Obamacare replacement looks all but dead in the Senate.
If by some magic it passes the Senate, it will still have to meet House approval.
On top of it all, there are budget reconciliation procedures that have to be met. Let’s investigate the key hurdles.
Ron Johnson, a Republican senator from Wisconsin, blasted Obamacare in a New York Times Op-Ed Where the Senate Health Care Bill Fails
The primary goals of any health care reform should be to restrain (if not lower) costs while improving quality, access and innovation. This is exactly what consumer-driven, free-market competition does in other areas of our economy. Look no further than how laser eye surgery went from exotic to affordable during the years it was not covered by most insurance.
Washington believes that the solution to every problem is more money. But throwing more money at insurers won’t fix the lack of consumer-driven competition, combined with government mandates that artificially drive up the cost of care and insurance.
Obamacare imposes enormous taxes and plans to spend nearly $2 trillion over the next 10 years to decrease the number of uninsured, mostly through Medicaid but also through taxpayer-subsidized exchanges. In doing so, Obamacare has largely destroyed an already struggling individual health insurance marketplace. It does this by mandating high-cost provisions as standard for every insurance policy, then forcing a small percentage of the population to shoulder the cost.
Senate Adds Penalty
Please consider Senate adds penalty for going uninsured to healthcare bill.
Senate Republicans on Monday released a revised version of their healthcare reform bill that adds a provision requiring consumers with a break in coverage to wait six months before buying insurance.
The Senate bill would make those who had a lapse in coverage for 63 days or more wait six months before obtaining insurance. Read the bill here.
The addition of the six-month waiting period could make it more difficult to pass the legislation if the Senate parliamentarian rules the provision violates the complex budget reconciliation rules. Republican leadership was working over the weekend to make sure the provision complies with the rules and can be included.
It’s unclear whether Senate Republicans will have the votes to pass the bill, with at least five Senate Republicans on record as opposing the bill in its current form.
On Monday, Senate Majority Whip John Cornyn (R-Texas) doubled down that a vote will be this week.
The Congressional Budget Office (CBO) said it will issue its analysis of the bill on Monday afternoon. A Senate aide told The Hill the CBO report will include the six-month lockout provision.
The continuous coverage provision is intended to prevent a “death spiral” in insurance markets.
22 Million More Without Insurance
The Hill reports New CBO analysis imperils GOP ObamaCare repeal.
Several Senate Republicans said Monday that they would not back a procedural motion on legislation repealing and replacing ObamaCare after a Congressional Budget Office (CBO) report found the bill would leave 22 million more people without insurance over the next decade.
The findings cast serious doubt on Senate Majority Leader Mitch McConnell’s (R-Ky.) ability to get the measure through his chamber this week. McConnell can only afford to lose two votes, and four senators as of Monday night said they would not vote for a motion to proceed to the bill.
Sen. Susan Collins (R-Maine) wrote on Twitter after the release of the CBO report that she would vote no on the motion to advance the bill.
“CBO says 22 million people lose insurance; Medicaid cuts hurt most vulnerable Americans; access to healthcare in rural areas threatened,” she wrote.
Sens. Rand Paul (R-Ky.), Mike Lee (R-Utah) and Dean Heller (R-Nev.) also indicated they would vote against the motion without changes. The three senators, along with Sens. Ron Johnson (R-Wis.) and Ted Cruz (R-Texas), had previously announced they opposed the measure as drafted.
Even before Collins made her feelings known, the CBO analysis was raising alarm bells for centrist Republicans.
“It certainly makes me more concerned,” Sen. Bill Cassidy (R-La.) said of the analysis on CNN. “It makes me want to explore this more.”
A staff member from a GOP moderate’s office expressed frustration that the Senate bill doesn’t do substantially more than the House version to lower costs for low-income people.
“The president said the Senate bill should be more generous, and this goes in the opposite direction,” the source said.
Senator Lisa Murkowski (R-Alaska) says I don’t have enough information to vote in favor of healthcare bill.
“Today I don’t have enough information, I don’t have enough data, in terms of the impact to my state, to be able to vote in the affirmative,” Murkowski, considered a key swing vote on the bill, told CNN’s Dana Bash.
Murkowski’s comments came hours after the Congressional Budget Office (CBO) released its nonpartisan analysis of the bill, which it projected would cause 22 million people to become uninsured over the course of 10 years.
- Rand Paul (Kentucky)
- Ron Johnson (Wisconsin)
- Susan Collins (Maine)
- Dean Heller (Nevada)
- Ted Cruz (Texas)
- Mike Lee (Utah)
- Lisa Murkowski (Alaska)
- Bill Cassidy (Louisianna)
Impossible Nut to Crack
Republicans can only afford to lose two votes. Three to four senators will not vote for the bill because it does not go far enough. Another two to four senators are wavering because the bill goes too far.
If everyone was opposed for the same reason, there might be an easy solution. In reality, Senators are opposed for opposite reasons.
I actually doubt if there will be a vote. It’s just as well.
The position of Ron Johnson is impeccable. Pragmatically speaking, however, it better to hope there is no vote.
The Rule of Nothing explains why.
In any given political situation, the best outcome one can reasonably expect generally happens when politicians do nothing.
Implied corollary#1: When politicians attempt to fix any problem, they are highly likely to make matters worse.
Corollary #2: Politicians almost never do nothing. It’s why we have a messed up healthcare system, education system, public pension system, etc..
Law of Bad Ideas
Inquiring minds may also wish to investigate the Law of Bad Ideas.
Mike “Mish” Shedlock
Zion National Park – Autumn – Hiking “The Narrows” Part I
Obamacare is imploding under its own weight. So then, why do the Republicans want to do anything? They should simply let the program fail, put the blame where the blame is due and then move on. Instead though, they will now get the blame for the inevitable failure of a system that was designed to fail in the first place.
Where I live the Emergency Rooms are still clogged with people that come in for simple things like cold, individuals that answer the questions in a manner to obtain pain pills and other assorted individuals who can not speak English. While that situation is not the cause of a highly complex situation it does demonstrate that the people that pay for their health insurance pay higher insurance bills to cover the costs of those Emergency Room fiascoes in addition to paying higher taxes for the Government subsidies to the hospitals as well. According to many health care is supposed to be “a right” but running up costs imposed upon society because someone goes to the Emergency Rooms instead of lower cost options is not. Let Obamacare fail as it was designed to do and let the left leaning politicians that imposed it take the blame once and for all.
