Author Topic: Trump punts healthcare down the road until after election.  (Read 6006 times)

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Re: Trump punts healthcare down the road until after election.
« Reply #15 on: December 19, 2019, 04:07:58 PM »

Offline SDceltGuy

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Bingo....insurance is just used to obfuscate the real issue and insulate the real drivers of escalating healthcare cost... the providers. Isnt it interesting that a lot of hospitals are nonprofit yet the cost of care keeps going up.

Insurance is the primary driver for escalating healthcare costs.  It has removed competition and market forces from controlling costs.  Nobody knows or cares what anything costs when they go for care - consumers have no incentive to make cost/benefit decisions since it is largely detached from their wallets.  We need less insurance - not more.   

Re: Trump punts healthcare down the road until after election.
« Reply #16 on: December 19, 2019, 04:16:19 PM »

Offline fairweatherfan

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Big mistake, IMO.

You think so? 

I think it's smart politics.  He can criticize Obama's bill, while blaming Democrats for refusing to fix it.  Meanwhile, he doesn't have to get into the details of solving the problem, which will ultimately leave some constituency upset.

Campaigning against Obamacare and the Democrats has been a winning strategy.  It was only in 2018 -- when Trump couldn't blame Democrats, because Republicans controlled everything -- that it was a losing issue.
I think it's smart politics to secure his base but if Trump is to win, he needs one of two things to happen.

1. He attracts more of moderate America than he did last election or

2. Hope the Democratic base is turned off of their candidate again and doesn't go to the polls.

I happen to think the Dems will come to the polls in this election to support their own. I think a lot of people on the left have learned their lesson that not voting because you don't like your candidate can be a giant mistake.

So since option 2 isn't available, Trump isn't doing himself any favors with moderate America by not coming up with an alternative solution.

2016 was 2016. Times have changed. The mid terms set the tone that healthcare and it's costs are what America is most concerned with. Republicans lost 40 seats in the House based on Healthcare.

I think it will be a mistake just to continue to criticize Obamacare without giving an alternative for the 10th and 11th straight year. Sure Republicans who have already decided they are voting again for Trump will eat up the "Repeal and Replace" rhetoric but not addressing this issue will severely hurt Trump with undecideds and or blue collar voters that went his way in 2016 but could go Dem due to unfulfilled promises to them and because their health insurance still sucks and is expensive

It's smart politics if you don't actually have a replacement plan, just vague promises of how amazing it's gonna be. Every alternative Congress floated last time around increased costs and reduced coverage. They don't really have an angle that's sellable, because something like the ACA WAS going to be the alternative to a more left-wing Obamacare.

Re: Trump punts healthcare down the road until after election.
« Reply #17 on: December 19, 2019, 04:26:01 PM »

Offline Sophomore

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Big mistake, IMO.

You think so? 

I think it's smart politics.  He can criticize Obama's bill, while blaming Democrats for refusing to fix it.  Meanwhile, he doesn't have to get into the details of solving the problem, which will ultimately leave some constituency upset.

Campaigning against Obamacare and the Democrats has been a winning strategy.  It was only in 2018 -- when Trump couldn't blame Democrats, because Republicans controlled everything -- that it was a losing issue.
I think it's smart politics to secure his base but if Trump is to win, he needs one of two things to happen.

1. He attracts more of moderate America than he did last election or

2. Hope the Democratic base is turned off of their candidate again and doesn't go to the polls.

I happen to think the Dems will come to the polls in this election to support their own. I think a lot of people on the left have learned their lesson that not voting because you don't like your candidate can be a giant mistake.

So since option 2 isn't available, Trump isn't doing himself any favors with moderate America by not coming up with an alternative solution.

2016 was 2016. Times have changed. The mid terms set the tone that healthcare and it's costs are what America is most concerned with. Republicans lost 40 seats in the House based on Healthcare.

I think it will be a mistake just to continue to criticize Obamacare without giving an alternative for the 10th and 11th straight year. Sure Republicans who have already decided they are voting again for Trump will eat up the "Repeal and Replace" rhetoric but not addressing this issue will severely hurt Trump with undecideds and or blue collar voters that went his way in 2016 but could go Dem due to unfulfilled promises to them and because their health insurance still sucks and is expensive

It's smart politics if you don't actually have a replacement plan, just vague promises of how amazing it's gonna be. Every alternative Congress floated last time around increased costs and reduced coverage. They don't really have an angle that's sellable, because something like the ACA WAS going to be the alternative to a more left-wing Obamacare.

