Trumpcare vs Obamacare vs Single Payer

[Loren Pechtel]

Single payer now.

http://www.channel4.com/programmes/confessions-of-a-junior-doctor/episode-guide/

 

[Jolly_Penguin]

Yes. This exactly. I never understood how anybody could believe that adding a profit motive to health care insurance could make it cheaper. I also don't see how it could encourage preventative care.



My OHIP card (government single payer health insurance) pays for all but dental and prescription drugs. Also doesn't pay for cosmetic surgery etc. For dental and prescription drugs, many employers will give health insurance that pays for this, but many don't, and there is no obligation for them to. I've never had any such insurance from an employer myself. I pay that out of pocket. It doesn't amount to a whole lot, as our drugs are considerably cheaper here than they are in the USA.

Huh? If you are an insurance company and it costs $20 to prevent something compared to the $10K to fix it then there is definitely an incentive for prevntative care. I see the opposite, with socialized medicine there is no incentive to improve.

That would presume the person sticks with this coverage from this particular company forever, when the reality may be that they are on this insurance only for a few years until they switch to some other insurer (or none at all). In a single payer system, there is only one insurer (the state), and preventative care matters because failing to provide it means far more cost later on to this same payer.

It would also presume that the insurance company cares about lifespan of the customer and general well being of them beyond mere dollars spent, which is something government is supposed to care about and corporations are not (they have duties to stockholders, not citizens).

 

[untermensche]

....Most of the costs of treating those who can't pay is recovered through inflated fees for those who can pay.....

Yes. Ultimately anyone paying for insurance pays more because of the uninsured. It effects everyone buying insurance when millions don't have insurance.

But the people "running" the US government would rather fund wars without end than pay the small costs in comparison to give everybody health insurance.

We live in insane times.

With a government totally unresponsive to the needs of millions and ultimate to the welfare of us all.

We live in times where revolution is called for.

The system is so corrupt and so entrenched in wealth it is useless to most. A hindrance to most except the very rich.

 

[bilby]

Single payer now.

http://www.channel4.com/programmes/confessions-of-a-junior-doctor/episode-guide/

The current problems in the NHS are caused by a deliberate attempt by the Conservative government to sabotage it, in the hope that they will be able to privatize hospitals and move to a US style 'for-profit' insurance system, allowing the Government to slash taxes, and the wealthy Conservative MPs and their mates to line their pockets.

Privatization is, of course, theft. But ever since the dark days of Thatcher, successive Conservative governments in the UK have been hell-bent on doing as much of it as possible, to the detriment of the ordinary Briton, and the massive financial benefit of the wealthiest people in the country.

When I was growing up, I, purely by dint of my British Citizenship, owned a small fraction of a large and efficient Telecommunications company; A large Gas company; A nationwide railway network; A number of mines, shipyards, steelworks, car manufacturers, munitions companies, hospitals, research organizations, etc. etc...

Over time, each of these has been sold to 'investors'. And every time, the sale price has been set at a level that meant that shares were expected to MASSIVELY increase in value as soon as they began trading. So, in short, the Government sold my share, at a steep discount, and without asking my permission, to their supporters. And then expected me to be grateful for it, because they used the meagre proceeds to fund tax cuts (which, surprise surprise, largely favoured the rich, while having little or no effect on the poor). If you see Sid, tell him he's a fucking thief.

Each time, before selling, the concerns in question were underfunded and run down, to give a false impression that the proposed sale price was fair and reasonable, and to undercut any support from the public for keeping these assets in public hands.

Right now, NHS hospitals are underfunded and run down. This is not necessary - The public have repeatedly indicated that they would happily pay higher taxes to ensure that hospitals were properly funded. It's a purely ideological decision, and is a deliberate sabotage of the system, calculated to allow it to be broken up and sold off at a massive discount. It's Robin Hood in reverse - the Conservatives are, once again, robbing the poor to give to the rich.

Privatization is theft. If a national asset is not worth keeping, then you wouldn't be able to sell it; If you can sell it, then that indicates that it was better to keep it.