Well, they are doing it because this is not about healthcare. It is about giant tax cuts for the top 1% or 2%. That being the case, they can’t afford to do nothing.
Allocate money to Emergency Rooms, and provide student loan forgiveness for doctors volunteering or working pro bono or for low wages at hospitals run by charities and religious organizations. No one need go without emergency room health care, and having health insurance would be irrelevant. Charity would be cheaper than expanded Medicaid.
Of course, the health insurance industry and hospitals behind Obamacare’s provision outlawing doctor-owned hospitals would never permit charitable alternatives (i.e. competition). Crony Capitalism 101. Charitable competition, especially if religious in nature, is also unfortunately anathema to atheistic socialist dogma and would erode government health care mandates forcing birth control, abortions, sex-change operations, etc. Also, USA Congress and media propaganda outlets do not seem to believe health care is possible unless 90% of spending (costs) is for administrative bureaucratic overhead via IRS, health insurance industry, etc. Right now only 10% of USA health spending goes to medicine, which is why medical tourism is becoming popular.
The CBO says a 64-year-old with an annual income of $56,800 will have a $20,500 per year premium, with a lofty deductible. How is that cheaper and better? Do GOP promises mean nothing?
Compare that to $300 annual premium for an American ex-pat in the Philippines. Why doesn’t the GOP keep their promise, and give us affordable cash prices like the entire rest of the world has? What’s with Americans paying megabucks, and everyone else on the planet paying a song?
Carl R. said:
One of the few healthy areas of the US Economy is in medical research. That sector depends on Americans continuing to pay megabucks. Once Americans have paid enough to provide ample profit, then the products can be sold overseas for significantly less.
The enforcer which requires Americans to pay the high prices is the plaintiff’s bar. If a new product is 1% better than the state of the art, then all doctors must prescribe the new product, regardless of price, or be at risk of being sued for malpractice if they prescribe a lesser product, and there is a bad outcome.
The Medical research sector, attorneys, and insurance companies are all opposed to any system that would bring lower prices to the US.
Here’s the thing. The bottom 60% of Americans can’t afford megabucks, and never will.
john clark said:
Rs are in an enviable place. Just let O’B care rot on the vine, block supplemental or emergency funding for it and blame Dem obstruction in cong. After a few years Dems will be co-authoring repeal. Only downside is millions of americans suffering the consequences in the interim.
Rs are offering proposals assuming anything will be better than O’B care. Not yet, but in a couple years that will probably be true.
1. Fully repeal obamacare
2. No replacement
3. Enforce anti-trust laws against hospitals, medical insurance companies, doctors and pharmaceutical corporations.
4. Pass a law that any new reform of the medical sector Congress must be enrolled and use
Yup. Force them to publish prices and not allow differentiated prices for different customers. If Medicare pays $X, Joe Blow pays $X, end of story.
I would also either eliminate the employer deduction for medical expenses, or provide that same deduction to individuals.
A One-Sentence Bill To Force The Health-Care Issue
23 Jun 2017
Here it is:
“Notwithstanding any other provision in state or federal law, a person who presents themselves while uninsured to any provider of a medical good or service shall not be charged a price greater than that which Medicare pays for the same drug, device, service or combination thereof.”
If you want to add a penalty clause with it I propose the following:
“Any bill rendered to a person in excess of said amounts shall (1) be deemed void, with all services and goods provided as a gift without charge or taxable consequence to said consumer but not deductible by said physician or facility from any income or occupational tax and (2) is immediately due to the customer in the exact amount presented as liquidated damages for the fraud so-attempted.”
It ends the “Chargemaster” ripoff game.
It ends the $150,000 snake bite or the $80,000 scorpion sting.
It ends the $500,000 cancer treatment.
It ends all of that, immediately and instantly.
I remind you that Medicare is required to set pay rates by law at a level that in fact are profitable — that is, above cost by a modest amount — for everything it covers. Further, those pay rates are audited regularly to prove that they in fact are above cost.
Does this solve every problem? No, and in fact that would leave alone the existing monopolistic pricing systems that many medical providers, whether they be drug makers, device makers, service providers or otherwise have in place. It would do exactly nothing to get rid of the 10 paper pushers hired for every doctor or nurse, none of whom ever provide one second of care to an actual person through their entire time of employment.
But it would instantly end walking into an emergency room and getting hammered with a $50,000 bill for something that Medicare will pay $5,000 for.
I remind you that even quite poor people can manage to come up with $5,000 in a life-threatening emergency. Sure, they might wind up paying 25% interest on the credit card, they might have to stop smoking their $5 pack/day cigs, and it might take them three or five years to pay it off, but they can probably do it.
Much longer column:
The Bill To Permanently Fix Health Care For All*
30 Mar 2017
Medex Man said:
@2banana — Already has 3 likes, I would add a 4th like if I had the time to fight with the blog’s login system.
The federal government cannot control costs, on any subject. They have proven that again and again and again. Its just stupid to think they can control costs on subjects that are more complicated.
Obamacare is dead, and good riddance. Single payer is dead, and good riddance to that stupid idea too. Socialism kills, lets all stop pretending like we don’t know this.
Stop the regulations already. Didn’t Trump sign an executive order to that effect?
Just kill the bill and repeal.
Why rescue progressives from the disaster they’ve foisted upon America?
‘Pain’ is an outstanding tutor. Let’s learn something together.
Stuki Moi said:
Because the progressives who foisted in on America are, as usual, not the ones suffering the pain.
I would add to your list, Mr 2banana. Revoke all Not for Profit healthcare organizations. There are several states in which the NPFs provide coverage and freeze out any clinics any doctors may wish to set up. This is done in cases where an out patient surgery for more simple procedures like colon screening and the like can be done without the cost of hospital operating rooms. The NPF simply deny hospital privileges to those doctors. One might ask why this is done? For the monopoly practice. Who greatly benefits? The “charity” and its board whose members make very handsome salaries. No, make everything a for profit operation so they don’t double dip, taking public and patient monies.
