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Peter1469
05-13-2017, 04:58 AM
The bipartisan ‘single payer’ solution: Medicare Advantage Premium support for all (http://healthaffairs.org/blog/2017/05/11/the-bipartisan-single-payer-solution-medicare-advantage-premium-support-for-all/)

This is somewhat like what I have been advocating for. Take this plan- ad in my Stan Broc plan and we will give people who want freebies cheap quality care.


FinancingThe most important objection for any single-payer proposal to overcome is that it is so expensive it will require unpalatable tax increases. This has been raised invariably on the right and even on the left, including by columnist Paul Krugman in his notorious about-face (https://www.nytimes.com/2016/01/18/opinion/health-reform-realities.html) on the issue. But, folks, our health care system is already unsustainably expensive (https://www.theatlantic.com/health/archive/2014/06/us-healthcare-most-expensive-and-worst-performing/372828/). There is more than enough money already being spent on health care to provide affordable, high-quality coverage to every American, if we allocate the resources more efficiently.
To prove this point, I’m going to present you with some very barroom-napkin math that, nonetheless, relies on well-established data regarding health care spending in the United States, drawing from the most recent National Health Expenditures (https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html) report from 2015, unless otherwise noted.
In that year, the United States spent more than $3.2 trillion on health care, almost $10,000 per resident. If we remove Medicare (which is after all going to be the nucleus of the new system), that leaves more than $2.5 trillion. The components of that spending come from federal, state, and local governments (primarily Medicaid, Affordable Care Act [ACA] subsidies, coverage for federal employees, veterans, military families, and so forth). It also comes from employers, the tax exemptions they are afforded for it, and households—you and me.
If you remove employer and household spending from the equation for the moment, which means both elements would contribute nothing (you’re welcome), that leaves about $1.5 trillion or $5,371 per person available to fund the new system.
Now, Medicare spent about $11,642 per person in 2015, but keep in mind that these beneficiaries are aged or disabled, much less healthy, and more expensive to care for than the average American, which includes children, young invincibles, and so forth. If we take health plans (https://www.washingtonpost.com/opinions/how-to-repeal-and-replace-obamacare--responsibly/2016/12/07/c392011a-bca3-11e6-91ee-1adddfe36cbe_story.html?utm_term=.e15e2f0fb6f4) and actuaries (https://www.actuary.org/files/publications/Acad_eval_indiv_mkt_011817.pdf) at their word, an “age rating band” (or ratio between what we charge the oldest and youngest members of the insurance pool) of 5:1 is appropriate. This is also, I’d note, the ratio advanced by Republicans in the AHCA.
This suggests that $6,985 is the average cost of coverage if we use Medicare spending as the benchmark (that is, calculating premiums at a 3:1 ratio if 5:1 is Medicare’s $11,642). That may be too high, because for this exercise we are actually excluding current Medicare beneficiaries, so the fifth quintile of the rest of the population would actually cost less, on average, to cover.
Another, perhaps better, benchmark, is the average cost (https://aspe.hhs.gov/system/files/pdf/212721/2017MarketplaceLandscapeBrief.pdf) of a gold-level plan in the individual market, which, in 2017, was $6,456 (before any applicable tax credit). I am using the gold tier as an illustration because, as I will explain later, it most closely resembles the Medicare benefit, primarily because such plans have an actuarial value of approximately 80 percent.
So, going back to our math equation, we’ve got $5,371 in all-government spending on health care to allocate to an average plan cost of $6,456. That leaves $1,085 as the average annual premium contribution with anticipated cost sharing of 20 percent, or $1,291. Per capita household spending would thus be $2,376, which is cheaper than the current average rate of $2,705.
If we wanted to increase household savings further, a maintenance of effort policy, or obligation to continue some portion of their existing health care spending, could be imposed on employers who will see their profits rise substantially when health care costs are dropped from their ledgers. I’m not recommending this, but just to further demonstrate the abundance of dollars currently in the system, if you required employers to maintain 100 percent of that spending on health care by paying in to this system, there would be more than enough funding to cover all anticipated household costs (premiums and cost sharing).
So, in summary, no new taxes, a $600-plus billion windfall for businesses, and about $350 in savings per person—and everyone is covered. This does not count the substantial efficiencies that the health care system would undoubtedly gain by economizing it in this fashion. (While the exact amount is disputed, even conservative analysis (http://mforall.net/files/CAHI_Medicare_Admin_Final_Publication.pdf) shows Medicare spends about 10 percent less on administrative costs than commercial coverage, yielding more than $200 billion in savings from that alone.)

