Like you CAN’T HEAR how having 2-3 fewer employers in the practise (to manage forms, calls, lawyers and insurers!) seriously raises how much the practice profits? That kind of ‘can’t hear’?
More like not being able to hear that THE FIGURES FOR MEDICARE FOR ALL ALREADY INCLUDE ADMINISTRATIVE SAVINGS FROM NOT HAVING TO MANAGE DIFFERENT INSURERS. AND DOCTORS LOSE MONEY ON MEDICARE PATIENTS.
That kind of “can’t hear”.
Regards,
Shodan
Focus on exactly how many Billion is spent on some program, or how many are spent by some particular family is a way to lose sight of the forest for the trees. Instead one should focus first on the broadest brushstrokes:
- The per capita spending on healthcare by the U.S. has been growing rapidly, and is projected to continue growing. This is caused by the increasing number of old Americans, and the increased use of expensive therapies. Often large sums are spent during the final months of life. Can society afford this? If a public organization tried to ration such care the right-wingers would shriek about the government sending Granny to the death camps; the same people would applaud if “free market” providers rationed.
Since costs will continue to grow no matter what, right-wingers will blame this on government involvement. Obamacare gets the blame for costs which would have grown anyway. Such ignorant heckling will continue to be an obstacle for reform.
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Government-funded healthcare will require taxes whereby the rich help pay for the healthcare of the poor. Wealthy people should anticipate that their taxes will rise; perhaps they can salvage a charitable instinct for poor Americans. For rational-thinking and charitable Americans this rise in taxes is a simple matter of arithmetic. For many right-wingers it is simply a deal-killer.
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A massive change in funding will require other massive changes. For example, a person getting $5000 worth of employer-provided insurance or care might expect a $5000 raise when the employer’s healthcare role is taken over by government. Will such raises be automatic? The right-wing, with its right-to-scab laws etc., is fighting hard against employees and for the excess profits of corporations.
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Government funding provides opportunities for cost savings. For example, America employs millions of insurance adjusters along with clerks needed to interact with adjusters. Wages for these useless employees might no longer be needed under a rational healthcare system. However, the power of insurance company lobbyists make it unlikely that these middlemen could be eliminated (unless voters wise up and reject the corrupt Congressmen suckling at the corrupt corporate teats).
TL;DR: Don’t focus on specific accounting or whether a particular family will benefit. First address the big questions, starting with: Does America as a country want to provide healthcare for people who can’t afford it?
I’m still not sure why this is so surprising to people. If all of my choices are free, I’m going to go to the one that is the fastest - the emergency room.
Do other countries that have a form of UHC ration that care? If so, what form does the rationing take? Is that bad?
I’ve asked this before, but does your statement mean if I was a doctor, and I opened up a practice that ONLY saw Medicare patients, I would not make any money?
But you could make it up in volume!
Except that emergency rooms often aren’t the fastest in terms of waiting time. Nobody expects people to stop going to the ER if they had a heart attack or a stoke or were in a major car accident - the ER visits we’re hoping to cut down on are those for pneumonia and that sort of thing. And you may be in the ER 10-12 hours for that sort of issue - triage is going to take the strokes and car accidents first. I think there are two different issues that drive uninsured people to the emergency room for non-urgent injuries and illnesses. One is that ERs typically treat regardless of the ability to pay. Sure you might get a bill later, but you’ll get treated now. And the other, related reason is that people without insurance try to hold out , hoping to recover without any treatment - and they end up at the ER at 4am Sunday morning rather than at the urgent care at 7pm Saturday or at he PCP at 3pm on Friday.
Having insurance hopefully means that people no longer go to the ER because the urgent care or PCP won’t treat them without payment/insurance upfront - but they still may hope they can get over their illness without a dr’s visit and the associated copay.
What are you talking about? I can make an appointment with my PCM for 1 week from now, or I can be seen tonight in the ER? Which one seems faster to you?
Me personally, I never see my PCM. When I have an issue (always tonsillitis), I go to Urgent Care that night because it costs me the same as a doctor’s visit and I’m done in a couple hours.
If I wake up feeling ill, I can be seen later on today or possibly tomorrow by my PCP , who leaves space in his schedule for sick patients. I can go to an urgent care and be seen within an hour or two, just like you can. Or I can go to the ER , where I will spend a minimum of 8 hours .So yeah, it’s possible I might wait a little longer under more comfortable circumstances to see the PCP the next day. Or not- I said the minimum in an ER would be 8 hours. It could be longer - I know I’ve waited more than 12.
Therefore the only reason I go to the ER is if A) the urgent care is closed and I don’t think I can wait till the next day ( which means I’m pretty much never going to the ER for tonsillitis or pneumonia or B) I think the urgent care is going to send me to the ER anyway.
That’s all pretty much true, but from reading about people’s health care options on this board, Urgent Care is not something that seems to be available to a lot of people. Which is surprising to me, since my town has Urgent Care facilities popping up every 6 months it seems.
One problem with Urgent Care centers under the current system is they may not be in network or covered by your insurance, which may want you to see your PCP.
