Trumpcare vs Obamacare vs Single Payer

[TSwizzle]

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?

Proper funding is always going to be a problem but they could do a lot better in the management department.

 

[SimpleDon]

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.

The ACA included mandated preventive care. TrumpCare removes this requirement.

The connection between preventive care and better health results is unproven but intuitive. Preventive care should result in the long term improvement of health care. This is another problem with mandating that we have to buy our medical care through an insurance company, as both ObamaCare and TrumpCare do.

It isn't just that it is vastly more expensive to be forced to buy insurance from a private, for profit insurance company, it is that on average employers in the small group market and individuals purchasing individual policies change insurance companies every two to three years. This means that the insurance companies have no incentive to take the long view with their policy holders on issues like preventive care.

Under socialized medicine* the government and the taxpayers would have a vested interest in preventive care and the long term health of the members of society.

* Which I assume is your hyperbole for single payer, which is more appropriately socialized insurance, not medical care. Medical care is best left in the hands of trained professionals, the doctors.

 

[Jimmy Higgins]

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?

I'd be shocked if including "free" contraception from insurance companies didn't have a notable decrease on cost for reproductive services.

 

[SimpleDon]

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.

I answered you about the incentives that a for profit insurance company has vs. the incentives that governments have somewhere above. This post of yours reminded me of some more points,

- before ObamaCare even, more than one half of all of the medical care in the nation was paid for by government, vastly more than was paid for by for profit insurance companies through health care policies where the insurance companies were at risk. The type of policies that ObamaCare mandated that we buy and the only policies that TrumpCare allows.

- no government even in the deepest red states buys the type of insurance policies that ObamaCare and TrumpCare force onto the individual and small group markets. These policies are simply too expensive compared to the single payer policies that governments use.

- large companies, those with fifty to two hundred full time employees, depending on their financial strength, don't buy the type of insurance policies that ObamaCare and TrumpCare force onto the individual and small group markets. These types of policies are simply too expensive for the company compared to self-insuring.

(Yes, if you work for one of these companies you think that United Healthcare or Atena or Blue Cross-Blue Shield provides your insurance but these companies only administer the self-insurance from your company. Your company pays for your medical care plus about 5% extra for the insurance company that administers the self-insurance.)

Can you imagine the outrage if Congress dictated that both governments and large companies had to buy these appallingly expensive policies from the health insurance companies? They would be telling federal, state and local governments as well as large companies that they are going to have to pay 20 to 30% more for less insurance. That they have no other option. This is the same thing that ObamaCare did, with federal government subsidies added in, and TrumpCare will do, without the subsidies.

- if ObamaCare or TrumpCare truly wanted to reduce the costs of medical care for the individuals and for small groups, instead of allowing them to group together to buy expensive insurance company at risk policies, they would have allowed them to form a group to self-insure.

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

You left off a very important part of this sentence. It should be,

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

This reminded me of another point,

- insurance companies profit from the industry wide slow increase in medical costs because of the way that they set their premiums. They base their premiums on the anticipated increase in medical costs for the next year and their target loss ratio. If they anticipate a medical cost increase of 10% and their target loss ratio is ObamaCare's maximum of 0.8 then they will increase their premiums by 12.5%. Amazingly enough, they almost all anticipate nearly the same medical cost increases and their target loss ratio. This becomes less amazing when we find out that this information is disclosed to the other health care insurance companies, along with the details of any provider agreements that they have negotiated.

In my opinion, this idea of market based insurance shared by both ObamaCare and TrumpCare, protection from competition, forcing individuals and small groups to buy these policies in ObamaCare or allowing only these policies to be offered in TrumpCare is coming down dramatically on the side of more profit for the insurance companies at the costs of the highest possible insurance premiums for the policyholders. You can't seriously argue otherwise. Or is this what you are defending?

 

[bilby]

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.

That's the exact opposite of the truth.

The NHS has been progressively starved of funds for years, in an attempt to reduce public support for it; but this has largely failed, mostly due to the astonishingly effective managers and staff at every level below that of direct political appointees.

 

[Elixir]

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.

That's the exact opposite of the truth.

Yes, yes it is. But it's the parrot line of every right wing critic of socialized medicine. Just like Obamacare is "failing" because there are a bunch of greedy rich republicans in DC trying their best to make it do so, in order to pocket huge sums for themselves.

 

[Horatio Parker]

That's the exact opposite of the truth.

Yes, yes it is. But it's the parrot line of every right wing critic of socialized medicine. Just like Obamacare is "failing" because there are a bunch of greedy rich republicans in DC trying their best to make it do so, in order to pocket huge sums for themselves.

Like they're trying to do to the VA.

Or the Postal Service.

 

[Jolly_Penguin]

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.

Clearly it wouldn't. Not in any way that I can think of or that Toni has expressed. But apparently it is arrogant to say that.

 

[Elixir]

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.

