Do You Believe MFA Would Not Cost Middle Class Taxpayers One Penny?

Cynical said:

There is no way we can have MFA without the middle class footing some or most of the costs, either in the form of taxes or very high deductibles. The question is in what ways will healthcare change when government is the ONLY (or by and large) payer of this portion of the economy. As single payer government will have complete power over that industry and will be able to control it as it deems necessary. It is very unlikely that we will see a reduction in costs and an improvement in care. Also how much would a President Warren increase immigration? If President Warren = massive influx of impoverished migrants from all over the world then that will absolutely impact both the costs and quality of care for many Americans.

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Campaign politics poses these sorts of threatening gotcha questions all the time. "Er you gunna raise mah taxes?! Yes er No?!" Politicians are under enormous pressure to just say no, even if they know they're lying through their teeth. Lie now to get elected, deal with the fallout later.

The biggest way health care changes is that hospitals and major health systems likely become a global-budget based operation instead of a fee-for-service based operation with the budget allocation being provided by DHHS, and the rest of the providers (smaller clinics and independent private providers for example) have their rates set by DHHS. So how DHHS decides to administer the annual operating budgets of hospitals and major health systems, and where it decides to set rates compared to the fees for service currently being charged, is what will determine how health care quality and availability change. If DHHS gets really aggressive, MFA will "save money," but access and quality of care will suffer. If they are weak about it, access and quality may be maintained, but MFA will demonstrably be failing to save significant money.

Neomalthusian said:

If they are weak about it, access and quality may be maintained, but MFA will demonstrably be failing to save significant money.

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I mean, America already pays more for and has less access to healthcare compared to other 1st world nations. So I'm not sure how access could fall much further.

But it is true, that there is quite a bit of potential for a Universal Healthcare system to save significant amounts of money, but it's not guaranteed as it will depend on how the government sets it up.

Ikari said:

I mean, America already pays more for and has less access to healthcare compared to other 1st world nations. So I'm not sure how access could fall much further.

But it is true, that there is quite a bit of potential for a Universal Healthcare system to save significant amounts of money, but it's not guaranteed as it will depend on how the government sets it up.

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Let's look at one example and imagine how it might extrapolate out. In the early 2000s, Medicare paid around $102 for a mental health psychotherapy session. Today it pays less than $85. A 30% decline, adjusted for inflation. A lot of mental health therapists out there are in private practice, either independently or as part of a group and bill private insurance for closer to the $100 rate that Medicare used to pay, or in some cases more than that. Their entire practices and businesses are built up around this reimbursement rate and many of them do not exactly have fat margins.

So imagine DHHS comes in and says "the Medicare rate is now THE RATE, so you're all gonna get $85 per session." There aren't many businesses anywhere that can sustain a 30% cut to their gross revenue. The practices that run on thin margins aren't going to operate at a loss. Many would stop doing therapy and vie for jobs in a larger health system, social service organization, or government agency, likely performing some sort of administrative task rather than direct therapy. So the supply of psychotherapy providers shrinks, and people start to really struggle to find psychotherapists who are accepting new clients. The fact that Medicare For All says "we'll pay your $85 psychotherapy bill for you!" sounds great but it doesn't help people who can't actually find someone willing to provide therapy to them.

Just because access is arguably bad by some standards now does not mean it can't get worse. It can.

Checkerboard Strangler said:

Why are you attempting to turn me into a hater of capitalism when you know better?
First, I said that Wall Street is a pure casino.
That doesn't mean that I think that the concept of a capitalist stock market is bad, it means that I think it needs to be run a lot better than the average casino, and in this day and age it is a Trump casino, and that does not bode well at all if past history is any indicator.

And even the casinos have better regulations than Wall Street.
To paraphrase Meatloaf, if money truly is LOVE, then what I am attempting to say is, there needs to be a point at which it's right to say

"I'll do anything for "LOVE", but I won't do that."

(And money isn't love, but for Donald Trump, it is. Just an aside...He literally WILL do ANYTHING for money.)

The best gamblers make a lot of money and the rest fold their hands and lose their chips?
Sorry, but there's a whole lot more to running an economy than just throwing our hands up in the air and saying "Welp, them's the breaks, tough luck" because while Wall Street may be big on gambling, for millions of working families and small business owners (and I mean actual SMALL businesses, not WSJ definition, which includes Apple, Inc.) this is not a gamble, and those people NEED PROTECTION from the more rapacious aspects of the great big casino.

If you're 100% dyed in the wool anarcho-capitalist, then unfortunately that's a gap I can't cross.
We have fire regulations for a reason. Capitalism is a lot like fire, and while fire is a very useful tool, at times it can be hazardous to tangle with, thus we have those fire safety regulations.
So while you may (if you're anarcho) see nothing wrong with smoking around the gas pump and lighting matches to check the fuel level in the tank, or while you might say "them's the breaks", I see a need for some common sense regulation and ethics.

