Trump's Legacy

[Phil1111 913]

Former House Speaker John Boehner predicted on Thursday that a full repeal and replace of Obamacare is “not what’s going to happen” and that Republicans will instead just make some fixes to the health care law.

Boehner, who retired in 2015 amid unrest among conservatives, said at an Orlando healthcare conference that GOP lawmakers were too optimistic in their talk of quickly repealing and then replacing Obamacare.
http://www.politico.com/story/2017/02/john-boehner-obamacare-republicans-235303

[Bob_Church 7]

gowlerk

Anyone who believed that any Republican administration would come up with a plan that would make health insurance more affordable for lower middle class people surely does not understand the philosophy of American conservatism.

I think the best plan would be to dig around in the trash and find Obama's original plan, put Trump's name on it if necessary, then get it passed as it was originally written, not the mess that was left of it once it got through Congress.

[jakee 1,259]

gowlerk

Anyone who believed that any Republican administration would come up with a plan that would make health insurance more affordable for lower middle class people surely does not understand the philosophy of American conservatism.

Well one conservative here stated that the main problem with Obamacare was that it helped poor people and sick people too much, and instead of also helping the healthy and wealthy who were doing just fine anyway.

So if the new plan provides a wholly inadequate level of assistance to poor people and sick people but also provides it to the healthy and wealthy because it's 'fair' then it's pretty much exactly what they want.

Do you want to have an ideagasm?

[gowlerk 1,924]

Quote

So if the new plan provides a wholly inadequate level of assistance to poor people and sick people but also provides it to the healthy and wealthy because it's 'fair' then it's pretty much exactly what they want.

Yes. If you are wealthy it is because you are worthy. If you are not wealthy you just aren't trying hard enough. It also does not help that large numbers of the unworthy happen to be darker skinned on average. That is by no means all of it, but it's the factor that tips their society away from the nearly universal health insurance that all other western democracies have.

Even in Canada, which did not have the racial history of America, medicare was a fierce fight between the right and the left. It is now widely accepted. But it was not always so. And that fight came in the 60s. Well before the massive spiraling out of control price increases that have come along with the incredible advances medicine has had since then.

Heath insurance is not simple. Indeed.

Always remember the brave children who died defending your right to bear arms. Freedom is not free.

[gowlerk 1,924]

This is typical of what I mean by the conservative attitude toward helping the poor get health care.

http://time.com/4697680/republican-roger-marshall-poor-people-health-care/?xid=homepage

Quote

He added that “morally, spiritually, socially,” poor people and homeless people “just don’t want health care.”

If you don't find this disgusting then you are probably an American conservative.

Always remember the brave children who died defending your right to bear arms. Freedom is not free.

[Phil1111 913]

For some they may be off the scale:

https://www.politicalcompass.org/

[Stumpy 256]

Bit of a concern that Paul Ryan doesn't seem to understand the basic concept of insurance.

Never try to eat more than you can lift

[Lawndarter 3]

Stumpy

Bit of a concern that Paul Ryan doesn't seem to understand the basic concept of insurance.

That has been the most hilarious part of the whole thing. It's not that he has trouble with nuances and complexity in health insurance, it's that at a fundamental, basic level, he doesn't seem to get what insurance is at all. It's literally always been the fortunate subsidizing the less fortunate in their time of need, which they do by paying premiums for insurance because they have no idea or way of knowing if/when they're going to need it, and have on the long track similar odds of needing it.

[airdvr 200]

jakee

***Anyone who believed that any Republican administration would come up with a plan that would make health insurance more affordable for lower middle class people surely does not understand the philosophy of American conservatism.

Well one conservative here stated that the main problem with Obamacare was that it helped poor people and sick people too much, and instead of also helping the healthy and wealthy who were doing just fine anyway.

So if the new plan provides a wholly inadequate level of assistance to poor people and sick people but also provides it to the healthy and wealthy because it's 'fair' then it's pretty much exactly what they want.

