ACA Repeal/Replace: Progressives Face Moral Dilemma

[David Horn]

(08-14-2017, 08:36 PM)Bob Butler 54 Wrote:

(08-14-2017, 06:01 PM)Kinser79 Wrote: There may be 25-30 decent models to base a system off of.  However as the PBS article I linked to demonstrates that there are only four main types.  The problem with the US is that even with Obamacare we are still using all four.  

With the VA it is a Beveridge type system like Britian or Cuba.

With Medicare it is a National Insurance like Canada or France.

With employer based care it is like Germany.  (They still essentially use the Bismarck model.)

For everyone else on out of pocket, well its like Cambodia or Rural India.

The goal should be for the US to pick one type (like other countries have done) and to stick with it.

Seconded.  The article is a worth while short read.  True, any of the four basic structures can be altered significantly to get to David's higher number of choices, but I would choose one of the four and tweak from there.

I'll join the Amen chorus on this one ... and I already have a Medicare.

[David Horn]

(08-15-2017, 02:19 AM)Warren Dew Wrote:

(08-14-2017, 03:49 PM)David Horn Wrote:

(08-01-2017, 04:19 PM)Warren Dew Wrote: I myself am in the "not-quite-elderly" category, so I have a strong incentive to give us the best system.  However, the best system is not one that makes us sick and then gives us expensive, counterproductive medical care by bankrupting the next generation.

The best system is one that keeps us healthy.  That involves better diet and lifestyle, not more medical care.  The more money you throw at the medical system, the worse it gets.

OK, but don't have cancer, a stroke, any of a hundred ailments involving internal organs, or a major accident requiring surgeries and rehab.

No worries.  Better diet and lifestyle prevent cancer, stroke, etc.

My wife worked in an oncology practice for roughly 10 years. Lifestyle helps, but it is far from a preventative. Mostly, it made it easier to recover. Yes, lung cancer, and a few others, are mostly lifestyle triggered, but many are due to predisposition, environmental issues (often unknown ones) or to factors not all that well understood at all. I know a guy who had colon cancer on the outside of the colon that metastasized to his liver. He survived because he was otherwise healthy, but he had several operations and chemotherapy for 3 years to get there.

Warren Dew Wrote:

David Horn Wrote:The purpose for insurance is to cover unexpected or preexisting conditions with a structure that permits the affected to get affordable care.  Everybody for himself is not an answer, so pick an option that is.  There are easily 25 of 30 decent models in use somewhere.

Pick whatever option you want, as long as you pay for it yourself instead of trying to get others to pay for you.

Should we follow that model with police and fire protection? Don't laugh, it's been tried. Suffice it to say that those are not viable options. There is no value in having a partially contracted police force, that only enforces the law for those willing to pay. Healthcare is similar, and the cost has to be shared or it won't work. Once you get there, then the only question that remains: how to do it effectively at the lowest possible cost? Everyone else seems to know that.

[David Horn]

(08-15-2017, 05:39 AM)Bob Butler 54 Wrote: There are people, Christian Scientists for example, who just don’t believe in modern health care.  I’m half tempted to let such people opt out and go pay as you go.  

My ex-wife was one of them.  It's one of the reasons we got divorced.  She also died of a massive coronary at 57.  She never went to a doctor, so it may have been easily preventable.

[tg63]

(08-15-2017, 02:19 AM)Warren Dew Wrote: No worries.  Better diet and lifestyle prevent cancer, stroke, etc.

Quote:...

I had a long chat with my doctor recently about cholesterol.  Diet, exercise, lifestyle choices, will impact 20% of my cholesterol levels.  The other 80% is pre-destined - my doctor asked me "can you get different parents?  'cause that's the only way to change that 80%".

There are limits to what we can control.

[Warren Dew]

(08-15-2017, 10:32 AM)David Horn Wrote:

(08-15-2017, 02:19 AM)Warren Dew Wrote:

(08-14-2017, 03:49 PM)David Horn Wrote:

(08-01-2017, 04:19 PM)Warren Dew Wrote: I myself am in the "not-quite-elderly" category, so I have a strong incentive to give us the best system.  However, the best system is not one that makes us sick and then gives us expensive, counterproductive medical care by bankrupting the next generation.

