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      Abbreviated rules   07/28/2017

      Underdawg did an excellent job of explaining the rules.  Here's the simplified version: Don't insinuate Pedo.  Warning and or timeout for a first offense.  PermaFlick for any subsequent offenses Don't out members.  See above for penalties.  Caveat:  if you have ever used your own real name or personal information here on the forums since, like, ever - it doesn't count and you are fair game. If you see spam posts, report it to the mods.  We do not hang out in every thread 24/7 If you see any of the above, report it to the mods by hitting the Report button in the offending post.   We do not take action for foul language, off-subject content, or abusive behavior unless it escalates to persistent stalking.  There may be times that we might warn someone or flick someone for something particularly egregious.  There is no standard, we will know it when we see it.  If you continually report things that do not fall into rules #1 or 2 above, you may very well get a timeout yourself for annoying the Mods with repeated whining.  Use your best judgement. Warnings, timeouts, suspensions and flicks are arbitrary and capricious.  Deal with it.  Welcome to anarchy.   If you are a newbie, there are unwritten rules to adhere to.  They will be explained to you soon enough.  
cmilliken

Bernie's Medicare Plan

61 posts in this topic

34 minutes ago, cmilliken said:

http://www.cnn.com/2017/09/13/politics/bernie-sanders-medicare-for-all-plan-details/index.html

Personally, I suspect something like this is inevitable.

I'm glad to see it's actually out on the table so it can be thrashed out.

 

I'll be happy if it IS thrashed out - to include a full and honest discussion of the costs, and a pragmatic discussion of coverage expectations. 

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When is the USA going to get around to inventing the wheel?

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47 minutes ago, A guy in the Chesapeake said:

I'll be happy if it IS thrashed out - to include a full and honest discussion of the costs, and a pragmatic discussion of coverage expectations. 

Costs? As long as it's less than 17% of GDP it's a bargain.....

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1 hour ago, A guy in the Chesapeake said:
2 hours ago, cmilliken said:

http://www.cnn.com/2017/09/13/politics/bernie-sanders-medicare-for-all-plan-details/index.html

Personally, I suspect something like this is inevitable.

I'm glad to see it's actually out on the table so it can be thrashed out.

 

I'll be happy if it IS thrashed out - to include a full and honest discussion of the costs, and a pragmatic discussion of coverage expectations. 

it would be interesting to see which current programs can / would be rolled into it (medicare, medicaid, schip, va, planed phood, etc)

and if it will cover mental health and addiction

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Planned parenthood functions yes (they specifically mention abortion services so I assume that means birth control and preventative care), but the others we'll have to see.

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Personally, I'd be happy with a 'minimum coverage Medicare' plan with addons from the private markets.  You have strep?  Great, here's the 100% medically proven to work shot in the butt.  Don't like shots and want the designer pill pack instead?  Great, pay for it yourself or have your supplemental insurance cover it.  Murphy's plan isn't a bad start.

 

 

 

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4 minutes ago, cmilliken said:

Personally, I'd be happy with a 'minimum coverage Medicare' plan with addons from the private markets.  You have strep?  Great, here's the 100% medically proven to work shot in the butt.  Don't like shots and want the designer pill pack instead?  Great, pay for it yourself or have your supplemental insurance cover it.  Murphy's plan isn't a bad start.

 

 

 

works for me. 

 

Edit to ad: allowing cash customers to pay discounted rates would be YUGE as well. I was in Hong Kong and got a case of something nasty. $50 for a shot in the ass to keep my stomach contents down, and the appropriate Cipro-pack to kill the bug.

AND the Dr visited me in my room at 2am while I was heaving away....

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4 hours ago, SloopJonB said:

When is the USA going to get around to inventing the wheel?

:D Does feel rather like that from our perspective.

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As long as we can pay to skip to head of the line I'm cool with it.

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10 minutes ago, Rockdog said:

As long as we can pay to skip to head of the line I'm cool with it.

You can pay whatever you want to get in your own line.  Free trade and all that.  That's kinda the point :)  

 

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Ya never know..el president has such a disconnect when it comes to health care and such a driving urge to play King..he may very well back this plan ..because it's simple enough for him to understand and backing Bernie would piss both parties off :D

You get SP by accident :D

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22 minutes ago, cmilliken said:

You can pay whatever you want to get in your own line.  Free trade and all that.  That's kinda the point :)  

 

Government forcing me to pay for some other bums health insurance is not free trade.

