Repealing the ACA begins...

[agent00f]

There is no evidence that universal healthcare in America would be cheaper. In fact given the data we have the opposite looks true- the fact that we spend so much on Medicare and it only covers a small part of the population.

The real problem is the American demand for instant gratification and consumption of any product including healthcare

Until we can learn to accept "no grandma can't have that procedure that will only give her an extra week of life at a cost of a half million dollars" or "no you can't see YOUR doctor until the people in line before you see one so here is a nurse instead" we are screwed when it comes to the cost of health care.

The greatest difference between our cost of care and other civilized nations is they control those costs from above. The swiss for example use private insurers (w/ attendant overhead) but cantons set the prices, and they still pay substantially less in aggregate despite one of the most expensive places to live.

 

[agent00f]

How do you "negotiate" a price when only one party owns a gun? Drug companies negotiate with Europe because the cost of getting a drug on the market is mostly government approval, so something is better than nothing. Manufacturing is pennies. Drug design, on the other hand, has been on a long downhill slope in Europe. Maybe if people couldn't file billion dollar law suits when 0.01% of the population suffers an adverse reaction to an otherwise perfectly usable drug, we drug companies wouldn't need to charge obscene prices.

People make excuses not for things they can't do (that's just embarrassing), but things they won't do.

 

[HamburgerBoy]

People make excuses not for things they can't do (that's just embarrassing), but things they won't do.

Translate for me, Confucius. Are you saying that pharma companies are happy paying a billion dollars just to get a drug approved for sale on the market?

 

[agent00f]

Translate for me, Confucius. Are you saying that pharma companies are happy paying a billion dollars just to get a drug approved for sale on the market?

Notice they're not complaining about the benefits of billions in government funded research, and whose PR you choose to voice.

 

[HamburgerBoy]

To add, fwiw there's no doubt that the biggest pharmaceutical companies are dirty as hell when you consider how they try so hard to block something as simple as an EpiPen competitor, all with the FDA's help. The system is corrupt, but just saying "Hey, let's negotiate, I want a 50% reduction on drug costs right now kthxbai" makes as much sense as trying to reduce organized crime by having the crooked cops say "Hey, I want you to double my pay-off" to the mafia.

Notice they're not complaining about the benefits of billions in government funded research, and whose PR you choose to voice.

That's a sexy non sequitur you've got there. The researchers that perform government funded research do so on their own accord. They don't have to worry about FDA rejection or billion dollar law suits.

 

[poofyhairguy]

The greatest difference between our cost of care and other civilized nations is they control those costs from above.

They don't just control the costs, they also control the demand via social conditioning and rationing (however they want to label the latter). We don't have those two advantages.

In the US consumers are conditioned to think of healthcare as a product that they consume. There is some evidence that 25% of medical visits in this country have no cause. What that means is hypochondriacs are filling up seats in doctors' offices now and causing billions in waste, but the because heathcare is for profit no doctor (who gets paid regardless) says no unless their insurance won't cover it.

Overall 16% of our medical costs is wasted on these people:

http://www.alternet.org/personal-health/hypochondriacs-cost-our-healthcare-industry-billions

So any politician that talks about a national healthcare system is taking about telling those people no, and grandma who wants a new hip no, and grandad who has a cataract so why not get a multi focal implant as part of the treatment no or they are creating a system that we can't afford.

Eventually the total all the Americans who have to be told no make it a risky political proposition for any politician, which is why even "I support single payer" Obama built a healthcare system on the backs of insurance companies. Those companies serve a real purpose in our system that politicians can't replace- they tell people no.

Sarah Palin is a dumbass but her "death panels" label showed a retard wisdom about why Americans would never accept a system almost any other nation has. We are too spoiled, entitled and politically volatile (as shown last week).

 

[agent00f]

They don't just control the costs, they also control the demand via social conditioning and rationing (however they want to label the latter). We don't have those two advantages.

In the US consumers are conditioned to think of healthcare as a product that they consume. There is some evidence that 25% of medical visits in this country have no cause. What that means is hypochondriacs are filling up seats in doctors' offices now and causing billions in waste, but the because heathcare is for profit no doctor (who gets paid regardless) says no unless their insurance won't cover it.

Overall 16% of our medical costs is wasted on these people:

http://www.alternet.org/personal-health/hypochondriacs-cost-our-healthcare-industry-billions

So any politician that talks about a national healthcare system is taking about telling those people no, and grandma who wants a new hip no, and grandad who has a cataract so why not get a multi focal implant as part of the treatment no or they are creating a system that we can't afford.