And by the way, make no mistake about it, the technology revolution that you speak of is going to eventually make a vast swath of human labor, even skilled labor, irrelevant and obsolete. There's your unintended consequences.
So while you're talking about how great your ROTH is, that's wonderful for you but it's an awfully narrow way to look at how the rest of our society is forced to make do.

A Roth IRA, yeah sure...lots of Americans have that, and even more do not.
And it's not because "most Americans are lazy" or "made poor choices"...our economy has been making poor choices ever since we threw the middle class overboard forty-something years ago in favor of catering to the CEO class.
And for the average working American family, that forty year Wolf of Wall Street wet dream has translated into a lower quality of life despite productivity increases that boggle the mind.
And that's why most Americans don't care.
It's not because they are "fat, dumb and happy" as you say, but because they are not a part of that economic class and see no way forward for them to ever BE part of it.

Hey, we're all glad your retirement is all figured out but the "I got mine, screw you" approach not only isn't working, it's starting to piss off the birds on the bottom rung, who are sick and tired of being crapped on.

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That was a long rant so my reply will be shorter. There is nothing you can do about technology. It will march on. My advice is be a part of it or it will rumble right over you. That's how you protect yourself. That's how to be part of the future and not become yet another victim. So yeah, most Americans won't do that; they will want government to "protect" them. They will want government to take money from other people and give it to them. Those mean old CEO's don't need all that money~!! Take it from them first.

To say there is "no way forward" is really insulting. You don't think much of your fellow citizens. I think there is always a way forward for every person, if they can identify what to do, and then actually do it. People aren't helpless. And millionaires are created every day. Ever watch Shark Tank?

Some people embrace Capitalism and thrive under it, while others quiver and shake and demand protection.

Cynical said:

There is no way we can have MFA without the middle class footing some or most of the costs, either in the form of taxes or very high deductibles. The question is in what ways will healthcare change when government is the ONLY (or by and large) payer of this portion of the economy. As single payer government will have complete power over that industry and will be able to control it as it deems necessary. It is very unlikely that we will see a reduction in costs and an improvement in care. Also how much would a President Warren increase immigration? If President Warren = massive influx of impoverished migrants from all over the world then that will absolutely impact both the costs and quality of care for many Americans.

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Amen. And, a good point. Both Warren and Sanders want MFA and that includes illegals.

Neomalthusian said:

Just because access is arguably bad by some standards now does not mean it can't get worse. It can.

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That is true indeed. However, I have to think that in many of the other nations with some form of Universal Healthcare, who are paying less and who do have more access to medical care than we have in America, that there are also mental health professionals there. So obviously, it can be done.

But there is the point that if we do it badly, we can make things worse. It's one reason I'm wary of MFA or a Universal Healthcare plan. I think that it can be done well and to the benefit of the People, that in other places it has been done adequately and has reduced costs and opened up accessibility. But I'm not sure how much faith I would place in our current government to actually construct a functional and productive Universal Healthcare system.

Waddy said:

That was a long rant so my reply will be shorter. There is nothing you can do about technology. It will march on. My advice is be a part of it or it will rumble right over you. That's how you protect yourself. That's how to be part of the future and not become yet another victim. So yeah, most Americans won't do that; they will want government to "protect" them. They will want government to take money from other people and give it to them. Those mean old CEO's don't need all that money~!! Take it from them first.

To say there is "no way forward" is really insulting. You don't think much of your fellow citizens. I think there is always a way forward for every person, if they can identify what to do, and then actually do it. People aren't helpless. And millionaires are created every day. Ever watch Shark Tank?

Some people embrace Capitalism and thrive under it, while others quiver and shake and demand protection.

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And it doesn't seem like you read a single word of it.
Oh well.

Again:
Why are you attempting to turn me into a hater of capitalism when you know better?

And now, why are you questioning my grasp of technology? I've been a film editor for forty years.
I not only grasped the technology, I added 25 years to my career by adapting to it when analog went dark and digital took the place of a splice tool.

You don't sound like your normal mindful self, what with throwing out broad-brush sweeping generalizations like "most Americans won't do that; they will want government to "protect" them. They will want government to take money from other people and give it to them"

What does a statement like that even mean?
You're not you when you're hungry. Eat a Snickers bar, because listening to you pretend that 40 percent of Americans who HAVE A JOB (or even two or three) and aren't making ends meet aren't having trouble because they're lazy.
When I said that there is no way forward for too many people, you seem to think I was insulting them.
You really should rethink that reflex. It has a ton of knee-jerk in it.

There is absolutely nothing I can say if you absolutely believe all taxation is theft, which is what your broad brush statements certainly sound like today.