Clearly it wouldn't. Not in any way that I can think of or that Toni has expressed. But apparently it is arrogant to say that.

Well, stop being so arrogant then.

Seriously though, that's the nature of government - and almost their job description. IMO it would be better if everyone (including Republican Congresscritters) was subject to the exact same level and kind of interference in our health care, as true single payer would tend to do. Otherwise we have varying levels, as disgustingly proposed by the aforementioned critters. This guy is high risk, these people have pre-existing conditions, this person is Godly and deserves better, cheaper treatment, this woman is old... I can't believe they expect anyone to swallow that garbage.

 

[Loren Pechtel]

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.

This has been going on a lot longer than that. UHC leaves the foxes guarding the henhouse, of course it's underfunded.

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.

They say they would pay more but raising taxes gets politicians voted out.

 

[Loren Pechtel]

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.

The usual fate of monopolies. Monopolies are very poor at combating waste.

 

[untermensche]

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.

The usual fate of monopolies. Monopolies are very poor at combating waste.

You are taking a lie for the truth.

Private monopolies based on the profit motive are wasteful.

Medicare is less wasteful than any for profit insurance.

In healthcare profit is waste.

It is money not spent on healthcare. Money taken from healthcare.

 

[bilby]

http://www.independent.co.uk/news/uk/politics/nhs-hospitals-austerity-finances-a6918896.html

The problem is that Conservative party ideology is being used as a substitute for reality.

Funding has been put on hold, despite rising costs - and the major cause of rising costs is the imposition of new working conditions that have made recruiting permanent nursing staff almost impossible, leading to the necessity for expensive agency nurses to fill the gaps. All of this is directly and deliberately caused by the government in an attempt to make privatisation appear necessary and reasonable (when in fact it is neither).

And the minister's response? To do to doctors what they already did with disastrous results to nurses. Because if Conservative ideology doesn't work, clearly that means they didn't do enough of it.

The UK's wealthy can see what a great opportunity for riches a US style health system provides. They don't want a system that merely treats patients effectively at a reasonable cost. They want a system that makes rich people vastly richer, and never mind if it's expensive and ineffective for the ordinary people.

 

[bilby]

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.

The usual fate of monopolies. Monopolies are very poor at combating waste.

Except that it's completely untrue. The NHS has not been unraveling for years; the only mismanagement is deliberate and politically motivated, and the big problem is that money is not being pumped in at all.

So fuck off with your dumb rationalisation of this load of crap as somehow expected - it's not even fucking true.

Oh, and the NHS isn't a monopoly. There are private hospitals in the UK, and you can buy private health insurance. But there's not a lot of either, because they can't compete with the much more efficient NHS.

I'm prepared to bet that neither of you two have actually visited an NHS hospital to see how things are run, before spouting your ignorance based bullcrap.

Your ideology is no substitute for facts.

 

[TSwizzle]

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.

The usual fate of monopolies. Monopolies are very poor at combating waste.

There is always going to be waste, their multi million pound IT project hangs in the balance. But the NHS does have a slight competitor called BUPA for health care. And often times, the NHS will contract them to perform procedures, at a premium of course. The NHS, the way things are going, is unsustainable now.

 

[untermensche]

The usual fate of monopolies. Monopolies are very poor at combating waste.

There is always going to be waste, their multi million pound IT project hangs in the balance. But the NHS does have a slight competitor called BUPA for health care. And often times, the NHS will contract them to perform procedures, at a premium of course. The NHS, the way things are going, is unsustainable now.

You don't have the slightest clue what healthcare is like in Britain.

You are just another mindless supporter of corporate for profit health insurance.

The most inefficient and wasteful system possible.

 

[Horatio Parker]

Health care expenditure per capita, 2015

United Kingdom 4003
United States 9451

 

[dismal]

Health care expenditure per capita, 2015

United Kingdom 4003
United States 9451

So it's time for a Constitutional amendment capping US government healthcare spending per capita at UK levels, right?

 

[Toni]

The usual fate of monopolies. Monopolies are very poor at combating waste.

You are taking a lie for the truth.

Private monopolies based on the profit motive are wasteful.

Medicare is less wasteful than any for profit insurance.

In healthcare profit is waste.

It is money not spent on healthcare. Money taken from healthcare.

The biggest problem with Medicare is that, increasingly, Medicare reimbursements do not actually cover the cost of treatment.

This is not efficient and it's not sustainable.

 

[Jolly_Penguin]

The biggest problem with Medicare is that, increasingly, Medicare reimbursements do not actually cover the cost of treatment.

This is not efficient and it's not sustainable.

And its not single payer universal health care. Under single payer the patient never even learns what the cost is. The care is just given and billed between the doctor and the program and the program has set rates that are paid out. I know this as both a patient and as the brother of a doctor who bills under OHIP as her sole source of income.

And before anybody says doctors get paid peanuts under single payer, know that she is far more wealthy from this than I am from my law practice.