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Democrats and single payer

You've nailed the political talking points. The goal not often mentioned is improving the health of Americans. Obesity is a problem. Diabetes is a problem. Hypertension is a problem. Drug abuse is a problem. All of these have strong lifestyle components. To address these issues, we need to be judgmental of people's life choices. Our politics doesn't permit that, so we instead talk about "Medicare for all!"

I always laugh at the people who cry their eyes out about health care costs sky-rocketing while they shove Big Mac's in their face.

And the second you mention eating right or exercising, they start foaming at the mouth with, "HITLER!!!!"

Our health care costs would drop in half, at least, if people just took better care of themselves. But the "We're the Party of Personal Responsibility" would rather blame everyone else while demanding their health care cost basically nothing while gorging on fried Twinkies.
 
Nope. Medicare improper payments are around 10% of total Medicare disbursements, assuming the annual $60b figure is about right. As you note, the figure for the total system is much less.

What might be worse, and is a point I haven't fully investigated, is that the improper payments are probably more concentrated in Part B, than parts A, C, or D. Part B is what people think of when they want Medicare for all to see their doctor and is where the pay and chase flourishes.
$60 billion is the high end of what "some people say" the annual fraud total might be. FBI's estimate for Medicare fraud is much lower, because it assumes 3 percent, and not 10 percent -- according to your linked article. But now you've changed the subject from fraud to "improper payments" -- a much broader term that includes such innocuous errors as miscoded charges. But even here you make no attempt to show that "improper payments" are substantially higher in Medicare than they are in private insurance, nor do you make any effort to explain how improper payments prove that single-payer can't work. (Of course, it demonstrably does work elsewhere, but this fact has never disturbed conservative confidence that single-payer health care is unpossible.)

Why are you wasting everyone's time? Please start your own thread for this nonsense.
 
I agree. I think the more people hear about single payer the less radical it seems to more Americans and that can get us to single payer faster. Single payer isn't really radical and many countries have it and pay less than we do per capita. Rockfish is right that we can't get there all at once but talking about it doesn't mean that we have to get there all at once. It's normalizing the idea. Maybe the answer is to start taking other government programs and replacing them with Medicare if Medicare for all is the right way to go. Maybe replacing Medicaid with Medicare is a good first step. All the funding for Medicaid could be put into Medicare. You can take my Tricare and replace it with Medicare. Just eliminate every government healthcare program one at a time and replace it with Medicare then replace employer provided healthcare with Medicare by allowing companies to buy in to it. They would if it was a better deal for the employers. I'm not a wonk so I don't know how any of the details of this would work but it seems logical that the government could move the money its spending for an existing program to Medicare and eliminate the old program. Bottom line is I think it's great that more people think single payer is the ultimate solution now than thought it was the solution two years before now.

National single payer is unusual in the world. Yet that is what we most frequently talk about because "Medicare for all!" is easily understood and easy to comprehend, and both features dominate our policy and politics. Regionalized or localized single payer would be much preferable. I can't imagine the bureaucracy managing a system in the Boston/New York corridor also managing one in rural Colorado and Wyoming. But a regionalized system will require more thought, direction, and leadership, from Congress and others in local authority. That ain't happening. We could write volumes about why and how we got into this fix.

If I had to pick a system, I'd look at Germany, which is more like a regulated public utility.
 
and no sooner would you do it, than the moneyed interests would push for "privatization" non stop.

full govt ownership might be a laudable end goal, but like i said, it would be infinitely more impossible, both politically and logistically, than even just single payer.

like i said, the most doable, both politically and logistically, is to first transition to single negotiator. (piece of cake logistically, and the only political obstacle is the moneyed interests, not the citizenry or anyone with employer distributed healthcare.

once you achieve single negotiator, you can then politically transition to single payer.

then when you achieve single payer, you can much more easily transition to full govt ownership if you still wish to.

but maybe "doable", is exactly what the powers that be wish to avoid at all costs, as that's not what the party owners are paying good money for.

as for full govt ownership, you can't get there from here, and you know it.

flat impossible.

therefore, anyone pushing even trying to get there from here is just trying to deflect away from doing something that is quite doable, now, like transitioning to single negotiator first, by deflecting the debate to something that has absolutely zero chance of happening from where we are now.

please tell me why we shouldn't pursue the road i suggested in my other thread, or does it possibly solve a problem the moneyed interests don't want solved, therefore don't want said solution even mentioned or debated.

https://indiana.forums.rivals.com/t...ansition-to-single-payer.156980/#post-2215357


Your idea is a pipe dream.

