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Read the rules in the OP before posting, please.In order to ensure that this thread continues to meet TL standards and follows the proper guidelines, we will be enforcing the rules in the OP more strictly. Be sure to give them a re-read to refresh your memory! The vast majority of you are contributing in a healthy way, keep it up! NOTE: When providing a source, explain why you feel it is relevant and what purpose it adds to the discussion if it's not obvious. Also take note that unsubstantiated tweets/posts meant only to rekindle old arguments can result in a mod action. |
On June 23 2017 05:52 LegalLord wrote:Show nested quote +On June 23 2017 05:37 GreenHorizons wrote:On June 23 2017 05:32 Plansix wrote:On June 23 2017 05:21 GreenHorizons wrote:On June 23 2017 05:18 Plansix wrote:On June 23 2017 05:13 Doodsmack wrote:On June 23 2017 05:03 Plansix wrote:Source
Republicans' Proposed Medicaid Cuts Would Hit Rural Patients Hard
For the hundreds of rural U.S. hospitals struggling to stay in business, health policy decisions made in Washington, D.C., this summer could make survival a lot tougher.
Since 2010, at least 79 rural hospitals have closed across the country, and nearly 700 more are at risk of closing. These hospitals serve a largely older, poorer and sicker population than most hospitals, making them particularly vulnerable to changes made to Medicaid funding.
"A lot of hospitals like [ours] could get hurt," says Kerry Noble, CEO of Pemiscot Memorial Health Systems, which runs the public hospital in Pemiscot County, one of the poorest in Missouri.
The GOP's American Health Care Act would cut Medicaid — the public insurance program for many low-income families, children and elderly Americans, as well as people with disabilities — by as much as $834 billion. The Congressional Budget Office has said that would result in 23 million more people being uninsured in the next 10 years. Even more could lose coverage under the budget proposed by President Trump, which suggests an additional $610 billion in cuts to the program.
That is a problem for small rural hospitals like Pemiscot Memorial, which depend on Medicaid. The hospital serves an agricultural county that ranks worst in Missouri for most health indicators, including premature deaths, quality of life and even adult smoking rates. Closing the county's hospital could make those much worse.
And a rural hospital closure goes beyond people losing health care. Jobs, property values and even schools can suffer. Pemiscot County already has the state's highest unemployment rate. Losing the hospital would mean losing the county's largest employer.
"It would be devastating economically," Noble says. "Our annual payrolls are around $20 million a year."
All of that weighs on Noble's mind when he ponders the hospital's future. Pemiscot's story is a lesson in how decisions made by state and federal lawmakers have put these small hospitals on the edge of collapse.
Back in 2005, things were very different. The hospital was doing well, and Noble commissioned a $16 million plan to completely overhaul the facility, which was built in 1951.
"We were going to pay for the first phase of that in cash. We didn't even need to borrow any money for it," Noble says while thumbing through the old blueprints in his office at the hospital.
But those renovations never happened. In 2005, the Missouri legislature passed sweeping cuts to Medicaid. More than 100,000 Missourians lost their health coverage, and this had an immediate impact on Pemiscot Memorial's bottom line. About 40 percent of their patients were enrolled in Medicaid at the time, and nearly half of them lost their insurance in the cuts.
Those now-uninsured patients still needed care, though, and as a public hospital, Pemiscot Memorial had to take them in.
"So we're still providing care, but we're no longer being compensated," Noble says.
And as the cost of treating the uninsured went up, the hospital's already slim margins shrunk. The hospital went into survival mode.
The Affordable Care Act was supposed to help with the problem of uncompensated care. It offered rural hospitals a potential lifeline by giving states the option to expand Medicaid to a larger segment of their populations. In Missouri, that would have covered about 300,000 people.
"It was the fundamental building block [of the ACA] that was supposed to cover low-income Americans," says Sidney Watson, a St. Louis University health law professor.
In Missouri, Kerry Noble and Pemiscot Memorial became the poster children for Medicaid expansion. In 2013, Noble went to the state capital to make the case for expansion on behalf of the hospital.
"Our facility will no longer be in existence if this expansion does not occur," Noble told a crowd at a press conference.
"Medicaid cuts are always hard to rural hospitals," Watson says. "People have less employer-sponsored coverage in rural areas and people are relying more on Medicaid and on Medicare."
But the Missouri legislature voted against expansion.
For now, the doors of Pemiscot Memorial are still open. The hospital has cut some costly programs — like obstetrics — outsourced its ambulance service and has skipped upgrades.
"People might look at us and say, 'See, you didn't need Medicaid expansion. You're still there,' " Noble says. "But how long are we going to be here if we don't get some relief?"
Relief for rural hospitals is not what is being debated in Washington right now. Under the GOP House plan, even states like Missouri that did not expand Medicaid could see tens of thousands of residents losing their Medicaid coverage.
Rural parts of America cannot economically support a hospital that delivers babies. There is no place for them to have their children in one of the richest nations on the planet. Don't blame Republican voters - their concerns have been heard. I am not blaming Republican voters. I’ll continue to blame Republicans for caring about tax burdens for the wealthy as opposed to the rural people that need help. And for not expanding Medicaid. Can we blame Democrats for losing to them? Has my disapproval of you blaming democrats every slowed you down? I said we  Careful with "we", he might think you British. It goes without saying that Republicans are pretty scummy. But it's about time that Democrats realize that just because Republicans are terrible, it doesn't mean they are entitled to win jack shit if they are only marginally better.
I think, in general, the excuse of "well the other side is terrible, so that gives us license to not care either" needs to be tossed out the window. Both sides are terrible, for their own uniquely terrible reasons, and right now partisan politics is sending people into a race to the bottom. I fully understand how debate works, and how, when you assume a position, you naturally want to defend it, but there's not an awful lot left to defend right now.
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On June 23 2017 06:05 Mohdoo wrote:Show nested quote +On June 23 2017 05:56 GreenHorizons wrote:On June 23 2017 05:52 LegalLord wrote:On June 23 2017 05:37 GreenHorizons wrote:On June 23 2017 05:32 Plansix wrote:On June 23 2017 05:21 GreenHorizons wrote:On June 23 2017 05:18 Plansix wrote:On June 23 2017 05:13 Doodsmack wrote:On June 23 2017 05:03 Plansix wrote:Source
Republicans' Proposed Medicaid Cuts Would Hit Rural Patients Hard
For the hundreds of rural U.S. hospitals struggling to stay in business, health policy decisions made in Washington, D.C., this summer could make survival a lot tougher.