Eventually the total all the Americans who have to be told no make it a risky political proposition for any politician, which is why even "I support single payer" Obama built a healthcare system on the backs of insurance companies. Those companies serve a real purpose in our system that politicians can't replace- they tell people no.

Sarah Palin is a dumbass but her "death panels" label showed a retard wisdom about why Americans would never accept a system almost any other nation has. We are too spoiled, entitled and politically volatile (as shown last week).

It's certainly true there are a lot of narcissists living within our borders. But there are also many who aren't; they're more than happy to be in a pool with the like minded.

To add, fwiw there's no doubt that the biggest pharmaceutical companies are dirty as hell when you consider how they try so hard to block something as simple as an EpiPen competitor, all with the FDA's help. The system is corrupt, but just saying "Hey, let's negotiate, I want a 50% reduction on drug costs right now kthxbai" makes as much sense as trying to reduce organized crime by having the crooked cops say "Hey, I want you to double my pay-off" to the mafia.

Consider why they might not desire negotiating with a party with more leverage. The kind of party that allows them to sell drugs (or not) legally in the first place, and one accountable to people other than shareholders.

That's a sexy non sequitur you've got there. The researchers that perform government funded research do so on their own accord. They don't have to worry about FDA rejection or billion dollar law suits.

The point is the manufacturers complain about a chore but not a benefit; it's not hard to see why.

 

[HamburgerBoy]

No shit drug companies don't want more leverage over them. That doesn't mean exercising leverage actually addresses the real costs of selling a drug.

Your point is irrelevant. "Why do bands want to copyright and sell their music? I don't see them fighting for royalties to the music professors or instrument trainers that taught them, nor the earlier bands that influenced them. What hypocrites!"

 

[agent00f]

No shit drug companies don't want more leverage over them. That doesn't mean exercising leverage actually addresses the real costs of selling a drug.

Your point is irrelevant. "Why do bands want to copyright and sell their music? I don't see them fighting for royalties to the music professors or instrument trainers that taught them, nor the earlier bands that influenced them. What hypocrites!"

The cost isn't paid to gubmint regulators to twiddle their thumbs. Read what I said careful and with some thought.

 

[poofyhairguy]

It's certainly true there are a lot of narcissists living within our borders. But there are also many who aren't; they're more than happy to be in a pool with the like minded.

That EXACT flawed logic is the reason why Obamacare exchange enrollment is far behind the original goal in many parts of the country. You are wrong. In 2016 most Americans are selfish and are unwilling to sacrifice for others.

People are more than happy to give whoever whatever when it's abstracted past them in a government agency or via their employer. But when it's time for THEM to make a personal sacrifice most Americans are against it currently.

In fact in Obamacare we already have a lessor version of the shared sacrifice single payer healthcare would require in our healthcare mandate. The whole point of the mandate is we are all forced to pay and get insurance (even and especially the young and healthy who might prefer to self-insure) so that way the pool is big enough that we can all get by on it including the very sick and poor. The exchanges and the mandate together therefore creates a prenatal version of the pool you are talking about.

And guess what? That part of Obamacare is the least popular part, liked by less than half the population:

Turns out your vision of an America who will sacrifice for each other is still years away. I would have thought Trump winning would have made that clear already though.

 

[Sunburn74]

There is no evidence that universal healthcare in America would be cheaper. In fact given the data we have the opposite looks true- the fact that we spend so much on Medicare and it only covers a small part of the population.

The real problem is the American demand for instant gratification and consumption of any product including healthcare

Until we can learn to accept "no grandma can't have that procedure that will only give her an extra week of life at a cost of a half million dollars" or "no you can't see YOUR doctor until the people in line before you see one so here is a nurse instead" we are screwed when it comes to the cost of health care.

Actually you are dead wrong about 2 or 3 things in your post which I'd like to clarify.

First, universal healthcare would almost certainly (near 100% confidence) result in cheaper healthcare. There are many ways to establish this and I'll try and pick the easiest (btw I worked with a Harvard physician and public health specialist who will remain unnamed who directly advised President Obama in regards to the development and design of the ACA alongside a few other people, granted the heritage foundation laid the framework for much of it).