The best system is one that keeps us healthy.  That involves better diet and lifestyle, not more medical care.  The more money you throw at the medical system, the worse it gets.

OK, but don't have cancer, a stroke, any of a hundred ailments involving internal organs, or a major accident requiring surgeries and rehab.

No worries.  Better diet and lifestyle prevent cancer, stroke, etc.

My wife worked in an oncology practice for roughly 10 years.  Lifestyle helps, but it is far from a preventative.  Mostly, it made it easier to recover.  Yes, lung cancer, and a few others, are mostly lifestyle triggered, but many are due to predisposition, environmental issues (often unknown ones) or to factors not all that well understood at all.

The environmental issues are unknown and the other factors not well understood because it is against the interests of the medical and health insurance establishments to permit the knowledge to be widespread.  After all, they make many orders of magnitude more money on cancer surgery and chemotherapy than on vitamin D supplements and sunshine.  Dig enough and you can find the data, though.

[Warren Dew]

(08-15-2017, 11:25 AM)tg63 Wrote:

(08-15-2017, 02:19 AM)Warren Dew Wrote: No worries.  Better diet and lifestyle prevent cancer, stroke, etc.

Quote:...

I had a long chat with my doctor recently about cholesterol.  Diet, exercise, lifestyle choices, will impact 20% of my cholesterol levels.  The other 80% is pre-destined - my doctor asked me "can you get different parents?  'cause that's the only way to change that 80%".

Your doctor appears to be looking only at total cholesterol.  Far more important are the types of cholesterol, and even more, triglycerides and the ratio of triglycerides to high density lipoprotein (HDL), also known as "good cholesterol".

You can vary your HDL levels by close to a factor of two through exercise.  You can vary triglycerides by a whopping order of magnitude through diet, mostly by cutting out sugar and other carbohydrates.  And that's even before you get to inflammation, another big factor in heart attacks.

[Eric the Green]

(08-15-2017, 02:19 AM)Warren Dew Wrote:

(08-14-2017, 03:49 PM)David Horn Wrote:

(08-01-2017, 04:19 PM)Warren Dew Wrote: I myself am in the "not-quite-elderly" category, so I have a strong incentive to give us the best system.  However, the best system is not one that makes us sick and then gives us expensive, counterproductive medical care by bankrupting the next generation.

The best system is one that keeps us healthy.  That involves better diet and lifestyle, not more medical care.  The more money you throw at the medical system, the worse it gets.

OK, but don't have cancer, a stroke, any of a hundred ailments involving internal organs, or a major accident requiring surgeries and rehab.

No worries.  Better diet and lifestyle prevent cancer, stroke, etc.

Quote:The purpose for insurance is to cover unexpected or preexisting conditions with a structure that permits the affected to get affordable care.  Everybody for himself is not an answer, so pick an option that is.  There are easily 25 of 30 decent models in use somewhere.

Pick whatever option you want, as long as you pay for it yourself instead of trying to get others to pay for you.

What David said. You aren't getting others to pay you, if you use medicare, medicaid, single payer, or health insurance. You are using social or capitalist insurance. You pay for it, and others pay for it; we pay together, and that protects us, when we're healthy, and when we're not.

I and others I know had a diet and lifestyle better than most Americans, and I am still getting those things. Age is still a factor, and unforeseen events. And our faulty diet and lifestyle is marketed and promoted by the capitalists whom you favor, and required by the job market. We have a choice, but frequently it's not easy. And what is the best diet and lifestyle for you? No-one really knows. Science changes its mind all the time about these things. As with all things in the free market, what is offered to us is what the oligarchy decides to offer to us, for their convenience and benefit, at inflated prices that leave most people out. The market does not correct itself. The free market is not enough; it does not work. It creates a few rich people that have all the power.

[Eric the Green]

(08-15-2017, 04:04 PM)Warren Dew Wrote:

(08-15-2017, 10:32 AM)David Horn Wrote:

(08-15-2017, 02:19 AM)Warren Dew Wrote:

(08-14-2017, 03:49 PM)David Horn Wrote:

(08-01-2017, 04:19 PM)Warren Dew Wrote: I myself am in the "not-quite-elderly" category, so I have a strong incentive to give us the best system.  However, the best system is not one that makes us sick and then gives us expensive, counterproductive medical care by bankrupting the next generation.