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5 minutes ago, Rockdog said:

Government forcing me to pay for some other bums health insurance is not free trade.

But some other bum is paying for yours you ijjit..you don't think your health insurance is actually covering the cost of people when they get to your age do you?

My mother's paid top private health insurance all her working life...she 85 now and boy does she think she's entitled to have every treatment that it covers..and as often as SHE thinks she has a need for it.

She gets a little antsy when someone points out that because she claims so much so often some younger families can't afford private cover cos the premiums are too dam high.

This is why single payer is inevitable..gen x and gen y are sick and tired of paying for boomers to the point that they can't afford the same things for their own families.

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just curious, how many people here are actually on Medicare and are aware of what is and isn't covered and what the supplemental ins. costs? also, if this were to be adopted, I assume everybody will have to pay the $130+ a month that a medicare recipient now has to pay every month to be covered?

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50 minutes ago, rhakct said:

just curious, how many people here are actually on Medicare and are aware of what is and isn't covered and what the supplemental ins. costs? also, if this were to be adopted, I assume everybody will have to pay the $130+ a month that a medicare recipient now has to pay every month to be covered?

I'm on Medicare and have been since 2009.  My wife went on Medicare Sept 1 of this year.  And I know very well what our supplemental insurance costs.

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58 minutes ago, rhakct said:

just curious, how many people here are actually on Medicare and are aware of what is and isn't covered and what the supplemental ins. costs? also, if this were to be adopted, I assume everybody will have to pay the $130+ a month that a medicare recipient now has to pay every month to be covered?

Good question. Part B premiums, the Medicare deductible and co pays can add up to some considerable costs for the working poor.

i managed my mother's care and finances the last couple of years of her life. Medicare and a supplemental purchased under he retirement plan.  3 years ago, her supplemental was not too bad and between it and Medicare, her out of pocket was pretty low, other than prescription copays. Those were ok as long as she was on generics. Medicare coverage was pretty good for her various conditions. I don't believe we ran into much that wasn't covered. 

I'd say it isn't a bad baseline for universal coverage. 

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3 hours ago, Shortforbob said:

But some other bum is paying for yours you ijjit..you don't think your health insurance is actually covering the cost of people when they get to your age do you?

My mother's paid top private health insurance all her working life...she 85 now and boy does she think she's entitled to have every treatment that it covers..and as often as SHE thinks she has a need for it.

She gets a little antsy when someone points out that because she claims so much so often some younger families can't afford private cover cos the premiums are too dam high.

This is why single payer is inevitable..gen x and gen y are sick and tired of paying for boomers to the point that they can't afford the same things for their own families.

How much do you suppose these guys are paying, ijit?

 

Australian-Aborigines-in-chains-at-Wyndham-prison-1902-small.jpg.7c7f25d109dfadf2398f96204beca237.jpg

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3 hours ago, Rockdog said:

Government forcing me to pay for some other bums health insurance is not free trade.

That's why it's called insurance you fucking moron.

Jeezuss right wingers are amazing. Dunning - Kruger need to do a special study of them.

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Just now, SloopJonB said:

That's why it's called insurance you fucking moron.

Jeezuss right wingers are amazing. Dunning - Kruger need to do a special study of them.

Why not fuck the insurance industry and just pay for healthcare

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22 minutes ago, Moderate said:

Why not fuck the insurance industry and just pay for healthcare

We tried that. Bankruptcy and loss of payments raised the cost for everyone else. Cheaper for the nation to have everyone pay in.

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Trumps hard left turn may make Medicare for all a reality....

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24 minutes ago, Moderate said:

Why not fuck the insurance industry and just pay for healthcare

King of Socks :mehthis:

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11 minutes ago, Shortforbob said:

King of Socks :mehthis:

Do you disagree?

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14 minutes ago, Raz'r said:

We tried that. Bankruptcy and loss of payments raised the cost for everyone else. Cheaper for the nation to have everyone pay in.

When was that?

I would posit that eliminating the  insurance industry with their profits and their drones would go along way to paying for actuall healthcare

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6 minutes ago, Moderate said:

When was that?

I would posit that eliminating the  insurance industry with their profits and their drones would go along way to paying for actuall healthcare

What are you, 8? You don't remember the self insured from pre-ACA? Alzheimer's?