Since 2010, at least 79 rural hospitals have closed across the country, and nearly 700 more are at risk of closing. These hospitals serve a largely older, poorer and sicker population than most hospitals, making them particularly vulnerable to changes made to Medicaid funding.
"A lot of hospitals like [ours] could get hurt," says Kerry Noble, CEO of Pemiscot Memorial Health Systems, which runs the public hospital in Pemiscot County, one of the poorest in Missouri.
The GOP's American Health Care Act would cut Medicaid — the public insurance program for many low-income families, children and elderly Americans, as well as people with disabilities — by as much as $834 billion. The Congressional Budget Office has said that would result in 23 million more people being uninsured in the next 10 years. Even more could lose coverage under the budget proposed by President Trump, which suggests an additional $610 billion in cuts to the program.
That is a problem for small rural hospitals like Pemiscot Memorial, which depend on Medicaid. The hospital serves an agricultural county that ranks worst in Missouri for most health indicators, including premature deaths, quality of life and even adult smoking rates. Closing the county's hospital could make those much worse.
And a rural hospital closure goes beyond people losing health care. Jobs, property values and even schools can suffer. Pemiscot County already has the state's highest unemployment rate. Losing the hospital would mean losing the county's largest employer.
"It would be devastating economically," Noble says. "Our annual payrolls are around $20 million a year."
All of that weighs on Noble's mind when he ponders the hospital's future. Pemiscot's story is a lesson in how decisions made by state and federal lawmakers have put these small hospitals on the edge of collapse.
Back in 2005, things were very different. The hospital was doing well, and Noble commissioned a $16 million plan to completely overhaul the facility, which was built in 1951.
"We were going to pay for the first phase of that in cash. We didn't even need to borrow any money for it," Noble says while thumbing through the old blueprints in his office at the hospital.
But those renovations never happened. In 2005, the Missouri legislature passed sweeping cuts to Medicaid. More than 100,000 Missourians lost their health coverage, and this had an immediate impact on Pemiscot Memorial's bottom line. About 40 percent of their patients were enrolled in Medicaid at the time, and nearly half of them lost their insurance in the cuts.
Those now-uninsured patients still needed care, though, and as a public hospital, Pemiscot Memorial had to take them in.
"So we're still providing care, but we're no longer being compensated," Noble says.
And as the cost of treating the uninsured went up, the hospital's already slim margins shrunk. The hospital went into survival mode.
The Affordable Care Act was supposed to help with the problem of uncompensated care. It offered rural hospitals a potential lifeline by giving states the option to expand Medicaid to a larger segment of their populations. In Missouri, that would have covered about 300,000 people.
"It was the fundamental building block [of the ACA] that was supposed to cover low-income Americans," says Sidney Watson, a St. Louis University health law professor.
In Missouri, Kerry Noble and Pemiscot Memorial became the poster children for Medicaid expansion. In 2013, Noble went to the state capital to make the case for expansion on behalf of the hospital.
"Our facility will no longer be in existence if this expansion does not occur," Noble told a crowd at a press conference.
"Medicaid cuts are always hard to rural hospitals," Watson says. "People have less employer-sponsored coverage in rural areas and people are relying more on Medicaid and on Medicare."
But the Missouri legislature voted against expansion.
For now, the doors of Pemiscot Memorial are still open. The hospital has cut some costly programs — like obstetrics — outsourced its ambulance service and has skipped upgrades.
"People might look at us and say, 'See, you didn't need Medicaid expansion. You're still there,' " Noble says. "But how long are we going to be here if we don't get some relief?"
Relief for rural hospitals is not what is being debated in Washington right now. Under the GOP House plan, even states like Missouri that did not expand Medicaid could see tens of thousands of residents losing their Medicaid coverage.
Rural parts of America cannot economically support a hospital that delivers babies. There is no place for them to have their children in one of the richest nations on the planet. Don't blame Republican voters - their concerns have been heard. I am not blaming Republican voters. I’ll continue to blame Republicans for caring about tax burdens for the wealthy as opposed to the rural people that need help. And for not expanding Medicaid. Can we blame Democrats for losing to them? Has my disapproval of you blaming democrats every slowed you down? I said we Careful with "we", he might think you British. It goes without saying that Republicans are pretty scummy. But it's about time that Democrats realize that just because Republicans are terrible, it doesn't mean they are entitled to win jack shit if they are only marginally better. One of few firm positions from Democrats is in opposition to that realization. It's pretty universal among democrats that anyone who doesn't support marginally less destructive candidates is an idiot purist. While Trump has been bad and wants to be much worse, there's an argument that Hillary getting more of her less bad agenda could have been more destructive than Trump getting little of his very destructive agenda. On June 23 2017 05:54 WolfintheSheep wrote:On June 23 2017 05:50 GreenHorizons wrote:On June 23 2017 05:44 Plansix wrote:On June 23 2017 05:37 GreenHorizons wrote:On June 23 2017 05:32 Plansix wrote:On June 23 2017 05:21 GreenHorizons wrote:On June 23 2017 05:18 Plansix wrote:On June 23 2017 05:13 Doodsmack wrote:
[quote]
Don't blame Republican voters - their concerns have been heard. I am not blaming Republican voters. I’ll continue to blame Republicans for caring about tax burdens for the wealthy as opposed to the rural people that need help. And for not expanding Medicaid. Can we blame Democrats for losing to them? Has my disapproval of you blaming democrats every slowed you down? I said we Have democrats ever held a majority in Missouri in the last 40 years? Don't be coy, Democrats wrote a bill that left this as an option for Republican held states. They could have avoided this outcome if they wanted. They chose to give Republicans this option, they exercised it, and Democrats still lost. So can we blame Democrats for losing to destructive Republicans yet? Democrats wrote a bill that let Republicans be democratically elected and write their own bills? How dare Democrats not outlaw Republican lawmakers. lol no, they could have had a public option. If my memory serves me correctly, a few shitbag democrats were against the public option and said they'd vote against it.
You are correct. Specifically Joe Lieberman, independent after a left leaning democrat challenged him in 2006, killed it. It was his sole mission in the senate to kill the public option.