Heaven forbid we would have something that treats all people equally. How do you know healthy and wealthy people are 'doing just fine'? Is it because they have the means to pay outrageous doctor and hospital bills so some poor schmuck can femur without insurance and expect others to pick up the tab?

I'm all for making insurance more affordable for everyone. In your world everyone has a different definition than mine.

Please don't dent the planet.

Destinations by Roxanne

[wmw999 2,148]

There are three ways to make insurance more affordable.
1. Require everyone to have it; that way the healthy subsidize the unhealthy
2. Make medical care more affordable.
3. Remove by edict some of the profit that insurance companies can make

If you simply remove expensive people from insurance (what we had before ACA), then cities and hospital districts have to absorb the care of the unhealthy. We still pay for that through taxes.

If you limit the care that is available via insurance (e.g. "no transplants"), then there will be outrage on the part of people who need that care ("the government is in our healthcare decisions!").

And if you legally limit the profit of insurance companies, well, you know who's going to holler about that.

There has to be a combination of the three. Just like you can have a project done fast, cheap, or safe (but not all three), you can't have healthcare fast, cheap, and safe. Particularly with all those MRI machines to pay off.

Wendy P.

There is nothing more dangerous than breaking a basic safety rule and getting away with it. It removes fear of the consequences and builds false confidence. (tbrown)

[billvon 2,434]

>I'm all for making insurance more affordable for everyone.

Me too. How do you do that?

You can spread the costs over more people. That's what the individual mandate does.

You can restrict what healthcare people can get. That's the "death panels." Note that despite the fiery rhetoric, places do this now. Oregon's Medicaid system, for example, ranks treatments by effectiveness and cost, then figures out how much money is in the system, and sets a cutoff at some treatment level. (i.e. covers first round chemotherapy but not second round, which is much less likely to work.)

You can set prices by government fiat. Say "you are not allowed to charge more than X for this treatment." Result - companies will stop offering many treatments; everyone suffers.

You can go to single payer and have a single "customer" for healthcare; that gives that one customer (the government) much more power to demand lower prices. But private organizations still provide all care at market prices.

What's the solution?

[jakee 1,259]

Quote

Heaven forbid we would have something that treats all people equally.

If 'equal treatment' means giving the same $1000 subsidy to a person who's $4000 dollars shy of being able to afford fully comprehensive health insurance and a person who has millions in the bank.

That's equal in terms of output from the government but it's far from equal in terms of result.

It's also horrendously innefficient and unproductive. You're wasting money subsidising people who still won't be able to afford good insurance, and you're wasting money subsidising people who have absolutely no need of your help. So you've got to ask yourself what you are actually trying to achieve? Something that makes you feel warm and fuzzy because you're upholding your idealogical definition of fairness - or something that works?

Quote

Is it because they have the means to pay outrageous doctor and hospital bills so some poor schmuck can femur without insurance and expect others to pick up the tab?

Hey, you know what would eradicate the issue of uninsured people? Universal healthcare

Quote

I'm all for making insurance more affordable for everyone. In your world everyone has a different definition than mine.

As 'affordable' does in yours, apparently.

Do you want to have an ideagasm?

[gowlerk 1,924]

People here might take some time to consider this:

Quote

In 2014, total Canadian spending on health care, by governments, businesses and individuals, was $5,543 per person. Americans spent nearly twice as much, or more than $11,000 per person.

In fact, the U.S. system is so screwed up that, despite leaving insurance largely in the hands of the private sector, and despite leaving millions of Americans without insurance, American governments spend more taxpayer dollars for Swiss-cheese coverage than Canadian taxpayers spend to get universal coverage.

The American health-care system’s slogan might as well be: Delivering Less, Costing More.

http://www.theglobeandmail.com/opinion/editorials/globe-editorial-killing-obamacare-will-make-canadians-feel-smug-again/article34269124/?click=sf_globefb

Quote

As Americans get ready to fight it out over how to make their world-trailing health-care system slightly worse,

I know these facts matter very little. America is in the thrall of big medicine and especially big insurance. The politicians are bought and paid for. Cash.