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I once saw a dramatization about a senator championing healthcare for all in America. He were giving a speech (SPEECH! SPEECH!) and when he stepped away from the podium an insurance guy standing behind a wall shot him through the head with a high powered rifle.

 

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More like alzhiemers.

The last .gov helthcare scam I was concerned with was Hillarycare. Remember the HMOs.

I just stay near the border most of the time and pay cash

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As long as it isn't the northern border.

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6 hours ago, Rockdog said:

Government forcing me to pay for some other bums health insurance is not free trade.

Yeah. Neither is the government forcing me to pay for some military expenditure I disagree with. That's the breaks of living in a first world democracy - your taxes aren't spent solely on you. Man up, son, and deal with it.

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1 hour ago, Moderate said:
1 hour ago, Shortforbob said:

King of Socks :mehthis:

Do you disagree?

Not at all. I agree you are King of Socks.

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6 hours ago, Innocent Bystander said:

Good question. Part B premiums, the Medicare deductible and co pays can add up to some considerable costs for the working poor.

i managed my mother's care and finances the last couple of years of her life. Medicare and a supplemental purchased under he retirement plan.  3 years ago, her supplemental was not too bad and between it and Medicare, her out of pocket was pretty low, other than prescription copays. Those were ok as long as she was on generics. Medicare coverage was pretty good for her various conditions. I don't believe we ran into much that wasn't covered. 

I'd say it isn't a bad baseline for universal coverage. 

That's actually why I like this particular version as a starting point as well. 

 

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I think that everyone agrees that the US healthcare system is a horrible mess. The ACA was an attempt, somewhat successful, at evolutionary change. Its biggest flaw is that it did not go far enough, e.g. the political will was not there to include a single-payer option. The question of what next is really how far. Sanders' suggestion is good in that it is starting the type of dialogue we see here about how to proceed. Obviously serious healthcare reform, not repeal/replace, will be the big issue in 2018 and 2020. Add this to Trump's and the GOP's general unpopularity right now and these will be fascinating elections to watch. Tough to run as a GOPer I think and that is exactly what they deserve.

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Aw..Trump doesn't think we have a better healthcare system than you anymore :(

http://www.smh.com.au/world/donald-trump-backs-down-on-comment-praising-australias-health-care-20170505-gvzhk7.html

Bernie Sanders is pushing hard for a single payer healthcare plan - a curse on the U.S. & its people...

  1. ...I told Republicans to approve healthcare fast or this would happen. But don't worry, I will veto because I love our country & its people.


  2.  
     

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Feel the Bern!

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So under "single payer" what would be the cost to the individual? I know with Medicare, Medicare supplement, and part D drug coverage - it costs me about $700 a month for the two of us. Is this going to change? if not, are you saying the low income will have to pay this also? don't forget there are still co-pays and drug co-pays on top of this figure.

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37 minutes ago, rhakct said:

So under "single payer" what would be the cost to the individual? I know with Medicare, Medicare supplement, and part D drug coverage - it costs me about $700 a month for the two of us. Is this going to change? if not, are you saying the low income will have to pay this also? don't forget there are still co-pays and drug co-pays on top of this figure.

my medicare contribution is 2% of my gross salary.. as is everyone's (cover's my kids too). Most pharmaceuticals cost about $15 per script. (unless you are low income or on SS of some sort, then they are $5) I can choose my own GP, choose my own specialists, choose where I go for pathology or imaging even choose my own public hospital unless it's an emergency admission.

Most of our public hospitals have done away with multi bed wards (you might get a twin), have private bathroom facilities. And the medical treatments for just about everything that's not cosmetic are state of the art. 

You guys really have no understanding about how badly you are being ripped off.

Low income earners like age pensioners and single parents pay nothing.

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10 minutes ago, Shortforbob said:

my medicare contribution is 2% of my gross salary.. as is everyone's (cover's my kids too). Most pharmaceuticals cost about $15 per script. (unless you are low income or on SS of some sort, then they are $5) I can choose my own GP, choose my own specialists, choose where I go for pathology or imaging even choose my own public hospital unless it's an emergency admission.

Most of our public hospitals have done away with multi bed wards (you might get a twin), have private bathroom facilities. And the medical treatments for just about everything that's not cosmetic are state of the art. 