Bingo.

There is no Republican plan that has majority support or anything remotely close to it. Remember what happened the last time they tried to give us something much better than Obamacare?  Big fat nothing.  What's changed?

Re: Trump punts healthcare down the road until after election.
« Reply #18 on: December 19, 2019, 05:10:18 PM »

Offline Vermont Green

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Bingo....insurance is just used to obfuscate the real issue and insulate the real drivers of escalating healthcare cost... the providers. Isnt it interesting that a lot of hospitals are nonprofit yet the cost of care keeps going up.

Insurance is the primary driver for escalating healthcare costs.  It has removed competition and market forces from controlling costs.  Nobody knows or cares what anything costs when they go for care - consumers have no incentive to make cost/benefit decisions since it is largely detached from their wallets.  We need less insurance - not more.   

I don't feel this is accurate.  When you need medical care, how can you shop around for a better deal?  If you need a car you can choose a used car or a new car.  If you need your hip replaced, are you going get a used hip to save money?

It is true that buyers of health care do not apply the same comparative cost/benefit approach as they do when they buy a car for example.  But I feel that is due to the nature of health care, not the structure of the insurance system.  Insurance companies have plenty of incentive to say "we don't cover this or that".  How is that helping to hold down costs?

Re: Trump punts healthcare down the road until after election.
« Reply #19 on: December 19, 2019, 05:21:11 PM »

Online slamtheking

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Bingo....insurance is just used to obfuscate the real issue and insulate the real drivers of escalating healthcare cost... the providers. Isnt it interesting that a lot of hospitals are nonprofit yet the cost of care keeps going up.

Insurance is the primary driver for escalating healthcare costs.  It has removed competition and market forces from controlling costs.  Nobody knows or cares what anything costs when they go for care - consumers have no incentive to make cost/benefit decisions since it is largely detached from their wallets.  We need less insurance - not more.   

I don't feel this is accurate.  When you need medical care, how can you shop around for a better deal?  If you need a car you can choose a used car or a new car.  If you need your hip replaced, are you going get a used hip to save money?

It is true that buyers of health care do not apply the same comparative cost/benefit approach as they do when they buy a car for example.  But I feel that is due to the nature of health care, not the structure of the insurance system.  Insurance companies have plenty of incentive to say "we don't cover this or that".  How is that helping to hold down costs?
you're right, it's not accurate.  I work in health insurance so seeing how that part of healthcare works from the inside, I can say that insurance carriers are far from perfect but they aren't the primary cause of the increasing cost.

Primary drivers of the cost: Pharmaceuticals, Provider reimbursements and Consumer demands on wanting unlimited access to everything as well as consumers not taking particularly good care of themselves requiring all those services.

Re: Trump punts healthcare down the road until after election.
« Reply #20 on: December 20, 2019, 08:58:49 AM »

Offline SDceltGuy

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you're right, it's not accurate.  I work in health insurance so seeing how that part of healthcare works from the inside, I can say that insurance carriers are far from perfect but they aren't the primary cause of the increasing cost.

Primary drivers of the cost: Pharmaceuticals, Provider reimbursements and Consumer demands on wanting unlimited access to everything as well as consumers not taking particularly good care of themselves requiring all those services.

I didn't blame insurance carriers.  I blame disconnecting consumers from directly paying for services.  If I was paying for a hip replacement out of my pocket - I would shop around to see what doctor gave me the best combination of service/quality for my money and would make sure they weren't doing unnecessary stuff.  Right now with insurance - I just pick the absolute best and don't object to any extras.  I really have no idea what it will cost or care what the total will be.  This is why prices are out of control - 3rd party pays for my services. 

Additionally health insurance should not be connected in any way to employers. 
« Last Edit: December 20, 2019, 09:44:41 AM by SDceltGuy »

Re: Trump punts healthcare down the road until after election.
« Reply #21 on: December 20, 2019, 09:23:22 AM »

Offline SDceltGuy

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When you need medical care, how can you shop around for a better deal?  If you need a car you can choose a used car or a new car.  If you need your hip replaced, are you going get a used hip to save money?

You cant shop around now because the system has removed the consumer from the paying for services.  Except for major medical or emergencies - most healthcare is just service like any other service you buy. 