You have to ask yourself what is driving American healthcare costs. Is it utilization (we use too much stuff? too many pills, too many procedures, too many tests? etc) or is it costs (the pills cost too much, the procedures cost to much, the tests cost to much?). Its overwhelmingly costs; there is pretty much no question about it. If you compare resource utilization between the US and say England or France, we use about 10% more "stuff" per person. The cost of the procedures between the two countries is dramatic. How is it then that collectively as a nation we pay more than anyone else with universal health care and we pay more per person (up to 3-5x per person compared to some westernized countries that offer universal healthcare the last time I looked at the data) but are unable to insure everyone when all other countries that insure everyone pay less collectively AND per capita pay less per person? Once you see this, it becomes clear the issue isn't a lack of a financial ability to give everyone insurance, but rather an inability to efficiently ensure everyone. In other words, there are forces in the healthcare market that are favoring rising costs and utilization rather than favoring rising coverage and efficiency. The forces that favor rising costs are best mitigated by a central adversarial negotiation process. Currently there is no such force on any level in the american healthcare system.

 

[agent00f]

That EXACT flawed logic is the reason why Obamacare exchange enrollment is far behind the original goal in many parts of the country. You are wrong. In 2016 most Americans are selfish and are unwilling to sacrifice for others.

People are more than happy to give whoever whatever when it's abstracted past them in a government agency or via their employer. But when it's time for THEM to make a personal sacrifice most Americans are against it currently.

In fact in Obamacare we already have a lessor version of the shared sacrifice single payer healthcare would require in our healthcare mandate. The whole point of the mandate is we are all forced to pay and get insurance (even and especially the young and healthy who might prefer to self-insure) so that way the pool is big enough that we can all get by on it including the very sick and poor. The exchanges and the mandate together therefore creates a prenatal version of the pool you are talking about.

And guess what? That part of Obamacare is the least popular part, liked by less than half the population:

Turns out your vision of an America who will sacrifice for each other is still years away. I would have thought Trump winning would have made that clear already though.

The whole point of the republican healthcare plan obamacare is to avoid pool powerful enough to exert its own leverage, in addition to of course avoiding things that actually reduce costs in aggregate.

If people could buy into "medicare+ for non-retirees" the results would be rather different.

 

[MajinCry]

US Healthcare is a capitalist venture with a bit of socialism hot-glued on the end. It's no wonder the costs are prohibitive.

 

[Arachnotronic]

Orrrrr...... We could just allow the importation of drugs. Why shouldn't a person be allowed to purchase the same exact safe prescription drug from Canada made by the same manufacturer that costs 1/10th of the price? Since we are talking about the same manufacturers they are obviously able to make money selling the drugs at far lower prices in Canada, if they can't sell them for the absurd markups in the US anymore because anyone, including pharmacies and people themselves, can purchase them at 1/10th the price they will have to lower their prices.

I approve of this.

That is true free market at work, something we currently don't have with healthcare in the US. You might be wondering why we can't do this already and the answer would be Congress and even the president being bought off by lobbyists.

Yup.

 

[sactoking]

Medicare/Medicaid may only cover about 1/3 of the population but it is by far the most expensive third. The elderly (99.9% of Medicare) use extraordinarily large disproportion of medical services. Renal failure patients are also allowed to be dumped into Medicare regardless of age; dialysis isn't cheap. Medicaid covers the young and poor, two groups that traditionally have disproportionately high medical costs. In other words we're already covering the most expensive users overall and adding the healthiest part of the population to the program will be relatively inexpensive.

 

[pauldun170]

http://www.npr.org/sections/health-...-may-wind-up-using-penalties-like-the-mandate

Health policy wonks point out that the individual mandate was originally a Republican idea, advocated by academics and conservative thinkers as a way to avoid a government-run single-payer system. "The purpose of it was to round up the stragglers who wouldn't be brought in by subsidies," said Mark Pauly, a University of Pennsylvania economist, in a 2011 interview. He co-authored a Health Affairs study in 1991 that aimed to persuade then-President George H.W. Bush to adopt a universal health care requirement.


The drafters of Obamacare incorporated the individual mandate concept because they hoped to get Republicans on board, said Sara Rosenbaum, a professor of health law and policy at George Washington University in Washington, D.C.

 

[Darwin333]

Translate for me, Confucius. Are you saying that pharma companies are happy paying a billion dollars just to get a drug approved for sale on the market?

Are you saying that the same companies are selling the same drugs at far cheaper prices in other countries at a loss? Frankly we don't even have to negotiate with them, we could simply import there drugs from Canada or a number of other nations. Amazing how they make money just about everywhere else while charging a fraction of the price, isn't it?

The only possible argument is that we are subsidizing everyone else's vastly lower prices with our vastly higher prices, so if everyone else has to pay a little more so that we can pay a hell of a lot less then I'm ok with that. How about you?