 

[Toni]

Yes. This exactly. I never understood how anybody could believe that adding a profit motive to health care insurance could make it cheaper. I also don't see how it could encourage preventative care.

The myth is the competition makes a more efficient--and cheaper-- system than a government one which would be filled with waste. None of the people who make that argument are arguing that they don't want Medicare (retirement age insurance via govt.) when it comes. Also those who make the rules also make rules that award themselves with pretty nice health care benefits, unlike what they select for the folks back home.

Of course, everybody who possibly can purchases supplemental Medicare insurance, even some older relatives of mine who are far from well off. If you are well off, you can afford better supplemental insurance, which means you pay less out of pocket for most of your health care needs.


FWIW, the biggest names in health care in the US tend to be non-profits: Mayo, Cleveland Clinic, Johns Hopkins, for instance, are all non-profit or at least have significant portions of their practice as non-profit. Between the three, they serve millions of patients each year, from around the country and around the world, and also serve local patients as well. Probably true of other big names in US health care as well. I believe that many/most hospitals are non-profits.

 

[Toni]

Huh? If you are an insurance company and it costs $20 to prevent something compared to the $10K to fix it then there is definitely an incentive for prevntative care. I see the opposite, with socialized medicine there is no incentive to improve.

Insurance companies make money by a)investing premiums and b) by denying whatever they can c)paying as little as they can d)charging as much as they can.

As far as it being a no brainer to spend $20 to prevent something that will cost $10K to fix: look at birth control coverage in the US under Obama care and what is being proposed/slashed.

The reason that NO INSURER cried out against no charges for birth control is because birth control is relatively inexpensive compared with covering prenatal and child birth care. However, if the can call pregnancies preexisting conditions (which they used to do all the time. Happened to me when the doc insisted my due date was a month earlier than it was so we were on the hook for all costs related to our oldest child's birth, prenatal, labor/deliver, etc. And that was extremely common in those days).

Look at what's happening now re: birth control.

I've said before that the only reason I was worried/opposed to single payer is that many/most hospitals/clinics/providers are struggling with the fact that Medicare reimbursements do not actually cover the cost of providing care. That's long been true of Medicaid, which is why when possible many providers limit the number of medicaid patients they will see. Now, providers are looking to see what they can do re: medicare patients. It seems inevitable that the same struggles will come up with a single payer system.

The other issue is like what is currently happening in the war over coverage for birth control, pregnancy, pre-existing conditions. I don't want a single entity driven by rabid politicians making medical decisions for me or for anyone else.

 

[bilby]

Yes. This exactly. I never understood how anybody could believe that adding a profit motive to health care insurance could make it cheaper. I also don't see how it could encourage preventative care.

The myth is the competition makes a more efficient--and cheaper-- system than a government one which would be filled with waste. None of the people who make that argument are arguing that they don't want Medicare (retirement age insurance via govt.) when it comes. Also those who make the rules also make rules that award themselves with pretty nice health care benefits, unlike what they select for the folks back home.

Of course, everybody who possibly can purchases supplemental Medicare insurance, even some older relatives of mine who are far from well off. If you are well off, you can afford better supplemental insurance, which means you pay less out of pocket for most of your health care needs.


FWIW, the biggest names in health care in the US tend to be non-profits: Mayo, Cleveland Clinic, Johns Hopkins, for instance, are all non-profit or at least have significant portions of their practice as non-profit. Between the three, they serve millions of patients each year, from around the country and around the world, and also serve local patients as well. Probably true of other big names in US health care as well. I believe that many/most hospitals are non-profits.

That's true; But it is important to remember that the defining characteristic of 'non-profit' hospitals is their exemption from tax in return for the provision of vaguely defined 'community benefits'; They don't actually have to not make a profit in order to qualify for 'non-profit' status.

An uneducated or unwary person might imagine that 'non-profit hospital' necessarily implies 'hospital that doesn't make a profit', but that would be a mistake.

 

[untermensche]

...I've said before that the only reason I was worried/opposed to single payer is that many/most hospitals/clinics/providers are struggling with the fact that Medicare reimbursements do not actually cover the cost of providing care....