The best system is one that keeps us healthy.  That involves better diet and lifestyle, not more medical care.  The more money you throw at the medical system, the worse it gets.

OK, but don't have cancer, a stroke, any of a hundred ailments involving internal organs, or a major accident requiring surgeries and rehab.

No worries.  Better diet and lifestyle prevent cancer, stroke, etc.

My wife worked in an oncology practice for roughly 10 years.  Lifestyle helps, but it is far from a preventative.  Mostly, it made it easier to recover.  Yes, lung cancer, and a few others, are mostly lifestyle triggered, but many are due to predisposition, environmental issues (often unknown ones) or to factors not all that well understood at all.

The environmental issues are unknown and the other factors not well understood because it is against the interests of the medical and health insurance establishments to permit the knowledge to be widespread.  After all, they make many orders of magnitude more money on cancer surgery and chemotherapy than on vitamin D supplements and sunshine.  Dig enough and you can find the data, though.

Now there, as John McLaughlin would say, you have lurched uncontrollably into the truth.

(at least in part; we still need the medical system)

[Bob Butler 54]

(08-14-2017, 06:01 PM)Kinser79 Wrote: There may be 25-30 decent models to base a system off of.  However as the PBS article I linked to demonstrates that there are only four main types.  The problem with the US is that even with Obamacare we are still using all four.  

With the VA it is a Beveridge type system like Britian or Cuba.

With Medicare it is a National Insurance like Canada or France.

With employer based care it is like Germany.  (They still essentially use the Bismarck model.)

For everyone else on out of pocket, well its like Cambodia or Rural India.

The goal should be for the US to pick one type (like other countries have done) and to stick with it.

As picking and sticking is definitely a good idea, I'll throw out a few notions.

There are many retired, unemployed, small employer employed, children, etc... that arguably can't pay out of their own or their employers pocket.  It would follow that out of pocket or employer based schemes are highly questionable.  That leaves Beveridge and or National Insurance types on the table, with the government as the obvious single payer.

Those who like to gamble, those wealthy enough to recover from a failed gamble, those young and healthy enough for favorable gambles, those who have convinced themselves that their ad-lib health system is better than the usual main stream approach, might all shun a cost and risk sharing approach.  Why share cost and risk if one's cost and risk are subjectively low?  One might quiet their complaints by giving them an option out of cost and risk sharing.

But the more these people opt out, the less effective the cost and risk sharing becomes.  We get Republican "health care" proposals that are optimized towards the healthy and wealthy, leaving fewer people covered and poor coverage.  One example of the opposite is Obamacare's mandates.  Under Obamacare, most are mandated to participate in cost and risk sharing.  You are not allowed to opt out.

When I was young, healthy and wealthy, I was willing to contribute.  I had an employer based health plan.  I assumed that my salary and others in my company was lower by the cost of the health care premiums.  Perhaps in another country, my salary would be larger, but my taxes would be higher.  In another country, my taxes would not be higher, but I'd have to pay for health care.  As Kinser says, pick one.  My values include Freedom from Want and HDHR 25, a positive right to medical care, so I would pick government sponsored Beveridge or National Insurance.  That said, I quite sympathize that the litigation and profit shaped US health system could stand some culture shift, though I don't see that system shifting if the system remains the same.

And I do welcome a conversation about it.  I guess the prime question is whether we allow those who see their odds as good to gamble, or whether cost and risk sharing is mandated.  Is the objective to share the cost and risks, or to optimize the odds of some gamblers while forcing others to gamble at really bad odds?

I keep coming back to auto insurance.  Most states mandate some coverage.  Often, those with good driving records get discounts.  Often those with bad records pay extra, or can have their licenses pulled.  Often, those with lots of money can purchase better insurance. 

How much of that do we want to do?  Do we punish the old for being old?  Do premiums get higher for practitioners of dangerous extreme sports?  Is there a non-smokers discount?  Or do we keep it simple, stupid?