PS: I was deep into technology when you were still mastering how to program a VCR.

rickc said:

We are the only developed country in the world without universal health care

we spend twice as much money per capita on health care as the rest of the developed world with universal health care

We certainly don't rank near the top in health care compared with the rest of the developed world with universal health care

Like most things in america it is all about the money. Profits for the insurance companies, big pharma and HMO's. We have the best health care in the world if you can afford it. If you can't then you are in trouble.

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We are already spending the money. Universal Health Care will cost no more than we spend now. In fact many studies say it will be less expensive.

How they collect the money remains to be seen.

Checkerboard Strangler said:

And it doesn't seem like you read a single word of it.
Oh well.

Again:
Why are you attempting to turn me into a hater of capitalism when you know better?

And now, why are you questioning my grasp of technology? I've been a film editor for forty years.
I not only grasped the technology, I added 25 years to my career by adapting to it when analog went dark and digital took the place of a splice tool.

You don't sound like your normal mindful self, what with throwing out broad-brush sweeping generalizations like "most Americans won't do that; they will want government to "protect" them. They will want government to take money from other people and give it to them"

What does a statement like that even mean?
You're not you when you're hungry. Eat a Snickers bar, because listening to you pretend that 40 percent of Americans who HAVE A JOB (or even two or three) and aren't making ends meet aren't having trouble because they're lazy.
When I said that there is no way forward for too many people, you seem to think I was insulting them.
You really should rethink that reflex. It has a ton of knee-jerk in it.

There is absolutely nothing I can say if you absolutely believe all taxation is theft, which is what your broad brush statements certainly sound like today.

PS: I was deep into technology when you were still mastering how to program a VCR.

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You're making my point. there is always a way forward. maybe it means training in a different industry, or watching your money better, or any number of things. There are NO Americans "stuck" on the bottom with no way forward. THAT's what's insulting. I would never tell students that; it's not what young people want to hear. Nor should they believe it. The same thing for telling black kids "it's a white man's world". Defeats them before they start. EVERY person in this country can get ahead if they make the right decisions. Low expectation is one of the worst forms of racism.

You don't have a monopoly on tech. ALL smart people have been into tech for most of their lives. And taxation is theft; just legal theft. Based on force to insure compliance. Taxes ain't voluntary charity. Yet growing numbers of Americans are turning to the government to take more money from actual taxpayers and spread it around to people who haven't earned it. Ever heard of guaranteed minimum income? Favored by the left. Student loan forgiveness? Favored by the left. Free health care? Favored by the left. Yet someone will pay for all of it. It's easy to vote yourself benefits you won't have to pay for. that's what Democratic politicians count on.

Waddy said:

You're making my point. there is always a way forward.

You don't have a monopoly on tech. ALL smart people have been into tech for most of their lives. And taxation is theft; just legal theft. Based on force to insure compliance. Taxes ain't voluntary charity. Yet growing numbers of Americans are turning to the government to take more money from actual taxpayers and spread it around to people who haven't earned it. Ever heard of guaranteed minimum income? Favored by the left. Student loan forgiveness? Favored by the left. Free health care? Favored by the left. Yet someone will pay for all of it. It's easy to vote yourself benefits you won't have to pay for. that's what Democratic politicians count on.

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Show me where I said I had a monopoly on tech. Man, you're all over the road here, this morning. :lamo
How is it you get away with saying that people aren't keeping up on tech, I point out that tech and I are old friends, and you come back with an accusatory sounding

"You don't have a monopoly on tech."

I never said I had a monopoly on tech. I was letting you know I have zero difficulty adapting to technology.
What the actual **** are you trying to say?

Waddy said:

You're making my point. there is always a way forward. maybe it means training in a different industry, or watching your money better, or any number of things. [...] Low expectation is one of the worst forms of racism.

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For most people who CAN AFFORD IT, that is the ticket, find a new job, go back to school, etc.
Is there something wrong with making training and other higher education more affordable and accessible to more people?

You seem to think school is expensive.
It's a lot cheaper than a generation of ignoramuses, so do we invest in our future generation or sit back and watch as we get older and become more dependent upon them as the torch is passed? I don't know about you but I'd feel a lot more secure about our position in a world where other superpowers are investing heavily in the very things we currently lack - A HIGHLY TRAINED WORKFORCE ADEPT WITH TECH.

That doesn't just happen by itself, and it doesn't pay for itself, and if it is so expensive that only a handful can afford it, expect more unemployable people as time marches on. That is the STUCK part which you either can't see or won't see.

Defeats who before they start? I'm talking about people who are currently working their asses off and cannot get their head above water.
And here you are accusing me of racism via low expectations?
Where is this coming from? It sure isn't coming from what you know of MY views, that's for sure.