Biggest reason is that hospitals and other HC providers would take it in the chin. And hospitals/HC is often the largest employer in smaller and mid-sized communities.

What makes you think insures don't have the same economic incentive to negotiate reimbursement rates as govt does? You act as if they are just a price taker, rather than a price setter. Their entire competitive advantage in the employer based insurance market is based upon negotiating the lowest reimbursement rates as they possibly can, to then beat out competitors on rates to employers. And BTW, most insurers do use Medicare reimbursement rates as their benchmark already....paying a certain margin over them.

The entire fixation on the insurance model misses the point of the real problem anyway. An aging population, that lives longer, but has a high rate of ongoing chronic conditions. The payment mechanism used is rather irrelevant. The cost of actual HC is the issue.
 
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$60 billion is the high end of what "some people say" the annual fraud total might be. FBI's estimate for Medicare fraud is much lower, because it assumes 3 percent, and not 10 percent -- according to your linked article. But now you've changed the subject from fraud to "improper payments" -- a much broader term that includes such innocuous errors as miscoded charges. But even here you make no attempt to show that "improper payments" are substantially higher in Medicare than they are in private insurance, nor do you make any effort to explain how improper payments prove that single-payer can't work. (Of course, it demonstrably does work elsewhere, but this fact has never disturbed conservative confidence that single-payer health care is unpossible.)

Why are you wasting everyone's time? Please start your own thread for this nonsense.

Yeah, I agree there is a definitional problem. So what? Improper payments mostly include over utilization and needless or ineffective care for the economic gain of the provider. That is extremely difficult to detect or control. Public pay for all private care will always have this tension. The controls are a fortiori politial, not economics and contracts like private third party pay.

edited
 
Your idea is a pipe dream.

Biggest reason is that hospitals and other HC providers would take it in the chin. And hospitals/HC is often the largest employer in smaller and mid-sized communities.

What makes you think insures don't have the same economic incentive to negotiate reimbursement rates as govt does? You act as if they are just a price taker, rather than a price setter. Their entire competitive advantage in the employer based insurance market is based upon negotiating the lowest reimbursement rates as they possibly can, to then beat out competitors on rates to employers. And BTW, most insurers do use Medicare reimbursement rates as their benchmark already....paying a certain margin over them.

The entire fixation on the insurance model misses the point of the real problem anyway. An aging population, that lives longer, but has a high rate of ongoing chronic conditions. The payment mechanism used is rather irrelevant. The cost of actual HC is the issue.
I don't agree with this. Insurance companies do negotiate with providers, but they have much less leverage than a single payer would -- particularly as hospitals and other providers are concentrating their own market power. That's among the reasons why Medicare reimbursement rates are substantially lower than the rates that private insurers must pay.
 
I'm not saying the government is perfect, by any means, but there are two problems I have with this statement:

1) Our military seems to be run fairly well. We have the best universities. NASA doesn't suck. Some other agencies do a decent job.

2) There is an endless example of Big Business doing an AWFUL job so I always laugh when people say, "If only we ran the government like a business....." How many people HATE their cable company? Equifax? Wells Fargo?

These are good points, the military, I agree is run very well but in an unbelievably extremely high cost. Also, there is no question that there are a lot of the business that are run horribly. Most of the time when there is competition those businesses don't survive. Finally, we also have the best medical systems although they are expensive and they do not cover everybody equally.

I think the best comparison for the situation is the VA. After all, it is providing medical benefits to our veterans. It provides a very low cost service to the Vets but the quality of service as well documented. Also, I have no idea what it cost per person.
 
I always laugh at the people who cry their eyes out about health care costs sky-rocketing while they shove Big Mac's in their face.

