Author Topic: Trump punts healthcare down the road until after election.  (Read 6005 times)

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Re: Trump punts healthcare down the road until after election.
« Reply #45 on: January 02, 2020, 01:11:58 PM »

Offline bellerephon

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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.
I have to disagree with this, I think rationing is inevitable and unavoidable in a government run system. We actually have a form of rationing now, care is rationed by people's ability to pay. Under a single payer system there will need to be a different way of dealing with the problem of supply. We already have a shortage of providers, and that will likely get worse in a government run system. Places like the UK have acute shortages, and the result is rationing. They don't call it that of course, they package it in a more palatable way, but it is real. The government will not, IMHO, be able to provide all the care that people want, as quickly as they want, and lower costs without large tax increases all at the same time. They will need to find a way to get people to use the system less often. Currently we do that with price and denial of coverage. In a single payer system they do it with wait times and a strict list of which procedures providers are allowed to offer. I call that rationing.

Re: Trump punts healthcare down the road until after election.
« Reply #46 on: January 02, 2020, 01:14:29 PM »

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.
I have to disagree with this, I think rationing is inevitable and unavoidable in a government run system. We actually have a form of rationing now, care is rationed by people's ability to pay. Under a single payer system there will need to be a different way of dealing with the problem of supply. We already have a shortage of providers, and that will likely get worse in a government run system. Places like the UK have acute shortages, and the result is rationing. They don't call it that of course, they package it in a more palatable way, but it is real. The government will not, IMHO, be able to provide all the care that people want, as quickly as they want, and lower costs without large tax increases all at the same time. They will need to find a way to get people to use the system less often. Currently we do that with price and denial of coverage. In a single payer system they do it with wait times and a strict list of which procedures providers are allowed to offer. I call that rationing.

Exactly.

Re: Trump punts healthcare down the road until after election.
« Reply #47 on: January 02, 2020, 01:27:12 PM »

Offline Vermont Green

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The "free market is always the answer" position is flawed.  History shows us that at one time we didn't have municipal fire departments.  Private insurance companies had private fire brigades but those brigades would only respond to structures that held insurance from the company.  It didn't take long for it to become clear that this made no sense.  If a house is on fire, whether insured by a given company or not, the fire will spread if not dealt with.  Government run fire departments are much better.  This is just one example.  You can also look at utilities.  Does is make sense to have multiple companies run power lines to every house?  Of course not.  It makes the most sense for everyone to use the same power lines.

Health Care unfortunately is in that same category.  There is no perfect solution but a purely free enterprise system doesn't work because when you need health care services, you have no choice.  Sure you can shop around which may nibble around the edges of the overall costs but that isn't really going to make even a dent in the costs.  If you suffer severe injuries in a car accident for example, how much shopping around are you going to do?  Maybe there are options for the physical therapy at the end of your treatment but that is about it.

I certainly don't know the answer but I do know that the republican initiative to use the courts to some how cancel ACA (Obamacare) is cutting off your nose to spite your face (which is what this discussion started about).  I don't understand why people are still cheering this on.  If you have a better approach, bring it on, let's hear it.  But the reality is something along the lines of ACA (including a mandate) or medicare for all type approach.  Those are your options.

And yes, I agree that it should be wholly disconnected from employers in either case.

Re: Trump punts healthcare down the road until after election.
« Reply #48 on: January 02, 2020, 02:28:26 PM »

Offline gift

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The "free market is always the answer" position is flawed.  History shows us that at one time we didn't have municipal fire departments.  Private insurance companies had private fire brigades but those brigades would only respond to structures that held insurance from the company.  It didn't take long for it to become clear that this made no sense.  If a house is on fire, whether insured by a given company or not, the fire will spread if not dealt with.  Government run fire departments are much better.  This is just one example.

It's interesting that we are starting to see a rise in private fire fighters employed by insurance companies again.

Re: Trump punts healthcare down the road until after election.
« Reply #49 on: January 02, 2020, 03:06:19 PM »

Offline spikelovetheCelts

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The "free market is always the answer" position is flawed.  History shows us that at one time we didn't have municipal fire departments.  Private insurance companies had private fire brigades but those brigades would only respond to structures that held insurance from the company.  It didn't take long for it to become clear that this made no sense.  If a house is on fire, whether insured by a given company or not, the fire will spread if not dealt with.  Government run fire departments are much better.  This is just one example.  You can also look at utilities.  Does is make sense to have multiple companies run power lines to every house?  Of course not.  It makes the most sense for everyone to use the same power lines.