Read the entire article or STFU.

FindersKeepers
05-13-2017, 06:02 AM
I think that's probably on the right track, as much as I dislike it.

Even Krauthammer and Krugman are in some agreement on certain aspects. I really never thought I'd see that.

Here's my thing. We ARE sliding toward single-payer, nearly everyone is in agreement on that, but, if handled correctly, it should not cost more -- it should cost less.

The author stipulates that his plan could be "privately delivered" and that's the nail in his plan's coffin. We simply cannot support the insurance industry any longer.

I followed the author's link to Krugman's piece and he (surprisingly) admits that the PPACA is in bed with the insurance industry.

I truly believe that the only way we can do this is to offer an OPTIONAL single-payer plan and NO MANDATE of any sort. People have to be free to choose a private plan if they like. That's the saving grace. That's what makes us America.

The truth is -- we really don't need all those warm bodies that are currently working for the insurance industry to process payments. No need to sell anything. Everything is technology-driven today. The healthcare provider keys in services and the system generates payment. Easy cheesy.

I hear objections that the loss of insurance jobs will have a negative impact on the economy. Probably. But, temporarily and we have no obligation to prop up that industry anyway. The people who maintain their private policies, which will dwindle given the cost, will still keep a few of them in business.

The need for industries changes with time. People have to change with the times. The smart insurance-industry employee will see the handwriting on the wall now and switch gears.

So, yeah, the author's plan looks like what will probably come down the pipe. I just hope we can keep the insurers out of the equation. We really have to in order to make this affordable for all.

Common
05-13-2017, 07:04 AM
The bipartisan ‘single payer’ solution: Medicare Advantage Premium support for all (http://healthaffairs.org/blog/2017/05/11/the-bipartisan-single-payer-solution-medicare-advantage-premium-support-for-all/)

This is somewhat like what I have been advocating for. Take this plan- ad in my Stan Broc plan and we will give people who want freebies cheap quality care.



Read the entire article or STFU.

I read the article :P so I dont have to stfu lol. I have a question, the article doesnt address the medical community itself, the providers. I dont know how Universal Health Care works in other countries so I have a question about that.

Do Drs work for the govt at a salary? does the govt then own all medical facilities, like clinics and testing facilities like Imaging offices etc, does the govt buy these facilities. If not how does the govt tell them what they can charge and who and how they care for.

DGUtley
05-13-2017, 07:32 AM
In a single payer system, where do the great advances come from? If the government pays a salary, where is the drive to be the best, rather than a functionary?

Peter1469
05-13-2017, 04:01 PM
I read the article :P so I dont have to stfu lol. I have a question, the article doesnt address the medical community itself, the providers. I dont know how Universal Health Care works in other countries so I have a question about that.

Do Drs work for the govt at a salary? does the govt then own all medical facilities, like clinics and testing facilities like Imaging offices etc, does the govt buy these facilities. If not how does the govt tell them what they can charge and who and how they care for.
Docs get paid by the government.

That is why quality Canadian docs come to the US. Not sure what they will do when we go full socialist.

Smart kids won't go to medical school.

Common
05-13-2017, 05:06 PM
In a single payer system, where do the great advances come from? If the government pays a salary, where is the drive to be the best, rather than a functionary?
Thats another point do all the medical personel become Govt employees

Common
05-13-2017, 05:07 PM
Docs get paid by the government.

That is why quality Canadian docs come to the US. Not sure what they will do when we go full socialist.

Smart kids won't go to medical school.
Drs are not going to give up possibly hundreds of thousands to in the millions for surgeons to be a govt employee for peanuts.

Peter1469
05-13-2017, 05:15 PM
Drs are not going to give up possibly hundreds of thousands to in the millions for surgeons to be a govt employee for peanuts.
That is why single payer won't fly in the US.


Slower students are all for free stuff.

Dr. Who
05-13-2017, 05:33 PM
Drs are not going to give up possibly hundreds of thousands to in the millions for surgeons to be a govt employee for peanuts.