Insurance should be insurance against large and unexpected costs like car and home owners is.  Not routine services. 

If I need a new hip and I had to front the majority of cost (and the system was transparent) - I would shop between the hospitals in my city or even consider looking at neighboring cities.  Maybe there would be hip replacement clinics in major cities where that's all they do and people would go there to get specialized service and better prices - who knows what the market would provide - but it would provide what people want if there is a dollar to be made. 

Re: Trump punts healthcare down the road until after election.
« Reply #22 on: December 20, 2019, 09:41:44 AM »

Online slamtheking

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you're right, it's not accurate.  I work in health insurance so seeing how that part of healthcare works from the inside, I can say that insurance carriers are far from perfect but they aren't the primary cause of the increasing cost.

Primary drivers of the cost: Pharmaceuticals, Provider reimbursements and Consumer demands on wanting unlimited access to everything as well as consumers not taking particularly good care of themselves requiring all those services.

I didn't blame insurance carriers.  I blame disconnecting consumers from directly paying for services.  If I was paying for a hip replacement out of my pocket - I would shop around to see what doctor gave me the best combination of service/quality for my money and would make sure they weren't doing unnecessary stuff.  Right now with insurance - I just pick the absolute best and don't object to any extras.  I really have no idea what it will cost or care what the total will cost.  This is why prices are out of control - 3rd party pays for my services. 

Additionally health insurance should not be connected in any way to employers. 
TP for the clarification. 

I agree that if people were paying for services out of pocket, they'd do more shopping around for the best price but here's some things to consider:
- people do that now with other services/products in the economy and not always with good results.  if you pick a doctor and facility to have a hip replacement, if something goes wrong or the end result isn't beneficial as you'd hoped, now you're possibly undergoing the same process again (multiple surgeries for the same problem are not something you want to endure) or having to live with the initial results.
- insurance companies are currently responsible for finding the best providers of services at lower costs.  there are certainly the fly-by-night insurance companies allowed to operate in lightly-regulated states that are directing people to whichever providers offer their services for the cheapest rates but in most states, insurers are obligated to find the best quality providers available.  They have the leverage with high volumes of members (patients) to extract the best rates from these providers thus saving money.
- most insurance covers people from personal bankruptcy over health issues.  Again there's crappy coverages out there that in some cases are nothing more than 'catastrophic' protections or some that don't even offer that much coverage.  unfortunately, people end up with these types of coverage either because they can't afford a better coverage or they have health issues where they can't get a company to offer them a better coverage. 

as for not linking health care to employers, I whole-heartedly agree.  It's a huge cost for employers that offer it as well as for employees who pay for part or all of it out of their pockets.   As a country, we need to migrate to a system that is national.  it's inevitable.  It won't happen in my lifetime but it will happen.  As for worrying about the cost in terms of taxes, consider how much money is going to insurance companies now.  change that to going to a govt tax/fund instead where your services are covered.  For those claiming it'll cost trillions consider this, the govt is already covering the sickest populations of this country --> the elderly and unable-to-work disabled through Medicare and the low/no-income who have a lower quality of health through Medicaid.  the rest of the population not covered through a govt program is relatively healthy by comparison and a lower cost to cover per person on average. 

Re: Trump punts healthcare down the road until after election.
« Reply #23 on: December 20, 2019, 09:50:35 AM »

Offline SDceltGuy

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As a country, we need to migrate to a system that is national.  it's inevitable.  It won't happen in my lifetime but it will happen.  As for worrying about the cost in terms of taxes, consider how much money is going to insurance companies now.  change that to going to a govt tax/fund instead where your services are covered.

No thanks but sadly agree that it is inevitable.  People need to acknowledge that skyrocketing prices are due to lack of competition and market forces.  Going to govt payer doesn't fix that primary issue and will only lead to rationing and poorer quality of service as a way try to control prices - it would be their only weapon. 
« Last Edit: December 20, 2019, 10:29:25 AM by SDceltGuy »

Re: Trump punts healthcare down the road until after election.
« Reply #24 on: December 20, 2019, 11:32:29 AM »

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As a country, we need to migrate to a system that is national.  it's inevitable.  It won't happen in my lifetime but it will happen.  As for worrying about the cost in terms of taxes, consider how much money is going to insurance companies now.  change that to going to a govt tax/fund instead where your services are covered.

