last edited by Ambivalid; 09-18-2019 at 11:19 PM.
  #112  
Old 09-18-2019, 11:35 PM
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Originally Posted by Aspenglow View Post
You can view this through whatever lens you like, but non-profits can be and are used as pass through entities to distribute money to, for example, administrators, charities (some of which are questionable), parent companies and others that do have shareholders. They also use the funds to purchase real estate which they then hold in perpetuity. If you're an accountant, you know this to be true.

This whole discussion is off topic, so I won't address it further unless you offer something substantive.
Non-profits don't have shareholders to distribute to, even to parent companies. You are simply incorrect.

Quote:
Finally, there is no nonprofit equivalent for the statement of stockholders' equity, since a nonprofit has no equity.
https://www.accountingtools.com/arti...ccounting.html
  #113  
Old 09-18-2019, 11:59 PM
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Originally Posted by D'Anconia View Post
Incorrect. Obviously, you're not an accountant. Non-profit accounting doesn't even include the term "profit" on the statement of statement of activities, since there isn't any.

Also, there aren't any shareholders since the organization has no equity.

Your cites are b.s.

https://www.accountingtools.com/arti...ccounting.html
What Aspenglow said is exactly right - you are allowed to make a profit as long as it is related to your mission statement and is reinvested in activities related to your mission statement.

If your mission statement is related to healthcare, it makes you a ton of money and you pay it out to any employee or business who in some way furthers your mission your 501c3 status is not in jeopardy.

Cite: https://www.nolo.com/legal-encyclope...ngs-30284.html
  #114  
Old 09-19-2019, 12:03 AM
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Who the fuck would answer in a positive way to that framing of the question?
Well, I understand my insurance company is an adversary and not an ally. So with that in mind, I can only evaluate their performance in the context that it's what they are contractually obligated to do for me.

My insurance is OK. I understand that everyone's isn't. But the thing that should bind us all together is that if you can lose insurance at any time, then it isn't worth much. My insurance is actually fairly generous, but if my employer hoses me, then I and my children are scrambling. Not because any of us took any extra health risks, simply because control of my salary changed hands.
  #115  
Old 09-19-2019, 12:18 AM
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Price points have to be set such that the costs are limited as a % of income.
You'd have to factor in cost of living in the customer's area of residence, number of family members in the plan, as well as other factors, and you're still going to have to convince insurance companies.
  #116  
Old 09-19-2019, 07:28 AM
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You'd have to factor in cost of living in the customer's area of residence, number of family members in the plan, as well as other factors, and you're still going to have to convince insurance companies.
I'm talking about the subsidies and things like CSR payments (which Trump stopped paying, as part of his attack). There's reinsurance, too. Mechanisms were in place to make the markets stable, to help insurance companies stay in them, to help people afford the coverage, and so forth. These items were put in place in the states where the exchanges operate. It just wasn't originally set up with rich enough subsidies, and some of them were sunsetted too early. That needs to be fixed, and won't require insurance company approval. Nor will it require a new health insurance or health care system.

Almost everything that's brought up in these threads as a critique can be fixed within the basic structure of the ACA, but just with more money committed to it by the government. Technically, it's simple at this point. The problem is politics.
  #117  
Old 09-19-2019, 08:55 AM
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A couple of random observations about the last few hours of discussion:

From what I can gather, employers are reluctant to get on board with UHC because of the leverage they would lose with employees. Leverage supported by the current systemic mess. If UHC was implemented, I wouldn't expect wages to go up in accordance with employers' direct cost savings; they'll go up for competitive and market reasons as always. Besides, employers are probably going to pay higher tax rates as their share of contribution to the national program.

Non-profits, like the one for which I work, certainly generate surpluses which are the real life equivalent of profits (I'm an accountant). So the semantics are unimportant from a certain POV. However, a non-profit is tasked for a mission and that mission is controlled by a board that does not seek the enrichment of itself, it's executives nor its shareholders. It's not just a money making entity for the people who run it.

Finally, too many people, like the OP, are concerned with health insurance instead of health care and Americans' access to it.

Last edited by Red Wiggler; 09-19-2019 at 08:56 AM.
  #118  
Old 09-19-2019, 09:37 AM
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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)
Just for a point of comparison, I've worked at five companies- one small one, one subsidiary of a colossal European aerospace company, one large US healthcare company, one mid-sized consulting firm, and one large municipality over the last 22 years.

Not ONE of them offered to boost your take-home pay if you opted not to take health care coverage. It was always offered as a perquisite that you could take or leave as you saw fit.

And I agree... I don't understand why businesses aren't pushing the universal health care angle a lot harder- it would save them a bundle of cash. About the only reason I can think of, and it's not a terribly strong one, is that maybe they perceive it as a competitive advantage in attracting workers. Which is funny, because most people I know aren't in a position to go "Hmmm... potential job X has Cigna plan Q, while potential job Y has Cigna plan R. I think I'll go with Y, because I like their plan more."