You guys really have no understanding about how badly you are being ripped off.

Low income earners like age pensioners and single parents pay nothing.

Good insight. The US citizen is being robbed blind in HC. 2x world costs, shit results. The crime? They keep telling us how great it is, and how doing what every other country does will mean the end of GR8! Healthcare. Lying bastards, and idiot voters

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This is our new (ish) public childrens hospital.

https://www.google.com.au/search?q=royal+children's+hospital&rlz=1C1CHBD_en-gbAU714AU714&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjBtYnDjabWAhVLJ5QKHQb_A_EQ_AUIDCgD&biw=911&bih=441

These are the rooms

https://www.google.com.au/search?rlz=1C1CHBD_en-gbAU714AU714&biw=911&bih=441&tbm=isch&sa=1&q=royal+children's+hospital+beds&oq=royal+children's+hospital+beds&gs_l=psy-ab.3...100172.101483.0.102112.5.5.0.0.0.0.352.949.2-2j1.3.0....0...1.1.64.psy-ab..2.3.949...0j0i67k1j0i8i30k1j0i24k1.mOZJlkII3UM

and some more images

https://www.google.com.au/search?rlz=1C1CHBD_en-gbAU714AU714&biw=911&bih=441&tbm=isch&sa=1&q=royal+children's+hospital+theatres&oq=royal+children's+hospital+theatres&gs_l=psy-ab.3...46797.51154.0.52375.8.8.0.0.0.0.628.2245.2-1j1j1j2.5.0....0...1.1.64.psy-ab..3.2.621...0i8i30k1j0i24k1.pblpLPc0-ho

Without Medicare I'd be living in a trailer park :)

We can even be admitted to Private hospitals at no extra cost if they have better specialists (eg..the best oncologist for my daughters cancer was at a private hospital..so that's where The Childrens Hospital arranged for her treatment..over five years!!.

Like I said..you guys are so blinded you have no idea of the possibilities within a single payer system..the top end of my tax bracket is only 19% over $18,000 (nil before $18,000)

 

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On 9/14/2017 at 2:26 AM, Raz'r said:

works for me. 

 

Edit to ad: allowing cash customers to pay discounted rates would be YUGE as well. I was in Hong Kong and got a case of something nasty. $50 for a shot in the ass to keep my stomach contents down, and the appropriate Cipro-pack to kill the bug.

AND the Dr visited me in my room at 2am while I was heaving away....

You should be more discriminating with your selection of the Hong Kong hookers.  ;)

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On 9/14/2017 at 3:19 AM, Rockdog said:

Government forcing me to pay for some other bums health insurance is not free trade.

I hate to break it to you doggie, but you already are.  

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I think the answer is somewhere in the middle of Bernie's plan and the so-called "free market" insurance.

First of all, the insurance market isn't going to go away quietly and Bernie's plan would put them out of business essentially overnight.  Hence why it has less than zero chance in hell of even coming to a vote much less passing.  And that is true even if the D's owned all branches of gov't.  It just ain't going to happen.  The Senators from Aetna, UHC and BC/BS aren't going to let it happen.

My SOLution is to have medicare (or similar) for all, but have it be truly bare bones emergency, catasptohic and very basic coverage.  Including some very basic preventative health - i.e. yearly screenings and such.  Whatever the minimum it takes to keep you alive and relatively healthy, unless it's end of life care and then there will be death panels convened to pull the plug and send you to Hospice.  

Anything above that level of basic coverage - you are more than free to avail yourself of the market and buy whatever supplemental insurance you want to cover any and all ailments and cosmetic shit that are not covered under the single payer plan.  

The single payer/medicare aspect gets you your basic care and keeps you from losing the house if you get cancer or have a heart attack.  And the insurance market will then vye for all the rest of the "nice to have" stuff.  And there will be plenty.  Win Win.

Problem SOLved.  Shootist Jeff for Preznit.  Or at least HHS Secretary.  

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What do you guys imagine will be the effect of government controlled remuneration on the pharmaceutical  and medical technology industries?. What will be the effect on the medical professions? What will be the effect on the evolution of medicine which today is largely driven by the US free market?

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22 minutes ago, Dog said:

What do you guys imagine will be the effect of government controlled remuneration on the pharmaceutical  and medical technology industries?. What will be the effect on the medical professions? What will be the effect on the evolution of medicine which today is largely driven by the US free market?