Health Care unfortunately is in that same category.  There is no perfect solution but a purely free enterprise system doesn't work because when you need health care services, you have no choice.  Sure you can shop around which may nibble around the edges of the overall costs but that isn't really going to make even a dent in the costs.  If you suffer severe injuries in a car accident for example, how much shopping around are you going to do?  Maybe there are options for the physical therapy at the end of your treatment but that is about it.

I certainly don't know the answer but I do know that the republican initiative to use the courts to some how cancel ACA (Obamacare) is cutting off your nose to spite your face (which is what this discussion started about).  I don't understand why people are still cheering this on.  If you have a better approach, bring it on, let's hear it.  But the reality is something along the lines of ACA (including a mandate) or medicare for all type approach.  Those are your options.

And yes, I agree that it should be wholly disconnected from employers in either case.
The problem is Socialized Medicine does not work. We need to have health care savings accounts. A predetermined percent If one smokes or is overweight they have to pay an extra fee. We need to pay for our own health care. It can be done without getting the government getting involved. Fires and Utilities are like apples. Healthcare is an orange it shoots all over the place.
"People look at players, watch them dribble between their legs and they say, 'There's a superstar.'  Well John Havlicek is a superstar, and most of the others are figments of writers' imagination."
--Jerry West, on John Havlicek

Re: Trump punts healthcare down the road until after election.
« Reply #50 on: January 02, 2020, 03:40:12 PM »

Offline SDceltGuy

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The "free market is always the answer" position is flawed.  History shows us that at one time we didn't have municipal fire departments.  Private insurance companies had private fire brigades but those brigades would only respond to structures that held insurance from the company.  It didn't take long for it to become clear that this made no sense.  If a house is on fire, whether insured by a given company or not, the fire will spread if not dealt with.  Government run fire departments are much better.  This is just one example.  You can also look at utilities.  Does is make sense to have multiple companies run power lines to every house?  Of course not.  It makes the most sense for everyone to use the same power lines.

Health Care unfortunately is in that same category.  There is no perfect solution but a purely free enterprise system doesn't work because when you need health care services, you have no choice.  Sure you can shop around which may nibble around the edges of the overall costs but that isn't really going to make even a dent in the costs.  If you suffer severe injuries in a car accident for example, how much shopping around are you going to do?  Maybe there are options for the physical therapy at the end of your treatment but that is about it.

I certainly don't know the answer but I do know that the republican initiative to use the courts to some how cancel ACA (Obamacare) is cutting off your nose to spite your face (which is what this discussion started about).  I don't understand why people are still cheering this on.  If you have a better approach, bring it on, let's hear it.  But the reality is something along the lines of ACA (including a mandate) or medicare for all type approach.  Those are your options.

And yes, I agree that it should be wholly disconnected from employers in either case.

I see very little connection between healthcare and fire protection and what we have now is nothing close to free market healthcare.  Almost nobody currently pays for their own healthcare services. 

I struggle to think of a single service where government provides more choices at less cost to the average citizen than the 'free market'.  Even most of my utilities are provided by private companies, but with utilities there are space/infrastructure limitations that are unique to that sector.  In addition to just the cost benefit, there is a freedom benefit - once the government takes over - you will never get it back and you will have no recourse against it.  Rationing (controlling supply) will happen. 

Providing food distribution is a better example and arguably a much more acute personal need, yet almost nobody would say that we would be better off if government took that over.  Some people need help, but throwing the whole system out because of that is counter productive.  Many of the current problems with healthcare in this country are directly attributed to government interference in the first place (including connecting it to employers). 

Re: Trump punts healthcare down the road until after election.
« Reply #51 on: January 02, 2020, 04:37:06 PM »

Offline Vermont Green

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Providing food distribution is a better example and arguably a much more acute personal need, yet almost nobody would say that we would be better off if government took that over.  Some people need help, but throwing the whole system out because of that is counter productive.  Many of the current problems with healthcare in this country are directly attributed to government interference in the first place (including connecting it to employers).