 

[Darwin333]

Medicare/Medicaid may only cover about 1/3 of the population but it is by far the most expensive third. The elderly (99.9% of Medicare) use extraordinarily large disproportion of medical services. Renal failure patients are also allowed to be dumped into Medicare regardless of age; dialysis isn't cheap. Medicaid covers the young and poor, two groups that traditionally have disproportionately high medical costs. In other words we're already covering the most expensive users overall and adding the healthiest part of the population to the program will be relatively inexpensive.

Define relatively? I agree that it won't triple the costs by adding the other 2/3 of the population but even doubling is going to be a huge cost and that still doesn't account for the already 9.3% a year increase we are already seeing and can't afford going forward.

 

[ivwshane]

Define relatively? I agree that it won't triple the costs by adding the other 2/3 of the population but even doubling is going to be a huge cost and that still doesn't account for the already 9.3% a year increase we are already seeing and can't afford going forward.

How? If it already covers the most expensive people how will it double the costs? Show your work.

 

[Darwin333]

How? If it already covers the most expensive people how will it double the costs? Show your work.

So what, you are thinking a 10% increase to cover 3 times the people? 20% maybe?

If it was so cheap to cover those 2/3rds not currently covered by Medicare/Medicaid then we wouldn't have an issue because everyone's insurance and healthcare costs would be rather cheap.

The latest decent numbers I could find were from 2014 and that put total US healthcare costs at $3 trillion. Assuming a modest 5% a year increase that puts this years spending at $3.33T, so lets assume that first year medicare for all can reduce costs by $300B, that is still at total bill of $3 trillion. For reference our total budget is currently $3.8T. Not to mention, as I have constantly brought up at the current rate of increase in cost of Medicare and Medicaid we will be spending $2T in 4 years on just covering the same 1/3rd of the population. How do we afford that before we even start talking about adding the rest of the nation to the programs?

I would love to see your work on what the assumed cost would be.

 

[ivwshane]

So what, you are thinking a 10% increase to cover 3 times the people? 20% maybe?

If it was so cheap to cover those 2/3rds not currently covered by Medicare/Medicaid then we wouldn't have an issue because everyone's insurance and healthcare costs would be rather cheap.

The latest decent numbers I could find were from 2014 and that put total US healthcare costs at $3 trillion. Assuming a modest 5% a year increase that puts this years spending at $3.33T, so lets assume that first year medicare for all can reduce costs by $300B, that is still at total bill of $3 trillion. For reference our total budget is currently $3.8T. Not to mention, as I have constantly brought up at the current rate of increase in cost of Medicare and Medicaid we will be spending $2T in 4 years on just covering the same 1/3rd of the population. How do we afford that before we even start talking about adding the rest of the nation to the programs?

I would love to see your work on what the assumed cost would be.

The reason single payer universal health care works in every major country is exactly why it hasn't been done here...price controls. Our repub friends put corporate profits and capitalism before the people they are elected to represent and that is precisely why they've blocked every attempt at reforming our broken system. Can you show me where in the constitution, capitalism is mentioned, let alone put above the general welfare of the people? Can you show me where in the constitution, corporations are entitled to make a profit, let alone take precedence over the general welfare of the people? For a party that claims to love, respect, and uphold the constitution, they sure don't seem to be taking it seriously.

So what would our health care numbers look like if we implemented a similar system the rest of the world uses?

Lets take a look:
https://en.m.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

https://www.oecd.org/els/health-systems/Health-at-a-Glance-Europe-2014-CHARTSET.pdf

Now that is based on percent of GDP which in my opinion paints a distorted picture since we have the largest GDP of all countries so even if our health care costs were inline with the average health care costs per GDP as other countries, we would still be paying more for health care. Regardless, our costs would still be lower than they are now.*

https://en.m.wikipedia.org/wiki/List_of_countries_by_GDP_(nominal)





*eskimspy, if my assumption is wrong please feel free to correct me.

 

[Darwin333]

The reason single payer universal health care works in every major country is exactly why it hasn't been done here...price controls. Our repub friends put corporate profits and capitalism before the people they are elected to represent and that is precisely why they've blocked every attempt at reforming our broken system. Can you show me where in the constitution, capitalism is mentioned, let alone put above the general welfare of the people? Can you show me where in the constitution, corporations are entitled to make a profit, let alone take precedence over the general welfare of the people? For a party that claims to love, respect, and uphold the constitution, they sure don't seem to be taking it seriously.

So what would our health care numbers look like if we implemented a similar system the rest of the world uses?