Stuki Moi said:
Much simpler: Ban the ability of anyone, anytime, anywhere; from “revoking” any “privilege” from anyone else. Government sanctioned “privilege,” in any area, has exactly zero justification in any society aspiring to even the most rudimentary trappings of “freedom.”
the healthcare field is rife with abuses. We have turned out the same number of doctors every year for the past 75 to 100 years because the AMA decided that their members, the doctors, should have protection from competition of too many doctors in this country. There are only a handful of countries from whom we will accept an MD credentials to work in this country. Now days we run amok in board certifications for one specialty or another. Hospitals extend privileges to MDs who are in their network, others are out of luck. And those MDs are expected to push for as many procedures as the traffic will bear. Break a leg, you need an X-Ray. Fair enough, X-rays reveal bone tissue. but don’t be surprised if the MD wants an MRI as well, costs of $2000 or more. But the MRI only reveals soft tissue, not bone. Funny thing is that Smedley Butler (Marine Corp general and the only man to ever be awarded two Congressional Medals of Honor) said that war is a racket. Obviously he never took on healthcare.
But it’s not just healthcare. Many of our crafts require certification. Want to replace your water supply line from the curb to the house? You must be a master plumber. wire in a new light fixture in your house? You need to be a master electrician or a journeyman working under a master. Want to add an addition to your house that is more than 500 sqft? That foundation must be drawn up by a licensed civil or professional engineer. It’s his seal you are paying for. The list goes on and on. To work on a commercial radio and television signaling equipment you need a First Class Radio License. You can take that test, it’s all multiple guess and you really don’t need to know anything but memorize the answers. Crazy, huh?
Stuki Moi said:
…And if you look into it empirically; those who happen to be on the (at least in the short term) “benefit” side of the distortions, have all done really well over the past some decades. With the remaining 90-95% of the country getting stomped further and further into the dirt, to pay for it all. Which the former, like a bunch of self rationalizing women, naturally attributes to the latter’s so called “lack of skills.” As if having the government run a protection racket for your benefit, is some sort of demonstration of any meaningful “skill.”
Anyway, sooner or later (probably later, considering the success of this dump’s indoctrination apparatus), the ones stomped in the dirt will figure out Somalia is actually, never mind the hobgoblin stories, a better ran country than the USA.
I think you complain and exaggerate too much. For my money, it is the progressive left that is doing most of the “stomping” of the people in the ground.
Stuki Moi said:
” it is the progressive left that is doing most of the “stomping” of the people in the ground.”
Of course it is. The progressive left that is running both the major political parties. If we simply got rid of every single law and regulation enacted, by any party during any administration, since the dawn of the progressive era 150 years ago, some nuclear weapons related one perhaps excepted, we may just have ourselves the trappings of a half decent country again.
Michael Rudmin said:
Agreed, kill the Obamacare law.
How about a better one? Repeal ALL insurance. Make healthcare insurance illegal? That would force things into the open market.
There’s one incredibly mean aspect about that, though: it means that severely sick people would not be able to afford health care.
The answer to that, though, is to ask these super-wealthy doctors to take some cases for free, at their own good will.
Ask them to remember their oath, and consider why a person should want to be a doctor in the first place.
The ones who won’t… weren’t good doctors anyhow.
There was a time when doctors were poor, and did good. You won’t get back to controlled costs any other way.
(BTW… the law of nothing… people have been stating this for a long time. Mish’s contribution was to add a moniker. But it is why I usually win arguments about who was the best president in the past, by taking it back to Jimmy Carter for the US, and Gorbachev (who dropped the reins when the horse was running crazy) for the USSR.
Jon Sellers said:
How about physicians just be required to post an hourly rate for their labor? And hospitals also post a nightly room charge. Materials included.
Or maybe America can look at well-run systems in other countries that provide better outcomes at 60% of the cost.
Jon Sellers said:
“You can count on Americans to do the right thing – after they’ve tried everything else.” Winston Churchill
John Smith said:
Americans would look to the systems in other countries? Oh come on, Americans do not think the rest of the world has anything to tell them!
Stuki Moi said:
You mean, like we should have adopted the Soviet Central Planning System in the 50s, back when Nobel winning “economist” and chief indoctrinator Paul Samuelson, informed us that the Soviets were “growing” much faster, and would overtake “us” in a few decades?
Problem is, no “system” comprised of human beings, is well run. As human beings aren’t mechanical cogs that can be slotted into systems by five year planners or other progressive simpletons. And noone can “run” your life as well as you, no matter how much of a “system” they call themselves.
Only those who want socialized medicine should pay for it. That would accelerate the “running out of other people’s money” flaw because most of the “other people” wouldn’t participate. “Other people” are not the property of the socialist mindset and shouldn’t be forced to subsidize it. Feed and Breed, you know.
The real solution is to be free to choose whatever health care system you want, but not at someone else’s expense.
Maybe then some of the Walmart Whales would clean up their own act.
I believe it was Robinson-Patman Act that established the requirement against the establishment of price discrimination, something that is done in healthcare on a routine basis. There are quite a few laws concerning deceptive practice that require the posting of prices for goods or labor or services, anti-competition laws that prohibit restraint of trade practices, bait and switch, inclusion of unnecessary procedures, hidden charges, The list goes on and on. These laws are still on the books and every state has them. So even if Congress has given healthcare a pass on federal law, these organizations are still in violation of state laws.
Now this is the one thing I can’t really understand is why so many people are so set of making what amounts to a single payer system, which is what ACA was morphing into, work at such a high prohibitive cost. The only reason that might be assumed true is that with single payer, the poor get free healthcare, such as it may be rationed, and the taxpayer picks up the difference not paid by higher income workers. But that really amounts to the same thing. If one is living below, at, or a little above the poverty line, then one pays very little taxes and hence will not pay for single payer healthcare. Everyone who does pay a minimum amount or more to taxes will pay both their healthcare premiums and the taxes that will cover the poor.
The real issue is why should government, city, county, state, or federal be in the healthcare business? Yes, we do need some regulations and certifications, but we have an excess of both in this country. Why do we need medical monopolies when such monopolies have never led to better healthcare as a whole? And of course, why do we pretend that some many optional procedures should be paid by others or the public dime? So perhaps it’s time to take away the ability to incorporate healthcare. Why do we need behemoth healthcare institutions?
Jon Sellers said:
“So even if Congress has given healthcare a pass on federal law, these organizations are still in violation of state laws.”
Why aren’t they enforced at the state level? Could it be that our government has passed a threshold of corruption that makes it impossible for politicians to make moves against the medical mafia?
“Now this is the one thing I can’t really understand is why so many people are so set of making what amounts to a single payer system, which is what ACA was morphing into, work at such a high prohibitive cost.”
