Trumpcare vs Obamacare vs Single Payer

[untermensche]

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.

It could be easily fixed.

Unfortunately half the Congress wants to make Medicare look bad, they want to destroy it, not easily fix it.

 

[Playball40]

Well they want it so they don't have to pay the $20 or the $10K. They basically want 'accident' insurance, since every person in the world has a "pre-existing" condition. We just don't all know what that is yet.

Did I mention today how much I wish they would all just die. The whole lot of them.

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.

 

[Horatio Parker]

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?

I thought it means that ours is twice as good as theirs. No?

 

[untermensche]

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

I thought means that ours is twice as good as theirs. No?

They reflect the high cost of having a bunch of for profit entities in control.

Any profit in health care is waste.

It is money not going to health care.

 

[Horatio Parker]

I thought means that ours is twice as good as theirs. No?

They reflect the high cost of having a bunch of for profit entities in control.

Any profit in health care is waste.

It is money not going to health care.

My answer was as serious as dismals, which is to say not at all.

Monopolists dictate prices. That's the point behind his bizarre constitutional amendment post.

 

[SimpleDon]

....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.

It is insane. My wife and I paid the 2% surcharge for the ObamaCare subsidies on an admittedly small fraction of my and my wife's income (mainly my wife's) up until this year. We certainly didn't feel that we were being unfairly treated.

Conservatives have to try to face the realities of modern life. Just as it is a simple fact that the unaffected pay for the affected when they buy insurance; that is, the good drivers pay for the bad, the healthy and young pay for the sick and the old, etc.; the high income earners have to pay most of the taxes, if for no other reason than they have most of the money, the disposable income not required for basic needs.

The real irony is that with every step we take toward the conservative/libertarian/Republican ideal health care system the costs of that system increase and the burden on the economy and on our competitiveness in the world increases. Everything that the free marketers claim without any merit will happen if we raise the minimum wage to the equivalent of what it was in 1968, is happening because of their "profitization" of the health care system.

And it isn't going to stop with the health care system. I am listening to Rand Paul tell his town hall meeting that the government no longer has the money required to fully fund Social Security, Medicare and Medicaid much less to pay back the money that was borrowed from Social Security over the last thirty years to fund wars and tax cuts for the rich.

The next Trump legislative triumph scheduled is to further gut Dodd Frank so that Wall Street can get back to sowing the seeds for the next financial crisis and profitable bank bailout.

 

[Horatio Parker]

What amazes me about the gimme mine and fuck everybody else attitude is the idea of being comfortable and satisfied with an unhealthy, uneducated, unemployed and unstable population. Driving a substantial portion of the population to subsistence constitutes victory.

Doesn't look very far ahead.

 

[Loren Pechtel]

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.

Medicare is wasteful, also--it's just a matter of excess procedure.

 

[Horatio Parker]

Universal Healthcare Probably Requires LOWER Taxes, Not Higher

 

[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.

And of course, the NHS never had to deal with the likes of this until recently;

Aisha’s Pakistani-born parents, Mohammed and Barkat, are first cousins. There is fresh and growing evidence that marriage between relatives within the Pakistani community may be to blame – in part at least – for a dramatic rise in the number of children with genetic disorders being treated in British hospitals. Figures obtained by The Mail on Sunday under Freedom of Information laws reveal a huge challenge, not only for such communities, but also for the Health Service. And it comes with vast financial implications. The figures show that up to 20 per cent of the children treated for congenital problems in cities such as Sheffield, Glasgow and Birmingham are of Pakistani descent, a figure significantly greater than the background populations, which can be four per cent or lower.

DailyMail

But in general the NHS was not designed for current demographics.

 

[untermensche]

By far the biggest costs to any health care system are smokers, the obese with diabetes and kidney or cardiac dysfunction or peripheral circulation problems, the elderly and those dying from a disease like cancer.

Some rare genetic problem is minuscule compared to this.

To even talk about shows an agenda.

 

[Loren Pechtel]

By far the biggest costs to any health care system are smokers, the obese with diabetes and kidney or cardiac dysfunction or peripheral circulation problems, the elderly and those dying from a disease like cancer.

Some rare genetic problem is minuscule compared to this.

To even talk about shows an agenda.

You are simply assuming they are rare.

Furthermore, smokers aren't that much of a cost to a medical system--the costs hit a bit earlier but they're not more expensive because the smoking kills them. The truly expensive things are the things that don't kill you if you get proper care.

 

[untermensche]

By far the biggest costs to any health care system are smokers, the obese with diabetes and kidney or cardiac dysfunction or peripheral circulation problems, the elderly and those dying from a disease like cancer.

Some rare genetic problem is minuscule compared to this.

To even talk about shows an agenda.

You are simply assuming they are rare.

Furthermore, smokers aren't that much of a cost to a medical system--the costs hit a bit earlier but they're not more expensive because the smoking kills them. The truly expensive things are the things that don't kill you if you get proper care.

Smoking causes COPD and people live with that for years.

Constantly in and out of the hospital for years.

Many times requiring ICU beds and intubation. Very high cost patients.

And then there is lung cancer and other cancers associated with smoking.

Smoking costs a huge amount.

Far more that any minor genetic disorder in a small minority.

Again to even bring it up shows a racist agenda.

 

[Jolly_Penguin]

By far the biggest costs to any health care system are smokers, the obese with diabetes and kidney or cardiac dysfunction or peripheral circulation problems, the elderly and those dying from a disease like cancer.

Some rare genetic problem is minuscule compared to this.

To even talk about shows an agenda.

And this can be adjusted for. We tax cigarettes heavily here in Canada. This easily pays for the increased strain on the medical system from smokers.