Sorry Dog.  Don't agree.  While some medical research in the US is state of the art, Germany, France, Australia and others are just as active and possibly more innovative. Medical research is mostly driven my government grants, not free market at all.  Drug development is focused on high profit and protecting patents, not high impact treatments. 

Free market in health care is more about runaway profits than patient care.  Outcomes don't support your presumption that we are "world class" in many ways. 

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Yep ^

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59 minutes ago, Shootist Jeff said:

I think the answer is somewhere in the middle of Bernie's plan and the so-called "free market" insurance.

First of all, the insurance market isn't going to go away quietly and Bernie's plan would put them out of business essentially overnight.  Hence why it has less than zero chance in hell of even coming to a vote much less passing.  And that is true even if the D's owned all branches of gov't.  It just ain't going to happen.  The Senators from Aetna, UHC and BC/BS aren't going to let it happen.

My SOLution is to have medicare (or similar) for all, but have it be truly bare bones emergency, catasptohic and very basic coverage.  Including some very basic preventative health - i.e. yearly screenings and such.  Whatever the minimum it takes to keep you alive and relatively healthy, unless it's end of life care and then there will be death panels convened to pull the plug and send you to Hospice.  

Anything above that level of basic coverage - you are more than free to avail yourself of the market and buy whatever supplemental insurance you want to cover any and all ailments and cosmetic shit that are not covered under the single payer plan.  

The single payer/medicare aspect gets you your basic care and keeps you from losing the house if you get cancer or have a heart attack.  And the insurance market will then vye for all the rest of the "nice to have" stuff.  And there will be plenty.  Win Win.

Problem SOLved.  Shootist Jeff for Preznit.  Or at least HHS Secretary.  

So..essentially you want a two tier system..one for the rich and one for the poor..

Isn't that what you have now?

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5 minutes ago, Shortforbob said:

So..essentially you want a two tier system..one for the rich and one for the poor..

Isn't that what you have now?

Sorry, you have a 2 tier system.  I'm paying for my pensioner SIL in Melbourne's private insurance today as the public system failed to provide the appropriate continuity of care for her long term mental health issues. Carefully chosen, the supplemental isn't that expensive. 

Jeff's "basic care" is a little severe for my tastes, but somehow limits will be placed on medical care to help control costs.  An example in Aus is the Shingles Vaccine. Risk starts to climb at age 55.  In the US, Medicare and many insurance companies will pay at age 60.  In Australia, it isn't covered until age 70.  In the US, some high dose cancer treatments using doxorubicin are done during inpatient stays as a continuous infusion to significantly lower the risk of heart damage.  In Canada, "standard of care" is outpatient treatment at much higher infusion rates that will cause heart damage at a fairly low lifetime dose.  Appears Canada has traded off the probable heart damage to provide lower cost treatments for those drugs. 

Limits on procedures and treatments are part an parcel of controlling costs.  Private supplementals are a way for those who can afford it to go to the head of the line and/or circumvent those limits.  Where the "standard of care line is drawn is an important discussion but there is a line. 

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17 minutes ago, Shortforbob said:

So..essentially you want a two tier system..one for the rich and one for the poor..

Isn't that what you have now?

Yes, I do.  

And no, that is not what we have now.  We have a one tier system where only those that can afford it at all can get healthcare.  The poor get to use the ER for "free".  

And what's wrong with basic essential coverage for the poor?  

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On 9/13/2017 at 11:17 PM, SloopJonB said:

That's why it's called insurance you fucking moron.

Jeezuss right wingers are amazing. Dunning - Kruger need to do a special study of them.

I always think of the speech I got from my FoxyNews friend about how health insurance was a subsidy taking money from healthy working people (him) and giving it to bums, weak people, people with bad DNA, and people with poor lifestyle choices.

Soon after he needed expensive medical care and so did his wife :rolleyes:

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2 minutes ago, Innocent Bystander said:

Jeff's "basic care" is a little severe for my tastes, but somehow limits will be placed on medical care to help control costs. 