Lets take a look:
https://en.m.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

https://www.oecd.org/els/health-systems/Health-at-a-Glance-Europe-2014-CHARTSET.pdf

Now that is based on percent of GDP which in my opinion paints a distorted picture since we have the largest GDP of all countries so even if our health care costs were inline with the average health care costs per GDP as other countries, we would still be paying more for health care. Regardless, our costs would still be lower than they are now.*

https://en.m.wikipedia.org/wiki/List_of_countries_by_GDP_(nominal)





*eskimspy, if my assumption is wrong please feel free to correct me.

Obama and a Democrat house and senate passed the most "sweeping" healthcare reform in a billion years or something against complete republican opposition. They couldn't get some of those things added into the bill, things like being able to negotiate drug costs? Don't get me wrong, I'm not a fan of the Republicans but don't pretend that both sides aren't in the healthcare industries pockets.

And I know the numbers but I still haven't heard a single solitary well thought out argument on how they can reasonably cut more than 10% or so. I am open really eager to hear something different and I personally think that single payer is the way to go but I am also a realist.

 

[ivwshane]

Obama and a Democrat house and senate passed the most "sweeping" healthcare reform in a billion years or something against complete republican opposition. They couldn't get some of those things added into the bill, things like being able to negotiate drug costs? Don't get me wrong, I'm not a fan of the Republicans but don't pretend that both sides aren't in the healthcare industries pockets.

And I know the numbers but I still haven't heard a single solitary well thought out argument on how they can reasonably cut more than 10% or so. I am open really eager to hear something different and I personally think that single payer is the way to go but I am also a realist.

Sometimes you have to swallow a bitter pill to keep from dying (pun intended).

Here is a good read on the reality of big pharma and the ACA.
http://www.politico.com/story/2016/07/obamacare-prescription-drugs-pharma-225444

 

[agent00f]

Obama and a Democrat house and senate passed the most "sweeping" healthcare reform in a billion years or something against complete republican opposition. They couldn't get some of those things added into the bill, things like being able to negotiate drug costs? Don't get me wrong, I'm not a fan of the Republicans but don't pretend that both sides aren't in the healthcare industries pockets.

And I know the numbers but I still haven't heard a single solitary well thought out argument on how they can reasonably cut more than 10% or so. I am open really eager to hear something different and I personally think that single payer is the way to go but I am also a realist.

This isn't so much D vs R as liberal-democrat vs capitalist ideals. The democrats as led by the clintons are a centrist party, which is why they consider implementing the republican healthcare plan a great success. Everyone in politics in this country agrees trying to make a buck is the way to go, and there's a lot of money in healthcare.

The only thing necessary for the triumph of evil is for good men to do nothing, and a lot of so called liberals are content to be democrats.

 

[sportage]

I find this thread amusing.
So many have no idea what they are bitching about, and no idea how ACA works.
The only Cluster-F##k going on around here are the people repeating republican/Fox News/Rush Limbaugh idiotic talking points.
Which amount to a lot of hot air minus any fact.

ACA was a well designed package where one part relies on another part.
There is no "keep this and hack that" option for republicans seeking repeal.
You can't say that cars are too expensive, so just remove the body and keep the wheels. And there is your transportation, four bare wheels.
That will not get you to work nor to the market.

When republicans begin their tampering with ACA, they will discover how entwined the design of the program actually is. And they would not have known this before hand since they offered no input during the creation of ACA.

Republicans will soon discover that keeping children on the parents policy and the preexisting condition clause will be impossible to maintain or affordable if the other parts of ACA are stripped away.

Let me tell you exactly what will happen....
All of it, "ALL" will be trashed, and what will be left is nothing at all.
We will be right back to ever rising employer based insurance costing employers outrageous cost and employees no longer able to afford the premiums.
And for everyone else, back to the ER for your families healthcare.
And the ER is just a one-time shot.
If you or someone needs monthly lifesaving meds to treatments for cancer, the ER is not going to furnish that.
And when you walk into a doctors office seeking care, the very first thing the receptionist ask is "what insurance do you have?"
And when you say I have none, out the door you go.
Bye Bye Go Home And Die.

Actually what people should tell the receptionist is, "Donald Trump and Mike Pence took away my healthcare. So send the bill to Trump. Donald's a rich mother F0ker.
He can afford it better than me.

I suspect everyone bitching about Obamacare has never actually had it and doesn't have it now.
But they still think they know it all....
Someone must be using ACA or millions would not have signed up for it.
So the people that know nothing about ACA cheer for it's demise.
And those that have and rely on ACA, they can just drop dead.
Is that the attitude around here?
And some wonder why they are protesting in the streets....