Support drops for Medicare for All but increases for public option

jaeger19 · Nov 7, 2019

bave said:
Meh. Nurses in major metros often get paid as much as general practitioner physicians for less work, less education, and less risk. Healthcare as a whole used to treat people better (ie: 15 years ago) but the margins have effectively vanished in healthcare so the vice is starting to squeeze everyone. Physicians are retiring faster and earlier than ever, why do you think that is? More stress, less money, more hours.

Yeah... not on the less work. Those nurses have more stress and more hours and have to do more with less staff.

Waddy · Nov 7, 2019

tacomancer said:
Support drops for Medicare for All but increases for public option | TheHill

While I would prefer a single payer system, I am still not sure it is a culturally viable option yet. A public option may be a good or bad idea, depending on how its implemented.

I would support a public option IF it didn't use public funds to subsidize the program. I would like it to be a true pay as you go non profit. ALL administration of the program should be accounted for in the costs; unlike now where administration by Social Security distorts the true cost of Medicare. I would really like to see if government run health care could out compete private insurance. If the program wanted to subsidize the poor, but used the premiums to do it, I'm on board. Just NO taxpayer subsidy. That would make it almost impossible to evaluate the program. So it needs to be a stand alone government program, including ALL costs and expenses, and paid for ONLY by premiums. I'd vote for that.

jaeger19 · Nov 8, 2019

Waddy said:
I would support a public option IF it didn't use public funds to subsidize the program. I would like it to be a true pay as you go non profit. ALL administration of the program should be accounted for in the costs; unlike now where administration by Social Security distorts the true cost of Medicare. I would really like to see if government run health care could out compete private insurance. If the program wanted to subsidize the poor, but used the premiums to do it, I'm on board. Just NO taxpayer subsidy. That would make it almost impossible to evaluate the program. So it needs to be a stand alone government program, including ALL costs and expenses, and paid for ONLY by premiums. I'd vote for that.

It would work but the seed money would have to come from government. AND it would have to be run in such a way that the government could not mess it and make it a dumping ground for the most expensive insured.

Something like the FHA would work.

bave · Nov 14, 2019

Masterhawk said:
I think it depends on how well the public option operates. If it's plagued by long waiting periods, the private option will continue to exist.

The problem is that the "public option" right now is being represented as Medicare. The problem with Medicare is that it is financially unsustainable as a standalone because of two reasons. First, they operate at a loss and require massive injections of capital at the federal government level. Second, they don't reimburse providers at sufficient levels to keep their doors open, thus requiring a secondary subsidization, in this case by those privately insured. So, if you want me to seriously consider a public option, you need to show me that it can stand on its own as any other insurance program would be required to (ie: cash surplus and reserves) and then that it has to reimburse at a sufficient level to allow a health system to operate. However, it won't do that, none of them globally do that. You either have a NHS model where you are plagued with huge wait lines and restricted care options unless you can afford private care, or you end up in a Canadian model where everyone just suffers equally unless they can afford to leave the country. More to the point, single payor platforms globally are being crushed under the financial burdens and that is with all the above problems.

Only then we get to talk about how drug/device research/profit is paid for because as it stands right now the EU/Canada models are basically getting a free ride on research being done for the American marketplace by and large.

jaeger19 said:
Yeah... not on the less work. Those nurses have more stress and more hours and have to do more with less staff.

Bull****. Nurses are time card employees. They may be getting to do the impossible, but they are being paid very well to do it and when they are not working they are not working. Meanwhile physicians are getting paid ~60-70% *less* as they were 20 years ago adjusted for inflation and also being asked to do more, around the clock. Depending on location, nursing is very similar to public employee unions. Not a high barrier to entry, guaranteed employment, no risk or liability, and a disproportionate total comp package relative to education requirements. Do you have any experience working in healthcare? Managing medical facility? Or just your thoughts and feels?

Waddy said:
I would support a public option IF it didn't use public funds to subsidize the program. I would like it to be a true pay as you go non profit. ALL administration of the program should be accounted for in the costs; unlike now where administration by Social Security distorts the true cost of Medicare. I would really like to see if government run health care could out compete private insurance. If the program wanted to subsidize the poor, but used the premiums to do it, I'm on board. Just NO taxpayer subsidy. That would make it almost impossible to evaluate the program. So it needs to be a stand alone government program, including ALL costs and expenses, and paid for ONLY by premiums. I'd vote for that.

