Author Topic: Trump punts healthcare down the road until after election.  (Read 6004 times)

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Re: Trump punts healthcare down the road until after election.
« Reply #30 on: December 20, 2019, 03:24:44 PM »

Offline SDceltGuy

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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. 

I agree there is no current path as people have been conditioned to the current system and cant or wont consider radical change even if the outcome would be lower costs.  It would require more personal accountability and responsibility than current system. 

Insurance should be only for large unexpected events like cancer - not routine or elective services. 

Re: Trump punts healthcare down the road until after election.
« Reply #31 on: December 20, 2019, 03:26:12 PM »

Offline byennie

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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.

Certainly government run is no panacea, but the answer to why itís beyond you seems to be in your comment: unless you are poor. So itís worse for the most vulnerable, with no clear ceiling on who that comprises. Itís beyond me why market based system proponents think this can be glazed over.

Re: Trump punts healthcare down the road until after election.
« Reply #32 on: December 20, 2019, 03:31:28 PM »

Offline gift

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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.

Yeah, you said the same thing, but you're not seeing the true effect of what you're describing. If a provider is falling short of their target budget, they will find the money where they can. If they are locked in to certain rates, they will raise rates to make up the difference. The only way to stop this is to cap rates across the board, but then you end up with the downsides of inducing a price ceiling (shortages).

Re: Trump punts healthcare down the road until after election.
« Reply #33 on: December 20, 2019, 03:44:33 PM »

Offline SDceltGuy

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Certainly government run is no panacea, but the answer to why it’s beyond you seems to be in your comment: unless you are poor. So it’s worse for the most vulnerable, with no clear ceiling on who that comprises. It’s beyond me why market based system proponents think this can be glazed over.

I think the majority of the left thinks it is a panacea and generally ignore how bad and inefficient the government is at running anything despite a mountain of evidence.  Look at the people elected to run government - do they inspire confidence?  You want Trump making decisions for your HC?  I don't.  I want as much freedom and personal choice as I can.  When I have a problem with my HC I have a multitude of options - with government I would have far less and no real recourse against them.

Lots of people are poor and cant afford food.  Do we demand government commandeer the whole food distribution and payment system?  Does anyone want government paying everyone's grocery bill and think that will lead to a better outcome for the vast majority than what we currently have?  I like choices.  Once government moves in that all permanently is gone.
« Last Edit: December 20, 2019, 03:51:06 PM by SDceltGuy »

Re: Trump punts healthcare down the road until after election.
« Reply #34 on: December 20, 2019, 03:48:27 PM »

Offline Fan from VT

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I think there are clearly multiple factors in rising medical costs. I don't even know how to rank them.

1. Provider costs. And even within provider costs, there is a huge discrepancy, mainly between primary care and specialists. The proportion of specialists in the US is very out of control compared to other countries, and specialists simply cost many times that of a primary care doctor. This is also exacerbated by an internet and media that encourages people to assume an issue is not settled until 1-2 specialists say so.

2. Fee for service. The reimbursement structure itself incentivizes rising costs. Even the most well meaning physicians unconsciously err on the side of performing a procedure if it reimburses at a higher rate than just talking about it. And as above, the proportional costs are a bit out of control, such that our procedure-happy culture ends up footing a huge bill for unnecessary procedures.

3. Insurance. Insurance, as a concept, is basically a group of people saying "some of us will get sick and some will not. On average, we will have medical expenses of 10,000 per year. So if we all put in 10,000 per year, and use what we need when we need it, then we won't have unexpected bankruptcy." And if you have a large enough pool of people, it works. These types of systems have some sort of inherent efficiency, in other words, Money In - Money Out. The most efficient systems will have the smallest gap between money in and money out. Medicare/medicaid sometimes look wasteful due to the massive size of the population, but is by far more efficient in terms of money in - money out. In private insurance, there is a huge gap between money in - money out, mainly going into executive suites, executive salaries, etc. Ideally, the money "should" be going to lower premiums (taxes?) and higher output.

4. Pharmaceuticals. Big one. Patent law regarding pharmaceuticals is broken, as is price negotiation law, with laws basically preventing consumers and providers from price comparing, etc. It's really really bad.

Re: Trump punts healthcare down the road until after election.
« Reply #35 on: December 20, 2019, 03:55:27 PM »

Offline gift

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Certainly government run is no panacea, but the answer to why itís beyond you seems to be in your comment: unless you are poor. So itís worse for the most vulnerable, with no clear ceiling on who that comprises. Itís beyond me why market based system proponents think this can be glazed over.

I think the majority of the left thinks it is a panacea and generally ignore how bad and inefficient the government is at running anything despite a mountain of evidence.  Look at the people elected to run government - do they inspire confidence?  You want Trump making decisions for your HC?  I don't.  I want as much freedom and personal choice as I can.  When I have a problem with my HC I have a multitude of options - with government I would have far less and no real recourse against them.

Lots of people are poor and cant afford food.  Do we demand government commandeer the whole food distribution and payment system?  Does anyone want government paying everyone's grocery bill and think that will lead to a better outcome for the vast majority than what we currently have?  I like choices.  Once government moves in that all permanently is gone.