And the second you mention eating right or exercising, they start foaming at the mouth with, "HITLER!!!!"

Our health care costs would drop in half, at least, if people just took better care of themselves. But the "We're the Party of Personal Responsibility" would rather blame everyone else while demanding their health care cost basically nothing while gorging on fried Twinkies.
You and CO. Hoosier are welcome to develop and advocate policies to encourage wellness. (This would require more than ridiculing fat people, which mistakes cheap-shotting for policy seriousness.) But that is no reason to ignore the huge savings we could realize through systemic reform of the health care system.

As I have frequently pointed out, our per capita health care costs are about twice as high as the rest of the developed world's. That's mostly because the prices we pay for each and every item of health care -- from ambulance rides to prescription drugs to hospital stays to procedures to medical devices -- are much higher than the prices everyone else pays. This has nothing to do with patient health.

And as MtM has frequently pointed out, the regions in this country with the highest health care costs aren't the regions with the worst patient health -- just as the regions with the lowest costs don't have the healthiest patient populations. If you want to know what's actually going on, you have to look at data.
 
I don't agree with this. Insurance companies do negotiate with providers, but they have much less leverage than a single payer would -- particularly as hospitals and other providers are concentrating their own market power. That's among the reasons why Medicare reimbursement rates are substantially lower than the rates that private insurers must pay.

Yes. I realize that.....but the difference isn't nearly as drastic as its made out to be.

And as I said....the main reason it's not politically viable because it would pinch hospital systems in smaller communities.....often the largest employer in these areas.
 
Yes. I realize that.....but the difference isn't nearly as drastic as its made out to be.

And as I said....the main reason it's not politically viable because it would pinch hospital systems in smaller communities.....often the largest employer in these areas.
It will take a long time to make the transition here, and it will legitimately be very difficult because people's lives and livelihoods have been constructed around the current system. But it could happen here, because it has happened in every other developed country. The main reason other developed countries pay about half as much as we do is that their systems are much better than ours.
 
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Another of my concerns about "Medicare for all" is that single-payer is only one of many ways to achieve universal coverage. I've linked it before, but this Frontline piece illustrates some of the varied ways in which other developed countries have achieved universal coverage. I have my preferences among these systems, but I'd take any of them over ours -- and I'd hate to see a fixation on a particular means imperil progress toward the desired end, by unthinkingly excluding what might turn out to have been more politically sustainable paths.
 
It will take a long time to make the transition here, and it will legitimately be very difficult because people's lives and livelihoods have been constructed around the current system. But it could happen here, because it has happened in every other developed country. The main reason other developed countries pay about half as much as we do is that their systems are much better than ours.

I was going to reply with saying you can get to universal coverage without single payer....and then I saw your next post:)
 
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Yeah, I agree there is a definitional problem. So what? Improper payments mostly include over utilization and needless or ineffective care for the economic gain of the provider. That is extremely difficult to detect or control. Public pay for all private care will always have this tension. The controls are a fortiori politial, not economics and contracts like private third party pay.

edited
Once again, the phenomenon with which you are suddenly concerned is intrinsic to third-party payment generally, and not to Medicare in particular. Thus, it is incorrect to say that "Public pay for all private care will always have this tension." It would be correct to say that "Third-party payment for anything will always have this tension."

As I keep pointlessly telling you, none of this is material to a discussion of health care policy. "Improper payments" are a routine cost of any insurance business, just as "shrinkage" is a routine cost of any business with an inventory. It isn't an argument against insurance any more than it is an argument against inventories -- and in particular, it isn't an argument against single-payer health care. It's just another intellectually dishonest argument deployed by people who don't know what they're talking about.
 
You and CO. Hoosier are welcome to develop and advocate policies to encourage wellness. (This would require more than ridiculing fat people, which mistakes cheap-shotting for policy seriousness.) But that is no reason to ignore the huge savings we could realize through systemic reform of the health care system.

.

I'm a yuge proponent of single payer (or whatever people want to call it).

But I'd also make yuge changes to the entire food system. I'd tax the crap out of sugar, instead of subsidizing it, for starters.

No matter what system you have, if people eat crap all day and never exercise, it will fail.....badly.
 