Instead, most are approaching it from a perspective of "Current job has Y insurance plan, potential job has X insurance plan. Are they broadly comparable, and do they cover any specifics that I know my family or myself needs?"
  #119  
Old 09-19-2019, 10:01 AM
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What’s more: some folks pitch, what, “Medicare For All Who Want It,” right? As far as I can tell, that’s smart branding: you don’t lead off, like Warren, with a line about not knowing anyone who likes their health insurance; and you don’t bring up the idea of killing private-sector health insurance, because you don’t need to say it; you force the other side to mouthily connect the dots on that.
100% agree -- except I prefer "Medicare For Anyone" to “Medicare For All Who Want It” because it's punchier.

But the Dem candidates have seriously got to drop this storyline about taking away people's insurance. Right or wrong, people like the OP just won't get behind it, and they may even vote against it. Is pitching your ideal solution (that almost certainly won't transpire anyway) really worth 4 more years of Trump?
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  #120  
Old 09-19-2019, 10:20 AM
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This is categorically false. I'm in Canada ...
In the United States, there is a lot of paperwork that accompanies billing Medicare. It varies from practice to practice. It is still fundamentally procedure and diagnosis coding, but it is vast and complex and requires staff trained to do it well. You can take a glance at the Medicare billing regulations if you want a sense of it. That is the nature of a healthcare system that is much larger and more complex than Canada's, perhaps among other differences.

You don't get rid of that paperwork by eliminating private insurers. As I conceded in the post which you're labeling "categorically false," you may well marginally reduce the administrative cost associated with billing. But you don't likely reduce it so much that you gain all the savings of having all that staff and staff time.
  #121  
Old 09-19-2019, 12:23 PM
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In the United States, there is a lot of paperwork that accompanies billing Medicare. It varies from practice to practice. It is still fundamentally procedure and diagnosis coding, but it is vast and complex and requires staff trained to do it well. You can take a glance at the Medicare billing regulations if you want a sense of it. That is the nature of a healthcare system that is much larger and more complex than Canada's, perhaps among other differences.

You don't get rid of that paperwork by eliminating private insurers. As I conceded in the post which you're labeling "categorically false," you may well marginally reduce the administrative cost associated with billing. But you don't likely reduce it so much that you gain all the savings of having all that staff and staff time.
You may not eliminate the Medicare paperwork, but now you don't have to also deal with the Aetna paperwork, the United Healthcare paperwork, the Cigna paperwork, und so weiter...

I really have no idea how many man-hours (person-hours?) that would eliminate, but if each company's paperwork is on the scale of the Medicare paperwork, each with their own coding rules, then the savings could be substantial, couldn't it?
  #122  
Old 09-19-2019, 05:50 PM
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In the United States, there is a lot of paperwork that accompanies billing Medicare. It varies from practice to practice. It is still fundamentally procedure and diagnosis coding, but it is vast and complex and requires staff trained to do it well. You can take a glance at the Medicare billing regulations if you want a sense of it. That is the nature of a healthcare system that is much larger and more complex than Canada's, perhaps among other differences.
I'm aware that Medicare generates paperwork and I acknowledged as much, but as I explained, that's only because it's structured much like private insurance which it has to coexist with. This is simply not the case in single payer in Canada. There's nothing ambiguous or contentious about the fact that I've never even seen a health care form or claim. Complaints about insurance bureaucracy and paperwork is the major thing I hear about from those who have relocated to the US from other countries -- it's kind of the distinguishing trademark of US health care.

The only thing about US health care that makes it "more complex" than Canada's is the vast plethora of different and often overlapping insurance systems that health care providers have to navigate. The productive work of actually providing health care is exactly the same, and therefore the per-capita costs of providing that care should be similar if similarly managed. The size of the system has nothing to do with it, and indeed economies of scale should make per-capita administrative costs even lower. Yet it's a fact that the US has the highest health care administration costs in the world by a wide margin, and it's also a fact that it's the only country in the world where the majority of health care coverage is provided by private businesses operating in what is largely a free-market environment.
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Originally Posted by Richard Parker View Post
You don't get rid of that paperwork by eliminating private insurers. As I conceded in the post which you're labeling "categorically false," you may well marginally reduce the administrative cost associated with billing. But you don't likely reduce it so much that you gain all the savings of having all that staff and staff time.
Check out some of these cites and see if you still believe that; rough estimates suggest that around $550 billion is wasted every year on unnecessary administrative costs that don't exist in other countries, and that for every 10 physicians in the US, there are 7 staffers employed solely for billing administration:
A widely cited study published in The New England Journal of Medicine used data from 1999 to estimate that about 30 percent of American health care expenditures were the result of administration, about twice what it is in Canada. If the figures hold today, they mean that out of the average of about $19,000 that U.S. workers and their employers pay for family coverage each year, $5,700 goes toward administrative costs.
https://www.nytimes.com/2018/07/16/u...h-care-us.html