I can't dispute that there is no direct parallel to health care but I am still not convinced that every citizen could have a health savings account and just buy their services on an open, competitive market (or some other such fictional free enterprise approach).  My point is that it is not always true that private is better than public.  I believe that Health Care is one such instance.

The idea of food could have some similarities but with food, you can buy prime rib and crab legs or frozen hamburger and fish sticks.  I don't think we want a system where the wealthy get the crab leg health care and the poor get fish sticks (if they can afford even that).  Everyone should get the best health care, that is why it is always going to cost so much.  Unless you think the bar could be lowered where everyone gets good enough health care if that is all you can afford and the rich can buy better health care for themselves.

Re: Trump punts healthcare down the road until after election.
« Reply #52 on: January 02, 2020, 04:56:22 PM »

Offline gift

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Providing food distribution is a better example and arguably a much more acute personal need, yet almost nobody would say that we would be better off if government took that over.  Some people need help, but throwing the whole system out because of that is counter productive.  Many of the current problems with healthcare in this country are directly attributed to government interference in the first place (including connecting it to employers).

I can't dispute that there is no direct parallel to health care but I am still not convinced that every citizen could have a health savings account and just buy their services on an open, competitive market (or some other such fictional free enterprise approach).  My point is that it is not always true that private is better than public.  I believe that Health Care is one such instance.

The idea of food could have some similarities but with food, you can buy prime rib and crab legs or frozen hamburger and fish sticks.  I don't think we want a system where the wealthy get the crab leg health care and the poor get fish sticks (if they can afford even that).  Everyone should get the best health care, that is why it is always going to cost so much.  Unless you think the bar could be lowered where everyone gets good enough health care if that is all you can afford and the rich can buy better health care for themselves.

"Everyone should get the best health care"

How is that even possible? I understand the sentiment. But in what world can everyone actually get the best of anything? I think the only way to do that in any sector is to lower the best to a standard far below what we now consider the best.

Re: Trump punts healthcare down the road until after election.
« Reply #53 on: January 03, 2020, 08:48:20 AM »

Offline SDceltGuy

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I am still not convinced that every citizen could have a health savings account and just buy their services on an open, competitive market (or some other such fictional free enterprise approach).  My point is that it is not always true that private is better than public.  I believe that Health Care is one such instance.

I need some evidence of this.  Please provide instances where government provides better services at less cost.  We have a tremendous record of the private sector doing it for pretty much every other service and good you want to purchase.  Government is corrupt, inefficient and dumb - where decisions are made via politics. 

I don't think we want a system where the wealthy get the crab leg health care and the poor get fish sticks (if they can afford even that).  Everyone should get the best health care, that is why it is always going to cost so much.  Unless you think the bar could be lowered where everyone gets good enough health care if that is all you can afford and the rich can buy better health care for themselves.

What will happen with government healthcare is everyone (but the very wealthy) will get fish sticks as their only choice while paying more for it.  Why should everyone expect the 'best' anyway, at their neighbors expense?  Should obese smokers that ride motorcycles have their HC subsidized by those that eat healthy, exercise and don't engage in risky behavior?  I want choices, lower costs and fairness - that only the free market can provide.

Re: Trump punts healthcare down the road until after election.
« Reply #54 on: January 03, 2020, 09:25:55 AM »

Offline Vermont Green

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I am still not convinced that every citizen could have a health savings account and just buy their services on an open, competitive market (or some other such fictional free enterprise approach).  My point is that it is not always true that private is better than public.  I believe that Health Care is one such instance.

I need some evidence of this.  Please provide instances where government provides better services at less cost.  We have a tremendous record of the private sector doing it for pretty much every other service and good you want to purchase.  Government is corrupt, inefficient and dumb - where decisions are made via politics. 

I don't think we want a system where the wealthy get the crab leg health care and the poor get fish sticks (if they can afford even that).  Everyone should get the best health care, that is why it is always going to cost so much.  Unless you think the bar could be lowered where everyone gets good enough health care if that is all you can afford and the rich can buy better health care for themselves.

What will happen with government healthcare is everyone (but the very wealthy) will get fish sticks as their only choice while paying more for it.  Why should everyone expect the 'best' anyway, at their neighbors expense?  Should obese smokers that ride motorcycles have their HC subsidized by those that eat healthy, exercise and don't engage in risky behavior?  I want choices, lower costs and fairness - that only the free market can provide.