Anyway, my gut feel is that more folk want to share costs and risks than want to gamble with their lives and fortunes.  I also grumble loudly at gamblers who suddenly want cost and risk sharing when their gambles fail.  Still, turning them away to watch them die seems extreme.

[Bob Butler 54]

Just stumbled into a main stream press article favoring main stream medicine.  I figure we've had enough dissing of main stream medical that their case might best be made.  Anyway, CNN reports Choosing alternative cancer therapy doubles risk of death, study says, but it covers other concerns such as favorable life styles.

[Warren Dew]

(08-17-2017, 07:35 AM)Bob Butler 54 Wrote: Just stumbled into a main stream press article favoring main stream medicine.  I figure we've had enough dissing of main stream medical that their case might best be made.  Anyway, CNN reports Choosing alternative cancer therapy doubles risk of death, study says, but it covers other concerns such as favorable life styles.

Leaving aside the bogus "logic" - of course your 5 year survival chance is better early on than it is later when you've already lived a few of those first 5 years - the point of diet and lifestyle is prevention of cancer, not treatment afterwards.  Yeah, Steve Jobs died because he tried to treat cancer with a vegetarian lifestyle.

However, there's a simple supplement which has been shown in randomized controlled trials to reduce cancer incidence by 77%.  You don't have to worry about survival chances if you don't get the cancer in the first place.

[Bob Butler 54]

(08-17-2017, 04:57 PM)Warren Dew Wrote:

(08-17-2017, 07:35 AM)Bob Butler 54 Wrote: Just stumbled into a main stream press article favoring main stream medicine.  I figure we've had enough dissing of main stream medical that their case might best be made.  Anyway, CNN reports Choosing alternative cancer therapy doubles risk of death, study says, but it covers other concerns such as favorable life styles.

Leaving aside the bogus "logic" - of course your 5 year survival chance is better early on than it is later when you've already lived a few of those first 5 years - the point of diet and lifestyle is prevention of cancer, not treatment afterwards.  Yeah, Steve Jobs died because he tried to treat cancer with a vegetarian lifestyle.

However, there's a simple supplement which has been shown in randomized controlled trials to reduce cancer incidence by 77%.  You don't have to worry about survival chances if you don't get the cancer in the first place.

Here in the New England area more than elsewhere, I hear Tom Brady lauded as a champion of working to maintain health and fitness.  Eat avocado ice cream?  You can’t complain about his results.  However, most can’t match his intensity and commitment.

I’ve got a friend who complains that her breast hurts.  She’s eventually going to have a doctor look at it.  She’s also a heavy smoker who is afraid of syringes.  I think of her, alas, as a much more typical example of a human being than Tom Brady.  She doesn’t work anywhere near so hard on maintaining health and fitness.

Should we all be more like Tom, working hard to maintain our health?  Sure.  Yes.  Definitely.  Should we build a health care system designed for Tom or for ordinary folk?  I’d say ordinary folk.

Should you get some sort of discount on health care if you take really good care of yourself?  In principle, I’m open to it.  Maybe its a tax break, or maybe it is lower premiums.  The exact form it would take depends heavily on which of Kinser’s / PBS's four basic schemes you are working under.  If the discount is on the table, is some sort of penalty to be considered for doing stuff like playing NFL football?  Is the concussion related threat of brain damage to be considered in even Tom’s case?

And sure.  Preventative medicine is fine.  One of my prescriptions isn’t for a specific problem, but my doctor read a study saying people taking that pill live longer.  They have no clue why.  He’s also been pushing me towards a baby aspirin regimen.  People with thinner blood just have few strokes.  I’ve just had bleeding bowels in an earlier phase of life before I cut back on fat.  I’m dubious about thinner blood just now.

More of that sort of avocado ice cream stuff should be shared with all and done by all.

But no matter how much avocado ice cream he eats, Tom is eventually going to retire from the NFL.  You can change the odds.  You can put off the inevitable.  You can make health a high priority in your life style.  Fine.  (I’m tempted to say “You go girl!” but the gender is wrong.)  You can go that route no matter what health plan the country adopts.