Bureaucracy in the health care system accounts for about a third of total U.S. health care spending -- a sum so great that if the United states were to have a national health insurance program, the administrative savings alone would be enough to provide health care coverage for all the uninsured in this country, according to two new studies.
https://pnhp.org/news/2003/august/ad...tive_costs.php

In a 2003 article in The New England Journal of Medicine, researchers Steffie Woolhandler, Terry Campbell, and David Himmelstein concluded that overall administrative costs in 1999 amounted to 31 percent of total health care expenditures or $294 billion—roughly $569 billion today when adjusted for medical care inflation. A more recent paper by Woolhandler and Himmelstein, which looked at 2017 spending levels, placed the total cost of administration at $1.1 trillion.
https://www.americanprogress.org/iss...h-care-system/
  #123  
Old 09-20-2019, 07:05 AM
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A couple of random observations about the last few hours of discussion:

From what I can gather, employers are reluctant to get on board with UHC because of the leverage they would lose with employees. Leverage supported by the current systemic mess. If UHC was implemented, I wouldn't expect wages to go up in accordance with employers' direct cost savings; they'll go up for competitive and market reasons as always. Besides, employers are probably going to pay higher tax rates as their share of contribution to the national program.

Non-profits, like the one for which I work, certainly generate surpluses which are the real life equivalent of profits (I'm an accountant). So the semantics are unimportant from a certain POV. However, a non-profit is tasked for a mission and that mission is controlled by a board that does not seek the enrichment of itself, it's executives nor its shareholders. It's not just a money making entity for the people who run it.

Finally, too many people, like the OP, are concerned with health insurance instead of health care and Americans' access to it.
Some employers would love to get out of the health insurance business, and leave that to the exchanges. It's a big cost to companies, and a hassle to manage. Large companies are often self-insured, too.
  #124  
Old 09-20-2019, 12:48 PM
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Originally Posted by Gyrate View Post
I'll just point out that even in UHC systems there often exists a second private tier of health insurance for those who want more than the basic healthcare service.
Please let us note that "public" does not equal "basic". In Spain, while there areas where some fancy machine or other happens to be in a private clinic/hospital, most of the fanciest ones are in public hospitals; people choosing private care are often surprised to have their doc send them to the public system for certain tests.

One of the issues I had when I was a TA in the US, a long, long time ago, was that the insurance I received from my regional government wasn't considered acceptable by my US uni: the uni was expecting the kind of detailed coverage list in tiny print that US policies include; my insurance covered "all costs of medical care, except for elective procedures (i.e., anything which would be covered in Spain's public system)". It was a lot wider than the coverage I had to pay for locally (for example, any costs associated with pregnancy and delivery would have been covered except for artificial insemination), but it wasn't a language the Americans understood.


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Originally Posted by Richard Parker View Post
In the United States, there is a lot of paperwork that accompanies billing Medicare. It varies from practice to practice. It is still fundamentally procedure and diagnosis coding, but it is vast and complex and requires staff trained to do it well. You can take a glance at the Medicare billing regulations if you want a sense of it. That is the nature of a healthcare system that is much larger and more complex than Canada's, perhaps among other differences.

You don't get rid of that paperwork by eliminating private insurers. As I conceded in the post which you're labeling "categorically false," you may well marginally reduce the administrative cost associated with billing. But you don't likely reduce it so much that you gain all the savings of having all that staff and staff time.
What is this "billing" you speak of? Spanish private clinics working for the public system work on the basis of estimates, not itemized billing. Periodically the clinic and the regional healthcare administration get the list of "procedures done in the last period which aren't elective and which the patient didn't pay for out of pocket", and use that as the basis to define payments for the next period. Adjustments are done only if the lists of "stuff done" turn out to be extremely different from the previous period (situations such as a clinic opening a whole new wing, for example).
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Last edited by Nava; 09-20-2019 at 12:53 PM.
  #125  
Old 09-20-2019, 03:30 PM
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Originally Posted by Linden Arden View Post
Having voted for every Democrat since Bill Clinton I would like to vote for another pro-business Democrat. Barack Obama was the gold standard with his JOBS Act and TPP.

Now there is this:



https://www.cnn.com/2019/09/14/polit...nce/index.html

And Senator Warren claims she doesn't know ANYONE who likes their health insurance?

Kaiser:



If successful in the primaries a Warren or Sanders would doom the Democratic Party in 2020.