No thanks but sadly agree that it is inevitable.  People need to acknowledge that skyrocketing prices are due to lack of competition and market forces.  Going to govt payer doesn't fix that primary issue and will only lead to rationing and poorer quality of service as a way try to control prices - it would be their only weapon. 
actually, govt programs are what commercial insurers base their payment rates on.  Medicare and Medicaid have lower reimbursement rates for the same services than Commercial insurers.  When provider groups band together for negotiations with the Commercial insurers, that's when they have to pay rates higher than what Medicare and Medicaid pay.  As for rationing, that's a fallacy pushed by the people working against it.  you can find isolated instances in the countries that have universal coverage for its people but for the most part, everyone gets the treatment they need in a timely manner.   of course there needs to be a corresponding shift in people's expectations that they're entitled to everything they want on demand as well as a general improvement in people taking better care of themselves.

competition amongst insurers doesn't drive how much providers are paid.  only impact is how much the consumers are paying for coverage. 

Re: Trump punts healthcare down the road until after election.
« Reply #25 on: December 20, 2019, 12:25:10 PM »

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As a country, we need to migrate to a system that is national.  it's inevitable.  It won't happen in my lifetime but it will happen.  As for worrying about the cost in terms of taxes, consider how much money is going to insurance companies now.  change that to going to a govt tax/fund instead where your services are covered.

No thanks but sadly agree that it is inevitable.  People need to acknowledge that skyrocketing prices are due to lack of competition and market forces.  Going to govt payer doesn't fix that primary issue and will only lead to rationing and poorer quality of service as a way try to control prices - it would be their only weapon. 
actually, govt programs are what commercial insurers base their payment rates on.  Medicare and Medicaid have lower reimbursement rates for the same services than Commercial insurers.  When provider groups band together for negotiations with the Commercial insurers, that's when they have to pay rates higher than what Medicare and Medicaid pay.  As for rationing, that's a fallacy pushed by the people working against it.  you can find isolated instances in the countries that have universal coverage for its people but for the most part, everyone gets the treatment they need in a timely manner.   of course there needs to be a corresponding shift in people's expectations that they're entitled to everything they want on demand as well as a general improvement in people taking better care of themselves.

competition amongst insurers doesn't drive how much providers are paid.  only impact is how much the consumers are paying for coverage.

You've kind of got some circular reasoning going on there. Commercial insurers base their rates on the lowest rates, which happen to be Medicare and Medicaid. But why do Medicare and Medicaid have low rates? You might as well say the system is better off having people who can't pay for medical treatment because it drives pricing down. It doesn't work that way because treatment is still being provided and now those costs need to be recouped.

Also, rationing isn't a fallacy. It's an economic effect any time there is a price ceiling in place.

Re: Trump punts healthcare down the road until after election.
« Reply #26 on: December 20, 2019, 01:00:55 PM »

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When you need medical care, how can you shop around for a better deal?  If you need a car you can choose a used car or a new car.  If you need your hip replaced, are you going get a used hip to save money?

You cant shop around now because the system has removed the consumer from the paying for services.  Except for major medical or emergencies - most healthcare is just service like any other service you buy. 

Insurance should be insurance against large and unexpected costs like car and home owners is.  Not routine services. 

If I need a new hip and I had to front the majority of cost (and the system was transparent) - I would shop between the hospitals in my city or even consider looking at neighboring cities.  Maybe there would be hip replacement clinics in major cities where that's all they do and people would go there to get specialized service and better prices - who knows what the market would provide - but it would provide what people want if there is a dollar to be made.

Insurers already do essentially what you want. They negotiate prices with providers, and try to set the payment at a level they can get back in premiums. If they miss and pay the provider too much, they'll lose money or have to raise premiums - which will drive people to another insurer. Commonly, insurers set a price they will pay a provider in their network, and if a policyholder wants a different doc and goes out of network the insurer typically pays an even lower amount.

There isn't any plausible path in the foreseeable future for having people pay "the majority of the cost" for a joint replacement - or many other treatments like cancer therapy. These are very large, unplanned expenses, essentially akin to your house burning down after a lightning strike.  They are precisely the kind of thing you buy insurance for, where the whole point of insurance is not to have to pay the "majority of the cost" because you'd be bankrupt. Maybe you think the market will magically transform $200,000 of medical bills into $2,000, but I'm not that great an optimist. You are involving highly skilled professionals and cutting edge techology. Maybe if we're lucky in 100 years this will be as cheap and easy as taking an aspirin - and correspondingly cheap - but we are nowhere near that.