To me, you are mixing up two things.  First, the government is not going to provide the health care, just pay for it.  The government has provided health care directly to veterans for years.  My Dad is a veteran and gets care through the VA.  No one is proposing to expand the VA to cover the entire country, just Medicare as a way to pay for the care.  There is a big difference.  The VA is not all bad by the way.  My Dad has some health issues and has been well cared for by the VA.

The second thing that you (and others) are commenting on is the idea that everyone should get the best care.  I put that in fully to bait responses as I feel that is the crux of the issue of the cost of health care, not how health care is paid for.  Right now, that is the system, nothing but the best for everyone.  Any politician who even suggests changing that will get cat calls of rationing and death panels but that is ultimately going to need to be part of the solution.  I don't know how you go about determining when a cost is warranted and when not (for example, an expensive cancer treatment that extends the life for 3 months or 6 months) but if we don't figure it out, health care will bankrupt the country eventually.

Re: Trump punts healthcare down the road until after election.
« Reply #55 on: January 03, 2020, 09:59:33 AM »

Offline SDceltGuy

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To me, you are mixing up two things.  First, the government is not going to provide the health care, just pay for it.  The government has provided health care directly to veterans for years.  My Dad is a veteran and gets care through the VA.  No one is proposing to expand the VA to cover the entire country, just Medicare as a way to pay for the care.  There is a big difference.  The VA is not all bad by the way.  My Dad has some health issues and has been well cared for by the VA.

The second thing that you (and others) are commenting on is the idea that everyone should get the best care.  I put that in fully to bait responses as I feel that is the crux of the issue of the cost of health care, not how health care is paid for.  Right now, that is the system, nothing but the best for everyone.  Any politician who even suggests changing that will get cat calls of rationing and death panels but that is ultimately going to need to be part of the solution.  I don't know how you go about determining when a cost is warranted and when not (for example, an expensive cancer treatment that extends the life for 3 months or 6 months) but if we don't figure it out, health care will bankrupt the country eventually.

I'm probably not being very clear.  I agree the government will not directly run the hospitals - but if they are paying the for the services then they will dictate - what, where and when. 

I think the crux of the entire HC issue is who is paying, which was my initial argument in this thread.  Be it private or public insurance, when someone else pays - the only concern is getting the best - not making value judgements like we do for every other service we purchase.  This IMO is the primary reason for HC costing so much.  HC insurance should only be for emergencies only.  If you want to control cost, the only way to do it is to make the consumer responsible for evaluating, selecting and paying for their consumption.   

I have worked for the VA and it is maddening how wasteful, inefficient and political it is compared to working for private sector operations.  Being a government entity, every action and decision there takes longer and adds costs because of all the restrictions, regulations and directives that aren't applicable to private sector.  Public insurance/HC will absolutely cost more do to this built in inefficiency.

Addtionally, because the VA pays below market rates, it struggles to get doctors and has to contract services in from private sector (at a premium).   



Re: Trump punts healthcare down the road until after election.
« Reply #56 on: February 19, 2020, 11:25:58 AM »

Offline SDceltGuy

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Fact: Healthcare is a scarce resource and therefore will be rationed somehow.  This is the foundation of economics.

1) My professional opinion, as an economist, is that you are not an economist.

2) 29% of Americans reported not taking some or all of their prescribed medication because they couldn’t afford it.  There is a lot of rationing in today’s healthcare system, and there is little evidence that such rationing at such levels exists in nations with universal health care.

That’s why Medicare-for-All is a winning issue.

Nope, I'm not and I don't know how good of an economist you are.  I'm correct about what I said  - and you agreed - rationing will happen.   We just may disagree about the severity.   

Also, your poll comes from where?  The ones I've seen have it much less and there are far greater reasons people don't take their meds.  This one for example.  https://www.npr.org/sections/health-shots/2017/09/08/549414152/why-do-people-stop-taking-their-meds-cost-is-just-one-reason




Re: Trump punts healthcare down the road until after election.
« Reply #57 on: February 19, 2020, 12:01:12 PM »

Offline W8ting2McHale

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Fact: Healthcare is a scarce resource and therefore will be rationed somehow.  This is the foundation of economics.

1) My professional opinion, as an economist, is that you are not an economist.