Why would a candidate wear such a millstone?
If, somehow, Bernie or Elizabeth W became President, they could not simply declare the end of private insurance and usher in the new age of Medicare for all. I sincerely doubt that they would find enough support even among their fellow Democrats in the House and Senate to ever make it fly. Furthermore, I think they both know that. That is a big reason I like Joe. He is not promising anything he does not have a reasonable chance of fulfilling. No, he is not the most progressive liberal in the pack. That, to me, is a big reason why he is who we need in the Oval Office next time round. Anyone too far left of center, in my opinion, will over-correct the skid we are in thanks to Orange Doody Head. Now, if you'll excuse me, I have to use the Trump.
  #126  
Old 09-20-2019, 04:16 PM
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Originally Posted by Richard Parker View Post
You don't get rid of that paperwork by eliminating private insurers. As I conceded in the post which you're labeling "categorically false," you may well marginally reduce the administrative cost associated with billing. But you don't likely reduce it so much that you gain all the savings of having all that staff and staff time.
I am honestly curious here: How do you imagine "billing" happens in systems outside the US? In the public sector I mean. Serious question. How do you imagine it?
  #127  
Old 09-20-2019, 07:22 PM
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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.
Cool. I've been your guinea pig. I've been on Medicaid. It's really nice having negligible co-pays, like a couple dollars. It's not nice that I don't seem to have access to certain specialists in my area, but that seems like a physician shortage, which is possibly a training issue.

If you really want to see what's possible, look at Canada, Australia, France....
  #128  
Old 09-20-2019, 08:25 PM
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My spouse was on Medicaid the last six years of his life.

During that time, all his daily medications were paid for, no or negligible co-pays. There diabetes meds, high cholesterol, depression/chronic pain meds, and antibiotics for recurrent urinary tract infections. Also two rounds of fungal medications for fungal urinary tract infections, the second of which was administered by PICC line and home infusion. All paid for.

His cancer treatment, from initial hospitalization and diagnosis, a round of chemo, two more hospitalizations and four trips to the ER all paid for. His month in a "rehab" facility paid for - in fact, we had a choice of three different ones. His final two weeks in a hospital on "comfort care" all paid for.

My-sister-the-doctor, at Mr. Broomstick's request, reviewed his treatment as he was concerned that he was getting less than what other did because he was poor and on Medicaid. Dr. Sister said that he received the proper and standard treatment for his cancer and the stage it was in, the only difference being that Medicaid would not pay for a PET scan... but she pointed out that regardless of the test results the treatment would be the same (and, alas, so would the prognosis) so that made no difference, the other imaging modalities used would do just as well for staging the cancer.

Our total out-of-pocket cost: $25. For the co-pay for the first emergency room visit just before Thanksgiving.

Keep in mind - under Indiana rules we in fact DID pay a monthly premium for our Medicaid coverage. It was 2% of our gross income. A sum even we, as people below the official Federal poverty line, could afford to pay.

So... happy to be a guinea pig.

Because I am now financially better off I now have employer-sponsored private insurance. I pay significantly more, have substantial out-of-pocket costs, and if I have a cancer diagnosis myself those out-of-pocket costs will bankrupt me rapidly.

Give me UHC. Please.
  #129  
Old 09-21-2019, 05:27 AM
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Cool. I've been your guinea pig. I've been on Medicaid. It's really nice having negligible co-pays, like a couple dollars. It's not nice that I don't seem to have access to certain specialists in my area, but that seems like a physician shortage, which is possibly a training issue.

If you really want to see what's possible, look at Canada, Australia, France....
FTR: I wasn't speaking for myself. I was referring to people like the OP and my friends.
  #130  
Old 09-21-2019, 09:00 AM
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The US had decided that they'd rather use GoFundMe as their healthcare insurance plan. SMH.

After years of living in the UK and Japan, I shudder at the thought of having to live again under the US healthcare system. It's such a joke, it'd be funny if it wasn't so tragic.

US pays more, for worse outcomes, than the rest of the world - healthcare spending per capita is more than double that of Japan, the UK, Australia, France, Canada.... what's crazy is that even though the US doesn't have UHC, it still spends more public money on health care than other countries, while covering vastly fewer people.

The US has higher rates of medical/lab errors than the rest of the world. The rest of the world on average has faster access to a doctor than the US. In the US, you're more likely to use the emergency department in place of a regular office visit than in other countries. Administration costs account for around 8% of total healthcare costs in the US, vs....1-2% everywhere else.

I've experienced the health care system in the US, Japan and the UK. Only in the US do people seriously worry about the financial implications of a serious illness. My wife (Japanese) had colon cancer. The out-of-pocket cost for the entire process - diagnosis, surgery, follow-up visits, medication, over around two years - was less than $3,000.

We had two children while living in London - both free NHS care, including clinic visits and midwife visits to our home.

Seriously - anyone that looks around and thinks the US health care/insurance system is ok is delusional.
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  #131  
Old 09-21-2019, 09:30 AM
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Having voted for every Democrat since Bill Clinton I would like to vote for another pro-business Democrat. Barack Obama was the gold standard with his JOBS Act and TPP.