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On June 23 2017 06:11 LegalLord wrote:
Yes, the traitors sunk the public option. I wonder if, with that deficiency, if Obamacare should have just been mothballed for a time. It survives despite being unviable only because Republicans can't make anything better.
Some of them have proposed something better - a full repeal. But they're too spineless to follow through with it. They know they'll be crucified for 'losing 20 million health insurances' and maybe 'killing poor people' even though the endpoint of Obamacare is "only the rich have decent health care but everyone pays" anyway, via blowing up the entire market. And possibly the labor market as collateral.
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On June 23 2017 06:25 Buckyman wrote:Show nested quote +On June 23 2017 06:11 LegalLord wrote:
Yes, the traitors sunk the public option. I wonder if, with that deficiency, if Obamacare should have just been mothballed for a time. It survives despite being unviable only because Republicans can't make anything better. Some of them have proposed something better - a full repeal. But they're too spineless to follow through with it. They know they'll be crucified for 'losing 20 million health insurances' and maybe 'killing poor people' even though the endpoint of Obamacare is "only the rich have decent health care but everyone pays" anyway, via blowing up the entire market. And possibly the labor market as collateral.
Your bait is showing. It's obnoxious and transparent. The way you spin in moments of condescension is a dead giveaway for anyone who has been posting on forums for more than a few years.
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I was about to say, why don’t we go for option 3: Fix it and improve the system? Just think of a world where Republicans just wanted to keep everyone insured, but also keep it from running up the national debt? If they just fixed the problems with the ACA, explained Medicaid and moved on? Rather than rope us into a decade long fight to afford to go to the doctor.
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Awesome. This must mean they are actually worried. Her history is irrelevant. She is not fit for the modern political fights. She's just another Clinton with respect to the fact that she is good at what she does but what she does isn't helpful. Using a screw driver as a hammer, etc.
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On June 23 2017 06:25 Buckyman wrote:Show nested quote +On June 23 2017 06:11 LegalLord wrote:
Yes, the traitors sunk the public option. I wonder if, with that deficiency, if Obamacare should have just been mothballed for a time. It survives despite being unviable only because Republicans can't make anything better. Some of them have proposed something better - a full repeal. But they're too spineless to follow through with it. They know they'll be crucified for 'losing 20 million health insurances' and maybe 'killing poor people' even though the endpoint of Obamacare is "only the rich have decent health care but everyone pays" anyway, via blowing up the entire market. And possibly the labor market as collateral.
that's not the endpoint of obamacare at all. I do'nt see where you're getting that from. obamacare also doesn't really blow up the entire market, though it does cause some substantial irregularities. it sounds like you're projecting too much of your own personal experience onto the actual overall effects of it.
a full repeal is fine if you're ok with a bunch of losing their healthcare, and suffering injury/death as a result.
fundamentally, at some point you have to deny people healthcare because it's not affordable, there's only so much money to go around.
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On June 23 2017 06:45 Mohdoo wrote:Awesome. This must mean they are actually worried. Her history is irrelevant. She is not fit for the modern political fights. She's just another Clinton with respect to the fact that she is good at what she does but what she does isn't helpful. Using a screw driver as a hammer, etc.
That is the most convincing thing I have seen that she might be facing a real leadership fight in the house.
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On June 23 2017 06:18 Plansix wrote:Show nested quote +On June 23 2017 06:05 Mohdoo wrote:On June 23 2017 05:56 GreenHorizons wrote:On June 23 2017 05:52 LegalLord wrote:On June 23 2017 05:37 GreenHorizons wrote:On June 23 2017 05:32 Plansix wrote:On June 23 2017 05:21 GreenHorizons wrote:On June 23 2017 05:18 Plansix wrote:On June 23 2017 05:13 Doodsmack wrote:On June 23 2017 05:03 Plansix wrote:Source[quote] Rural parts of America cannot economically support a hospital that delivers babies. There is no place for them to have their children in one of the richest nations on the planet. Don't blame Republican voters - their concerns have been heard. I am not blaming Republican voters. I’ll continue to blame Republicans for caring about tax burdens for the wealthy as opposed to the rural people that need help. And for not expanding Medicaid. Can we blame Democrats for losing to them? Has my disapproval of you blaming democrats every slowed you down? I said we Careful with "we", he might think you British. It goes without saying that Republicans are pretty scummy. But it's about time that Democrats realize that just because Republicans are terrible, it doesn't mean they are entitled to win jack shit if they are only marginally better. One of few firm positions from Democrats is in opposition to that realization. It's pretty universal among democrats that anyone who doesn't support marginally less destructive candidates is an idiot purist. While Trump has been bad and wants to be much worse, there's an argument that Hillary getting more of her less bad agenda could have been more destructive than Trump getting little of his very destructive agenda. On June 23 2017 05:54 WolfintheSheep wrote:On June 23 2017 05:50 GreenHorizons wrote:On June 23 2017 05:44 Plansix wrote:On June 23 2017 05:37 GreenHorizons wrote:On June 23 2017 05:32 Plansix wrote:On June 23 2017 05:21 GreenHorizons wrote:On June 23 2017 05:18 Plansix wrote:
[quote]
I am not blaming Republican voters. I’ll continue to blame Republicans for caring about tax burdens for the wealthy as opposed to the rural people that need help. And for not expanding Medicaid. Can we blame Democrats for losing to them? Has my disapproval of you blaming democrats every slowed you down? I said we Have democrats ever held a majority in Missouri in the last 40 years? Don't be coy, Democrats wrote a bill that left this as an option for Republican held states. They could have avoided this outcome if they wanted. They chose to give Republicans this option, they exercised it, and Democrats still lost. So can we blame Democrats for losing to destructive Republicans yet? Democrats wrote a bill that let Republicans be democratically elected and write their own bills? How dare Democrats not outlaw Republican lawmakers. lol no, they could have had a public option. If my memory serves me correctly, a few shitbag democrats were against the public option and said they'd vote against it. You are correct. Specifically Joe Lieberman, independent after a left leaning democrat challenged him in 2006, killed it. It was his sole mission in the senate to kill the public option.