But it just shifts the odds some.  Eventually you’ll suffer a trauma or a disease which is considered a pre existing condition.  Believing otherwise is a delusion.  If not you, a predictable percentage in your demographic will lose their bets of their health and fortunes and crap out.  Suddenly sharing risks and costs will seem attractive, and it would be up to the bulk of us to bail out the person who gambled and lost.

Sure.  We should all exercise more, eat less and eat avocado ice cream sort of stuff.  That’s true regardless of Kinser’s / PBS's four choices.  If you could suggest how to make it so, please do so.  Lots of folk both in and out of main stream medicine would applaud if you could do it.

But the basic question remains.  Do we design health care for the healthy and wealthy with economic values who are willing to gamble lives and fortune on the chance to save a buck?  Or are we concerned about health care, real people, you know, folks who live in the real world and need care.  If we bend over backwards for the healthy and wealthy gamblers, those less healthy and wealthy get thrown under the bus, and the healthy and wealthy gamblers end up under the bus too, eventually.  The basic question remains.  Are we looking to share risks and costs, or are we looking to give some a free ride which they ought to know will end eventually.

[Bob Butler 54]

Here we have a very likely partisan article from CNN, Pediatricians say Florida hurt sick kids to help big GOP donors.  Read at the surface level, assuming the follow the money trail approach is a decent one, Florida GOP politicians withheld care from children in order to please and increase profits for donor insurance companies.

You can read it at its own level, but you don't have to look deep to see a values question.  Do folk care more about money, or children?

That's the bottom line.  Are folks in it to help each other out, or looking to squeak out a few extra bucks for themselves?  Generally, blue folk would tend towards binding communities together and helping each other.  Red folk value independence and self sufficiency.  In many ways you can take these differences, point at different regions, see an emphasis on different lessons learned, and hope for some degree of mutual respect. Too often you get mutual demonization rather than mutual respect.

But if one holds strong values of mutual support, it seems that economic values and independence can be taken too far.  The article seems to illustrate how the healthy and wealthy will harm others for a buck.  This is a values clash.  This makes it nigh on unsolvable.  Those with economic values will always have economic values.  Some will pursue a buck regardless of who they hurt.

Something is wrong.

[Kinser79]

(08-16-2017, 08:07 PM)Bob Butler 54 Wrote:

(08-14-2017, 06:01 PM)Kinser79 Wrote: There may be 25-30 decent models to base a system off of.  However as the PBS article I linked to demonstrates that there are only four main types.  The problem with the US is that even with Obamacare we are still using all four.  

With the VA it is a Beveridge type system like Britian or Cuba.

With Medicare it is a National Insurance like Canada or France.

With employer based care it is like Germany.  (They still essentially use the Bismarck model.)

For everyone else on out of pocket, well its like Cambodia or Rural India.

The goal should be for the US to pick one type (like other countries have done) and to stick with it.

As picking and sticking is definitely a good idea, I'll throw out a few notions.

There are many retired, unemployed, small employer employed, children, etc... that arguably can't pay out of their own or their employers pocket.  It would follow that out of pocket or employer based schemes are highly questionable.  That leaves Beveridge and or National Insurance types on the table, with the government as the obvious single payer.

Those who like to gamble, those wealthy enough to recover from a failed gamble, those young and healthy enough for favorable gambles, those who have convinced themselves that their ad-lib health system is better than the usual main stream approach, might all shun a cost and risk sharing approach.  Why share cost and risk if one's cost and risk are subjectively low?  One might quiet their complaints by giving them an option out of cost and risk sharing.

But the more these people opt out, the less effective the cost and risk sharing becomes.  We get Republican "health care" proposals that are optimized towards the healthy and wealthy, leaving fewer people covered and poor coverage.  One example of the opposite is Obamacare's mandates.  Under Obamacare, most are mandated to participate in cost and risk sharing.  You are not allowed to opt out.

When I was young, healthy and wealthy, I was willing to contribute.  I had an employer based health plan.  I assumed that my salary and others in my company was lower by the cost of the health care premiums.  Perhaps in another country, my salary would be larger, but my taxes would be higher.  In another country, my taxes would not be higher, but I'd have to pay for health care.  As Kinser says, pick one.  My values include Freedom from Want and HDHR 25, a positive right to medical care, so I would pick government sponsored Beveridge or National Insurance.  That said, I quite sympathize that the litigation and profit shaped US health system could stand some culture shift, though I don't see that system shifting if the system remains the same.