Now there is this:



https://www.cnn.com/2019/09/14/polit...nce/index.html

And Senator Warren claims she doesn't know ANYONE who likes their health insurance?

Kaiser:



If successful in the primaries a Warren or Sanders would doom the Democratic Party in 2020.



Why would a candidate wear such a millstone?
I'm really kinda hoping that Warren can find a compromise or plan B position to satisfy voters such as yourself, and I agree that hers is a risky position to take into a general election.

Having said that, I think a lot of people who love, love, love their insurance love it because they've never really, really, really needed it. Some, of course, really do have excellent healthcare plans through their employers...which they would lose if their health declined to the point where they were no longer considered valuable as employees. And you can't just sign up for Medicaid the moment you need it.

Just a thought.
  #132  
Old 09-21-2019, 09:54 AM
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I'm really kinda hoping that Warren can find a compromise or plan B position to satisfy voters such as yourself, and I agree that hers is a risky position to take into a general election.

Having said that, I think a lot of people who love, love, love their insurance love it because they've never really, really, really needed it. Some, of course, really do have excellent healthcare plans through their employers...which they would lose if their health declined to the point where they were no longer considered valuable as employees. And you can't just sign up for Medicaid the moment you need it.

Just a thought.
Warren is smart enough to know that there's more than one way to skin a cat. We'll see if she moderates her position on healthcare, because I honestly don't think she thought this issue through as much as she typically does in most issues. It's easy to scream about insurance companies and drug companies making "billions and billions", and just play to the crowd and talk about eliminating an industry.

I like Biden's view. He understands that alot of improvement can be made by building on the ACA. It's practical, and it's true.
  #133  
Old 09-21-2019, 10:15 AM
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Saying most Americans are satisfied with their current coverage is like saying 83% of Russian Roulette players are happy with the outcome.
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  #134  
Old 09-21-2019, 11:05 AM
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Saying most Americans are satisfied with their current coverage is like saying 83% of Russian Roulette players are happy with the outcome.
That's nonsense. Is your comment a variation of the "Americans are stupid and ignorant" point? I sure hope our Democrat politicians don't use that line. If so, they'll get killed in the election. Good Lord.
  #135  
Old 09-21-2019, 11:39 AM
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That's nonsense. Is your comment a variation of the "Americans are stupid and ignorant" point? I sure hope our Democrat politicians don't use that line. If so, they'll get killed in the election. Good Lord.
No, I believe he is saying that the people who are satisfied are mainly those who have never had to use it for serious medical emergencies.
  #136  
Old 09-21-2019, 11:47 AM
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No, I believe he is saying that the people who are satisfied are mainly those who have never had to use it for serious medical emergencies.
Indeed. Catastrophic injuries and illnesses are essentially random (at least for relatively young people - the odds increase dramatically with age) so the majority who manage to evade them think, not unjustly, they're doing fine.

But hey, feel free to get all offended if that floats your boat, surv.
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  #137  
Old 09-21-2019, 02:48 PM
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That's nonsense. Is your comment a variation of the "Americans are stupid and ignorant" point?
I don't think HIS comments are, but wait for it...

I DO think that when it comes to health care, health insurance, and health coverage (with a side of actual medical care) that the average actually IS ignorant. Along with misinformed, which only sustains the ignorance. Americans have been lied to on this issue all their lives and most, yes, are too stupid to research the topic in a truly rational manner, that is, by actually looking at what (literally) over a hundred other nations are doing and doing successfully: healthcare for everyone at less cost per person and better results.

Failure to recognize that the rest of the world is in fact doing this better is both stupid and cruel.

Quote:
I sure hope our Democrat politicians don't use that line. If so, they'll get killed in the election. Good Lord.
Yes unfortunately truth will not set you free here. Politicians sometimes have to lie to get shit done. Or to get elected.

The difference here is that Republicans and lie and other Republicans don't give a damn. But a Democrat is raked over the coals for the least little inconsistency, even worse if there's an actual lie.
  #138  
Old 09-21-2019, 03:17 PM
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I don't think HIS comments are, but wait for it...

I DO think that when it comes to health care, health insurance, and health coverage (with a side of actual medical care) that the average actually IS ignorant. Along with misinformed, which only sustains the ignorance. Americans have been lied to on this issue all their lives and most, yes, are too stupid to research the topic in a truly rational manner, that is, by actually looking at what (literally) over a hundred other nations are doing and doing successfully: healthcare for everyone at less cost per person and better results.

Failure to recognize that the rest of the world is in fact doing this better is both stupid and cruel.
As an asides, if you follow this subject on forums, it is not unusual for Americans to propose "solutions" to the healthcare problem that are clearly products of intelligent and reasoning minds. And that are basically a proto-version of the French or German, or Norwegian or whatever systems. Which they have come up with out of a desire to solve the issue without copying any other nations system, without single payer and without ever looking up how single payer or systems in other nations actually work.