We can't forget Ben Nelson
who went on to lead the National Association of Insurance Commissioners
Which is all the more important in light of Kwark highlighting that one fundamental difference between what we could have had (if it weren't for Democrats) and what we do have is the enshrining of private for profit insurers. Which when paired with limiting all reform within such framework ensures that the Democrats want prefer uninsured people and private insurers over no uninsured people and a dramatically smaller private market.
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On June 23 2017 06:46 zlefin wrote:Show nested quote +On June 23 2017 06:25 Buckyman wrote:On June 23 2017 06:11 LegalLord wrote:
Yes, the traitors sunk the public option. I wonder if, with that deficiency, if Obamacare should have just been mothballed for a time. It survives despite being unviable only because Republicans can't make anything better. Some of them have proposed something better - a full repeal. But they're too spineless to follow through with it. They know they'll be crucified for 'losing 20 million health insurances' and maybe 'killing poor people' even though the endpoint of Obamacare is "only the rich have decent health care but everyone pays" anyway, via blowing up the entire market. And possibly the labor market as collateral. that's not the endpoint of obamacare at all. I do'nt see where you're getting that from. obamacare also doesn't really blow up the entire market, though it does cause some substantial irregularities. it sounds like you're projecting too much of your own personal experience onto the actual overall effects of it. a full repeal is fine if you're ok with a bunch of losing their healthcare, and suffering injury/death as a result. fundamentally, at some point you have to deny people healthcare because it's not affordable, there's only so much money to go around.
Buckyman has adopted a forum-poster archetype that we've all seen before. Take a somewhat dull, matter of fact approach to explaining Libertarian'esque philosophies as simple matter of fact logic. Use the appearance of logic and elegance as a form of argumentative support while minimizing the appearance of underlying assumptions. Perhaps it only speaks to the fact that I spend too much time on forums (19 years of regular forum posting, jesus), but this is just another of the same type of person who likes to take on this kind of appearance and find comfort in the self-consistent axioms of Libertarian'esque thought patterns. Even in this thread alone, we've already had a couple over the past 8 or so years. It's not a new technique in baiting and he won't be the last we see wander in here.
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On June 23 2017 06:48 GreenHorizons wrote:Show nested quote +On June 23 2017 06:18 Plansix wrote:On June 23 2017 06:05 Mohdoo wrote:On June 23 2017 05:56 GreenHorizons wrote:On June 23 2017 05:52 LegalLord wrote:On June 23 2017 05:37 GreenHorizons wrote:On June 23 2017 05:32 Plansix wrote:On June 23 2017 05:21 GreenHorizons wrote:On June 23 2017 05:18 Plansix wrote:On June 23 2017 05:13 Doodsmack wrote:
[quote]
Don't blame Republican voters - their concerns have been heard. I am not blaming Republican voters. I’ll continue to blame Republicans for caring about tax burdens for the wealthy as opposed to the rural people that need help. And for not expanding Medicaid. Can we blame Democrats for losing to them? Has my disapproval of you blaming democrats every slowed you down? I said we Careful with "we", he might think you British. It goes without saying that Republicans are pretty scummy. But it's about time that Democrats realize that just because Republicans are terrible, it doesn't mean they are entitled to win jack shit if they are only marginally better. One of few firm positions from Democrats is in opposition to that realization. It's pretty universal among democrats that anyone who doesn't support marginally less destructive candidates is an idiot purist. While Trump has been bad and wants to be much worse, there's an argument that Hillary getting more of her less bad agenda could have been more destructive than Trump getting little of his very destructive agenda. On June 23 2017 05:54 WolfintheSheep wrote:On June 23 2017 05:50 GreenHorizons wrote:On June 23 2017 05:44 Plansix wrote:On June 23 2017 05:37 GreenHorizons wrote:On June 23 2017 05:32 Plansix wrote:On June 23 2017 05:21 GreenHorizons wrote:
[quote]
Can we blame Democrats for losing to them?
Has my disapproval of you blaming democrats every slowed you down? I said we Have democrats ever held a majority in Missouri in the last 40 years? Don't be coy, Democrats wrote a bill that left this as an option for Republican held states. They could have avoided this outcome if they wanted. They chose to give Republicans this option, they exercised it, and Democrats still lost. So can we blame Democrats for losing to destructive Republicans yet? Democrats wrote a bill that let Republicans be democratically elected and write their own bills? How dare Democrats not outlaw Republican lawmakers. lol no, they could have had a public option. If my memory serves me correctly, a few shitbag democrats were against the public option and said they'd vote against it. You are correct. Specifically Joe Lieberman, independent after a left leaning democrat challenged him in 2006, killed it. It was his sole mission in the senate to kill the public option. We can't forget Ben Nelson
who went on to lead the National Association of Insurance CommissionersWhich is all the more important in light of Kwark highlighting that one fundamental difference between what we could have had (if it weren't for Democrats) and what we do have is the enshrining of private for profit insurers. Which when paired with limiting all reform within such framework ensures that the Democrats want prefer uninsured people and private insurers over no uninsured people and a dramatically smaller private market.
You are right, the majority of Americans did not want single payer in 2008-2010 and elected people who prevented it from being put in place. It was always doomed to fail because of the two senators cited above. As Democrats are made up of Americans, it is the democrats fault too. To bad we can't just delete CT from the map and remove Ben Nelson from history. But I love your mystical reality where there were other votes to be found to overcome a filibuster.
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On June 23 2017 06:12 KwarK wrote:Show nested quote +On June 23 2017 05:52 Atreides wrote:On June 23 2017 05:41 KwarK wrote:On June 23 2017 05:34 Atreides wrote:
My problem with Kwarks example is the actual numbers. It's sound in theory and seems reasonable but what about when/if the "sick persons" costs are 100x the healthy persons? It's complicated ofc but the actual facts for me personally are cheapest marketplace plan last cycle was 680/month and I haven't had any medical costs that would have been covered by that plan in 15 years. Lots of stuff is reasonable in theory and is completely unreasonable in reality.