I think the best comparison for the situation is the VA. After all, it is providing medical benefits to our veterans. It provides a very low cost service to the Vets but the quality of service as well documented. Also, I have no idea what it cost per person.
Not a good comparison unless you are talking about single-provider, like in the UK. The VA docs and nurses and everyone else are employees of the government. Single-payer refers to health care being provided by independent practitioners.
 
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t would be correct to say that "Third-party payment for anything will always have this tension."

Yes that is correct to say. But the methods of prevention, detection, control, and remedial measures are substantially different, as I explained often.

none of this is material to a discussion of health care policy.

Huh? Since when is the means and manner of payment for care not material to health care policy? That is nearly 100% of the debate.

"Improper payments" are a routine cost of any insurance business,

Indeed it is. Institutional variances in administration, regulation, and remedies, will make improper payments more or less likely. Medicare improper payment ratio is higher than private pay.
 
And as MtM has frequently pointed out, the regions in this country with the highest health care costs aren't the regions with the worst patient health -- just as the regions with the lowest costs don't have the healthiest patient populations. If you want to know what's actually going on, you have to look at data.
The Canadian system is regional, in that it is administered by the provinces. It would be more accurately called Medicaid For All. The costs are different in the big, sparsely populated prairie provinces than in Ontario or Quebec or the Maritimes.
 
I'm a yuge proponent of single payer (or whatever people want to call it).

But I'd also make yuge changes to the entire food system. I'd tax the crap out of sugar, instead of subsidizing it, for starters.

No matter what system you have, if people eat crap all day and never exercise, it will fail.....badly.

Subsudizing sugar? The govt creates artificial price floors for sugar producers....raising prices for consumers, already, over what they would be in a free market.....by some estimates domestic sugar is twice the cost that it would be without govt influence.

Maybe you meant HFCS?
 

You said you would "tax sugar".....I assume to reduce its consumption, since we were talking about health care and obesity.

The subsidies (price guarantees) you are talking about artificially RAISE prices of sugar.....not lower it. So sugar is already...in a market distorted way....taxed for consumers.

It's why so many food/drink manufacturers in the US long ago switched to HFCS.
 
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You said you would "tax sugar".....I assume to reduce its consumption, since we were talking about health care and obesity.

The subsidies (price guarantees) you are talking about artificially RAISE prices of sugar.....not lower it. So sugar is already...in a market distorted way....taxed for consumers.

It's why so many food/drink manufacturers in the US long ago switched to HFCS.

I'd tax both of them.....and put the money into a fund that goes to pay health care costs. People could still shovel whatever they wanted into their mouths but they are going to brunt the costs of exploding diabetes and everything else that leads to.
 
I'd tax both of them.....and put the money into a fund that goes to pay health care costs. People could still shovel whatever they wanted into their mouths but they are going to brunt the costs of exploding diabetes and everything else that leads to.

Eliminating corn subsidies would be a good start.
 
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Eliminating corn subsidies would be a good start.

You really gotta love how conservatives brag they "hate moochers" when virtually every farmer is a Righty with his hand out taking money from the Feds for crops we don't need.

I saw a documentary awhile back where they went to these farmer towns and EVERY farmer was mooching off the government.

I say stop ALL subsidies. And instead of growing corn, let them grow hemp....which is a miracle plant and has tons of actual applications.
 
Yes. I realize that.....but the difference isn't nearly as drastic as its made out to be.

And as I said....the main reason it's not politically viable because it would pinch hospital systems in smaller communities.....often the largest employer in these areas.

People said the same thing about the ACA regarding the hospital back in my hometown. Since IN decided to expand Medicaid under the ACA, the hospital is doing better because people showing up for treatment have coverage and the hospital is getting reimbursement. I talked to one of the administrators a few months ago and they were flipping their shit thinking the ACA was going to be repealed. Of course, they all flipped their shit when the ACA passed thinking it was going to destroy the hospital.
 