This desire not to copy the best practice in the area, and to try to avoid it and avoid even learning what it is... its quite unique in my experience.
  #139  
Old 09-21-2019, 03:47 PM
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It's because copying anyone else's system is to admit they did it first and better... which is contrary to the line they've heard all their life that "We're number 1!!!"
  #140  
Old 09-21-2019, 03:48 PM
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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.

I know that if everyone is on Medicaid then Medicaid will suffer more than it already does.

(For the record I support the ACA)
Most nations with UHC do not have true single payer. They have multiple payers, or they have a public payer which people can either opt out of or buy additional coverage on the private marketplace.

I'm not opposed to that. How do you feel about a system like Australia or the NHS in the UK? Over there they have single payer but if you want better health insurance, you can purchase it privately.

Or places like the Netherlands or Switzerland are good too. They basically have a much better run version of the ACA. There are exchanges to buy private insurance, premiums are capped as a % of income.

There are multiple paths to a working, humane, affordable UHC system. Single payer is only one. However single payer does seem to reduce costs more than any private system would, at least in the US.
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  #141  
Old 09-21-2019, 04:18 PM
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What I don't think the OP completely understands is that any plan offered by the Democrats is going to be an improvement over what Republicans will offer -- which is to simply overturn the ACA and replace it with... nothing.

No more controls on profits. No more protection for preexisting conditions. Back to crap plans offered by insurance companies that basically cover nothing. Employers will struggle even harder to offer good plans for their employees, and god help sole proprietors or unemployed folks who don't have access to insurance through a group plan.

Here (Vox) and here (Arizona Public Health Association) are a couple good articles that explain it.

Ruling expected from the 5th Circuit just about any day.
  #142  
Old 09-21-2019, 10:59 PM
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I don't think HIS comments are, but wait for it...

I DO think that when it comes to health care, health insurance, and health coverage (with a side of actual medical care) that the average actually IS ignorant. Along with misinformed, which only sustains the ignorance. Americans have been lied to on this issue all their lives and most, yes, are too stupid to research the topic in a truly rational manner, that is, by actually looking at what (literally) over a hundred other nations are doing and doing successfully: healthcare for everyone at less cost per person and better results.

Failure to recognize that the rest of the world is in fact doing this better is both stupid and cruel.
QFT, and well said, along with several other excellent recent posts.

Maybe a good way to articulate the fundamental problem with the original post is the following. If a politician in my province proposed a plan to nationalize car insurance, as at least two Canadian provinces have done, I'd be against it and he'd lose my vote. I like my car insurance company and because of my record, they like me. We get along fine and I would hate to lose that relationship, and I think it's also important to have a choice among competitive insurers. There are differences in how fairly and efficiently claims are adjudicated, how claims affect your record and your premiums, how they evaluate damage and assess write-offs, there are differences in rates, differences in accident forgiveness etc. IOW, it's insurance, and the many specific policy details vary quite a lot, and I like the one I have.

All of which sounds just like the OP's logic, except it fails in the case of health care because the OP has the same misunderstanding about health care coverage that most Americans do: they have been misled by the uniquely American health care experience and by industry propagandizing into believing that health care coverage is insurance just like any other insurance, and it fundamentally is not. Conventional insurance through private companies is absolutely the wrong tool for funding health care, like trying to hammer a nail with the handle of a screwdriver. In the single payer system that I know best, the one in Ontario under the terms of the Canada Health Act, the notion of choice in a competitive health insurance market is both non-existent and unnecessary. The "terms of coverage" can be stated in one sentence: all provinces receiving federal money for health care must run a system that covers all medically necessary procedures that are normally performed by doctors and hospitals, without condition or limitations and without cost to the patient. This is the only moral and ethical way to manage human health care, because the alternative is to let people suffer and die because they can't afford essential medical care.

And given that one-sentence description which basically says if you need medical care you will get it, and it will be provided at no cost by any physician or any hospital that you choose, what possible choices could you need to make? That's why it's not "insurance", but more like a public service that pays for health care, which itself mostly remains in the private sector. So if the OP continues to have access to all of his existing health care providers, with the only difference being that the government pays the bills, what is it that Warren's or Sanders' proposal is "taking away"? What they're taking away is literally a useless bureaucratic middleman.
  #143  
Old 09-22-2019, 07:53 AM
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I don't think HIS comments are, but wait for it...

I DO think that when it comes to health care, health insurance, and health coverage (with a side of actual medical care) that the average actually IS ignorant. Along with misinformed, which only sustains the ignorance. Americans have been lied to on this issue all their lives and most, yes, are too stupid to research the topic in a truly rational manner, that is, by actually looking at what (literally) over a hundred other nations are doing and doing successfully: healthcare for everyone at less cost per person and better results.