I favor a government run system more than what we have now, but I try to be very critical and honest about what that means. I wish there was a way to clean the system, but I'm not sure how.

Re: Trump punts healthcare down the road until after election.
« Reply #36 on: December 20, 2019, 04:19:34 PM »

Offline SDceltGuy

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I favor a government run system more than what we have now, but I try to be very critical and honest about what that means. I wish there was a way to clean the system, but I'm not sure how.

 

It could go 2 ways.  Towards free markets or towards government monopoly.  One gives more choices and lower costs, one gives less choices and higher costs (or rationing).  What incentive is there for prices not to rise if people have no incentive to save money, but every incentive to consume as my 'free' HC as possible?  Once government takes over the only way they have to control prices is by price controls (rationing and death panels :)) unless your rich enough to pay for private care on top what you pay for gov care. 

Re: Trump punts healthcare down the road until after election.
« Reply #37 on: December 20, 2019, 04:27:19 PM »

Offline liam

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I favor a government run system more than what we have now, but I try to be very critical and honest about what that means. I wish there was a way to clean the system, but I'm not sure how.

 

It could go 2 ways.  Towards free markets or towards government monopoly.  One gives more choices and lower costs, one gives less choices and higher costs (or rationing).  What incentive is there for prices not to rise if people have no incentive to save money, but every incentive to consume as my 'free' HC as possible?  Once government takes over the only way they have to control prices is by price controls (rationing and death panels :)) unless your rich enough to pay for private care on top what you pay for gov care.

"In 1973, Nixon did a personal favor for his friend and campaign financier, Edgar Kaiser, then president and chairman of Kaiser-Permanente.  Nixon signed into law, the Health Maintenance Organization Act of 1973, in which medical insurance agencies, hospitals, clinics and even doctors, could begin functioning as for-profit business entities instead of the service organizations they were intended to be.  And which insurance company got the first taste of federal subsidies to implement HMOA73 Ö *gasp* Ö why, it was Kaiser-Permanente!   What are the odds?"

Re: Trump punts healthcare down the road until after election.
« Reply #38 on: December 20, 2019, 04:44:54 PM »

Offline gift

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I favor a government run system more than what we have now, but I try to be very critical and honest about what that means. I wish there was a way to clean the system, but I'm not sure how.

 

It could go 2 ways.  Towards free markets or towards government monopoly.  One gives more choices and lower costs, one gives less choices and higher costs (or rationing).  What incentive is there for prices not to rise if people have no incentive to save money, but every incentive to consume as my 'free' HC as possible?  Once government takes over the only way they have to control prices is by price controls (rationing and death panels :)) unless your rich enough to pay for private care on top what you pay for gov care.

The way I look at it is that it can go 3 ways. Free markets, government monopoly or continue with the status quo. And of those three I view the status quo as the worst (not even because it's so bad now but because it's unsustainable and at some point catastrophic across the board), with a free market solution being the best but most difficult to achieve with so many people misunderstanding markets and not understanding/trusting economics. A large portion of the population has dug in and rejected the best solution, so that leaves us with the other two.

Re: Trump punts healthcare down the road until after election.
« Reply #39 on: December 20, 2019, 05:02:42 PM »

Offline nickagneta

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Just want to say that there is no chance whatsoever of medical rationing or death panels happening in this country. None. It's just scare tactics and rhetoric to get people to not look at the ACA, Medicare for All or some other health care solution in a positive light.

Re: Trump punts healthcare down the road until after election.
« Reply #40 on: December 20, 2019, 05:05:19 PM »

Offline 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.

Yeah, you said the same thing, but you're not seeing the true effect of what you're describing. If a provider is falling short of their target budget, they will find the money where they can. If they are locked in to certain rates, they will raise rates to make up the difference. The only way to stop this is to cap rates across the board, but then you end up with the downsides of inducing a price ceiling (shortages).
and you're saying the same thing but you're not seeing what you're stating.

if they're locked into certain rates, what rates are they planning to raise?  Are you referring to 'certain' rates on only specific items?  how's that work if the govt has a rate for everything and they're the payor?  what rates are they going to change --> the pay to the providers?  that's about it unless you're speculating they're going to cut the services they render that aren't profitable.  if that's the case, what happens today is they petition the govt for a rate change and provide the data to back it up.  If the proof is there, CMS has been reasonable in terms of adjusting payments if there's cause to do so. 

Re: Trump punts healthcare down the road until after election.
« Reply #41 on: January 02, 2020, 11:28:36 AM »

Offline gift

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Just want to say that there is no chance whatsoever of medical rationing or death panels happening in this country. None. It's just scare tactics and rhetoric to get people to not look at the ACA, Medicare for All or some other health care solution in a positive light.

Sure, rationing is being used as a scare tactic, but as I stated previously it's an economic effect whenever you induce a price ceiling. It's real. The question is how exactly the rationing plays out (is it always a moving target or is there a real crunch for vital services?). A significant problem is a real possibility and should not be ignored or written off. Saying it will never happen is just the inverse fallacy of using the scare tactic that it will happen.