I just don't see any solution without bringing costs down and the only way I see to do that is single payer. Sometimes they are but the pools don't just have two people, one sick, one healthy, in them. I made an extremely simplified example. Out of curiousity, how is it you think single payer works if not by forcing every single American into a single risk pool, whether they want to join or not, through general taxation? Obamacare is effectively single payer with the insurance companies deputized to be the tax collectors. Single payer solves the problem of insuring people who are uninsurable the exact same way Obamacare did, by putting everyone in a single risk pool regardless of their circumstances and spreading the cost between everyone. Like I said the only reason I've decided single payer may be better is because of the HOPE (probably) unreasonable) that it could bring down the total cost significantly. (Through a variety of mechanisms) at which point maybe the "concept" of the risk sharing pool is a little more palatable in reality. I mean personally I'm not really a believer in the whole sharing risk collectively as a society and the removal of all personal responsibility but since it seems a majority of our society is (in regards to healthcare at least) can we please come up with one that works? Ofc it's just my personal opinion that the ACA doesn't (and neither will these republican ones either) although passage of the senates bill might technically be better for me I don't really care for it. The other thing overlooked in these discussions is that the individual mandate is not as big of a stick as people think. For most uninsured people who the ACA doesn't work for they don't pay the penalty either. It's hard to say how many the mandate is even keeping in the pool. I agree that single payer, NHS style, is absolutely better. I'm British living in America, I've lived under both, there's no contest about which I'd prefer. However I also think it's important to recognize that fundamentally Obamacare is a copy of the mechanism that makes single payer work, broad risk pools that accept the sick without penalizing them and require participation by the healthy against their interests. Rather than general taxation and government run hospitals it uses insurance premiums and insurance reimbursed privately run hospitals but how it approaches the problem of providing healthcare is unchanged. Costs could be brought down hugely if it was run like the NHS (which spends about half what the US spends per capita on healthcare) and insurance companies suck as middle men. But as an answer to the question "how can we package the things that work about single payer in a way that Americans will accept?", Obamacare is actually pretty good. Not perfect by any means, but it takes money from the young and healthy by making them overpay for healthcare and it gives that money to the old and unhealthy by letting them underpay for healthcare and that was what needed to happen. There may be ways to fix Obamacare going forwards, perhaps by the creation of a nationalized health insurance company that could slowly dominate the market until people eventually get comfortable with the idea of the government taking their money and giving them healthcare. But you don't fix it by fucking with the mechanism that makes it work. That's nothing but demagoguery trying to take advantage of an underinformed population.
Ok so that IS the big problem with the ACA. Obviously if you want to have this big risk sharing pool someone has to pay for it. As you've pointed out the ACA attempts IN PART to do this by penalizing the "young and healthy" (your words over and over). It's a pretty fucked up wealth redistribution system where you take the money from people who are young and healthy as your determinant factors. Neither of which are necessarily factors that bear on financial ability to support the system, and in fact it is almost completely opposite of even most liberal views on wealth redistribution where kind of the ideal is to take the money from the old and dead. Heh
Edit: in case I wasn't clear a NHS funded by general tax dollars has a completely different profile of who it "punishes".
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On June 23 2017 06:55 Atreides wrote:Show nested quote +On June 23 2017 06:12 KwarK wrote:On June 23 2017 05:52 Atreides wrote:On June 23 2017 05:41 KwarK wrote:On June 23 2017 05:34 Atreides wrote:
My problem with Kwarks example is the actual numbers. It's sound in theory and seems reasonable but what about when/if the "sick persons" costs are 100x the healthy persons? It's complicated ofc but the actual facts for me personally are cheapest marketplace plan last cycle was 680/month and I haven't had any medical costs that would have been covered by that plan in 15 years. Lots of stuff is reasonable in theory and is completely unreasonable in reality.
I just don't see any solution without bringing costs down and the only way I see to do that is single payer. Sometimes they are but the pools don't just have two people, one sick, one healthy, in them. I made an extremely simplified example. Out of curiousity, how is it you think single payer works if not by forcing every single American into a single risk pool, whether they want to join or not, through general taxation? Obamacare is effectively single payer with the insurance companies deputized to be the tax collectors. Single payer solves the problem of insuring people who are uninsurable the exact same way Obamacare did, by putting everyone in a single risk pool regardless of their circumstances and spreading the cost between everyone. Like I said the only reason I've decided single payer may be better is because of the HOPE (probably) unreasonable) that it could bring down the total cost significantly. (Through a variety of mechanisms) at which point maybe the "concept" of the risk sharing pool is a little more palatable in reality. I mean personally I'm not really a believer in the whole sharing risk collectively as a society and the removal of all personal responsibility but since it seems a majority of our society is (in regards to healthcare at least) can we please come up with one that works? Ofc it's just my personal opinion that the ACA doesn't (and neither will these republican ones either) although passage of the senates bill might technically be better for me I don't really care for it. The other thing overlooked in these discussions is that the individual mandate is not as big of a stick as people think. For most uninsured people who the ACA doesn't work for they don't pay the penalty either. It's hard to say how many the mandate is even keeping in the pool. I agree that single payer, NHS style, is absolutely better. I'm British living in America, I've lived under both, there's no contest about which I'd prefer. However I also think it's important to recognize that fundamentally Obamacare is a copy of the mechanism that makes single payer work, broad risk pools that accept the sick without penalizing them and require participation by the healthy against their interests. Rather than general taxation and government run hospitals it uses insurance premiums and insurance reimbursed privately run hospitals but how it approaches the problem of providing healthcare is unchanged. Costs could be brought down hugely if it was run like the NHS (which spends about half what the US spends per capita on healthcare) and insurance companies suck as middle men. But as an answer to the question "how can we package the things that work about single payer in a way that Americans will accept?", Obamacare is actually pretty good. Not perfect by any means, but it takes money from the young and healthy by making them overpay for healthcare and it gives that money to the old and unhealthy by letting them underpay for healthcare and that was what needed to happen. There may be ways to fix Obamacare going forwards, perhaps by the creation of a nationalized health insurance company that could slowly dominate the market until people eventually get comfortable with the idea of the government taking their money and giving them healthcare. But you don't fix it by fucking with the mechanism that makes it work. That's nothing but demagoguery trying to take advantage of an underinformed population. Ok so that IS the big problem with the ACA. Obviously if you want to have this big risk sharing pool someone has to pay for it. As you've pointed out the ACA attempts IN PART to do this by penalizing the "young and healthy" (your words over and over). It's a pretty fucked up wealth redistribution system where you take the money from people who are young and healthy as your determinant factors. Neither of which are necessarily factors that bear on financial ability to support the system, and in fact it is almost completely opposite of even most liberal views on wealth redistribution where kind of the ideal is to take the money from the old and dead. Heh
Well, the fun thing about health is that the young and healthy are 100% guaranteed not to be the majority of their life (though preferably not-healthy a lot less than not-young).