The government whether state or federal, would negotiate rates of compensation with the AMA. The doctors would not be government employees, but still private contractors.

Peter1469
05-13-2017, 05:36 PM
People who are getting a free ride should not be treated as us who can pay.

Tahuyaman
05-13-2017, 05:44 PM
The bipartisan ‘single payer’ solution: Medicare Advantage Premium support for all (http://healthaffairs.org/blog/2017/05/11/the-bipartisan-single-payer-solution-medicare-advantage-premium-support-for-all/)

This is somewhat like what I have been advocating for. Take this plan- ad in my Stan Broc plan and we will give people who want freebies cheap quality care.



Read the entire article or STFU.

Would this also require legislation which forces all doctors to accept MEDICARE?

Tahuyaman
05-13-2017, 05:59 PM
In a single payer system, where do the great advances come from? If the government pays a salary, where is the drive to be the best, rather than a functionary?

Goid question...

Dr. Who
05-13-2017, 06:07 PM
Goid question...
From the universities and from private donations - where it comes from now. You don't think that doctors fund their own research do you?

DGUtley
05-13-2017, 06:08 PM
People who are getting a free ride should not be treated as us who can pay.
Peter1469 -- you are going to be sent off to the reeducation camp, talking like that.

DGUtley
05-13-2017, 06:11 PM
From the universities and from private donations - where it comes from now. You don't think that doctors fund their own research do you?

No, but research is funded because of a profit motive. Eliminate that and who has a motive to fund research

Common
05-13-2017, 06:13 PM
The government whether state or federal, would negotiate rates of compensation with the AMA. The doctors would not be government employees, but still private contractors.

Doc why would anyone that went to school for 12 yrs take a govt salary when they have always made as much money as they were good at what they did.

If the govt paid everyone what they are making now it would fail because it would be just as expensive.

Look im for everyone having healthcare, thats a position I have never changed but the illusion that in 2017 all medical personel and facilities are just going to take what they govt wants to pay is ludicrous. How about private entities that spent hundreds of millions of dollars to buy hospitals. How about the many millions to open a full imaging practice. How about all the investors invested in health care on wall street and how about all the 401ks and all the people in money markets that are invested in private health care. How about all the employees and the insurance companies and their investors and their employees

I dont see how universal health care could ever be accomplished in the USA

The only way to fix this is for the damned congress to get together and do SOMETHING NON PARTISAN for a change.

Dr. Who
05-13-2017, 06:28 PM
No, but research is funded because of a profit motive. Eliminate that and who has a motive to fund research
And yet it is still funded in other nations. Those who fund research tend to be wealthy people who like to have their names associated with good deeds or business entities who can make a profit on it, like big pharma and let's face it big pharma is still making a profit in so-called socialist countries. It just has carte blanche to price gouge in America. Interested parties fund all manner of research.

Dr. Who
05-13-2017, 06:42 PM
Doc why would anyone that went to school for 12 yrs take a govt salary when they have always made as much money as they were good at what they did.

If the govt paid everyone what they are making now it would fail because it would be just as expensive.

Look im for everyone having healthcare, thats a position I have never changed but the illusion that in 2017 all medical personel and facilities are just going to take what they govt wants to pay is ludicrous. How about private entities that spent hundreds of millions of dollars to buy hospitals. How about the many millions to open a full imaging practice. How about all the investors invested in health care on wall street and how about all the 401ks and all the people in money markets that are invested in private health care. How about all the employees and the insurance companies and their investors and their employees

I dont see how universal health care could ever be accomplished in the USA

The only way to fix this is for the damned congress to get together and do SOMETHING NON PARTISAN for a change.
As I said, rates of compensation would be negotiated not dictated. You underestimate the insurance industry. It will just enter the luxury medical market, offering everything that the primary market doesn't pay for. It's a much more profitable marketplace. There will be some contraction, but those people adjudicating medical claims for insurance companies will find work doing the same thing for government at least until all of those jobs become redundant because of technology. Given that government tends to lag behind the private sector in terms of technology, they will probably keep their jobs longer as a result. As to those who bought hospitals for a profit motive, I'm sure that they will be compensated. There are no guarantees in business.