Re: Trump punts healthcare down the road until after election.
« Reply #42 on: January 02, 2020, 11:38:10 AM »

Offline gift

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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.

Yeah, you said the same thing, but you're not seeing the true effect of what you're describing. If a provider is falling short of their target budget, they will find the money where they can. If they are locked in to certain rates, they will raise rates to make up the difference. The only way to stop this is to cap rates across the board, but then you end up with the downsides of inducing a price ceiling (shortages).
and you're saying the same thing but you're not seeing what you're stating.

if they're locked into certain rates, what rates are they planning to raise?  Are you referring to 'certain' rates on only specific items?  how's that work if the govt has a rate for everything and they're the payor?  what rates are they going to change --> the pay to the providers?  that's about it unless you're speculating they're going to cut the services they render that aren't profitable.  if that's the case, what happens today is they petition the govt for a rate change and provide the data to back it up.  If the proof is there, CMS has been reasonable in terms of adjusting payments if there's cause to do so.

I'm saying currently providers will raise whichever rates they can to make up for rates that are negotiated at a lower price. So your claim is that government funded rates are lowering everything across the board. But in fact that's only true where providers are meeting X budget and where they are not, they are charging more to make up the difference.

In a system where the government provides all the insurance and therefore the rates, you will have in effect a price ceiling on services. A very real effect of this, whether used as a scare tactic by some or not, is shortages of those services that are capped. This can range from mildly problematic to devastating.

Re: Trump punts healthcare down the road until after election.
« Reply #43 on: January 02, 2020, 12:59:48 PM »

Offline 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.

Yeah, you said the same thing, but you're not seeing the true effect of what you're describing. If a provider is falling short of their target budget, they will find the money where they can. If they are locked in to certain rates, they will raise rates to make up the difference. The only way to stop this is to cap rates across the board, but then you end up with the downsides of inducing a price ceiling (shortages).
and you're saying the same thing but you're not seeing what you're stating.

if they're locked into certain rates, what rates are they planning to raise?  Are you referring to 'certain' rates on only specific items?  how's that work if the govt has a rate for everything and they're the payor?  what rates are they going to change --> the pay to the providers?  that's about it unless you're speculating they're going to cut the services they render that aren't profitable.  if that's the case, what happens today is they petition the govt for a rate change and provide the data to back it up.  If the proof is there, CMS has been reasonable in terms of adjusting payments if there's cause to do so.

I'm saying currently providers will raise whichever rates they can to make up for rates that are negotiated at a lower price. So your claim is that government funded rates are lowering everything across the board. But in fact that's only true where providers are meeting X budget and where they are not, they are charging more to make up the difference.

In a system where the government provides all the insurance and therefore the rates, you will have in effect a price ceiling on services. A very real effect of this, whether used as a scare tactic by some or not, is shortages of those services that are capped. This can range from mildly problematic to devastating.
ask yourself this on that last item -> how much shortages of services are occurring for Medicare or Medicaid patients?  none that I'm aware of.  same situation could reasonably be expected for the rest of the population that is by and large healthier (thus with lower utilization of services) than the Medicare/Medicaid populations

this is just a theory until an actual example can be provided concerning those already being covered by govt programs.

Re: Trump punts healthcare down the road until after election.
« Reply #44 on: January 02, 2020, 01:02:39 PM »

Offline gift

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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.

Yeah, you said the same thing, but you're not seeing the true effect of what you're describing. If a provider is falling short of their target budget, they will find the money where they can. If they are locked in to certain rates, they will raise rates to make up the difference. The only way to stop this is to cap rates across the board, but then you end up with the downsides of inducing a price ceiling (shortages).
and you're saying the same thing but you're not seeing what you're stating.

if they're locked into certain rates, what rates are they planning to raise?  Are you referring to 'certain' rates on only specific items?  how's that work if the govt has a rate for everything and they're the payor?  what rates are they going to change --> the pay to the providers?  that's about it unless you're speculating they're going to cut the services they render that aren't profitable.  if that's the case, what happens today is they petition the govt for a rate change and provide the data to back it up.  If the proof is there, CMS has been reasonable in terms of adjusting payments if there's cause to do so.

I'm saying currently providers will raise whichever rates they can to make up for rates that are negotiated at a lower price. So your claim is that government funded rates are lowering everything across the board. But in fact that's only true where providers are meeting X budget and where they are not, they are charging more to make up the difference.

In a system where the government provides all the insurance and therefore the rates, you will have in effect a price ceiling on services. A very real effect of this, whether used as a scare tactic by some or not, is shortages of those services that are capped. This can range from mildly problematic to devastating.
ask yourself this on that last item -> how much shortages of services are occurring for Medicare or Medicaid patients?  none that I'm aware of.  same situation could reasonably be expected for the rest of the population that is by and larger healthier (thus with lower utilization of services) than the Medicare/Medicaid populations

this is just a theory until an actual example can be provided concerning those already being covered by govt programs.

There are no shortages because private insurance makes up the difference. I'm saying a full government funded insurance will essentially be forced to cap prices artificially. Currently, they don't cap prices because the market adjusts to their low rates by raising the rates that they can (there are many other forces at work too, but this is true).