People said the same thing about the ACA regarding the hospital back in my hometown. Since IN decided to expand Medicaid under the ACA, the hospital is doing better because people showing up for treatment have coverage and the hospital is getting reimbursement. I talked to one of the administrators a few months ago and they were flipping their shit thinking the ACA was going to be repealed. Of course, they all flipped their shit when the ACA passed thinking it was going to destroy the hospital.


There was a lot of intentional support for rural and smaller town health systems in the ACA......and Medicaid expansion was also beneficial for those states that did it....and why many GOP Sens from Alaska, WVA, etc were all about protecting it.
 
Your idea is a pipe dream.

Biggest reason is that hospitals and other HC providers would take it in the chin. And hospitals/HC is often the largest employer in smaller and mid-sized communities.

What makes you think insures don't have the same economic incentive to negotiate reimbursement rates as govt does? You act as if they are just a price taker, rather than a price setter. Their entire competitive advantage in the employer based insurance market is based upon negotiating the lowest reimbursement rates as they possibly can, to then beat out competitors on rates to employers. And BTW, most insurers do use Medicare reimbursement rates as their benchmark already....paying a certain margin over them.

The entire fixation on the insurance model misses the point of the real problem anyway. An aging population, that lives longer, but has a high rate of ongoing chronic conditions. The payment mechanism used is rather irrelevant. The cost of actual HC is the issue.

you open by saying my plan is no good because it lowers the price healthcare providers currently receive for services, which is bad for HC providers.

then close your argument with the sentence, "The cost of healthcare is the issue".

nice job of tripping over yourself, and 180 degree contradicting your opening statement with your closing statement.

"The cost of healthcare", is exactly what my plan addresses, and addresses in the most efficient way it can be addressed.

as for my idea being a pipe dream. it's half the pipe dream, because it's far far more politically and logistically doable, of going straight to single payer.

having to address blowback from the moneyed interests isn't nearly as tough as facing that blowback, plus the added blowback of people losing employer based healthcare in addition.

what i suggested gives you the cost reduction advantage of single payer, without forcing everyone off whatever plan, private or employer based, they currently have, which is why it's much more politically and logistically doable.

in addition, the cost containment fundamentals of my plan are already in place and currently being implemented, both in Medicare itself, and as you mentioned, in the Medicare benchmark plus X% on top of that, that you acknowledged insurance companies already use to negotiate their payment rates to providers.

the big difference is, instead of the Medicare benchmark rate plus X% on top of that that's negotiated now, we eliminate that negotiation for everybody, and just mandate use of the Medicare benchmark itself, with zero% adder on top, universally, regardless of who you get coverage through.

as for your point that insurers already negotiate the lowest rate they can for competitive reasons, the problem with staying with that strategy, is that HC providers can always play insurance companies against each other, thus insurance companies don't have the negotiating leverage, (or they already would by your own admission), to negotiate everything down to the Medicare benchmark plus zero% that i just negotiated for everyone.

insurers won't even have to negotiate reimbursement any more, as they'll all pay the same reimbursement, (Medicare plus zero), which i'm confident is less than any are now paying.

and having all insurers paying the same reimbursement rates means they'll have to compete on service, margin, and administrative costs, rather than being able to use scale to leverage their market power to negotiate lower reimbursement rates than smaller competitors. (or individuals paying out of pocket, who had zero negotiating leverage till i just gave them equal rates with everyone else).

every argument you made actually reinforces, not refutes, why my plan is sound, and superior to what we have now, or anything you or anyone else has suggested, so what exactly is your or anyone else's issue with it, other than it's source?
 
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you open by saying my plan is no good because it lowers the price healthcare providers currently receive for services, which is bad for HC providers.

then close your argument with the sentence, "The cost of healthcare is the issue".

nice job of tripping over yourself, and 180 degree contradicting your opening statement with your closing statement.