 

[Toni]

By far the biggest costs to any health care system are smokers, the obese with diabetes and kidney or cardiac dysfunction or peripheral circulation problems, the elderly and those dying from a disease like cancer.

Some rare genetic problem is minuscule compared to this.

To even talk about shows an agenda.

And this can be adjusted for. We tax cigarettes heavily here in Canada. This easily pays for the increased strain on the medical system from smokers.

We tax cigarettes here, too. Quite heavily.

 

[SimpleDon]

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.

<massive snip of good stuff>​

This is the standard neoliberal playbook. They all use the same one. The "crises" of insurance companies abandoning ObamaCare exchanges or demanding high premiums was largely caused by the Republicans sabotaging the risk channel, the mechanism to provide money to insurance companies that took on too many people who had long standing conditions that they would immediately have corrected with surgery when they had insurance.

It is worth noting that the Republicans don't oppose risk channels on ideological grounds. Their Medicare drug benefit, which is completely funded by debt, has a permanent risk channel that is still paying out debt financed money to the drug companies, fourteen years after the plan was started.

They still subsidize the failed experiment of Medicare Advantage that was suppose to prove that private, for profit insurance companies can administer Medicare better and cheaper than the government can.

The basic reason for all of these misadventures in support of the fantasy of the self-regulating free market is quite obvious. The highest earners have been gifted with tax cuts and intentional wage suppression to produce higher profits under the highly dubious theory that they will invest this money in job producing projects that will create jobs beyond the amount of investment that is supported by the demand in the economy.

The amount of money that they have been gifted far exceeds the amount of virtuous, job producing investment that the economy will support so the high earners have turned to the idea of privatizing government services and "profitizing" economic sectors like health care that history and logic tell us are best left to government and to non-profits.

The push for privatization and "profitization" has nothing to do with the belief that the private sector can do these things better and cheaper than the government and non-profits can and everything to do with the need for more enterprises to provide more investment income for the rich.

 

[SimpleDon]

And this can be adjusted for. We tax cigarettes heavily here in Canada. This easily pays for the increased strain on the medical system from smokers.

We tax cigarettes here, too. Quite heavily.

Not near as heavily as Canada does. Most of the increase in the price of cigarettes came from the state Attorney Generals' agreement with the cigarette companies in the form of the cigarette companies agreeing to pay money to the states to offset some of the states' Medicaid payments and fund an anti-smoking advocacy group. In exchange the biggest cigarette companies are exempted from private tort liability regarding harm caused by tobacco use. Needless to say it would be much better if we had imposed a punitive federal tax on cigarettes. The four major cigarette manufacturers quickly learned how to game the agreement and to turn the higher prices for the cigarettes into profits.

Google Tobacco Master Agreement to let whatever belief satisfying web site you frequent to explain it to you.

 

[Alcoholic Actuary]

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?

I don't disagree with your position, but you get this specific part wrong in every single post.

Let's start with the math error (well it's all math errors, but the basic one): Loss Ratio = Loss / Premiums. See that? The loss is the numerator. So if you anticipate losses increasing by 10%, then you increase premiums by 10%. 80/100 = 88/110. I don't know where you get the 12.5% from.

Next, and because the loss is the numerator, the 80% loss ratio is the minimum loss ratio. Not the max. If a company operates at $0.60 of loss per $1.00 of premium, it has to refund $0.25 to the policy holders. However, insurers are free to run the loss ratio as high as they want - 95%, 110%, 300%. Far from guaranteeing a profit, the introduction of the minimum loss ratio sets a ceiling on what the profits can be in the best case scenario. I promise you this is not some benefit or handout to the insurance company. It is just the opposite.

There are folks around who know exactly how an insurance company operates - both in theory and in reality. Feel free to reach out with any questions you have. You come off as well spoken and educated in economics in general, so your constant misrepresentation of this issue undermines your overall position.

aa

 

[fromderinside]

Why are Canadian cigarettes 25 per pack whilst American cigarettes are 20 per pack? Price per cigarette ratio is $0.48 per cigarette in Canada and $0.25 per cigarette in America. As for the rest providers work in a regulated free market economy producing costs somewhere in the vicinity of "what the market can bare". US and state Government regulatory policies exacerbate this factor compared to most SP programs in western democracies making fair far in favor of investors and away from customers.

If medical care is a right then ethically the return for investors should be reduced to minimums where progress is still being made but away from where investors are getting rich. Fair should be biased toward lower profit rather than higher return.

OK got the basics out of the way. So at what income point does the government consider zero payment from care receivers, or where does government impose a tax on payers who can pay for services and at what proportion of income can that tax be levied? Is it necessary for government to eliminate on of the profiting classes from the equation, make it single payer, or can the system stand belt tightening that is fair to low population servers and high population servers. Should health care follow a utility model or should it follow the normal business model?

I favor a utility, single payer, approach that eliminates insurance and imposes a progressive tax to pay for the system.

 

[Loren Pechtel]

You are simply assuming they are rare.

Furthermore, smokers aren't that much of a cost to a medical system--the costs hit a bit earlier but they're not more expensive because the smoking kills them. The truly expensive things are the things that don't kill you if you get proper care.

Smoking causes COPD and people live with that for years.

Constantly in and out of the hospital for years.

Many times requiring ICU beds and intubation. Very high cost patients.

And then there is lung cancer and other cancers associated with smoking.

Smoking costs a huge amount.

Far more that any minor genetic disorder in a small minority.

Again to even bring it up shows a racist agenda.

Except the smokers don't end up costing more, although they do cost it sooner.

The thing is lung cancer is usually picked up too late, there's not a lot to be done.