Can't happen, see #1.

jaeger19 said:
It would work but the seed money would have to come from government. AND it would have to be run in such a way that the government could not mess it and make it a dumping ground for the most expensive insured.

Something like the FHA would work.

Citing the FHA as a success is a great example of why people shouldn't take your statements seriously. Do you have any experience dealing with the FHA? Have you seen the results of what happens when you deal with the FHA?

Waddy · Nov 14, 2019

bave said:
The problem is that the "public option" right now is being represented as Medicare. The problem with Medicare is that it is financially unsustainable as a standalone because of two reasons. First, they operate at a loss and require massive injections of capital at the federal government level. Second, they don't reimburse providers at sufficient levels to keep their doors open, thus requiring a secondary subsidization, in this case by those privately insured. So, if you want me to seriously consider a public option, you need to show me that it can stand on its own as any other insurance program would be required to (ie: cash surplus and reserves) and then that it has to reimburse at a sufficient level to allow a health system to operate. However, it won't do that, none of them globally do that. You either have a NHS model where you are plagued with huge wait lines and restricted care options unless you can afford private care, or you end up in a Canadian model where everyone just suffers equally unless they can afford to leave the country. More to the point, single payor platforms globally are being crushed under the financial burdens and that is with all the above problems.
Can't happen, see #1.

What worries me is how badly government and politicians underestimated the costs of these programs back when they were proposed. I believe this was an intentional "cooking" of the books, because no one would have supported it if the true numbers were known. I think this is exactly what's happening now with "Medicare for All". Saying it won't cost taxpayers a dime is intentional deception; knowing people love freebies, especially if they think they'll get a benefit and won't have to pay for it.

When these programs were created back in 1965, no one ever thought they would get this big or cost this much. Congressional budgeters at the time thought Medicare, the healthcare program for the elderly, would cost about $12 billion by 1990. The actual cost that year was $90 billion.

We should have seen it coming. After all, it didn’t take decades for actual Medicare and Medicaid costs to overrun projections. That pretty much happened right away. In 1965, the House Ways and Means Committee estimated that Medicaid, the jointly funded federal-state program originally meant to cover the poor, would cost $238 million in its first year. It actually cost more than $1 billion. By 1971, Medicaid spending had reached about $6.5 billion, blowing away all previous estimates.

50 Years Later, Medicaid, Medicare Still Spend Us Into Oblivion

jaeger19 · Nov 14, 2019

bave said:
Bull****. Nurses are time card employees. They may be getting to do the impossible, but they are being paid very well to do it and when they are not working they are not working. Meanwhile physicians are getting paid ~60-70% *less* as they were 20 years ago adjusted for inflation and also being asked to do more, around the clock. Depending on location, nursing is very similar to public employee unions. Not a high barrier to entry, guaranteed employment, no risk or liability, and a disproportionate total comp package relative to education requirements. Do you have any experience working in healthcare? Managing medical facility? Or just your thoughts and feels?

?

]

Gee,, ,any experience in healthcare... how about being a doctor? How about OWNING a number of healthcare facilities ? THAT enough experience for you?

First..not all nurses are on the clock. Some are salaried. But even when on the clock..they cannot just leave when no one shows up for their next shift. They have to stay if there is no one to get call out. Nurses have to deal with those difficult patients for 12 hours depending on the shift they work. I get to walk in.. see the patient and go and leave the "code browns"..the hitting and spitting, to the nurses. Yep they get paid pretty well. BUT.. whose pay do you think suffers more when it comes to declining reimbursement? Generally not the doctors.. because of supply and demand. Sure we have been getting paid less. But the crunch gets applied to the nurses more so than the doctors... In fact... doctors have LESS hours than they did when I first started. That's because more and more.. there are regulations or policies limiting the number of hours a doctor can work before they must rest. It was nothing before to work 36 or 40 hours straight. and then do it again 12-24 hours later.

Citing the FHA as a success is a great example of why people shouldn't take your statements seriously. Do you have any experience dealing with the FHA? Have you seen the results of what happens when you deal with the FHA?

Actually.. yes.. I know.

The Federal Housing Administration Saved the Housing Market - Center for American Progress

bave · Nov 15, 2019

jaeger19 said:
]

Gee,, ,any experience in healthcare... how about being a doctor? How about OWNING a number of healthcare facilities ? THAT enough experience for you?