DGUtley
05-13-2017, 08:25 PM
I
And yet it is still funded in other nations. Those who fund research tend to be wealthy people who like to have their names associated with good deeds or business entities who can make a profit on it, like big pharma and let's face it big pharma is still making a profit in so-called socialist countries. It just has carte blanche to price gouge in America. Interested parties fund all manner of research.

Is it funded in other countries like it is funded in the US? Do they have the phenomenal advances there as here? Do they have the testing there as here? The liability? I question the good nature person notion. Do you realize the massive cost? I haven't seen it.

Dr. Who
05-13-2017, 09:15 PM
I

Is it funded in other countries like it is funded in the US? Do they have the phenomenal advances there as here? Do they have the testing there as here? The liability? I question the good nature person notion. Do you realize the massive cost? I haven't seen it.
I think that it is. All medical research discoveries are not just coming from America. They are coming from places all over the world. However, the funding is really coming from entities like big pharma. It has nothing to do with the healthcare funding model but the number of universities involved in medical research. Being a large country America has many top-tier universities that attract students from around the planet. As a result entities like Novartis have chosen to locate their research headquarters in Cambridge, Mass. near Harvard and MIT. It's more about available talent.

MisterVeritis
05-13-2017, 09:25 PM
I refuse to accept a mix of fascism and socialism as the answer. Your screwed up ideas are one more stepping stone to system-wide failure.

Boris The Animal
05-13-2017, 09:32 PM
I think that it is. All medical research discoveries are not just coming from America. They are coming from places all over the world. However, the funding is really coming from entities like big pharma. It has nothing to do with the healthcare funding model but the number of universities involved in medical research. Being a large country America has many top-tier universities that attract students from around the planet. As a result entities like Novartis have chosen to locate their research headquarters in Cambridge, Mass. near Harvard and MIT. It's more about available talent.Uhh actually, they are. No other country has had the breakthroughs like the US has.

Dr. Who
05-13-2017, 10:20 PM
Uhh actually, they are. No other country has had the breakthroughs like the US has.

It has no relationship to healthcare funding. It's about the universities and the talent that they attract.

Archer0915
05-13-2017, 11:05 PM
In a single payer system, where do the great advances come from? If the government pays a salary, where is the drive to be the best, rather than a functionary?

Is the government going to stop giving our tax dollars away to develop treatments and drugs so we can pay more for services and drugs while our tax dollars also make things affordable in other countries... Forget it, just pisses me off.

Peter1469
05-14-2017, 01:28 AM
@Peter1469 (http://thepoliticalforums.com/member.php?u=10) -- you are going to be sent off to the reeducation camp, talking like that.

I will break the camp. :wink:

Peter1469
05-14-2017, 01:31 AM
I

Is it funded in other countries like it is funded in the US? Do they have the phenomenal advances there as here? Do they have the testing there as here? The liability? I question the good nature person notion. Do you realize the massive cost? I haven't seen it.

It is easier for a cat to get an MRI in the US than it is for a human to get one in Canada. If you can pay for it, that is.

I chuckle at that thought.

Tahuyaman
05-14-2017, 10:18 AM
From the universities and from private donations - where it comes from now. You don't think that doctors fund their own research do you?

Sure. If government takes more control things will either stay the same or get better.

Archer0915
05-14-2017, 12:08 PM
From the universities and from private donations - where it comes from now. You don't think that doctors fund their own research do you?

FROM TAX DOLLARS! Yes, there are donations but man, it comes from the government pushing the research!

Dr. Who
05-14-2017, 12:23 PM
FROM TAX DOLLARS! Yes, there are donations but man, it comes from the government pushing the research!

So back to the original question. How would that change if health care were no longer private?

Newpublius
05-14-2017, 12:32 PM
So back to the original question. How would that change if health care were no longer private?

Because government intends to reduce health care costs by imposing price controls. When that happens there will be that much less incentive to research better medical practices/medicines.

Archer0915
05-14-2017, 12:37 PM
So back to the original question. How would that change if health care were no longer private?
I was adding to your post not answering another one.

As to you question:

How would that change if health care were no longer private?

Healthcare needs to be separated into the industry and the services.