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The core problem with the ACA environment is that it relies on health insurance acting like a market while tying its hands so that it can't act like a market. A secondary problem is that the ACA papers over the resulting market failure with subsides as the carrot and the individual and corporate mandates as the stick.
Total cost of providing health care? Only directly addressed by stuff like the medical device tax.
Total cost of providing insurance? "Keep shoveling subsidies at it until the price stops going up."
When will the price stop going up? When some other demand drop compensates for the inflating subsidies. This is necessarily people like me - people who don't get subsidies for various reasons and can't afford the insurance.
Net result - slightly better total health care, the subsidized gain some, the unsubsidized lose slightly less, but at what cost?
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On June 23 2017 06:52 Plansix wrote:Show nested quote +On June 23 2017 06:48 GreenHorizons wrote:On June 23 2017 06:18 Plansix wrote:On June 23 2017 06:05 Mohdoo wrote:On June 23 2017 05:56 GreenHorizons wrote:On June 23 2017 05:52 LegalLord wrote:On June 23 2017 05:37 GreenHorizons wrote:On June 23 2017 05:32 Plansix wrote:On June 23 2017 05:21 GreenHorizons wrote:On June 23 2017 05:18 Plansix wrote:
[quote]
I am not blaming Republican voters. I’ll continue to blame Republicans for caring about tax burdens for the wealthy as opposed to the rural people that need help. And for not expanding Medicaid. Can we blame Democrats for losing to them? Has my disapproval of you blaming democrats every slowed you down? I said we Careful with "we", he might think you British. It goes without saying that Republicans are pretty scummy. But it's about time that Democrats realize that just because Republicans are terrible, it doesn't mean they are entitled to win jack shit if they are only marginally better. One of few firm positions from Democrats is in opposition to that realization. It's pretty universal among democrats that anyone who doesn't support marginally less destructive candidates is an idiot purist. While Trump has been bad and wants to be much worse, there's an argument that Hillary getting more of her less bad agenda could have been more destructive than Trump getting little of his very destructive agenda. On June 23 2017 05:54 WolfintheSheep wrote:On June 23 2017 05:50 GreenHorizons wrote:On June 23 2017 05:44 Plansix wrote:On June 23 2017 05:37 GreenHorizons wrote:On June 23 2017 05:32 Plansix wrote:
[quote]
Has my disapproval of you blaming democrats every slowed you down? I said we Have democrats ever held a majority in Missouri in the last 40 years? Don't be coy, Democrats wrote a bill that left this as an option for Republican held states. They could have avoided this outcome if they wanted. They chose to give Republicans this option, they exercised it, and Democrats still lost. So can we blame Democrats for losing to destructive Republicans yet? Democrats wrote a bill that let Republicans be democratically elected and write their own bills? How dare Democrats not outlaw Republican lawmakers. lol no, they could have had a public option. If my memory serves me correctly, a few shitbag democrats were against the public option and said they'd vote against it. You are correct. Specifically Joe Lieberman, independent after a left leaning democrat challenged him in 2006, killed it. It was his sole mission in the senate to kill the public option. We can't forget Ben Nelson
who went on to lead the National Association of Insurance CommissionersWhich is all the more important in light of Kwark highlighting that one fundamental difference between what we could have had (if it weren't for Democrats) and what we do have is the enshrining of private for profit insurers. Which when paired with limiting all reform within such framework ensures that the Democrats want prefer uninsured people and private insurers over no uninsured people and a dramatically smaller private market. You are right, the majority of Americans did not want single payer in 2008-2010 and elected people who prevented it from being put in place. It was always doomed to fail because of the two senators cited above. As Democrats are made up of Americans, it is the democrats fault too. To bad we can't just delete CT from the map and remove Ben Nelson from history. But I love your mystical reality where there were other votes to be found to overcome a filibuster.
You're stubborn on this, but it's fun.
They were in opposition to general public opinion, but they were in line with the insurance industry.
Hard to say what the polls were specifically in Nelson's state, but it's not like it mattered, he didn't plan on getting elected by them anyway.
Seem to be trying really hard to cape for some Democrats that couldn't care less about you.
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On June 23 2017 07:04 GreenHorizons wrote:Show nested quote +On June 23 2017 06:52 Plansix wrote:On June 23 2017 06:48 GreenHorizons wrote:On June 23 2017 06:18 Plansix wrote:On June 23 2017 06:05 Mohdoo wrote:On June 23 2017 05:56 GreenHorizons wrote:On June 23 2017 05:52 LegalLord wrote:On June 23 2017 05:37 GreenHorizons wrote:On June 23 2017 05:32 Plansix wrote:On June 23 2017 05:21 GreenHorizons wrote:
[quote]
Can we blame Democrats for losing to them?
Has my disapproval of you blaming democrats every slowed you down? I said we Careful with "we", he might think you British. It goes without saying that Republicans are pretty scummy. But it's about time that Democrats realize that just because Republicans are terrible, it doesn't mean they are entitled to win jack shit if they are only marginally better. One of few firm positions from Democrats is in opposition to that realization. It's pretty universal among democrats that anyone who doesn't support marginally less destructive candidates is an idiot purist. While Trump has been bad and wants to be much worse, there's an argument that Hillary getting more of her less bad agenda could have been more destructive than Trump getting little of his very destructive agenda. On June 23 2017 05:54 WolfintheSheep wrote:On June 23 2017 05:50 GreenHorizons wrote:On June 23 2017 05:44 Plansix wrote:On June 23 2017 05:37 GreenHorizons wrote:[quote] I said we Have democrats ever held a majority in Missouri in the last 40 years? Don't be coy, Democrats wrote a bill that left this as an option for Republican held states. They could have avoided this outcome if they wanted. They chose to give Republicans this option, they exercised it, and Democrats still lost. So can we blame Democrats for losing to destructive Republicans yet? Democrats wrote a bill that let Republicans be democratically elected and write their own bills? How dare Democrats not outlaw Republican lawmakers. lol no, they could have had a public option. If my memory serves me correctly, a few shitbag democrats were against the public option and said they'd vote against it. You are correct. Specifically Joe Lieberman, independent after a left leaning democrat challenged him in 2006, killed it. It was his sole mission in the senate to kill the public option. We can't forget Ben Nelson
who went on to lead the National Association of Insurance CommissionersWhich is all the more important in light of Kwark highlighting that one fundamental difference between what we could have had (if it weren't for Democrats) and what we do have is the enshrining of private for profit insurers. Which when paired with limiting all reform within such framework ensures that the Democrats want prefer uninsured people and private insurers over no uninsured people and a dramatically smaller private market. You are right, the majority of Americans did not want single payer in 2008-2010 and elected people who prevented it from being put in place. It was always doomed to fail because of the two senators cited above. As Democrats are made up of Americans, it is the democrats fault too. To bad we can't just delete CT from the map and remove Ben Nelson from history. But I love your mystical reality where there were other votes to be found to overcome a filibuster. You're stubborn on this, but it's fun. They were in opposition to general public opinion, but they were in line with the insurance industry. Hard to say what the polls were specifically in Nelson's state, but it's not like it mattered, he didn't plan on getting elected by them anyway. Seem to be trying really hard to cape for some Democrats that couldn't care less about you.