First..not all nurses are on the clock. Some are salaried. But even when on the clock..they cannot just leave when no one shows up for their next shift. They have to stay if there is no one to get call out. Nurses have to deal with those difficult patients for 12 hours depending on the shift they work. I get to walk in.. see the patient and go and leave the "code browns"..the hitting and spitting, to the nurses. Yep they get paid pretty well. BUT.. whose pay do you think suffers more when it comes to declining reimbursement? Generally not the doctors.. because of supply and demand. Sure we have been getting paid less. But the crunch gets applied to the nurses more so than the doctors... In fact... doctors have LESS hours than they did when I first started. That's because more and more.. there are regulations or policies limiting the number of hours a doctor can work before they must rest. It was nothing before to work 36 or 40 hours straight. and then do it again 12-24 hours later.

Actually.. yes.. I know.

The Federal Housing Administration Saved the Housing Market - Center for American Progress

So, you're a physician? What specialty? What region? Employed or private? What type of facilities?

99% of hospital nursing staff is hourly employed, unless you are trying to expand that definition to include midlevels. While they may have to stay in the event of a short handedness they are *paid* for that extra time and at a higher rate. Nurses have to deal with difficult patients for 12 hours? What's your point? Lots of people in lots of fields have to deal with difficult people for long stretches of time, they are being paid for the hours. No different than being a cop or a prison guard.

You don't think doctors take the brunt of the hit with a decline in reimbursement? Look around genius. Look at the decline in private practices over the past 20 years, it's collapsing. Look at nursing pay/benefits over the same period compared to physician, negative correlation.

Talking about hours, are you referring to a resident or an attending? Because the residency hour limitation is a joke, if you try to enforce that at any decent program you will get blackballed instantly.

jaeger19 · Nov 15, 2019

bave said:
So, you're a physician? What specialty? What region? Employed or private? What type of facilities?

99% of hospital nursing staff is hourly employed, unless you are trying to expand that definition to include midlevels. While they may have to stay in the event of a short handedness they are *paid* for that extra time and at a higher rate. Nurses have to deal with difficult patients for 12 hours? What's your point? Lots of people in lots of fields have to deal with difficult people for long stretches of time, they are being paid for the hours. No different than being a cop or a prison guard.

You don't think doctors take the brunt of the hit with a decline in reimbursement? Look around genius. Look at the decline in private practices over the past 20 years, it's collapsing. Look at nursing pay/benefits over the same period compared to physician, negative correlation.

Talking about hours, are you referring to a resident or an attending? Because the residency hour limitation is a joke, if you try to enforce that at any decent program you will get blackballed instantly.

First...average nursing salaries statistics are based in including nursing managers and floor supervisors.. (and often they pull shifts on the floor as well as nursing supervision).

Nurses have to deal with difficult patients for 12 hours? What's your point? Lots of people in lots of fields have to deal with difficult people for long stretches of time, they are being paid for the hours. No different than being a cop or a prison guard.

Poo...if you think that nursing is not different than being a cop or a prison guard... well.. whatever man.. you don't know what you are talking about.

Just think of this.. if a difficult person starts hitting cop.. what happens? They get hit..or tazed or worse.
A prison guard? They get the SERT team out and that unruly person gets taken down by a number of COs

Now..what do you think happens when the 72 year old man with dementia starts swinging on a nurse that's trying to help him onto the toilet? You think she/he gets to hit back? Gets to let go of that patient and let them fall and break a hip because they are confused and don't know whats going on? You think that get to taze him... how about use pepper spray?

No.. they deal. They take it and go home with bruises and other injuries or much worse. I watched a fellow in stepdown. Yank down on a nurses neck when she was helping to bed. And he pulled her face down onto the half rail of the bed and knocked her front teeth out before I could get there. and that kind of stuff happens on a daily basis.

Everyday.. nurses have to make calls that might means someones life. Picking up that two different doctors have ordered medication that will cause reaction and kill the patient. Pick up that the patient has aspiration pneumonia , and so on.

You don't think doctors take the brunt of the hit with a decline in reimbursement?

No.. we don't. Just like when there is a downturn.. the CEO of the company doesn't take the big hit in salary. It always starts with the lower paid employees. Cutbacks and salary freezes.