Services (this is what you are talking about) have little effect on the industry. We need some re-regulation, de-regulation and competition. Anything that our tax dollars fund or help fund needs to be covered under a new type of patent that allows for far shorter time limits on exclusivity. Yes some perks need to be added but we are sick of paying for big companies to rip us again.

We also need to start putting the people paying for this first! As long as a single American goes without because they can not afford it, out tax dollars should not be spent to help other countries purchase drugs and the like. Our companies should be barred from offering different rates in other countries as well.

Dr. Who
05-14-2017, 01:22 PM
I was adding to your post not answering another one.

As to you question:


Healthcare needs to be separated into the industry and the services.

Services (this is what you are talking about) have little effect on the industry. We need some re-regulation, de-regulation and competition. Anything that our tax dollars fund or help fund needs to be covered under a new type of patent that allows for far shorter time limits on exclusivity. Yes some perks need to be added but we are sick of paying for big companies to rip us again.

We also need to start putting the people paying for this first! As long as a single American goes without because they can not afford it, out tax dollars should not be spent to help other countries purchase drugs and the like. Our companies should be barred from offering different rates in other countries as well.
Unfortunately those companies are multi-nationals. They manufacture and do R&D all around the world.

Robert Kneller published a detailed analysis of the origin of new drugs approved by the FDA between 1998 and 2007 on a country-by-country basis. The most striking finding was that about 61 percent of the 118 new drugs coming out of U.S.-based companies originated in either academia or in smaller biotechnology companies. In contrast, less than 20 percent of the 23 new drugs coming out of Japan and about 25 percent of the 98 new drugs generated by all European companies (including the UK) met these criteria. (http://www.xconomy.com/seattle/2014/09/02/which-countries-excel-in-creating-new-drugs-its-complicated/?single_page=true)



It's not that their products are being subsidized elsewhere. The only reason that they price gouge Americans is because of the distributed nature of the private health care system as well as their ability to collude with elected officials to keep generics out of the market on the flimsiest of pretences. In short, the American government will not get involved in negotiating drug prices (http://www.businessinsider.com/why-the-us-pays-more-for-prescription-drugs-2016-8). Big Pharma has a huge lobby. Other countries negotiate drug prices and will refuse a drug if it's unaffordable. However, given the fact that drugs can now be purchased over the internet from other countries, Big Pharma's stranglehold on the American market is weakening.

Archer0915
05-14-2017, 02:13 PM
Unfortunately those companies are multi-nationals. They manufacture and do R&D all around the world.

Robert Kneller published a detailed analysis of the origin of new drugs approved by the FDA between 1998 and 2007 on a country-by-country basis. The most striking finding was that about 61 percent of the 118 new drugs coming out of U.S.-based companies originated in either academia or in smaller biotechnology companies. In contrast, less than 20 percent of the 23 new drugs coming out of Japan and about 25 percent of the 98 new drugs generated by all European companies (including the UK) met these criteria. (http://www.xconomy.com/seattle/2014/09/02/which-countries-excel-in-creating-new-drugs-its-complicated/?single_page=true)



It's not that their products are being subsidized elsewhere. The only reason that they price gouge Americans is because of the distributed nature of the private health care system as well as their ability to collude with elected officials to keep generics out of the market on the flimsiest of pretences. In short, the American government will not get involved in negotiating drug prices (http://www.businessinsider.com/why-the-us-pays-more-for-prescription-drugs-2016-8). Big Pharma has a huge lobby. Other countries negotiate drug prices and will refuse a drug if it's unaffordable. However, given the fact that drugs can now be purchased over the internet from other countries, Big Pharma's stranglehold on the American market is weakening.
And I argue with none of this. This is part of what we need to fix!

Boris The Animal
05-14-2017, 03:05 PM
So back to the original question. How would that change if health care were no longer private?
Because you lose the profit motive. Not to mention specialists would not be allowed under government run medicine, and that's the ultimate goal of "progressives"

Dr. Who
05-14-2017, 03:33 PM
Because you lose the profit motive. Not to mention specialists would not be allowed under government run medicine, and that's the ultimate goal of "progressives"

How is that? Big Pharma is still making a profit in single payer nations. Also, all of those nations have medical specialists - they are necessary, since no individual could hope to develop the necessary skill in every speciality. Of course, that could change with technology.