And I do welcome a conversation about it.  I guess the prime question is whether we allow those who see their odds as good to gamble, or whether cost and risk sharing is mandated.  Is the objective to share the cost and risks, or to optimize the odds of some gamblers while forcing others to gamble at really bad odds?

I keep coming back to auto insurance.  Most states mandate some coverage.  Often, those with good driving records get discounts.  Often those with bad records pay extra, or can have their licenses pulled.  Often, those with lots of money can purchase better insurance. 

How much of that do we want to do?  Do we punish the old for being old?  Do premiums get higher for practitioners of dangerous extreme sports?  Is there a non-smokers discount?  Or do we keep it simple, stupid?

Anyway, my gut feel is that more folk want to share costs and risks than want to gamble with their lives and fortunes.  I also grumble loudly at gamblers who suddenly want cost and risk sharing when their gambles fail.  Still, turning them away to watch them die seems extreme.

If I were to suggest a model, I would suggest that it be as follows:

1.  Abolish medicaid, SCHIP, VA Hospitals (and yes I'm a "vet" too--I just served during a time of relative peace in a service unlikely to see action except in "big ones") and other sundry programs.
2.  Expand medicare to cover everyone and cover any procedures deemed by doctors to be medically necessary. 
3.  Allow private insurance to cover elective procedures
4.  Reduce total qualification age of medicare to birth.

Problem solved.  It will never be implemented of course because it makes too much sense.  Also this is the very ideas that have been pushed by Dennis Kuchinich since forever.

[Bob Butler 54]

(08-18-2017, 07:23 AM)Kinser79 Wrote: If I were to suggest a model, I would suggest that it be as follows:

1.  Abolish medicaid, SCHIP, VA Hospitals (and yes I'm a "vet" too--I just served during a time of relative peace in a service unlikely to see action except in "big ones") and other sundry programs.
2.  Expand medicare to cover everyone and cover any procedures deemed by doctors to be medically necessary. 
3.  Allow private insurance to cover elective procedures
4.  Reduce total qualification age of medicare to birth.

Problem solved.  It will never be implemented of course because it makes too much sense.  Also this is the very ideas that have been pushed by Dennis Kuchinich since forever.

I haven't gone over details, but at first read you've got a great start there.

[Kinser79]

(08-18-2017, 07:36 AM)Bob Butler 54 Wrote:

(08-18-2017, 07:23 AM)Kinser79 Wrote: If I were to suggest a model, I would suggest that it be as follows:

1.  Abolish medicaid, SCHIP, VA Hospitals (and yes I'm a "vet" too--I just served during a time of relative peace in a service unlikely to see action except in "big ones") and other sundry programs.
2.  Expand medicare to cover everyone and cover any procedures deemed by doctors to be medically necessary. 
3.  Allow private insurance to cover elective procedures
4.  Reduce total qualification age of medicare to birth.

Problem solved.  It will never be implemented of course because it makes too much sense.  Also this is the very ideas that have been pushed by Dennis Kuchinich since forever.

I haven't gone over details, but at first read you've got a great start there.

It isn't my idea honestly. As I pointed out Dennis Kucinich was promoting it as far back as 2006.

Over all I think it would work because most people who have medicare like it, and it more or less works for them.  It also allows for people to pay out of pocket or through specialized insurance for procedures that would normally be deemed elective.

[David Horn]

(08-18-2017, 07:23 AM)Kinser79 Wrote: If I were to suggest a model, I would suggest that it be as follows:

1. Abolish medicaid, SCHIP, VA Hospitals (and yes I'm a "vet" too--I just served during a time of relative peace in a service unlikely to see action except in "big ones") and other sundry programs.
   
2. Expand medicare to cover everyone and cover any procedures deemed by doctors to be medically necessary. 
   
3. Allow private insurance to cover elective procedures.
   
4. Reduce total qualification age of medicare to birth.
   

Problem solved.  It will never be implemented of course because it makes too much sense.  Also this is the very ideas that have been pushed by Dennis Kuchinich since forever.