Failure to recognize that the rest of the world is in fact doing this better is both stupid and cruel.


Yes unfortunately truth will not set you free here. Politicians sometimes have to lie to get shit done. Or to get elected.

The difference here is that Republicans and lie and other Republicans don't give a damn. But a Democrat is raked over the coals for the least little inconsistency, even worse if there's an actual lie.
Most people don't understand macro-systems. But they do know their own situation. For instance, I know that I'm doing very well with my health insurance here in the USA. I'm aware that about 8% of this country doesn't have health insurance, and that's a problem. But 92% does have coverage and most are doing quite well. So, when we talk about overhauling a macro-system, we need be cognizant of the fact that essentially 3 out of 4 people like what they themselves have. That's one of - not the only - but one of the reasons I like the incrementalist approach: Build on the ACA, don't throw out private insurance...

We can achieve UHC without throwing away what we already have. Some Dem candidates understand that. Some appear not to understand that.

I agree with you about Republicans and Democrats and how much their lies hurt them. Dem voters hold their politicians to a higher standard. But what I fear is that a jihad against private insurance will alienate independents and people who are persuadable.
  #144  
Old 09-22-2019, 10:31 AM
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As an asides, if you follow this subject on forums, it is not unusual for Americans to propose "solutions" to the healthcare problem that are clearly products of intelligent and reasoning minds. And that are basically a proto-version of the French or German, or Norwegian or whatever systems. Which they have come up with out of a desire to solve the issue without copying any other nations system, without single payer and without ever looking up how single payer or systems in other nations actually work.

This desire not to copy the best practice in the area, and to try to avoid it and avoid even learning what it is... its quite unique in my experience.
It's an indicator of societal decline when supposedly great nations are foolishly deluded into fantasies of their own cultural superiority.

"We know what's best for Americans because, well, we're Americans, and we're just different, you see."

  #145  
Old 09-22-2019, 10:38 AM
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Most people don't understand macro-systems. But they do know their own situation. For instance, I know that I'm doing very well with my health insurance here in the USA. I'm aware that about 8% of this country doesn't have health insurance, and that's a problem. But 92% does have coverage and most are doing quite well. So, when we talk about overhauling a macro-system, we need be cognizant of the fact that essentially 3 out of 4 people like what they themselves have. That's one of - not the only - but one of the reasons I like the incrementalist approach: Build on the ACA, don't throw out private insurance...

We can achieve UHC without throwing away what we already have. Some Dem candidates understand that. Some appear not to understand that.

I agree with you about Republicans and Democrats and how much their lies hurt them. Dem voters hold their politicians to a higher standard. But what I fear is that a jihad against private insurance will alienate independents and people who are persuadable.
I would hazard a guess that you don't really know how well you're doing with your health insurance until you really need it. You think you know, you have peace of mind, maybe, but you don't really know what your insurance company will pay for until you're confronted with an immediate health crisis that is both urgent and expensive. The urgency of the situation will lead to you making decisions of profound economic consequence without consideration of those consequences because you'll prioritize the urgency as it relates to your health. It'll only be after you've recovered - assuming you have - that you'll find out that the ambulance ride and the anesthetist were actually provided by out of network carriers, thereby leaving you stuck with a massive bill.

I've heard people say "Oh no, that won't be me because I've read my policy and I already know which ambulance I'll use, which hospital I'll go to, which doctor I'll use, which services I'll select while I'm in the ER." I'm like, come the fuck on! Wake up, Americans! Because there's no guarantee you'll even be conscious or in a cognitive state that would enable you to intelligently make such decisions, and b)....you shouldn't fucking have to worry about it in the first place! Isn't that why you GET insurance ?! Nobody in New Zealand, Canada, the UK, Australia, or the EU has to worry about making these kinds of economic decisions during a health crisis. It's utterly absurd.

Last edited by asahi; 09-22-2019 at 10:38 AM.
  #146  
Old 09-22-2019, 12:15 PM
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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....
Wow, I'm jealous. I haven't had a choice of health insurers in decades. I get what my employer decided I can get.

And even if health insurance were the only aspect of a job I cared about (and of course it's not) there isn't any real way to shop for a job with better insurance, because they don't give you the full details of the policy when they offer you a job. If you're lucky they may tell you which insurer they have negotiated a plan with, but that's about it.

That being said, I think you would be foolish to vote against a candidate because they promise to eliminate private health insurance in the US, because the odds of any candidate doing that are pretty close to zero.

I'm pro-choice, but I don't care what my governor's position is, because my state is not going to outlaw abortion whatever he thinks. I DO care what his position is on the death penalty, where my state legislature is mixed, and the governor could have a large impact.

So, I think you should focus your voting decision on things the possible candidates might actually accomplish. not their pie-in-the-sky promises.