Medicare is opposed by about half the people in government (guess which Party) and they would get rid of it if they could.

Is it no wonder it is not funded properly?

It is a deliberate attempt to make it appear as if the government is inefficient.

A religious dogma of the same people deliberately working to underfund Medicare and harm people in the process.

 

[Cheerful Charlie]

Single payer now.

Don't taunt Happy Fun Trumpcare(TM)

 

[LordKiran]

Utterly assinine.

The state has about as much incentive to not waste money it doesn't have to as an individual person does. Furthermore, in an privatized market those same 20 dollar prevention methods can often be price hiked to maximize profits.

Huh? Congressmen aren't paid on how much they save a tax payer, and many cases they are incentivized to become very inefficient. A CEO gets paid on how well he/she can drive down costs to improve performance.

Congresspersons are paid to govern. Part of governing is not wasting money. Again, utterly asinine.

 

[Jolly_Penguin]

Insurance companies make money by a)investing premiums and b) by denying whatever they can c)paying as little as they can d)charging as much as they can.

Exactly. Profit motive to deny care. I keep hearing from Americans how they don't want a bureaucrat between them and their doctor. They'd prefer a for-profit insurance adjuster who has a profit motive to deny them the care that they need?

Look at what's happening now re: birth control.

That's more of an ideological issue. You have to equate pregnancy to illness for birth control to make sense as essential preventative health care. Birth control is also not very expensive. Also we con't cover prescription drugs up here, so I don't see why we should cover birth control. That doesn't mean you can't get it however.

I don't want a single entity driven by rabid politicians making medical decisions for me or for anyone else.

That has nothing to do with the single payer system. Is it so bad if you have to pay for your own birth control or abortion etc, or get 3rd party private insurance for that, like we get it for dental here in Canada? Does that make things WORSE for you, after you've got universal health care for mostly everything else?

I've said before that the only reason I was worried/opposed to single payer is that many/most hospitals/clinics/providers are struggling with the fact that Medicare reimbursements do not actually cover the cost of providing care.

That's not a problem with single payer. That's a problem with your government and hospitals and can be fixed.

I am still surprised at you that you would oppose single payer for such unsound reasons.

 

[Jimmy Higgins]

Utterly assinine.

The state has about as much incentive to not waste money it doesn't have to as an individual person does. Furthermore, in an privatized market those same 20 dollar prevention methods can often be price hiked to maximize profits.

Huh? Congressmen aren't paid on how much they save a tax payer...

Correct. That is the basis for the donations they receive.

...and many cases they are incentivized to become very inefficient.

I work in the public sector and find your claim hilarious. And typically with regards to health care, one thing you never hear doctors say is "Man, I feel like I'm stealing from the government, taking in all those Medicare and Medicaid patients."

A CEO gets paid on how well he/she can drive down costs to improve performance.

You were ROFL'ing after posting that... right?

 

[coloradoatheist]

Huh? Congressmen aren't paid on how much they save a tax payer...

Correct. That is the basis for the donations they receive.

...and many cases they are incentivized to become very inefficient.

I work in the public sector and find your claim hilarious. And typically with regards to health care, one thing you never hear doctors say is "Man, I feel like I'm stealing from the government, taking in all those Medicare and Medicaid patients."

A CEO gets paid on how well he/she can drive down costs to improve performance.

You were ROFL'ing after posting that... right?

I'm not laughing at the last part. If the company can control long term costs with easy preventative stuff they would. Preventative care visits for the most part don't have a co-pay because they want them to use those instead of later visits. They have wellness programs and they would like to do some stuff like charging more for people who they will know to have higher costs like smokers.

It's interesting that you talk about them trying to save, but one of the major arguments during Obama Care was the physician payment schedule. Every year they threaten to actually use it and cut funding to physicians but because of the doctors lobbying power they don't ever cut it.

 

[Nice Squirrel]

A CEO gets paid on how well he/she can drive down costs to improve performance.

The bill for the new keyboard is in the mail.