2) 29% of Americans reported not taking some or all of their prescribed medication because they couldn’t afford it.  There is a lot of rationing in today’s healthcare system, and there is little evidence that such rationing at such levels exists in nations with universal health care.

That’s why Medicare-for-All is a winning issue.

Nope, I'm not and I don't know how good of an economist you are.  I'm correct about what I said  - and you agreed - rationing will happen.   We just may disagree about the severity.   

Also, your poll comes from where?  The ones I've seen have it much less and there are far greater reasons people don't take their meds.  This one for example.  https://www.npr.org/sections/health-shots/2017/09/08/549414152/why-do-people-stop-taking-their-meds-cost-is-just-one-reason

Strange? I read that as the opposite of what you stated.

He seems to be saying (to me anyway) that there is rationing in our current system, and gives an example. Are you saying rationing in our current system is worse than the article states? Is that the difference of severity?

Then he goes on to state that there is little evidence of rationing in universal healthcare programs sponsored by other countries. Are you seeing “little evidence “ as a level of severity? Because I certainly do not. I don’t read that as agreeing that rationing will happen.

Re: Trump punts healthcare down the road until after election.
« Reply #58 on: February 19, 2020, 12:09:44 PM »

Offline gift

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Fact: Healthcare is a scarce resource and therefore will be rationed somehow.  This is the foundation of economics.

1) My professional opinion, as an economist, is that you are not an economist.

2) 29% of Americans reported not taking some or all of their prescribed medication because they couldn’t afford it.  There is a lot of rationing in today’s healthcare system, and there is little evidence that such rationing at such levels exists in nations with universal health care.

That’s why Medicare-for-All is a winning issue.

Nope, I'm not and I don't know how good of an economist you are.  I'm correct about what I said  - and you agreed - rationing will happen.   We just may disagree about the severity.   

Also, your poll comes from where?  The ones I've seen have it much less and there are far greater reasons people don't take their meds.  This one for example.  https://www.npr.org/sections/health-shots/2017/09/08/549414152/why-do-people-stop-taking-their-meds-cost-is-just-one-reason

Strange? I read that as the opposite of what you stated.

He seems to be saying (to me anyway) that there is rationing in our current system, and gives an example. Are you saying rationing in our current system is worse than the article states? Is that the difference of severity?

Then he goes on to state that there is little evidence of rationing in universal healthcare programs sponsored by other countries. Are you seeing “little evidence “ as a level of severity? Because I certainly do not. I don’t read that as agreeing that rationing will happen.

Rationing and prohibitive price points are not the same thing. You do not take the same actions to deal with them.

Re: Trump punts healthcare down the road until after election.
« Reply #59 on: February 19, 2020, 12:16:27 PM »

Offline fairweatherfan

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Fact: Healthcare is a scarce resource and therefore will be rationed somehow.  This is the foundation of economics.

1) My professional opinion, as an economist, is that you are not an economist.

2) 29% of Americans reported not taking some or all of their prescribed medication because they couldn’t afford it.  There is a lot of rationing in today’s healthcare system, and there is little evidence that such rationing at such levels exists in nations with universal health care.

That’s why Medicare-for-All is a winning issue.

Nope, I'm not and I don't know how good of an economist you are.  I'm correct about what I said  - and you agreed - rationing will happen.   We just may disagree about the severity.   

Also, your poll comes from where?  The ones I've seen have it much less and there are far greater reasons people don't take their meds.  This one for example.  https://www.npr.org/sections/health-shots/2017/09/08/549414152/why-do-people-stop-taking-their-meds-cost-is-just-one-reason

Strange? I read that as the opposite of what you stated.

He seems to be saying (to me anyway) that there is rationing in our current system, and gives an example. Are you saying rationing in our current system is worse than the article states? Is that the difference of severity?

Then he goes on to state that there is little evidence of rationing in universal healthcare programs sponsored by other countries. Are you seeing “little evidence “ as a level of severity? Because I certainly do not. I don’t read that as agreeing that rationing will happen.

Rationing and prohibitive price points are not the same thing. You do not take the same actions to deal with them.

How many countries with universal health care literally have no other options if the gov't system denies the procedure/treatment, as opposed to just having to pay (far less than here) out of pocket to get it, just like people denied by insurance companies can do?

Also, does anyone know - does Medicare have any process of rationing care?