Quote:
Originally Posted by Grrr! View Post
....Let others be the guinea pig and if they do alright maybe the rest will come around.
There are about 50 countries that have already tried this experiment. And all of them have lower costs and most of them offer better care by most metrics.
  #147  
Old 09-22-2019, 03:06 PM
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Maybe a good way to articulate the fundamental problem with the original post is the following. If a politician in my province proposed a plan to nationalize car insurance, as at least two Canadian provinces have done, I'd be against it and he'd lose my vote. I like my car insurance company and because of my record, they like me. We get along fine and I would hate to lose that relationship, and I think it's also important to have a choice among competitive insurers. There are differences in how fairly and efficiently claims are adjudicated, how claims affect your record and your premiums, how they evaluate damage and assess write-offs, there are differences in rates, differences in accident forgiveness etc. IOW, it's insurance, and the many specific policy details vary quite a lot, and I like the one I have.
I understand where you're coming from, but I have to quibble with you a bit, in your description of how car insurance works in Sask. Yes, we have government-mandated car insurance from SGI ("Saskatchewan Government Insurance "). Everyone has to get their basic coverage from SGI.

But that's just the basic "plate package", to ensure everyone has the statutory minimum coverage, no funny exclusions or conditions. If you want more coverage than the stat minimum, there's nothing stopping you as consumer from shopping around getting more coverage from a different insurance company. SGI offers extended coverage as well.

And that's just what I did: sat down with my independent broker and reviewed the options available to me for added coverage.

And that type of model might work for UHC in the US. If I've understood correctly from posters from Australia and New Zealand, i think that sounds sort of like their UHC system.

There aren't still major diffs between car insurance and health insurance, though. Car insurance is simpler than health insurance. As a consumer, I understand the coverage issues for car insurance better than health insurance. ANd there's rarely that crisis situation that arises with health care. But still, a basic state package with individual private add-ons could offer a way to UHC. Doesn't have to be single payer monopoly, so long as the basic package is truly comprehensive.



Quote:
And given that one-sentence description which basically says if you need medical care you will get it, and it will be provided at no cost by any physician or any hospital that you choose, what possible choices could you need to make? That's why it's not "insurance", but more like a public service that pays for health care, which itself mostly remains in the private secto
General agreement here. I think it's best to consider health care as public service, not an insurance commodity.
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  #148  
Old 09-22-2019, 03:58 PM
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I would hazard a guess that you don't really know how well you're doing with your health insurance until you really need it. You think you know, you have peace of mind, maybe, but you don't really know what your insurance company will pay for until you're confronted with an immediate health crisis that is both urgent and expensive. The urgency of the situation will lead to you making decisions of profound economic consequence without consideration of those consequences because you'll prioritize the urgency as it relates to your health. It'll only be after you've recovered - assuming you have - that you'll find out that the ambulance ride and the anesthetist were actually provided by out of network carriers, thereby leaving you stuck with a massive bill.

I've heard people say "Oh no, that won't be me because I've read my policy and I already know which ambulance I'll use, which hospital I'll go to, which doctor I'll use, which services I'll select while I'm in the ER." I'm like, come the fuck on! Wake up, Americans! Because there's no guarantee you'll even be conscious or in a cognitive state that would enable you to intelligently make such decisions, and b)....you shouldn't fucking have to worry about it in the first place! Isn't that why you GET insurance ?! Nobody in New Zealand, Canada, the UK, Australia, or the EU has to worry about making these kinds of economic decisions during a health crisis. It's utterly absurd.
Thank you for your concern about whether we Americans are awake or not. I've had to use the ER a few times, as well as an ambulance once. No big deal from a cost standpoint, as insurance picked up almost all the cost. I also know people who have the same insurance I have, and who've had cancer. They had some out-of-pocket costs, but they were not much.

One thing to keep in mind here is that the ACA has put alot of regs on insurance even that's not on the exchanges. So, we don't have as many horror stories as what you're used to hearing about....Main problem is uninsured. That's the main item we need to tackle, not all this concern about people like me who have very good insurance and don't want to lose it.
  #149  
Old 09-22-2019, 07:47 PM
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Even your "very good health insurance" is light-years worse than what Bernie is pitching, which is a sort-of-Canadian Medicaid-for-everybody system.

Remember that Bernie come out of Vermont, which borders Quebec, which has one of the more generous provincial forms of Canadian "socialised medicine." He has constituents who know what's possible because it's right across the border.
  #150  
Old 09-22-2019, 08:00 PM
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Most people don't understand macro-systems. But they do know their own situation. For instance, I know that I'm doing very well with my health insurance here in the USA.
Are you?

Tell me, how much out of pocket would you be if you rang up a million dollar medical bill? Can you handle $200,000?

Most people are quite healthy most of the time, which is why they can be happy even with shitty insurance coverage. For the most part, they aren't using it, or only a very tiny bit of it.

That's the problem - people don't realize how vulnerable they are until it's too late. And then, well, it's too late.
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