 

[Elixir]

A CEO gets paid on how well he/she can drive down costs to improve performance.

The bill for the new keyboard is in the mail.

CEO Cheato using his golden club to "drive down costs":

 

[TSwizzle]

Single payer now.

http://www.channel4.com/programmes/confessions-of-a-junior-doctor/episode-guide/

The NHS in Britain has been unraveling for years through mismanagement at every level. No matter how much money they pump into it, the slide continues.

 

[Toni]

Exactly. Profit motive to deny care. I keep hearing from Americans how they don't want a bureaucrat between them and their doctor. They'd prefer a for-profit insurance adjuster who has a profit motive to deny them the care that they need?

Look at what's happening now re: birth control.

That's more of an ideological issue. You have to equate pregnancy to illness for birth control to make sense as essential preventative health care. Birth control is also not very expensive. Also we con't cover prescription drugs up here, so I don't see why we should cover birth control. That doesn't mean you can't get it however.

I don't want a single entity driven by rabid politicians making medical decisions for me or for anyone else.

That has nothing to do with the single payer system. Is it so bad if you have to pay for your own birth control or abortion etc, or get 3rd party private insurance for that, like we get it for dental here in Canada? Does that make things WORSE for you, after you've got universal health care for mostly everything else?

I've said before that the only reason I was worried/opposed to single payer is that many/most hospitals/clinics/providers are struggling with the fact that Medicare reimbursements do not actually cover the cost of providing care.

That's not a problem with single payer. That's a problem with your government and hospitals and can be fixed.

I am still surprised at you that you would oppose single payer for such unsound reasons.

I don't oppose single payer so much as I have grave concerns about the extent to which politics, in the guise of budgetary concerns and ideological concerns would --and do!insert themselves into medical issues. Particularly those pertaining to women.

I am not at all surprised that you ignore my concerns in favor of your own re conceived and arrogant views.

 

[Nice Squirrel]

http://www.channel4.com/programmes/confessions-of-a-junior-doctor/episode-guide/

The NHS in Britain has been unraveling for years through mismanagement at every level. No matter how much money they pump into it, the slide continues.

So the problem isn't money but mismanagement?

 

[Jolly_Penguin]

I am not at all surprised that you ignore my concerns in favor of your own re conceived and arrogant views.

I directly addressed your stated concerns. Why do you call what I wrote above arrogant? It is arrogant to call for single payer despite there being politicians that dont support contraception being part of it?

As I said above, there would be nothing stopping you from buying contraception or getting additional insurance that covers it, and other non covered items.

Are you seeing single payer as a back door for "family values" religious nutters banning abortion, call contraception and gay marriage, etc?

 

[Elixir]

Exactly. Profit motive to deny care. I keep hearing from Americans how they don't want a bureaucrat between them and their doctor. They'd prefer a for-profit insurance adjuster who has a profit motive to deny them the care that they need?



That's more of an ideological issue. You have to equate pregnancy to illness for birth control to make sense as essential preventative health care. Birth control is also not very expensive. Also we con't cover prescription drugs up here, so I don't see why we should cover birth control. That doesn't mean you can't get it however.

I don't want a single entity driven by rabid politicians making medical decisions for me or for anyone else.

That has nothing to do with the single payer system. Is it so bad if you have to pay for your own birth control or abortion etc, or get 3rd party private insurance for that, like we get it for dental here in Canada? Does that make things WORSE for you, after you've got universal health care for mostly everything else?

I've said before that the only reason I was worried/opposed to single payer is that many/most hospitals/clinics/providers are struggling with the fact that Medicare reimbursements do not actually cover the cost of providing care.

That's not a problem with single payer. That's a problem with your government and hospitals and can be fixed.

I am still surprised at you that you would oppose single payer for such unsound reasons.

I don't oppose single payer so much as I have grave concerns about the extent to which politics, in the guise of budgetary concerns and ideological concerns would --and do!insert themselves into medical issues.

How would single payer exacerbate those concerns? As it is, repugs are poised to put their hands so far down our throats they'll be able to unzip our pants.