When a doctor office takes a hit.. it first hits the support staff.. with lower hours..more outsourcing (like having a service handle claims, or even appointments)
Then providers.. for example orthopedic surgeons using "extenders"..like an athletic trainer.. to follow up with patients after surgery rather than a PA or NP.

Look around genius. Look at the decline in private practices over the past 20 years, it's collapsing. Look at nursing pay/benefits over the same period compared to physician, negative correlation

Bwwaaaah… yeah.. look around. Who do you think takes the hit when that private practice closed? Gee.. you think the nurses, aides, x ray techs, and secretaries who are out of a job now.. took the hit... or the doctor that sold his practice to the big hospital and now is a paid employee.. took the biggest hit. Think about it genius. Who ended up losing their jobs in that consolidation. And how does the hospital make it when the private clinic can't? oh.. you think its maybe by being more efficient by doing more patients with less support staff... you know.. like nurses?

Sheesh.

bave · Nov 16, 2019

jaeger19 said:
No.. we don't. Just like when there is a downturn.. the CEO of the company doesn't take the big hit in salary. It always starts with the lower paid employees. Cutbacks and salary freezes.

[/QUOTE]

What kind of physician are you again? Where did you train? What specialty? During downturns CEOs almost always take a huge hit, largely because their entire bonus structure is based on stock price/profitability. The proportionality of pain tends to tilted towards the higher end, not the lower end, and all the economic data in the world shows it. The difference is the higher end tends to be able to absorb more of it.

jaeger19 said:
When a doctor office takes a hit.. it first hits the support staff.. with lower hours..more outsourcing (like having a service handle claims, or even appointments)
Then providers.. for example orthopedic surgeons using "extenders"..like an athletic trainer.. to follow up with patients after surgery rather than a PA or NP.

This, right here, is how I know you are not a physician. An athletic trainer is never considered an extender. A PA or an NP is however considered an extender. If you are going to pretend to be a physician on the internet, you should first learn some of the basic terminology. For example an extender or a midlevel is considered someone who works under the registered supervision of a licensed physician, to include CRNAs, CNMs, PAs, and NPs.

jaeger19 said:
Bwwaaaah… yeah.. look around. Who do you think takes the hit when that private practice closed? Gee.. you think the nurses, aides, x ray techs, and secretaries who are out of a job now.. took the hit... or the doctor that sold his practice to the big hospital and now is a paid employee.. took the biggest hit. Think about it genius. Who ended up losing their jobs in that consolidation. And how does the hospital make it when the private clinic can't? oh.. you think its maybe by being more efficient by doing more patients with less support staff... you know.. like nurses?

Sheesh.

Again, showing you have zero actual experience in being a physician or "owning medical facilities". You're just another internet fraud.

When a private practice closes, or rather in your above example the physician is hired by a the local medical facility, they almost always bring the vast majority of the staff with them. The hospital will generally only have a redundancy in billing for the most part and really doesn't get a huge about of overlap efficiency.

jaeger19 said:
And how does the hospital make it when the private clinic can't? oh.. you think its maybe by being more efficient by doing more patients with less support staff... you know.. like nurses?

Yet another fine example of you being totally full of crap. The guy pretending to be a physician *and* medical facility owner doesn't understand the difference? Let me explain it to you in two simple steps....

1) A hospital/medical facility is going to have a higher reimbursement based on the same CPT code compared to a private practice, for all payors. So right off the top they are getting paid *significantly* more than their private peers. Why? Better contracts. BCBS can't play hard ball with a regional medical center nearly the way they can with a lone general surgeon. It shows up in the reimbursement schedule, often represented as a percentage of CMS reimbursement tables.

2) Then, were that not enough, medical centers (and their employed physicians) also get to charge an *additional* fee, called a facility fee. This is an added fee that is generally 30-50% on top of total baseline charges.

Both of these are 100% occurrences in all 50 states, it amazes me that a physician and medical facility owner doesn't know that?

Fraud.

jaeger19 · Nov 18, 2019

During downturns CEOs almost always take a huge hit, largely because their entire bonus structure is based on stock price/profitability. The proportionality of pain tends to tilted towards the higher end, not the lower end, and all the economic data in the world shows it. T

[/QUOTE]
Wait.. so you think that in the latest downturn.. it was the CEO that was more likely to be fired.. than the people working under them at the lowest levels?

Seriously.. do you even bother to think about the BS that you are spewing?

An athletic trainer is never considered an extender.