Correct.  And while I'm being a bit "glib" with my description of basic care, the point is that there will necessarily need to be a line drawn for exactly the reasons you describe.  I see nothing wrong with basic, essential care for the poor - which is likely better than they have now.  And Dad doesn't lose the house if he gets sick.  The devil is obviously in the fine print.  But IMHO, the only way to sell this is to not get too ambitious with where to draw the line.  Basic essential care with dignity should not be a dirty word.  And by keeping it to basic essential care and letting the insurance market compete for supplemental plans - you avoid the huge risk that the insurance lobby and the politicians they've bought and paid for will sink any effort to get there.  Like it or not, if big insurance doesn't have a profitable space to play in, this will be a non-starter in DC.  

Perfect is the enemy of good enough.

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10 minutes ago, Innocent Bystander said:

Limits on procedures and treatments are part an parcel of controlling costs.  Private supplementals are a way for those who can afford it to go to the head of the line and/or circumvent those limits.  Where the "standard of care line is drawn is an important discussion but there is a line. 

YOU LIE!  That right there is death panels and we can't have that!  :P

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58 minutes ago, Dog said:

What do you guys imagine will be the effect of government controlled remuneration on the pharmaceutical  and medical technology industries?. What will be the effect on the medical professions? What will be the effect on the evolution of medicine which today is largely driven by the US free market?

Dog..we still have private insurance, the companies still make heaps..Doctors stlii are doing allright and specialists still live in the posh places and drive Mercs..it's just a matter of how rich a 

 

14 minutes ago, Shootist Jeff said:

Yes, I do.  

And no, that is not what we have now.  We have a one tier system where only those that can afford it at all can get healthcare.  The poor get to use the ER for "free".  

And what's wrong with basic essential coverage for the poor?  

Because under such a "basic" system..my son would have only one leg and my daughter would probably be dead..I suppose it depends on what you mean by basic. What we have..we call basic health care...you want long term psychiatric care?? well then you need private,you want dental..you go private, you want massages and chiropractors?? or physio ..you go private.

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21 minutes ago, Innocent Bystander said:

Sorry, you have a 2 tier system.  I'm paying for my pensioner SIL in Melbourne's private insurance today as the public system failed to provide the appropriate continuity of care for her long term mental health issues. Carefully chosen, the supplemental isn't that expensive. 

Jeff's "basic care" is a little severe for my tastes, but somehow limits will be placed on medical care to help control costs.  An example in Aus is the Shingles Vaccine. Risk starts to climb at age 55.  In the US, Medicare and many insurance companies will pay at age 60.  In Australia, it isn't covered until age 70.  In the US, some high dose cancer treatments using doxorubicin are done during inpatient stays as a continuous infusion to significantly lower the risk of heart damage.  In Canada, "standard of care" is outpatient treatment at much higher infusion rates that will cause heart damage at a fairly low lifetime dose.  Appears Canada has traded off the probable heart damage to provide lower cost treatments for those drugs. 

Limits on procedures and treatments are part an parcel of controlling costs.  Private supplementals are a way for those who can afford it to go to the head of the line and/or circumvent those limits.  Where the "standard of care line is drawn is an important discussion but there is a line (eg. 

You can cherry pick as much as you want..our limits are on the "nice but not essential" things. and your SIL could be placed in a government place..but they are a bit basic..or a private place and the gov still picks up part of the tab.

Of course Medicare doesn't cover everything.and Govermnets tweek here and there.BUT both stripes of Government support it in more than just principle...

They tend to take a preventitive aproach too..

Pay for shingles vac's fo 60 year olds...or Gardacil for ALL girls and boys?

Breast screening over 50

Bowel cancer tests

Pap smears

all pathology

MRI for brain..if you have a headache and your GP thinks it advisable.

 

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Sigh

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10 hours ago, Raz'r said:

Good insight. The US citizen is being robbed blind in HC. 2x world costs, shit results. The crime? They keep telling us how great it is, and how doing what every other country does will mean the end of GR8! Healthcare. Lying bastards, and idiot voters

Where's the $$ going?  Answer that - and I think we'll know where to focus.  

My insight is based upon the consumer perspective, with the additional insight that comes from 10 years of writing software for Medicaid systems.  I'll offer that Medicaid does a LOT to reduce waste/fraud - but, has an even larger focus on ensuring that no service is improperly denied. The delivery methods and restrictions that result from those two factors often result in over provision of services, and complexity in documenting diagnoses and proposed treatments that in turn drive administrative overhead.