Given the answer to the first, what other choices do the American people have? It is not the poor who benefit from single-payer. The poor already have single-payer in the form of Medicaid. As do the elderly and military veterans.
It is the middle-class that knows that they are always, no matter what, one step away from bankruptcy because of some medical condition over which they have little control. They are the desperate ones.
I read an article the other day of a young couple switching jobs. She was pregnant and her husband didn’t want to go without health insurance so he paid for his prior employer’s COBRA, well over $1000/month for a couple in between jobs. He gets his new job and waits 30 days for the insurance benefit to kick in. Later she has the baby, which is a preemie. The baby has to stay in the hospital for 60 days.
She gets a bill for $120,000. Why? Because she didn’t know she had to call the insurance company and get the baby put on the new policy. Even though the insurance company had received billings for the birth from the hospital, which the insurance company paid.
The couple is bankrupt. This is what this country has turned into. Thank you conservatives!
What passes for wisdom these days is often beyond comprehension. A Dallas city councilwoman (Oh my god, the man is sexist, shoot him) was complaining at a council meeting that some old rich dude who didn’t want to give up he property to the city under a city attempt at eminent domain taking and had cost the city several years of delay and legal bills was now being rewarded from his defense of his property to the detriment of the citizens of Dallas. she said that if it were you or I, just average citizens, the city would have taken our property very quickly. It just doesn’t seem right that he gets to keep his property and win awards of lawyers fees because we really needed his property to put a water pipe through for the rest of his community. Seems the judge was not convinced that the old man’s property was the only avenue of running the new pipeline.
So why don’t the state AGs go after the healthcare industry? I suppose that if they want to continue their public careers, they shouldn’t bite the hands that feed them and their parties. Of course if I were a young man with a law degree and some experience with the AG’s office, I suppose that I could run against the other candidates for AG in my state on an independent platform and promise to break up the cartel of healthcare and reduce costs to ten or twenty percent of what is now current. Of course if my proposed constituents were more concerned with protecting illegal aliens then that might be a problem.
As for all those healthcare alarmist stories, most are true, people do get legally scammed. It is not the fault of conservatives although they have been a small part of the problem. Most of the blame goes to Liberals who believe, without any proof whatsoever, that big government knows best and can fix any problem. That has been the biggest lie of several centuries. Funny thing is that at the beginning of last century the progressive politicians ran against trusts and combines, against monopolies. they had the help of the liberals in their efforts. today, when was the last time any liberal ran against the healthcare monopolies, the trusts, the combines? Never. thank you liberals.
“Why aren’t they enforced at the state level? Could it be that our government has passed a threshold of corruption that makes it impossible for politicians to make moves against the medical mafia”
You make that statement and yet still advocate handing all remaining independent control over to the already corrupted/corruptible government. The government is made of people just like any private corporation and it can be corrupted like any private corporation. It is a mystery to me how you can be aware of that and yet reach a conclusion that unlimited centralized government is the answer to this problem.
Jon Sellers said:
I did not advocate handing any over to government. My advocacy was in a post above which simply requires physicians and hospitals to post prices.
My earlier comment was based on your statement above in regard to single payer:
“..what other choices do the American people have?”
I agree that prices should be posted and in addition I think pricing should be the same for everyone who receives the same service. Evidently you were only pointing out that people are desperate and not that single payer would be a good solution.
I do think there are better options than what we have. Unfortunately, I imagine voters will only ever be given a Hobson’s choice. I think that Senator Ron Johnson nailed the issue in his statement above.
Stuki Moi said:
“why so many people are so set of making what amounts to a single payer system,”
Once you’ve jumped the shark, into waters as inhospitable to freedom, decency, humanity and even ultimate survivability as any that includes a health care (or any other) “system”, the main attraction of single payer, is that you get rid of the drag from the bickering and squabbling over “pricing” and “coverage” that is endemic to “our” “system.”
Like the baby John mentioned, who, dumbass that he was, didn’t have the sense to call and arrange for a policy the second he was born.
You might as well ask why the low hanging fruit gets eaten first. A single payer system is not an insurance plan and never was but the average person prefers not to have to think too much about the world they live in. No one I know even worries about bickering and squabbling and haggling over prices. That is what their insurance companies do, they just pony up to co-pays and complain about the price. How many new car buyers ever go down the list on the sticker pricing sheet to see what they are actually getting. then they fall for all the extras like that clear plastic coat sprayed on the car to “protect” the paint finish. do they really understand that it is not added to the price of the car but directly to the loan amount borrowed?
I have very little hope that common sense and wisdom will prevail and we shall see the end of ACA and any attempt at a single payer system. The fact that healthcare accounts for approx 16-18% of the nation’s spending should makes us demand better. But hell, if you went through Nam in the sixties when the M-16 first came out and was prone to jamming after the second mag was loaded, demanding a better weapon on got you on the shit detail. One of life’s lessons is that the squeaky wheel doesn’t get the grease, it gets replaced and chucked in the trash.
But at least Trump reminds me of Howard Beale yelling at us to go to the window and open it and stick our heads out and yell, “I’m as mad as hell and I’m not going to take it any more.” But I doubt that even President Trump can get us to do that. Shame cause we need to do it.
Stuki Moi said:
Traditionally, originally, work in European single payer systems weren’t cost itemized in most instances. A patient comes in, gets looked over, doctors (and perhaps other PRACTITIONERS, not Administrators nor other bean counters) perhaps have a meeting, and if surgery seems reasonable, a surgeon who happens to be working then, does it. Or it gets scheduled for whenever it looks like a surgeon may have some time and a free operating room.
No “cost per procedure” (nor the surgeon getting paid per procedure. He gets his salary, and during those hours does what ‘has to be done’), and no bunch of bean counters having to OK what is done, and the surgeon “billing” for it……. But instead a bunch of professionals working together trying to do the best they can, with the patients that come in. The “money people’s” role not extending beyond paying rent, reasonable salaries, and ensuring there is enough in the kitty for medicines and a reasonable level of equipment. And otherwise shutting the heck up and staying out of the way of those doing actual work.
At least that is the way Swedish hospital life up until the 80s or so, was described to me by a retired professor. Now, even there, the whole thing is moving ever closer to just another American style HMO. With the main emphasis being, on finding ways to keep patients away from practitioners who can actually do something meaningful. Since doing so costs something, hence make the, inevitably politically ambitious, hospital administration look like they aren’t as good at “controlling cost….”