Yeah.. ouch man.. here is a scientific article that discusses the use of athletic trainers as extenders in orthopedic practices. .

https://www.nata.org/sites/default/files/financial-impact-ats-physician-practice.pdf

But hey.. man.. why let facts get in the way of your diatribes..you are on a role.

When a private practice closes, or rather in your above example the physician is hired by a the local medical facility, they almost always bring the vast majority of the staff with them.

Wait.. the "vast majority"? Heck.. even you believe that.. it proves my point. The vast majority.. means not ALL.. which means that some folks lose their job.

And the reality is that the "vast majority".. don't get brought along. It makes no sense to bring along not only the staff that does billing.. but you don't need x ray staff.. you don't need the cleaning staff or the office staff because the hospital already folds them into a practice. Its one of the ways the hospital makes money.. by being more efficient.

) A hospital/medical facility is going to have a higher reimbursement based on the same CPT code compared to a private practice, for all payors. So right off the top they are getting paid *significantly* more than their private peers. Why? Better contracts. BCBS can't play hard ball with a regional medical center nearly the way they can with a lone general surgeon. It shows up in the reimbursement schedule, often represented as a percentage of CMS reimbursement tables.

Actually they are going to be reimbursed the same for the most part. What actually happens is that initially the hospital will accept a LOWER rate based on the same CPT code compared to a private practice. WHY? Because they CAN accept a lower rate because they are more efficient.. its called economy of scale.. also.. because its a hospital system.. they can accept a lower price initially because the hospital can generate its own income through referrals. Sure it gets less per cpt code.. but because its physicians can then order outpatient therapy (at the hospital facility)..order x rays and MRI at the hospital facility and order pharmaceuticals to be gotten at the hospital pharmacy.. the hospital makes more money.. despite accepting the lower reimbursement.

NOW.. what happens is that BCBS.. goes to the individual private practice and says "well the hospital accepts this"... and if the private practice doesn't accept it..well then only the hospital is on the preferred list.

Eventually.. the private practice can't continue with that low reimbursement.. and so the end up selling out to the bigger hospital system.

When enough private practices have been gobbled up... THEN.. the hospital system can go to BCBS and demand a higher rate or not accept their patients.. because they are the only show in town.. NOW. That's not how it started though.

And because they have become the only show in town.. the hospital can charge a facility rate.. because they are the only facility.

Seriously man.. its amusing watch you tie yourself into knots on something you don't appear to know anything about.

At the end of the day.. you don't really have any rebuttal for what I said.. because its all true.

bave · Nov 18, 2019

jaeger19 said:
Wait.. so you think that in the latest downturn.. it was the CEO that was more likely to be fired.. than the people working under them at the lowest levels?

Seriously.. do you even bother to think about the BS that you are spewing?

I didn't say fired, I said suffer. A senior executive, or owner, is going to have their compensation much more directly tied to either stock price or profitability. Therefor they will proportionately be harmed more.

jaeger19 said:
Yeah.. ouch man.. here is a scientific article that discusses the use of athletic trainers as extenders in orthopedic practices. .

https://www.nata.org/sites/default/files/financial-impact-ats-physician-practice.pdf

Hahahahahahahaha.

You posted a "scientific article" that athletic trainers are considered medical extenders, that is sponsored and from the National Athletic Trainer's Association.

Since you pretend to be a physician, please show me an athletic trainer with an NPI/DEA#. You know, the way the federal government determines who a medical professional is.

Further, to highlight your own amazing and endless stupidity, from the same source mind you...

‘Physician Extender’ Will No Longer be Used to Identify ATs | NATA

The title, Physician Extender will no longer be used to identify Athletic Trainers, should give it away.

This btw, was because of a federal action by CMS prohibiting athletic trainers from pretending to be medical providers.

bave · Nov 18, 2019

jaeger19 said:
And the reality is that the "vast majority".. don't get brought along. It makes no sense to bring along not only the staff that does billing.. but you don't need x ray staff.. you don't need the cleaning staff or the office staff because the hospital already folds them into a practice. Its one of the ways the hospital makes money.. by being more efficient.