Then there’s the separate issue of stand alone ER’s and how they get confused for Urgent Care centers, but the billing is different. Go to one of those and payment may be denied because it’s decided you didn’t have an actual “emergency”.
What I did was call up my insurance company and ask them “which urgent care facilities in my zip code am I allowed to go to?” And then they told me. And I go to that one.
But still, I don’t know how much it costs, or if it costs more for me to go to an Urgent Care center, or wait to see my PCM. The copays are the same. So I go to the one that is easiest, and open until 10PM and I don’t need an appointment.
So, now the House Democrats have put something out in the public sphere that I have been advocating on this board for months. They are trying to fix some of the holes in the existing ACA, and pushing an ACA 2.0. It beefs up the subsidies significantly, fixes a few glitches from the original law, and it allows people who make over 400% of poverty level to also get subsidies by limiting the premiums as a % of income. The bill also tries to reverse some of the Trump-sabotage. If this bill were enacted, I think we’d get from the current 9% uninsured rate to below 5%. It would make a significant dent. I don’t think we get to 0% uninsured until we re-establish the individual mandate penalty and put some teeth to it.
But overall, I think this is a good thing, and should be applauded by anyone that wants to see UHC become a reality in the US.
And the President just said that the Republicans will be the party of healthcare. How? The hospitals will bill the government directly, who will pay the hospitals.
:smack: I thought he was opposed to single payer?
Oh, they’re cooking up a great healthcare plan. It’s been in the works since 2010, when they first started screaming “repeal and replace”. Believe me, it’ll be the bestest, most awesomest healthcare you’ve ever seen…Just keep following the rainbow, and the plan is located at the end, next to the pot of gold.
Well, you and I can at least agree on that point. When it comes to health care (or anything else, really) the current crop of Republicans are a bunch of immoral, opportunistic and unfeeling callous assholes concerned with no one but themselves.
It is a good thing. I don’t disagree on that point at all. Our disagreement is that I consider this to be a half-assed approach to a fundamental problem that is inevitably going to result in a half-assed solution. The more things you improve, the better things will be for most people, obviously, but a half-assed solution will never fix the fundamental problems. For instance, costs will keep going up out of proportion to the rest of the civilized world, and there will always be uninsured. The question “Ya got insurance?” is fundamentally a question that should never be asked, because the obvious response should be “I live here, don’t I?”.
When designing a system, there’s a slider that adjust between the mutually exclusive goals of fast response and greater throughput. Fast response means some providers are always sitting idle and ready to serve, which means you pay to have providers doing nothing. OTOH if we maximize throughput, that means some consumers have to wait a really long time, which means politically uncomfortable choices about which sorts of cases need to wait.
If we don’t have infinite funding, then we have to choose where we shift that slider. We either have a hugely expensive system where nobody needs to wait, or a very cheap system where most of us wait a long time, or a really contentious process about who needs to wait and who doesn’t (cue “Death Panel” hysteria).
So that’s basically it. We have to have a conversation about what’s an acceptable wait time in which circumstance, and another conversation about whether having a lot of money moves you up on the priority list. Most Americans seem OK with the idea that being poor means you’re at the end of the priority list, which sucks, but we still need to talk about relative priority among people of similar economic means.
Look, I understand that this is not the end goal, just getting UHC and declaring victory. I think once the Dems pass these ACA 2.0 fixes, and it becomes law, which will probably be 2021 if they win the 2020 elections, there will still be work to do. I especially think regulations need to be passed to limit the games that companies can play with pharmaceutical prices. Also, surprise bills need to be outlawed. There is also the individual mandate, and maybe a public option, as well as getting the rest of the states to accept the Medicaid expansion (I think the current count is now around 36 or so).
So, we can continue making improvements. But we start with ACA 2.0. It’s a very good bill, and anyone who cares about the uninsured in our country should support it.
They drive me crazy. The republican party used to be constructive on a number of fronts. But they gave up on governing years ago. They had a facade that finally came down completely with Trump’s election. Here’s an example of Republican-led government in the state of Utah…
I’ll let you read through the link to see how it went down. But the punchline is that the voters in Utah demanded a full Medicaid expansion via ballot. The Republicans are giving their voters the big fat middle-finger. The Republicans in the state legislature are only going to do a partial expansion, and it will cover fewer people and cost more. This kind of bullshit is what Republican governance gets us. This is all it’s good for.
OK, so now the state of Washington has passed a law that will pave the way for a public option. See link for details. This will be a big deal in that state, and might provide a template for other states to follow.
As I’ve said repeatedly, the path to UHC in America will come gradually through the states. I’d like to see it quicker. But that won’t happen as long as the Pubs control any one of the House, Senate or White House.
Latest from the CBO puts the uninured number up by about a million since 2016, now at 28.9 million.
Using our total population of around 327 million, then puts the overall uninsured rate at about 8.8%. My estimate by grabbing some population numbers.
https://www.cbo.gov/system/files/2019-04/55094-CoverageUnder65.pdf
The Trump sabotage is having an effect. Our system is holding up, but it’s slipping some.