All the drag involved in the itemization, individual accounting, obtaining authorization blah, blah, accounts for a good share of the increased amount spent by Americans on health care compared to Europeans.
I am well aware of the healthcare here in France as I have had occasion to use it. My English friends have also used it several times. the system is not quite as wonderful as many advocates for a single payer system make it to be. The doctor assigned to this village was driven out because the the villagers did not like her. They chose to take the bus to Langres, the big city (25,000 people). My own experiences with the system lead me to be very wary about how healthcare is dispensed. If one is on blood thinners then once or twice a week the nurse will come to your house and draw your blood. she may be competent or she may not, But that cost per visit is paid by me, not the state and it adds up quickly. The Romanian doctor, the one the villagers would not see, had no idea what she was doing when it came to heart problems and drugs needs for those problems. She would have killed me if I hadn’t taken the simple precaution of not seeing her again. Fortunately for me I research the drugs, the heart problems and found that I could substitute aspirin for rat poison (coumadin). I have heard enough stories for others that tell me healthcare here is not the greatest in the world. On the other hand, when my English neighbor fell down a flight of stairs and broke his neck he was flown by helicopter to Vesoul to be treated by a very good surgical hospital. On the other hand they were charging him five euros per aspirin tablet. It is a hit or miss situation. My emergency trip to the hospital due to an accident in my workshop cost me about one hundred euros.
Now I can contrast those experiences to mine in the US when I had to have emergency open heart surgery to the tune of nearly $90,000. My cost was about $5,000. But that was 2002 and I had decent heath insurance. Now I am on medicare and subject to the whim of the government as to what they will pay for. I make it a practice not to make medical appointments unless I really need them.
I do know that when I needed medical treatment in Mexico ( a small village where my wife’s parents were born) the costs were very reasonable. Two of her cousins were doctors and that may be why. Again, healthcare is a a relative matter and depends on what you expect.
Stuki Moi said:
No “system” will ever be “wonderful.”
Heck, no system will ever be even remotely as functional as No system.
Nobody benefits from being “managed” by anybody else. The only ones who come out on top in that scenario, are the ones who get to do the managing of others and their money.
But, once you are stuck with a population so dumbed down and indoctrinated ,they can’t even wrap their pathetic little heads around something that obvious; it’s not surprising that a “system” with one cook in the soup, ends up being less costly, and more efficient, than one with a whole battalion of them, each grubbily grabbing for his share, while the patient is stuck outside the building, the only one in the whole charade without any say on any matter.
Don’t just fix healthcare. Congress needs to use their wonderful leadership, economic brilliance, superior ability to run my life and create and pass the “Nothing Bad Can EVER Happen To You” Act or maybe “If You Like Your Unicorn, You Can Keep Your Unicorn” Act. Anyone who opposes such a perfect law can be accused of crushing puppy skulls and making ice cream taste bad.
Beach Bum said:
Wait, what happened to all the white males cheering and hugging as Trump gave them thumbs up and cameras ran?
Mission Accomplished said:
Full Democracy is the solution including The Null Party.
If nobody gets the most votes Nobody gets elected.
Quorum rules will make it bumpy at first but with eventually people will adapt to full Democracy
Stuki Moi said:
Even better: No matter who gets the most votes, Nobody gets elected!
I prefer panarchism as the only way to go. Treat political beliefs like religious beliefs so that each person would be rewarded or punished for the choices they make in this world
and the afterlife.
I can see why the forager lefties would be against this: they would be nonviolently bred out of the gene pool. Conservatives generally see what an encumbrance the liberal mindset is, what I don’t understand is why conservatives can’t see that a Velvet Divorce of liberals is the solution.
Otherwise, they’ll never reclaim what once made America great.
Alex Spencer said:
I have written to my two Republican senators trying to articulate a viewpoint similar to Ron Johnson. But they generally do what the party tells them. So disappointed that the two parties leadership positions have the same approach. The only difference is the amount of bloated healthcare costs pass through directly to me,
It doesn’t matter ultimately who pays if the money is being wasted so thoroughly in the healthcare industry. If I pay the healthcare bills then the wealthy will have one less person able to buy their products. If the wealthy pay the bills then they will not be able to develop beneficial products for me to buy. Either way the economy is screwed.
The new generation of inventors and developers in the world will seek out places where they can raise their families and have access to modern healthcare. The US will not be that place if we can’t get the politicians to wake up.
Stuki Moi said:
No matter who pays the bill, those running the health care scam will get wealthy.
Government is not about doing good or being beneficial, it’s about having control and being able to transfer wealth to those who otherwise wouldn’t have it.
I *had* insurance until I quit my job in May. HAD being the key word. Could not afford the premiums for the COBRA so I let it lapse. 9 days into June I had a major cardiac issue, the first major event of my life (other than childbirth) and something that I have basically zero risk factors for. I’m nearly $10K into medical bills that keep coming and I have no insurance to pay for them, and even if I did my deductible was $6700 with 70/30 coverage. All these bills courtesy of Obamacare.
Sorry to hear that. That’s some bad luck. You can frequently negotiate the prices down.
Alex Spencer said:
Sorry about the bad luck. You may feel a little better if you subtract what you would have paid in insurance premiums,deductibles, and copays from the total bill. Premiums are so high it’s practically almost like prepaying for care. I continue my coverage mainly to protect from the industry standard fraudulent billing practices.
No, if cash pay and market forces were allowed to govern prices this would not be an issue at all. I am a provider myself and I know how much the meds etc actually cost.
Sorry to hear about your misfortune. Too bad you don’t live in one of the many enlightened countries where everyone is covered for these needs. No deductibles. No Co-pays. No bill.
Of course, you will pay slightly higher taxes than in America.
Please remember that the countries you speak of also have rationed care where people die waiting to be treated, and drug costs that will be higher as soon as the US stops subsidizing drug prices for the world, and they also have many taxes that are more than slightly higher (VAT, etc). Selectively cherry picking costs and benefits when setting policy will ultimately lead to people being worse off.
Cautious observer; there is no perfect system. However, your fear mongering is part of the impediment that prevents Americans from looking at other systems. I have heard your politicians make similar outrageous claims, in order to justify leaving 30% of Americans with no coverage at all. Personally, in my lifetime, I have required four operations. Longest wait time: 3 weeks. Bottom line: Americans are being screwed by their politicians on health care.