Again, false. As I said, you will see a lot of reduction on the billing side. However you aren't going to see a change in imagine (because the physicians are still going to be generating the same in office imaging requests), your cleaning won't change (because the clinic still needs to use the same space). Hospitals generally make money through practice acquisition because they can control referrals, ancillaries, better contracts and facility fees. Anyone, and I mean anyone, who has ever been in medical management knows this.

jaeger19 said:
Actually they are going to be reimbursed the same for the most part. What actually happens is that initially the hospital will accept a LOWER rate based on the same CPT code compared to a private practice.

Citation. Blatantly false. Hospitals get higher rates on the same CPT codes universally as well as facility fees. This is nationwide and universal, show me the data.

jaeger19 said:
WHY? Because they CAN accept a lower rate because they are more efficient.. its called economy of scale.. also.. because its a hospital system.. they can accept a lower price initially because the hospital can generate its own income through referrals.

Hold on here. So let me get this right. You believe that a business will accept a *lower* rate of payment because otherwise their margin would be higher? So, you think a business is going to voluntarily reduce their profits when they have no competitive reason to do so as they generally tend to operate in monopolistic fashions? Hahahaah, this **** just gets better and better. Yet another great example of how you have never been in a medical practice in any capacity. This is great.

jaeger19 said:
Sure it gets less per cpt code.. but because its physicians can then order outpatient therapy (at the hospital facility)..order x rays and MRI at the hospital facility and order pharmaceuticals to be gotten at the hospital pharmacy.. the hospital makes more money.. despite accepting the lower reimbursement.

Ok, another example of how you don't know a damned thing.

When a physician sees a patient, that's a CPT bill code for an office problem visit. The ortho then decides to send a referral for PT, another CPT code. They then decide they need an xray, another CPT code, MRI, another CPT code. There is no great bundling here that changes the math. The hospital or the private practice all get to bill the same for each of those events independently. The only difference is that the hospital gets a higher reimbursement from BCBS, Aetna, Cigna, Humana etc *and* gets to charge a facility fee for another 30-50% on top of each one.

jaeger19 said:
NOW.. what happens is that BCBS.. goes to the individual private practice and says "well the hospital accepts this"... and if the private practice doesn't accept it..well then only the hospital is on the preferred list.

Preferred list? Making **** up again? You are either in network, or out of network. You just made my point for me btw, the hospital sets the high price in town. When BCBS goes to MD Andersen do you think they say... well the other private practices in town take X for this code, so we are going to give you 90% of X since you are bigger and more efficient? **** no. MD Andersen says, "No. You will pay us 140% of X, or you will not have one of the premier cancer centers in the nation in your network". BCBS caves. Every time, all the time. This is why every regional medical center wants a pediatric designation, so they can make the insurance companies pay their freight or lose the "Children's Hospital" status, which gets every angry mom and their sister to scream at them.

jaeger19 said:
Eventually.. the private practice can't continue with that low reimbursement.. and so the end up selling out to the bigger hospital system.

Wait, You just got done telling me the hospital accepts the lower reimbursement? Which is it? Can't keep your pretend expertise straight? You're a joke.

Helix · Nov 18, 2019

i support Medicaid for all, but i support winning first.

bave · Nov 18, 2019

jaeger19 said:
When enough private practices have been gobbled up... THEN.. the hospital system can go to BCBS and demand a higher rate or not accept their patients.. because they are the only show in town.. NOW. That's not how it started though.

When are you defining "started"? 1958? Hospitals have been getting reimbursement much higher than private practices since the 1988 shakeup of medicare billing.

jaeger19 said:
And because they have become the only show in town.. the hospital can charge a facility rate.. because they are the only facility.

All hospitals can charge a facility fee, regardless of how many hospitals are in town, or even if they are right across the street from one another. Didn't you know that pretend doctor?

jaeger19 said:
Seriously man.. its amusing watch you tie yourself into knots on something you don't appear to know anything about.

At the end of the day.. you don't really have any rebuttal for what I said.. because its all true.

Every time you speak you make an ass of yourself. Seriously, what is the point about lying on the internet? Are you somehow being validated by pretending to be something more than you are to strangers on the internet? I don't know who you are, and I don't care. I do however take issue with someone who is spreading outright falsehoods under the guise of being an expert.

As a side note, it is a crime to impersonate a physician.

bave · Nov 18, 2019

Helix said:
i support Medicaid for all, but i support winning first.

Ok, you're entitled to that opinion.

However, pay for it.

Medicaid reimbursement is 50-60% of the cost of providing care. Meaning, if Medicaid was the entirety of insurance then almost every hospital and practice goes bankrupt in 90 days. Moreover, Medicaid wait lists, drug formularies, and coverage options are horrendous.