I'm having a hard time even seeing what point you are making. What are you saying could have happened but didn't happen? Who are you saying chose to make that happen?
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United States42778 Posts
On June 23 2017 06:55 Atreides wrote:Show nested quote +On June 23 2017 06:12 KwarK wrote:On June 23 2017 05:52 Atreides wrote:On June 23 2017 05:41 KwarK wrote:On June 23 2017 05:34 Atreides wrote:
My problem with Kwarks example is the actual numbers. It's sound in theory and seems reasonable but what about when/if the "sick persons" costs are 100x the healthy persons? It's complicated ofc but the actual facts for me personally are cheapest marketplace plan last cycle was 680/month and I haven't had any medical costs that would have been covered by that plan in 15 years. Lots of stuff is reasonable in theory and is completely unreasonable in reality.
I just don't see any solution without bringing costs down and the only way I see to do that is single payer. Sometimes they are but the pools don't just have two people, one sick, one healthy, in them. I made an extremely simplified example. Out of curiousity, how is it you think single payer works if not by forcing every single American into a single risk pool, whether they want to join or not, through general taxation? Obamacare is effectively single payer with the insurance companies deputized to be the tax collectors. Single payer solves the problem of insuring people who are uninsurable the exact same way Obamacare did, by putting everyone in a single risk pool regardless of their circumstances and spreading the cost between everyone. Like I said the only reason I've decided single payer may be better is because of the HOPE (probably) unreasonable) that it could bring down the total cost significantly. (Through a variety of mechanisms) at which point maybe the "concept" of the risk sharing pool is a little more palatable in reality. I mean personally I'm not really a believer in the whole sharing risk collectively as a society and the removal of all personal responsibility but since it seems a majority of our society is (in regards to healthcare at least) can we please come up with one that works? Ofc it's just my personal opinion that the ACA doesn't (and neither will these republican ones either) although passage of the senates bill might technically be better for me I don't really care for it. The other thing overlooked in these discussions is that the individual mandate is not as big of a stick as people think. For most uninsured people who the ACA doesn't work for they don't pay the penalty either. It's hard to say how many the mandate is even keeping in the pool. I agree that single payer, NHS style, is absolutely better. I'm British living in America, I've lived under both, there's no contest about which I'd prefer. However I also think it's important to recognize that fundamentally Obamacare is a copy of the mechanism that makes single payer work, broad risk pools that accept the sick without penalizing them and require participation by the healthy against their interests. Rather than general taxation and government run hospitals it uses insurance premiums and insurance reimbursed privately run hospitals but how it approaches the problem of providing healthcare is unchanged. Costs could be brought down hugely if it was run like the NHS (which spends about half what the US spends per capita on healthcare) and insurance companies suck as middle men. But as an answer to the question "how can we package the things that work about single payer in a way that Americans will accept?", Obamacare is actually pretty good. Not perfect by any means, but it takes money from the young and healthy by making them overpay for healthcare and it gives that money to the old and unhealthy by letting them underpay for healthcare and that was what needed to happen. There may be ways to fix Obamacare going forwards, perhaps by the creation of a nationalized health insurance company that could slowly dominate the market until people eventually get comfortable with the idea of the government taking their money and giving them healthcare. But you don't fix it by fucking with the mechanism that makes it work. That's nothing but demagoguery trying to take advantage of an underinformed population. Ok so that IS the big problem with the ACA. Obviously if you want to have this big risk sharing pool someone has to pay for it. As you've pointed out the ACA attempts IN PART to do this by penalizing the "young and healthy" (your words over and over). It's a pretty fucked up wealth redistribution system where you take the money from people who are young and healthy as your determinant factors. Neither of which are necessarily factors that bear on financial ability to support the system, and in fact it is almost completely opposite of even most liberal views on wealth redistribution where kind of the ideal is to take the money from the old and dead. Heh Edit: in case I wasn't clear a NHS funded by general tax dollars has a completely different profile of who it "punishes".
Probably not so different because the young and healthy are inevitably going to be paying in more than they get out under anything but a private opt out system. Even in a progressive taxation system the young, healthy and poor are probably on the losing end of the deal. But yeah, I take your point, it's not especially progressive because it's effectively a poll tax.