I am stating the facts as I know them, not “fear mongering” and my claims are not “outrageous.” I, personally, have no insurance due to the current system in the US. My most recent experience with the system was going to the ER for a kidney stone, for which the hospital + doctor + radiologist attempted to collect $11,000 for providing little to no service. I would much rather have a no insurance system with strict fee-for-service than this current mess. You have had 4 operations with your countrymen paying the bill? Good for you. I do not want that. As far as Americans being screwed by out politicians, on that we largely agree.
Trump is playing the professional liars like a fiddle. He knows Republicans cannot pass a more generous plan, and he needs the O’care tax to balance his budget. 2018 could be a bad year for RINOs.
Stuki Moi said:
Kind of like Dumb and Dumber fighting over who gets to be Dumbest.
Until they address the real problem, high health care costs, no adjustment of insurance laws will solve anything.
By 2030, it’s expected that half the population will be diagnosed with cancer at some point in their life. All drugs that have been approved by the FDA since 2010 cost over $100k/yr. And in most cases, they only prolong life, They don’t cure. How can we possibly allow or afford this?
Stuki Moi said:
“We” can’t afford it. Some may be able to afford some of them, for some time, if that’s how they want to prioritize their spending. But any scheme attempting to socialize that kind of costs, will fail, Drugs with that high a cost/benefit ratio, will be severely rationed, regardless of “system.”
The progressives will, true to form, want government to do the rationing. Since they, themselves, are the ones closest to the bureaucrats, apparatchiks, and even doctors, who will be making the decisions whether the treatment is warranted “in this case.”
The merely wealthy will want a private insurance model like we have today, where “everyone” has to pitch in, but their “Cadillac” policies get first priority, as even for a wealthy person, a cocktail of a few $500K/year drugs, taken for a decade, starts taking it’s toll on their yacht fund.
While the poor (and non connected. As in not “poor” Harvard student children of some Goldmanite), and the straight up super rich, rationally will want the only thing sensible: A simple pay to play. As the superrich (the Kochs) will end up doing that anyway, while the poor will never see those drugs regardless. And only a pay-to-play model will give suppliers and developers of drugs, the price and demand signals they need, to focus their efforts in less silly directions.
Government prefers to 800 billion for defense that kills tens or hundreds of thousands of people across the world rather than cure cancer.
Aside from that, stopping “immortal” cancer cells from using telomerase and ALT (alternative lengthening of telomeres) would be cheaper than chemo, radiation, and surgery.
There is a private effort to stop ALT: Control ALT, Delete Cancer.
Ron J said:
Enforce 15 USC. What is the big problem with doing so in what i keep hearing is supposed to be a nation of laws? No health care bill is necessary to enforce 15 USC, which already exists. Denninger keeps pounding the table that it would dramatically drop the COST of health care and it is COST, not insurance, that is the problem.
Who in government is actually interested in fixing the problem?
Answer can be found in a quotation from Upton Sinclair:
“It is difficult to get a man to understand something, when his salary depends upon his not understanding it!”
The laser eye surgery example shows why “free market” isn’t the solution.
Nobody needs laser eye surgery, people can get on perfectly well without it by using eyeglasses, a cheap 400-year-old technology. So yes, the free market functions perfectly well, even optimally, when it comes to entirely discretionary consumer luxuries.
Healthcare in general is more like a public utility than anything else. Electricity, gas, water, police, fire services, residential trash collection, etc. are uniformly either provided directly by government, or by private providers in a close, long-term contractual relationship with government. Why should health care be any different?
I pay my own electricity, gas, water, and trash collection, don’t you?
As for police and fire, those also are serious issues of contention in my area. I believe the reason they do not get as much attention as the health care issue is because, for most people, police and fire services are seldom, if ever, used.
Jon Sellers said:
I pay for my own too. However, the prices are negotiated by my local elected government officials. So I guess the question would be “why can’t we get negotiated pricing?”. Why, when I walk into an emergency, am I required to sign a form that basically says “you will pay whatever is charged, and we’re not going to tell you what that is.”?
“Why, when I walk into an emergency, am I required to sign a form that basically says ‘you will pay whatever is charged, and we’re not going to tell you what that is.’?”
This is because a private hospital is prohibited by law from refusing service to anyone who walks into the emergency room, and as part of that Faustian bargain, they are given the option of making those who can pay cover the cost of those who cannot. This results in an unfortunate combination: the hospital is allowed to charge each person as much as they can collect.
The arrangement breaks antitrust laws. The government had a hand in creating this unfair practice.
To be clear, I pay my own electricity, gas, water and trash collection based on *my own usage* of those services.
Stuki Moi said:
Nobody, or at least very few, “needs” an MRI ether. The vast majority of times, the only thing it adds versus cheaper diagnostics, are a bit of certainty. 95% instead of 92%, say.
The low hanging, non luxuries, of health care kn the West, were pretty much done by the 70s or 80s. Now it’s predominantly about extending the life of a geezer another few months, at an enormous cost to someone, then quarreling over who that someone ought to be. Or, to keep pretending babies born as fertility drug experiments, to over the hill barren “career women,” somehow have as good a prognosis, as those born in a cave in Afghanistan to a more sensibly aged mother.
Alex Spencer said:
As someone caring for aging parents I know how difficult it is to get appropriate care. One had her life made impossibly difficult trying to get the right treatment until she succumbed to hospital acquired infection. One had arbitrary changes to dementia drug treatments causing all sorts of torment and multiple visits to the emergency room. Fortunately we found one of the few places offering good care which allowed him some piece in his final days.
Even a simple matter of controlling hypertension was not handled correctly. When a competent physician and daily medication supervision was eventually found the matter was treated and most of the mental deficits were corrected. Continuing with the incompetent care would have caused her health problems to snowball making her last years a true misery.
We pay dearly for care that makes us miserable. The health industry produces a poor product at very high costs.
“We pay dearly for care that makes us miserable. The health industry produces a poor product at very high costs.”
Excellent observations! Unfortunately, all too typical. Western Medical Care Business & Finance 101: The more miserable you make the patient and the more botched the treatment, the higher the quantity of additional treatment needed and the more money you make. Bad medical care is good for medical business bottom lines. In other words, financial rewards (incentives) are highest for those providing the worst/most botched medical care. Personally, I steer clear of Western medicine as much as possible.