The only reason Medicaid even appears to work is because it is being subsidized by people with decent insurance that makes up for the loss on medicaid patients.

Helix · Nov 18, 2019

bave said:
Ok, you're entitled to that opinion.

However, pay for it.

Medicaid reimbursement is 50-60% of the cost of providing care. Meaning, if Medicaid was the entirety of insurance then almost every hospital and practice goes bankrupt in 90 days. Moreover, Medicaid wait lists, drug formularies, and coverage options are horrendous.

The only reason Medicaid even appears to work is because it is being subsidized by people with decent insurance that makes up for the loss on medicaid patients.

the rest of the first world is doing just fine covering medical care. we will, too, as soon as we vote out enough naysayers.

bave · Nov 19, 2019

Helix said:
the rest of the first world is doing just fine covering medical care. we will, too, as soon as we vote out enough naysayers.

Well, hold on there a sec.

1) The developed nations with universal coverage are struggling with the cost of it as well. NHS has regular shortages and enormous waits. The most successful universal care nations are those that have a bifurcated system where only the wealthy have good access to high quality care and the rest are effectively in a clinic waiting line for lower quality care. Imagine if the US implemented a system where the wealthy still had access to a currently private-payor quality system while everyone else had a baseline model that resembled an even more poorly run/funded VA system. It wouldn't go well.

2) You are comparing apples and oranges a bit. The idea that the EU pays ~40% less for the same results is inaccurate for a few reasons. First, obesity. The US obesity rate is *much* higher and this drives a huge portion of healthcare spending. So the idea that our system would remain cheaper without adjusting for the morbidity of a population is laughable. Further, the US healthcare model is basically funding 90% of the R&D into new healthcare therapies. Take that away and you are going to lose a huge portion of development of new drugs, devices, and treatments. Pharma companies are not going to try and develop a new drug for a 3% margin.

3) Taxes. In order to model the EU style, that means lower/middle income people would have to see ~20% increase in taxes while the rich would see 3-5% increases. Good luck convincing the current leading Dem-nutjobs that this is acceptable.

Helix · Nov 19, 2019

bave said:
Well, hold on there a sec.

1) The developed nations with universal coverage are struggling with the cost of it as well. NHS has regular shortages and enormous waits. The most successful universal care nations are those that have a bifurcated system where only the wealthy have good access to high quality care and the rest are effectively in a clinic waiting line for lower quality care. Imagine if the US implemented a system where the wealthy still had access to a currently private-payor quality system while everyone else had a baseline model that resembled an even more poorly run/funded VA system. It wouldn't go well.

2) You are comparing apples and oranges a bit. The idea that the EU pays ~40% less for the same results is inaccurate for a few reasons. First, obesity. The US obesity rate is *much* higher and this drives a huge portion of healthcare spending. So the idea that our system would remain cheaper without adjusting for the morbidity of a population is laughable. Further, the US healthcare model is basically funding 90% of the R&D into new healthcare therapies. Take that away and you are going to lose a huge portion of development of new drugs, devices, and treatments. Pharma companies are not going to try and develop a new drug for a 3% margin.

3) Taxes. In order to model the EU style, that means lower/middle income people would have to see ~20% increase in taxes while the rich would see 3-5% increases. Good luck convincing the current leading Dem-nutjobs that this is acceptable.

I've heard these excuses, and I don't buy them. The US isn't so unique that we have no choice but to pay vastly more for comparable health care. Let's vote out the "we can't do it" crowd and see what we can do.

marke · Nov 19, 2019

tacomancer said:
Support drops for Medicare for All but increases for public option | TheHill

While I would prefer a single payer system, I am still not sure it is a culturally viable option yet. A public option may be a good or bad idea, depending on how its implemented.

I think government healthcare for all is more attractive to those who do not understand the real costs of such a socialist pipe dream.

Government provided insurance must be paid for through taxation and taxes for healthcare cannot be divorced from taxes for everything else the government pays for. With a national debt rising a trillion dollars a year nobody should expect taxes not to be raised enormously to try to keep up with costs and debt. Even then no amount of massive taxation will ever be able to pay all the bills the government now owes, much less all the new ones our modern leftist candidates are proposing.

bave · Nov 19, 2019

Helix said:
I've heard these excuses, and I don't buy them. The US isn't so unique that we have no choice but to pay vastly more for comparable health care. Let's vote out the "we can't do it" crowd and see what we can do.