Waddy said:

Ever heard of guaranteed minimum income? Favored by the left. Student loan forgiveness? Favored by the left. Free health care? Favored by the left. Yet someone will pay for all of it.

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Got some news for you:
In ten or fifteen years when AI and advanced robotics are both well on the way to rendering most human labor obsolete, and we have a generation of people who could not afford training in marketable skills, it will be interesting to see if your views on GBI because with 30 to 50 percent of the workforce rendered redundant, I doubt it will even be open for discussion anymore.
We can avoid it by paying for training and other higher education for deserving people who demonstrate the ambition or we can wait till tens of millions more are out of work and out of ideas.

Student loan forgiveness? See above.

Free health care? FREE? Whoever said anything about healthcare being free?
I'm weary of this, all you're doing this morning is insulting vast swaths of people you seem to think are interested in some quasi-commie confiscation scheme, when really our problems mostly boil down to the Despair Quotient.
Less despair and more upward mobility tend to solve a litany of other problems.

I'm not even going to dignify your statements on taxation with an answer, it is too manifesto worthy and it creeps me out.
Taxes are the price we pay to live in civilization. My only demand is that they do something with it that is efficient and effective but that's a concept anti-government warriors will never accept.

You've radicalized yourself since last time we had a convo.
I thought you were a reasonable and moderate person.
Yelling "all taxation is legalized theft" erases that assumption.

You go ahead and have the last word.
I am not the least bit interested in a lesson on "sovereign citizens" or any other Randy Weaver xenophobic nonsense.

Neomalthusian said:

I get that it's a gotcha question, but by sighing and saying "ok, I promise your taxes won't go up," she's feeding into it.

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If the American people are too stupid to understand saving money, maybe they don't deserve it.

Deuce said:

If the American people are too stupid to understand saving money, maybe they don't deserve it.

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To doubt a presidential campaign promise is not to be stupid. Most Americans who have been around for at least an election cycle or two know to be skeptical of presidential campaign promises (e.g., that they'll for sure save money).

Neomalthusian said:

Let's look at one example and imagine how it might extrapolate out. In the early 2000s, Medicare paid around $102 for a mental health psychotherapy session. Today it pays less than $85. A 30% decline, adjusted for inflation. A lot of mental health therapists out there are in private practice, either independently or as part of a group and bill private insurance for closer to the $100 rate that Medicare used to pay, or in some cases more than that. Their entire practices and businesses are built up around this reimbursement rate and many of them do not exactly have fat margins.

So imagine DHHS comes in and says "the Medicare rate is now THE RATE, so you're all gonna get $85 per session." There aren't many businesses anywhere that can sustain a 30% cut to their gross revenue. The practices that run on thin margins aren't going to operate at a loss. Many would stop doing therapy and vie for jobs in a larger health system, social service organization, or government agency, likely performing some sort of administrative task rather than direct therapy. So the supply of psychotherapy providers shrinks, and people start to really struggle to find psychotherapists who are accepting new clients. The fact that Medicare For All says "we'll pay your $85 psychotherapy bill for you!" sounds great but it doesn't help people who can't actually find someone willing to provide therapy to them.

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And just to follow up on this post, Warren's health care plan promises to do just what I said, make the current Medicare rates "THE RATES" going forward. So this scenario quoted above is entirely realistic under a Warren-style MFA proposal.

The new one-size-fits-all rate that all private therapists will be receiving will be a substantial cut to many providers' revenue, which virtually none of them will be able to absorb without dramatic changes to their practices. It's easily enough of a cut to constrain the supply of mental health therapists, those willing to remain in practice will likely need to see more people to sustain their business, which stretches them thinner and reduces quality, and the reduced supply of therapy appointment availability increases wait-lists on already-overworked therapists, and so on and so forth.

And so you can bet that the American Psychiatric Association and American Psychological Association, National Association of Social Workers, and a slew of other professional associations (which are generally overwhelmingly politically liberal organizations, by the way!) will be trying to break down the doors of the Warren Administration to lobby her hard, and try to turn other politicians against her if she won't listen to them and consider the mental health needs of the country. But Warren has already characterized groups like this that lobby the federal government as greedy and evil and to blame for all our health care policy problems. She will either listen to these groups and consider their warnings and soften her position (making her a total hypocrite relative to her prior statements), or she will refuse to listen to anyone and her list of political enemies will explode.

Maybe it would cost Americans money. What better way to use money then to invest in the health and well being of people and more specifically your fellow Americans. We are a society.

The real question is where do the Democrats find so many totally ignorant people? What type of moron believes that you can add a program that costs as much as the entire government takes in and it won't increase taxes?

Another quizzer. What twit thinks by renaming a health care system, not addressing any of the issues that make it expensive and adding tens of millions of people to it will make it cheaper? There can't really be people out there that are that stupid.