"The cost of healthcare", is exactly what my plan addresses, and addresses in the most efficient way it can be addressed.

as for my idea being a pipe dream. it's half the pipe dream, because it's far far more politically and logistically doable, of going straight to single payer.

having to address blowback from the moneyed interests isn't nearly as tough as facing that blowback, plus the added blowback of people losing employer based healthcare in addition.

what i suggested gives you the cost reduction advantage of single payer, without forcing everyone off whatever plan, private or employer based, they currently have, which is why it's much more politically and logistically doable.

in addition, the cost containment fundamentals of my plan are already in place and currently being implemented, both in Medicare itself, and as you mentioned, in the Medicare benchmark plus X% on top of that, that you acknowledged insurance companies already use to negotiate their payment rates to providers.

the big difference is, instead of the Medicare benchmark rate plus X% on top of that that's negotiated now, we eliminate that negotiation for everybody, and just mandate use of the Medicare benchmark itself, with zero% adder on top, universally, regardless of who you get coverage through.

as for your point that insurers already negotiate the lowest rate they can for competitive reasons, the problem with staying with that strategy, is that HC providers can always play insurance companies against each other, thus insurance companies don't have the negotiating leverage, (or they already would by your own admission), to negotiate everything down to the Medicare benchmark plus zero% that i just negotiated for everyone.

insurers won't even have to negotiate reimbursement any more, as they'll all pay the same reimbursement, (Medicare plus zero), which i'm confident is less than any are now paying.

and having all insurers paying the same reimbursement rates means they'll have to compete on service, margin, and administrative costs, rather than being able to use scale to leverage their market power to negotiate lower reimbursement rates than smaller competitors. (or individuals paying out of pocket, who had zero negotiating leverage till i just gave them equal rates with everyone else).

every argument you made actually reinforces, not refutes, why my plan is sound, and superior to what we have now, or anything you or anyone else has suggested, so what exactly is your or anyone else's issue with it, other than it's source?
What?
 
Another of my concerns about "Medicare for all" is that single-payer is only one of many ways to achieve universal coverage. I've linked it before, but this Frontline piece illustrates some of the varied ways in which other developed countries have achieved universal coverage. I have my preferences among these systems, but I'd take any of them over ours -- and I'd hate to see a fixation on a particular means imperil progress toward the desired end, by unthinkingly excluding what might turn out to have been more politically sustainable paths.
If there's a better way than Medicare for all to get to universal coverage I'm for that too. It just seemed to me that we already have a good Medicare program so it would make sense to expand that to cover everyone. But I'm not a wonk and don't have a clue what the best way is to get to universal coverage and I agree that I'd take any of those systems in that article over our current systems.
 
Why is single payer better than full government-provided care? Most people think Medicare loses $60 billion, (that's with a "B") per year to fraud and waste. How much would that increase with a medicare for all approach? Having public pay for privately provided care is an invitation for significant abuse--as we now see.

I think there are better approaches to single payer, but if we end of with a single something or other, it must be single full government ownership.

Edit: Fixed link
What if the government just ran free clinics or put money into existing ones? This way people without insurance and are poor can get at least basic care. I don't see why we have to have a completely government takeover of the medical field. Now one thought I had about a government takeover is how will you implement this? Will you have to force doctors into the government system? What if they want to practice privately? Do we then create criminals out of these people? This doesn't even cover all the government power that would have to be implemented. What about nurses,receptionists,medical suppliers, and all other industries connected to the medical field? If they do business with private companies they will become criminals. I don't like this kind of America and neither should any freedom loving citizen. We should have the right to become what we want and not have the government decide.
 
I hope you don't live near people who think like you do or they might like your stuff more than their stuff. It is their free choice right?
No, then they would be infringing on my freedom. Their freedom doesn't give them the right to invade mine.

But they infringe on no one's freedom if they choose to be a hooker or drug dealer.
 
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No, then they would be infringing on my freedom. Their freedom doesn't give them the right to invade mine.

But they infringe on no one's freedom if they choose to be a hooker or drug dealer.
Would you at least agree that choosing to be a hooker or drug dealer is an unwise choice? Sure people can choose to do certain things, but this doesn't mean they ought to make the choice. My parents used to ask me when I was a child, "what if everybody did that?" It makes one think that our actions that we are free to make has an impact on society for good or for bad.
 
Would you at least agree that choosing to be a hooker or drug dealer is an unwise choice? Sure people can choose to do certain things, but this doesn't mean they ought to make the choice. My parents used to ask me when I was a child, "what if everybody did that?"
You'd make a lousy hooker.
 
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