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On June 23 2017 07:06 Mohdoo wrote:Show nested quote +On June 23 2017 07:04 GreenHorizons wrote:On June 23 2017 06:52 Plansix wrote:On June 23 2017 06:48 GreenHorizons wrote:On June 23 2017 06:18 Plansix wrote:On June 23 2017 06:05 Mohdoo wrote:On June 23 2017 05:56 GreenHorizons wrote:On June 23 2017 05:52 LegalLord wrote:On June 23 2017 05:37 GreenHorizons wrote:On June 23 2017 05:32 Plansix wrote:
[quote]
Has my disapproval of you blaming democrats every slowed you down? I said we Careful with "we", he might think you British. It goes without saying that Republicans are pretty scummy. But it's about time that Democrats realize that just because Republicans are terrible, it doesn't mean they are entitled to win jack shit if they are only marginally better. One of few firm positions from Democrats is in opposition to that realization. It's pretty universal among democrats that anyone who doesn't support marginally less destructive candidates is an idiot purist. While Trump has been bad and wants to be much worse, there's an argument that Hillary getting more of her less bad agenda could have been more destructive than Trump getting little of his very destructive agenda. On June 23 2017 05:54 WolfintheSheep wrote:On June 23 2017 05:50 GreenHorizons wrote:On June 23 2017 05:44 Plansix wrote:
[quote]
Have democrats ever held a majority in Missouri in the last 40 years? Don't be coy, Democrats wrote a bill that left this as an option for Republican held states. They could have avoided this outcome if they wanted. They chose to give Republicans this option, they exercised it, and Democrats still lost. So can we blame Democrats for losing to destructive Republicans yet? Democrats wrote a bill that let Republicans be democratically elected and write their own bills? How dare Democrats not outlaw Republican lawmakers. lol no, they could have had a public option. If my memory serves me correctly, a few shitbag democrats were against the public option and said they'd vote against it. You are correct. Specifically Joe Lieberman, independent after a left leaning democrat challenged him in 2006, killed it. It was his sole mission in the senate to kill the public option. We can't forget Ben Nelson
who went on to lead the National Association of Insurance CommissionersWhich is all the more important in light of Kwark highlighting that one fundamental difference between what we could have had (if it weren't for Democrats) and what we do have is the enshrining of private for profit insurers. Which when paired with limiting all reform within such framework ensures that the Democrats want prefer uninsured people and private insurers over no uninsured people and a dramatically smaller private market. You are right, the majority of Americans did not want single payer in 2008-2010 and elected people who prevented it from being put in place. It was always doomed to fail because of the two senators cited above. As Democrats are made up of Americans, it is the democrats fault too. To bad we can't just delete CT from the map and remove Ben Nelson from history. But I love your mystical reality where there were other votes to be found to overcome a filibuster. You're stubborn on this, but it's fun. They were in opposition to general public opinion, but they were in line with the insurance industry. Hard to say what the polls were specifically in Nelson's state, but it's not like it mattered, he didn't plan on getting elected by them anyway. Seem to be trying really hard to cape for some Democrats that couldn't care less about you. I'm having a hard time even seeing what point you are making. What are you saying could have happened but didn't happen? Who are you saying chose to make that happen?
Democrats killed the public option that would have not made vulnerable the people who never got covered because Republicans didn't expand medicaid, also it wouldn't have Democrats currently fighting to hopefully leave 20,000,000+ people uninsured as a win against what Republicans are offering.
Despite that, Democrats lost after hedging, and are still looking at losing in 18 despite hedging even further.
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On June 23 2017 07:50 GreenHorizons wrote:Show nested quote +On June 23 2017 07:06 Mohdoo wrote:On June 23 2017 07:04 GreenHorizons wrote:On June 23 2017 06:52 Plansix wrote:On June 23 2017 06:48 GreenHorizons wrote:On June 23 2017 06:18 Plansix wrote:On June 23 2017 06:05 Mohdoo wrote:On June 23 2017 05:56 GreenHorizons wrote:On June 23 2017 05:52 LegalLord wrote:On June 23 2017 05:37 GreenHorizons wrote:[quote] I said we Careful with "we", he might think you British. It goes without saying that Republicans are pretty scummy. But it's about time that Democrats realize that just because Republicans are terrible, it doesn't mean they are entitled to win jack shit if they are only marginally better. One of few firm positions from Democrats is in opposition to that realization. It's pretty universal among democrats that anyone who doesn't support marginally less destructive candidates is an idiot purist. While Trump has been bad and wants to be much worse, there's an argument that Hillary getting more of her less bad agenda could have been more destructive than Trump getting little of his very destructive agenda. On June 23 2017 05:54 WolfintheSheep wrote:On June 23 2017 05:50 GreenHorizons wrote:
[quote]
Don't be coy, Democrats wrote a bill that left this as an option for Republican held states. They could have avoided this outcome if they wanted. They chose to give Republicans this option, they exercised it, and Democrats still lost.
So can we blame Democrats for losing to destructive Republicans yet? Democrats wrote a bill that let Republicans be democratically elected and write their own bills? How dare Democrats not outlaw Republican lawmakers. lol no, they could have had a public option. If my memory serves me correctly, a few shitbag democrats were against the public option and said they'd vote against it. You are correct. Specifically Joe Lieberman, independent after a left leaning democrat challenged him in 2006, killed it. It was his sole mission in the senate to kill the public option. We can't forget Ben Nelson
who went on to lead the National Association of Insurance CommissionersWhich is all the more important in light of Kwark highlighting that one fundamental difference between what we could have had (if it weren't for Democrats) and what we do have is the enshrining of private for profit insurers. Which when paired with limiting all reform within such framework ensures that the Democrats want prefer uninsured people and private insurers over no uninsured people and a dramatically smaller private market. You are right, the majority of Americans did not want single payer in 2008-2010 and elected people who prevented it from being put in place. It was always doomed to fail because of the two senators cited above. As Democrats are made up of Americans, it is the democrats fault too. To bad we can't just delete CT from the map and remove Ben Nelson from history. But I love your mystical reality where there were other votes to be found to overcome a filibuster. You're stubborn on this, but it's fun. They were in opposition to general public opinion, but they were in line with the insurance industry. Hard to say what the polls were specifically in Nelson's state, but it's not like it mattered, he didn't plan on getting elected by them anyway. Seem to be trying really hard to cape for some Democrats that couldn't care less about you. I'm having a hard time even seeing what point you are making. What are you saying could have happened but didn't happen? Who are you saying chose to make that happen? Democrats killed the public option that would have not made vulnerable the people who never got covered because Republicans didn't expand medicaid, also it wouldn't have Democrats currently fighting to hopefully leave 20,000,000+ people uninsured as a win against what Republicans are offering. Despite that, Democrats lost after hedging, and are still looking at losing in 18 despite hedging even further.
They didn't have the votes for the public option so they went for what they could pass because any improvement beats the shit system that existed prior to the ACA.
They tried to stop states from being able to opt out of the expansion but the supreme court stopped them (I assume the person in this thread stating so was telling the truth, please provide evidence otherwise if you disagree).
Please do provide a different option that was available at the time that would have improved the current situation.
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EPT