Medex Man said:
@MGT – “The laser eye surgery example shows why “free market” isn’t the solution. ”
Actually, your comment only proves the public education system is as bad and overpriced as the government run health system.
Whether you chose glasses or laser surgery was never the issue; and if your school taught basic reading comprehension you wouldn’t have written such a nonsensical comment.
Both laser surgery costs AND eyeglass costs — neither of which are covered by Obama’s insurance scam (and not covered by most insurance scams) — have both seen prices DECLINE for years, while the stuff insurance covers has had prices climb 15% before Obamacare and now 30%/yr after Obamacare.
MGT’s dim comment just proves the government shouldn’t be running public schools either. Basic reading comprehension eludes him/her.
Ron J said:
“Implied corollary#1: When politicians attempt to fix any problem, they are highly likely to make matters worse.”
That is becoming painfully obvious, as we approach the second shoe drop of the current economic depression.
Per Desteen said:
Since this thread is devolving into “I wish” scenarios, let me post the ultimate one:
All medical treatment, drugs, care, etc. shall be paid for in cash. No insurance, no medicare, no medicaid, etc. Disband the AMA, eliminate most regulations, reform tort laws such that the provider of the care/drug is responsible to pay for their errors in perpetuity.
Do the same with education or any industry in a bubble.
Simple Solution: PATIENCE!!! Let Obamacare implode. At that point the Republicans will be able to pass any health care bill they damn well want.
Medex Man said:
While Trump encourages Congress to neuter themselves… I wonder if his plan wasn’t to let Obamacare meet its fate from the beginning.
Encouraging Paul Ryan and Mitch McConnell to fail removes them as obstacles later on. Pelosi already rendered her entire party irrelevant.
Sometimes the best way to eliminate an opponent is to just let them exhaust themselves in their own arrogance and stupidity…
But I worry that Trump is going to try to implement some other government centric nonsense. Anyone with a single functioning brain cell knows the US federal government does not and is not able to control costs on anything. Paper clips, office space, aircraft carriers, space exploration, environmental issues, or healthcare … everything involving government costs at least 3-4x what a private person would pay (often more). And healthcare is just one more example.
Government cannot control health care costs, so there will never be an effective government solution.
Health care is the most important factor for many Americans yet by at least one measure we have the worst health care in the world. Cost, health care in America is the most expensive of any country in the world and it isn’t even remotely close. This is odd as by most measures the US is one of the cheapest first world countries to live in. So I decided to look into a few more details and it just gets worse. When compared to the next ten most expensive countries for health care we rank just as bad. We are last on this list for life expectancy and first for obesity (these may be related?). We have among the fewest doctors per capita making are wait times to see a doctor among the longest. Among the top ten countries we also have the fewest percentage of our citizens covered.
Neither party has effectively addressed the issue of cost to the public. Obama care did bring access to more people, so it had one win. The GOP plan seems to help a few people (young) at the expense of others (old), ultimately, it seems to have no redeeming value as for improving the health care in any of the statistics mentioned. Sad. Neither party has addressed structural issues that make an already terrible system completely unsustainable.
Medex Man said:
Excuse me for pointing out some really obvious stuff, but have you noticed the cost of government office space versus the private sector? have you noticed the cost of aircraft carriers? The cost to taxpayers of requisitioning one stapler for one bureaucrat?
How many stupid voters actually believed Obama (or anyone) could create an effective health care system on top of such a bureaucracy? What the hell was Obama thinking, other than how pretty he thinks he looks in the mirror?
Even if George Washington or Abe Lincoln or whomever came back to life and rallied support of the public — the United States federal bureaucracy is NEVER going to run a cost effective health system. NEVER.
I’m sure Obama’s political handlers have a list of prepared excuses, but we all knew from the VA system that a the US government is not capable of running a health system.
Obama likes to claim he was born in the USA (I don’t know or care) — but if he was born in the US, if the morons voting in San Franciscso were born in the USA — how did you people miss the disaster that is the VA system? You all claim to live here, and you can’t see the VA disaster right under your noses?
If you don’t like to talk about the VA hospital mess, take a look at Amtrak. Look at the Post Office. Look at FNMA or FHLMC. Look at the fact that more people are on food stamps now than when the government started their war on poverty — they made poverty worse!!! And yet there are people who think this time is going to be different???
Obama is a stupid man and/or a con artist. There is no excuse for anyone living in the USA to think the US government can run an effective health care system. Period.
You’re probably right Medex. The American government is probably too stupid to run an effective health care system. Fortunately, there are dozens of governments around the world who are, covering 100% of the populace for less than 12% of GDP. No wonder you are so angry.
Medex Man said:
I’ve visited many of those other countries, and they do no such thing.
They cover a lot of primary care, not all. Some cover certain surgeries, but those (like Canada and UK) use massive subsidies from oil royalties to get their “free money” — and those systems are breaking down.
Outside the lies and propaganda, most of the world pays cash — that is what works. That is what worked in the USA before the socialist FDR messed things up with his price controls. That is what works (even now) in the USA for things like eye glasses and LASIK surgery — both of which have seen costs decline while federal insurance frauds made everything else in the healthcare sector triple in cost.
You are continuing the fraud “realist” with your absurd claims that every other country offers 100% coverage. That just isn’t true, and you know it (or you should know it). So you are a liar, or stupid. There are no excuses for this.
People are dying and going broke (sometimes both) because of the fraud you socialists committed via Obama. May you rot in hell for it
Stop with the lies Medex. You have no idea what other countries do. Try doing some research on what other countries do before making your ridiculous claims. The statistics are out there if you want to look them up. But you won’t. You just like to make stuff upl And don’t have a coronary. It sounds like you will get lousy coverage (or none) in the USA. Ha! It sucks to be you!
Medex Man said:
I’ve been to Costa Rica and Singapore — two countries that supposedly offer universal care.
Officially, Costa Rica covers everything. That is what libtards read in their fake newspapers. As a practical matter, roads in Costa Rica are terrible, and most people can’t travel to a clinica in anything remotely close to a reasonable time. Even fewer can afford to take 2-3 days off from working. Officially, people are covered — in reality they don’t even try to go. They treat themselves.
Costa Rica has great medical outcomes because they eat fresh food, get lots of fresh air and lots of exercise. Its their lifestyle, not their health system, that produces great outcomes.