Always remember the brave children who died defending your right to bear arms. Freedom is not free.

[JerryBaumchen 1,064]

Hi Bill,

Quote

Martha Brawley of Monroe, N.C., said she voted for President Trump . . . “I’m scared, I’ll tell you that right now, to think about not having insurance at my age,” said Ms. Brawley

I have reached the point that I no longer care about what happens to those that voted for Trump.

You reap what you sew.

Jerry Baumchen

[millertime24 8]

JerryBaumchen

Hi Bill,

Quote

Martha Brawley of Monroe, N.C., said she voted for President Trump . . . “I’m scared, I’ll tell you that right now, to think about not having insurance at my age,” said Ms. Brawley

I have reached the point that I no longer care about what happens to those that voted for Trump.

You reap what you sew.

Jerry Baumchen

So a Trump supporter is a seamstress or tailor?

Muff #5048

[airdvr 200]

Quote

Hey, you know what would eradicate the issue of uninsured people? Universal healthcare

At this point I have to agree that the single payer system would probably work better than this clusterfuck. I guess I'm OK with 6 month lead time for non-emergency surgery and the loss of the R&D carat. We know enough about medicine at this point...no need to investigate further.

Please don't dent the planet.

Destinations by Roxanne

[JerryBaumchen 1,064]

Hi 24,

Quote

You reap what you sew, sow, so, etc.

I never said that I was perfect.



Jerry Baumchen

[sonnyblu 0]

gowlerk

In 2014, total Canadian spending on health care, by governments, businesses and individuals, was $5,543 per person. Americans spent nearly twice as much, or more than $11,000 per person.

There are a mix of reasons for this, some good, some bad:

- "a much larger proportion of physician visits in the U.S. are to specialists who get higher fees and usually order more high-tech diagnostic and therapeutic procedures than primary care physicians."

- "the U.S. delivers (population adjusted) almost three times as many mammograms, two-and-a-half times the number of MRI scans, and 31 percent more C-sections. Also, the U.S. has more stand-by equipment, for example, 1.66 MRI machines per 6,000 annual scans vs. 1.06 machines. The extra machines provide easier access for Americans, but add to cost."

- "occupancy rates in U.S. acute care hospitals are much lower than in OECD countries, reducing the likelihood of delays in admissions, but building that extra capacity adds to cost."

- "More amenities such as privacy and space in hospitals and more attractive clinics also add to U.S. costs."

- "In the U.S. many elderly patients are treated in intensive care units (ICUs), but in other countries they would receive only palliative care."

https://www.theatlantic.com/business/archive/2014/07/why-do-other-rich-nations-spend-so-much-less-on-healthcare/374576/

gowlerk

American governments spend more taxpayer dollars for Swiss-cheese coverage than Canadian taxpayers spend to get universal coverage.

Medicaid alone covers 70 million people, two times the total population of Canada.

gowlerk

The American health-care system�s slogan might as well be: Delivering Less, Costing More.

Well, I've already listed example of how it delivers more to more people. The problem is that it simply doesn't deliver it to everyone.

You may be tempted to assume that our lower life expectancy is a reflection of the quality of healthcare, but it's more likely due to other social/economic factors that this country needs to address separately.

[gowlerk 1,924]

Quote

You may be tempted to assume that our lower life expectancy is a reflection of the quality of healthcare, but it's more likely due to other social/economic factors that this country needs to address separately.

All of what you have posted are true. Health care is an enormously complex set of issues. Providing less stressful health insurance to all would be huge step in addressing those social/economic factors. Not to mention the tyranny of fearing losing your health insurance simply because you are unfortunate enough to be laid off from your job. I don't understand how Americans even deal with that stress. And that doesn't even begin to talk about the stress small employers trying to find insurance for their employees must have.

Come to think of it, stress may be the reason for the lower life expectancy all by itself!