Meanwhile, there are countries that pay much less than we do for health outcomes that are essentially the same or better. But we can't do that because... who knows? 

Re: Trump punts healthcare down the road until after election.
« Reply #27 on: December 20, 2019, 01:26:11 PM »

Online slamtheking

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As a country, we need to migrate to a system that is national.  it's inevitable.  It won't happen in my lifetime but it will happen.  As for worrying about the cost in terms of taxes, consider how much money is going to insurance companies now.  change that to going to a govt tax/fund instead where your services are covered.

No thanks but sadly agree that it is inevitable.  People need to acknowledge that skyrocketing prices are due to lack of competition and market forces.  Going to govt payer doesn't fix that primary issue and will only lead to rationing and poorer quality of service as a way try to control prices - it would be their only weapon. 
actually, govt programs are what commercial insurers base their payment rates on.  Medicare and Medicaid have lower reimbursement rates for the same services than Commercial insurers.  When provider groups band together for negotiations with the Commercial insurers, that's when they have to pay rates higher than what Medicare and Medicaid pay.  As for rationing, that's a fallacy pushed by the people working against it.  you can find isolated instances in the countries that have universal coverage for its people but for the most part, everyone gets the treatment they need in a timely manner.   of course there needs to be a corresponding shift in people's expectations that they're entitled to everything they want on demand as well as a general improvement in people taking better care of themselves.

competition amongst insurers doesn't drive how much providers are paid.  only impact is how much the consumers are paying for coverage.

You've kind of got some circular reasoning going on there. Commercial insurers base their rates on the lowest rates, which happen to be Medicare and Medicaid. But why do Medicare and Medicaid have low rates? You might as well say the system is better off having people who can't pay for medical treatment because it drives pricing down. It doesn't work that way because treatment is still being provided and now those costs need to be recouped.

Also, rationing isn't a fallacy. It's an economic effect any time there is a price ceiling in place.
the point about Medicare/Medicaid having the lowest pricing is the clout of government being able to dictate payment rates based on constant studies of task complexity, technological advances and availability of providers.    Similar principle holds to Commercial insurers where the bigger insurers are able to wield more leverage in negotiations with providers than smaller insurers. 

Rationing is being used as a scare tactic in that it's being mentioned as applied to many services.  The reality is that hard-to-get services, which already have a wait time to be available, would like still require a wait time to become available but extremely unlikely that the patient would not receive the treatment if necessary.

Re: Trump punts healthcare down the road until after election.
« Reply #28 on: December 20, 2019, 02:42:52 PM »

Offline Celtics4ever

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The Democrats won the House with their main platform item being healthcare. Trump's answer is let's get rid of Obamacare and after the election the Republicans will push through the best healthcare plan ever. Is this the same plan Republicans have been telling the country they will be putting in place of Obamacare for 9-10 years but have never told us the details of?

Both parties are horrible on this issue, it is inexcusable that the GOP had no replacement and the Dems lacked the moral courage to go all the way when they had the chance.

Re: Trump punts healthcare down the road until after election.
« Reply #29 on: December 20, 2019, 03:16:23 PM »

Offline SDceltGuy

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actually, govt programs are what commercial insurers base their payment rates on.  Medicare and Medicaid have lower reimbursement rates for the same services than Commercial insurers.  When provider groups band together for negotiations with the Commercial insurers, that's when they have to pay rates higher than what Medicare and Medicaid pay.  As for rationing, that's a fallacy pushed by the people working against it.  you can find isolated instances in the countries that have universal coverage for its people but for the most part, everyone gets the treatment they need in a timely manner.   of course there needs to be a corresponding shift in people's expectations that they're entitled to everything they want on demand as well as a general improvement in people taking better care of themselves.

competition amongst insurers doesn't drive how much providers are paid.  only impact is how much the consumers are paying for coverage.

While I disagree with all of this, it misses the point of my argument.  Insurance - govt or private - as a third party payer is the primary factor for exploding health care costs.  If you want lower costs, you need to get govt and insurance out of paying for services.   

It is beyond me that anyone would want this (or any) govt to have a monopoly on healthcare.  Unless your poor - you will get worse service and pay more for it than a market based system.