This has a shot, but not soon, but if ti does, I would leave the specialized health systems in place.  The VA is the best service for PTSD and rehab of war injuries.  The Indian and Native American Health Services also have special knowledge and support staffs that are hard to replace by a one-size-fits-all system.  Of course, the CDC and NIH are specialized, important, but not direct providers.

[Bob Butler 54]

(08-18-2017, 10:31 AM)David Horn Wrote:

(08-18-2017, 07:23 AM)Kinser79 Wrote: If I were to suggest a model, I would suggest that it be as follows:

1. Abolish medicaid, SCHIP, VA Hospitals (and yes I'm a "vet" too--I just served during a time of relative peace in a service unlikely to see action except in "big ones") and other sundry programs.
   
2. Expand medicare to cover everyone and cover any procedures deemed by doctors to be medically necessary. 
   
3. Allow private insurance to cover elective procedures.
   
4. Reduce total qualification age of medicare to birth.
   

Problem solved.  It will never be implemented of course because it makes too much sense.  Also this is the very ideas that have been pushed by Dennis Kuchinich since forever.

This has a shot, but not soon, but if ti does, I would leave the specialized health systems in place.  The VA is the best service for PTSD and rehab of war injuries.  The Indian and Native American Health Services also have special knowledge and support staffs that are hard to replace by a one-size-fits-all system.  Of course, the CDC and NIH are specialized, important, but not direct providers.

Good points.  If possible I might try to streamline the upper level administration and bureaucracy while keeping the specialist stuff intact at a meet-the-patient level.

[Kinser79]

(08-18-2017, 10:31 AM)David Horn Wrote:   The VA is the best service for PTSD and rehab of war injuries.

That can only be said by someone who has never used the VA. I wouldn't go to the VA to treat a kidney stone much less PTSD. Needless to say a kidney stone is very easy to treat without surgery.

Quote:  The Indian and Native American Health Services also have special knowledge and support staffs that are hard to replace by a one-size-fits-all system.  Of course, the CDC and NIH are specialized, important, but not direct providers.

A replacement of the current system with a "Medicare for Everyone" system would provide for the private sector to be in the business of providing healthcare while the state assumes the insurance part (except for perhaps specialized insurances).

The NIH and the CDC do not provide healthcare at all. The CDC is to prevent diseases from erupting into an epidemic. The NIH is to promote healthy living more generally, and facilitate the training and education of healthcare providers (doctors, nurses, etc)

[David Horn]

(08-20-2017, 01:59 PM)Kinser79 Wrote:

(08-18-2017, 10:31 AM)David Horn Wrote: The VA is the best service for PTSD and rehab of war injuries.

That can only be said by someone who has never used the VA.  I wouldn't go to the VA to treat a kidney stone much less PTSD.  Needless to say a kidney stone is very easy to treat without surgery.

I can't address the general case, but the VA Medical Center in Salem Virginia gets consistent rave reviews, even allowing for the intentional understaffing and low pay imposed by the party of 'No'.  I know many vets who use it for many reasons, and most are satisfied.  They need to be properly staffed and have the pay adjusted to match reality.  Only a truly dedicated MD is going to accept $90,000 a year when a PA makes that much in the private sector.

I have been there for disability evaluation and routine shots, but that's about it.  

Kinser79 Wrote:

David Horn Wrote:The Indian and Native American Health Services also have special knowledge and support staffs that are hard to replace by a one-size-fits-all system.  Of course, the CDC and NIH are specialized, important, but not direct providers.

A replacement of the current system with a "Medicare for Everyone" system would provide for the private sector to be in the business of providing healthcare while the state assumes the insurance part (except for perhaps specialized insurances).

The NIH and the CDC do not provide healthcare at all.  The CDC is to prevent diseases from erupting into an epidemic.  The NIH is to promote healthy living more generally, and facilitate the training and education of healthcare providers (doctors, nurses, etc)

I don't argue that Medicare For All is the most optimum system we're likely to get (I'm on it now), but health clinics on Indian Reservations and other similar specialized services are still a good option.  They seem to work, and are tied to the population being served.