Always remember the brave children who died defending your right to bear arms. Freedom is not free.

[billvon 2,434]

Quote

You may be tempted to assume that our lower life expectancy is a reflection of the quality of healthcare, but it's more likely due to other social/economic factors that this country needs to address separately.

One telling statistic is that US death rate goes down considerably during bad economic times. Researchers think that this is due to less money available for cigarettes, cocaine, alcohol, weekend binges, half pounders for lunch etc.

[Phil1111 913]

airdvr

Quote

Hey, you know what would eradicate the issue of uninsured people? Universal healthcare

At this point I have to agree that the single payer system would probably work better than this clusterfuck. I guess I'm OK with 6 month lead time for non-emergency surgery and the loss of the R&D carat. We know enough about medicine at this point...no need to investigate further.

Yes, single payer with free market competition around the edges to keep service providers honest.

Reform liability laws to cut back of the high costs of tests and excessive numbers of procedures to cover the asses of physicians from lawyers.

Force drug companies to bid and match international pricing for drugs.Use drug review boards to weed out ineffective and overpriced drugs from coverage. trump has talked about this but so far it hasn't gone far. As the pushback from drug companies is substantial.

http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective

http://www.cnn.com/2015/09/28/health/us-pays-more-for-drugs/

http://www.theverge.com/2016/8/23/12616730/prescription-drug-prices-american-healthcare-cost

All three of these measures would cut US costs in 1/2, cover everyone, cut procedures in 1/2 and likely extend average lives by 1-2 years.

Republicans need to overcome the ideas of "another entitlement" and legislation that forces the government to monitor competition, profits.

[JerryBaumchen 1,064]

Hi rushmc,

Quote

...is already better than Obama's...

But, apparrently not for Trump voters:

http://www.nbcnews.com/politics/first-read/trump-voters-would-be-hit-hardest-healthcare-replace-plan-n732086

"The numbers in the KFF analysis show the political promise and peril in the House plan for the places that were most strongly behind Trump. Under the House plan, many of those voters may get the repeal they sought, but higher costs would come as part of the deal."

Jerry Baumchen

[ryoder 1,398]

John Oliver on the "American Healthcare Act", explains the politics of why there is a lot missing from it: https://www.youtube.com/watch?v=Ifi9M7DRazI

"There are only three things of value: younger women, faster airplanes, and bigger crocodiles" - Arthur Jones.

[kallend 1,647]

sonnyblu

Well, I've already listed example of how it delivers more to more people. The problem is that it simply doesn't deliver it to everyone.

You may be tempted to assume that our lower life expectancy is a reflection of the quality of healthcare, but it's more likely due to other social/economic factors that this country needs to address separately.

My wife, an MD with over 30 years in clinical practice, assures me that the "delivers more" is true, but that the "more" is, as often as not, not indicated by any medical reasoning but by CYA and providing a steady revenue stream.

...

The only sure way to survive a canopy collision is not to have one.

[Phil1111 913]

kallend

***

Well, I've already listed example of how it delivers more to more people. The problem is that it simply doesn't deliver it to everyone.

You may be tempted to assume that our lower life expectancy is a reflection of the quality of healthcare, but it's more likely due to other social/economic factors that this country needs to address separately.

My wife, an MD with over 30 years in clinical practice, assures me that the "delivers more" is true, but that the "more" is, as often as not, not indicated by any medical reasoning but by CYA and providing a steady revenue stream.

Absolutely true. In exhibit #7 the commonwealth fund link that I made a couple posts above it shows that US healthcare costs for drugs, Physician services and hospital services is twice the UK, Canada and Australia. As well as higher than any other country in the study group.

So all the b.s. of how great competition in the area of health services is just that b.s. So if Paul Rand has anything to do with the reform of the ACA it will proudly remain that way. Except brand trumpcare as a new term for failure.

The only area of substantive difference referenced in the study above to indicate a social/physical reason for higher US costs was higher US obesity rates.