Excuses? They are statistics.

NCBI published a research article showing obesity directly related to ~28% of total healthcare spending. The obesity rate in Europe as a whole is roughly half what it is in the US. Right there we are talking about hundreds of billions of dollars a year in additional spending regardless of the system or modality. If you think it is comparable, please explain the spread in cancer survival rates, quality of life procedures (joint replacement) rates, and cardiac treatment duration and time.

What makes you believe that the pharma/biotech industry would continue to develop drugs when their profit motivate is effectively eliminated? What young person goes into medicine to make $100k a year as a physician?

Helix · Nov 19, 2019

bave said:
Excuses? They are statistics.

NCBI published a research article showing obesity directly related to ~28% of total healthcare spending. The obesity rate in Europe as a whole is roughly half what it is in the US. Right there we are talking about hundreds of billions of dollars a year in additional spending regardless of the system or modality. If you think it is comparable, please explain the spread in cancer survival rates, quality of life procedures (joint replacement) rates, and cardiac treatment duration and time.

What makes you believe that the pharma/biotech industry would continue to develop drugs when their profit motivate is effectively eliminated? What young person goes into medicine to make $100k a year as a physician?

The profit motive wouldn't be eliminated. They still make money off sick people in other countries. There's no reason why US citizens have to face going broke for health care when the rest of the first world doesn't. I do accept that the American right wing is unconvincible, however. That's fine with me. Voting them out is the better option.

bave · Nov 19, 2019

Helix said:
The profit motive wouldn't be eliminated. They still make money off sick people in other countries. There's no reason why US citizens have to face going broke for health care when the rest of the first world doesn't. I do accept that the American right wing is unconvincible, however. That's fine with me. Voting them out is the better option.

The average cost to bring a new drug to FDA trial stage is ~$1B. The running odds of that drug being approved for final market is about 1:9. So, that means each drug is going to run an average of $9B in R&D costs when you include the failures. If the whole world used the NHS drug prices, then every pharma company would be operating at a loss on day one. Or is this some more whacky Warren math that they don't have to count their losses, or that their overhead expenses would magically decrease? More importantly, again, why would smart people go into a business where they can't financially succeed financially? It's a classic brain drain trap.

Look at the profit margin on drugs in the EU, they run on average 5-6%. Then consider why you have *generic* shortages in the EU, Canada, and even sometimes the US. No business is going to operate with 5-6% margins, let alone invest in new and costly research. A utility company can't even operate on a 5% margin.

How do you expect to convince people when you are so blithely willing to ignore statistics and facts? You are making a decision based on your personal hopes and dreams.

Helix · Nov 19, 2019

bave said:
The average cost to bring a new drug to FDA trial stage is ~$1B. The running odds of that drug being approved for final market is about 1:9. So, that means each drug is going to run an average of $9B in R&D costs when you include the failures. If the whole world used the NHS drug prices, then every pharma company would be operating at a loss on day one. Or is this some more whacky Warren math that they don't have to count their losses, or that their overhead expenses would magically decrease? More importantly, again, why would smart people go into a business where they can't financially succeed financially? It's a classic brain drain trap.

Look at the profit margin on drugs in the EU, they run on average 5-6%. Then consider why you have *generic* shortages in the EU, Canada, and even sometimes the US. No business is going to operate with 5-6% margins, let alone invest in new and costly research. A utility company can't even operate on a 5% margin.

How do you expect to convince people when you are so blithely willing to ignore statistics and facts? You are making a decision based on your personal hopes and dreams.

I don't waste as much time these days trying to convince the unconvincible. Voting against them is a better use of my time. The rest of the first world pays a fraction of what the US pays for health care. Step one is voting out right wing obstructionists.

bave · Nov 19, 2019

Helix said:
I don't waste as much time these days trying to convince the unconvincible. Voting against them is a better use of my time. The rest of the first world pays a fraction of what the US pays for health care. Step one is voting out right wing obstructionists.

Great, like I said, voting with your heart and not your brain. Way to break the stereotype of the leftist.

Helix · Nov 19, 2019

bave said:
Great, like I said, voting with your heart and not your brain. Way to break the stereotype of the leftist.

I don't care about your opinion of me.