IMHO - the insurers make $$ on processing adminstratia and premium collections, and every payment for services is a reduction of that profit.  Insurance companies aren't fiscally motivated to provide services - just the opposite, in fact. Providers are motivated by fee-for-service, and thus I think have a profit motive to over-prescribe, more often observed during post-utilization review in larger providers, the average small practice was usually more in line w/UCR expectations. 

IMHO, analyzing the cost drivers associated with these behaviors would be a decent place to start understanding why our costs are so much outta line. 

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5 hours ago, Shootist Jeff said:

You should be more discriminating with your selection of the Hong Kong hookers.  ;)

Or Indian food vendors, depends on your proclivities...

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With apologies to NY Times for circumventing their paywall for you -

 

Buried Inside Bernie Sanders’s Bill: A Fallback Plan

https://mobile.nytimes.com/2017/09/15/upshot/buried-inside-bernie-sanderss-bill-a-fallback-plan.html

The Bernie Sanders “Medicare for All” plan promises rapid, sweeping change to the American health care system, with the elimination of all private insurance and the creation of a costly new government insurance program that will cover everyone and nearly every medical service.

But deep in its back pages is a more modest fallback plan.

The bill, introduced this week, has attracted the endorsement of 15 Democratic senators, including several of the party’s most ambitious liberals. But many more Democrats this week said they’d like to pursue more limited steps to expand health insurance coverage and the government’s role in the system. It turns out that the Sanders bill also has provisions along those lines. Taken together, the bill encapsulates much of the coming Democratic debate about the direction of health care.

In the statements of the bill’s co-sponsors, one can detect an openness to less tranformational approaches to health reform. “This bill is aspirational, and I’m hopeful that it can serve as a starting point for where we need to go as a country,” Senator Al Franken of Minnesota wrote in a Facebook post. He described the bill as a “marker” and “one way to achieve universal coverage.”

Parts of the Sanders bill help establish a road map for what some other strategies might look like.

The provisions are tucked into Title X of the bill and describe the four-year transition between current policy and the Sanders bill’s goal of a Medicare-for-all system. During that interim, some younger Americans would be able to buy access to the traditional Medicare program, which is now mainly for those 65 and up. The provisions would also establish an option for Americans to buy access to a Medicare-like government plan that would be sold on the Obamacare exchanges.

The public option section was written by Senator Kirsten Gillibrand of New York, a longtime proponent of the idea. As part of the Sanders bill, she said, a public option would help the government prepare to administer a full-fledged Medicare-for-all program.

“One part of the bill that I worked with my colleagues to put in was the ability for every American to buy into a nonprofit public option as part of a four-year transition to get to single-payer in this country,” she said during the news conference introducing the bill. “This would create affordable, public health care that is available to any American to purchase in the already available exchanges.”

The idea of mixing public and private insurance in a competitive marketplace was a goal of many Democrats during the writing of the Affordable Care Act. The hope was that a public option would provide more choice to consumers and more pricing discipline for insurers. The idea didn’t have enough support to stay in the final bill, but it has been experiencing a bit of a comeback. Before the 2016 election, both President Obama and Hillary Clinton, the Democratic presidential nominee, endorsed a public option. Mrs. Clinton also endorsed the idea of a Medicare buy-in for older Americans.

Other Democrats are working on similar provisions that would provide more access to public health insurance without upending the existing private system. Senator Chris Murphy of Connecticut, who has not endorsed the Sanders bill, has said he’s developing legislation to allow Americans to buy into the Medicare program, as Mr. Sanders’s bill does for Americans of certain ages. (A group of House Democrats has already offered one piece of legislation to create such a program.)

And Senator Brian Schatz of Hawaii, who did co-sponsor the Sanders bill, has said he’s working on legislation that would allow people to pay their way into the federal-state Medicaid program, while simultaneously making changes to Medicaid.

Such plans might avoid some of the difficult politics of adopting a total Medicare-for-all, because they would allow Americans who have private coverage to keep it if they wished.

There are some technical challenges to buy-in programs. Medicare primarily serves older Americans, and it would need different benefits and providers to serve children and women of reproductive age, for example. The bills will also need to decide on a price for the public plan. The Gillibrand provision assigns price-setting responsibility for the public option to the Department of Health and Human Services. Some Medicare buy-in plans would require people to pay the average cost of Medicare benefits, which would make coverage quite expensive.

There are also questions about what a public option would mean for private competition.

But expect those details to be part of the coming debate.

 

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