Singapore had a national debate years ago about “universal” care. The socialists cited China as their example country, and Lee Kwan absolutely humiliated them in national debates. You have to be stupid to think Chairman Mao and a peasant have the same access to care.
Singapore’s system is essentially catastrophe insurance — really big medical procedures. They pay cash (something close to HSA accounts in the USA) for everything else. Once again, Singapore has massive lifestyle advantages over the United States (better food, less sedentary lifestyle, etc).
European health systems are so bad I wouldn’t accept treatment there. I am talking the “free” (taxpayer) government clinics, not the private ones. The Queen of England may be a nice lady, but you have to be really stupid to think she waits in line at NHS like a commoner. I know plenty of wealthy Brits, and every single one of them has a concierge doctor. Every single one.
You “realist” are a clueless liar.
You are correct Tbird. There are dozens of countries with better and far less expensive health care systems. Yet American politicians and their supporters refuse to even acknowledge that such systems exist. Take a look at all the suggestions made by people regarding this topic. Only a few suggest looking at other countries for a solution (I assume that those making these suggestions are not American). Americans can’t see past their noses on this topic. Your politicians (both parties) are merely rearranging the deck chairs on the Titanic as it sinks. And all Americans suffer as a result, paying more than anyone else for a system that covers so few.
When I am travelling and talking to Americans, they inevitably ask about the health care system in my country. When I explain that we cover 100% of the populace for a much smaller percentage of GDP, they look like deer in the headlights. It’s like they can’t comprehend it. When I read the comments posted here, I get the same impression. Americans are so brainwashed on this topic that I doubt they will ever get a better system. Simply because they refuse to believe that such systems exist.
Here’s the thing – why don’t you ant colony socialists voluntarily form a universal health care plan JUST FOR YOURSELVES AND PAID FOR BY YOURSELVES and let the rest of us go our own ways.
I so sick of you idiots that can’t leave other people alone that I might start praying for an all-out nuclear war just get rid of your idiot mindset. Bring on Skynet, please.
The best health care system would be one without any government interference at all. But then you government lovers are loath to test your socialist beliefs against free market solutions.
That’s why there are NO free markets.
And that is why you will never have a good health care system. You look at the world through blinders. I look at the world realistically. Time for you to take off the blinders and take a look at what other countries do. You might be surprised. Or are you afraid to investigate?
Medex Man said:
Many of us have investigated lots of health systems outside the US… and in every case the practical reality on the ground does not match the political propaganda.
Those other countries officially offer universal care, but in practical terms there are endless obstacles that result in most people using private systems cash only. The government clinics are terrible except for catastrophic injuries — and then they are only useful if you can get to them in time (and most citizens don’t have a helicopter, so in practical terms they can’t get there in time).
And in all cases, those other countries have better lifestyles than the USA. Every single one. They have fresh fruits and veggies. They eat lots of fish. They get lots of exercise and fresh air. They don’t work behind a desk or live sedentary lives. In all cases, it is those lifestyle differences that account for their superior health outcomes.
officially, maybe they claim to offer universal care. But practically speaking they do not (they can not). Better lifestyles / better exercise is what gives them better health outcomes.
You lying about their health systems tells me it is you that hasn’t done any on the ground research. You just rely on political talking points. You are a liar, same as a politician
Why do you have to force your worldview on others?
I don’t give a hoot about what you believe. If you can’t prove Single Payer Thievery health care is cheaper and better than free-market provided health care, you can take your plan and stick it where the sun doesn’t shine. Given that yours is gov run, there is no way it can be cheaper or better.
So here it is again: voluntarily form a universal health care plan JUST FOR YOURSELVES AND PAID FOR BY YOURSELVES and let the rest of us go our own ways.
Is the 22mm the CBO notes predominantly the younger folks who would opt out of forced current coverage?
A true free market would be cheapest However, if the DEA will not permit patients to self medicate with Lipitor from Amazon without a prescription, and Indian medics to set up shop here without a license, Warren Buffett makes the point that national health care motivates at least some reining in of costs. Globally, national health care is half the price of the current system.
“With my limited knowledge, I think that probably [single payer] is the best system…But in almost every field of American business, it pays to bring down costs. There’s an awful lot of people involved in the medical – the whole just the way the ecosystem worked, there was no incentive to bring down costs.” Warren Buffett
Medex Man said:
Warren Buffett likes to downplay the fact that he is the son of a Congressman. He was born into privilege. He invested in other people’s companies, but never built a company himself.
And by his own admission, his tax rate is lower than his secretary’s. Buffett uses fancy accounting gimicks to avoid taxes — perfectly legal, yes. But he constantly preaches that OTHER people should pay higher taxes, while he exploits every loophole his lobbyists can secure.
Go ahead and try to get the sweetheart investment deals Buffett got. Try to get 10% cumulative preferred stock from Goldman, Bank America and GE. Try to get the SEC to allow you not to report your trades / holdings year after year — not even Goldman gets away with that but Buffett does.
Buffett thinks YOU should pay more taxes, not himself. Buffett thinks you should buy bonds yielding 2%; he is getting special sweetheart deals that yield 10%.
Buffett’s companies have been caught doing all sorts of illegal things, but they always get special treatment. From Solomon Bros to Gen Re, illegal activities that completely wiped out other companies were given soft gloves by regulators who don’t mess with Buffett and his special government connections.
And most recently, Buffett has become a slumlord. His RV company has been charged with pushing predatory loans on buyers. The company he just put money into in Canada company that is under multiple indictments — and don’t you think Buffett has already greased the wheels with Canadian regulators to get that all cleared up.
For all his talk of “ethics”, Buffett doesn’t play by the same rules as everyone else. He never has.
Socialism always has a small group of privileged elite that live REALLY well off everyone else’s suffering. Buffett has that position, so of course he likes it.
Your thoughts on Warren are interesting.
The current US system is so expensive that the bottom 60% can’t afford it. The top 40% don’t want to pay for the bottom 60%’s health care. Many US companies and cities are trying to figure out how to stop providing health care to their workers, and especially their retirees. Few are happy with health care inflation to the moon.
So what is the answer?
“I think that probably [single payer] is the best system”
Zero Payers is absolutely and beyond any reasonable doubt the best Obamacare system.
Dual Payer is better than Single Payer, with Warren Buffett and Bill Gate fortunes redistributed to pay for everybody. Warren Buffett needs to put his cash hoard where his crony capitalist mouth is.