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+---- Thread: ACA Repeal/Replace: Progressives Face Moral Dilemma (/thread-637.html)
RE: ACA Repeal/Replace: Progressives Face Moral Dilemma - Warren Dew - 07-28-2017
(07-28-2017, 04:44 PM)X_4AD_84 Wrote:(07-28-2017, 04:41 PM)Warren Dew Wrote:(06-09-2017, 10:32 AM)X_4AD_84 Wrote: Sorry to hear you are in a tight spot. My wife and I remember past times like that. We live as if we are in a tight spot. We buy huge bags of organically grown greens, cruciform veg, as well as week's worth of tofu, yogurt, as well, from Costco, for example. High veg protein, high veg, low carb and most of all .... cheap!
Those big bags of greens ... throw 'em in the microwave with a garnish of vinegar and herbs ... good stuff!!!
If you're buying organically grown anything, you're not living as if you are in a tight spot.
It's cheap at Costco.
Not compared to the nonorganically grown stuff there.
RE: ACA Repeal/Replace: Progressives Face Moral Dilemma - Bob Butler 54 - 07-28-2017
(07-28-2017, 04:45 PM)Warren Dew Wrote: Only 3 of the 49 voted for "skinny repeal" because they hoped something better would emerge. Probably most to all of the other 46 actually preferred "skinny repeal" to any of the alternatives offered.
I mean, seriously:
- Medicaid expansion untouched, which gave the moderate Republicans everything they could hope for.
- The individual mandate, hated by all, repealed.
- The employer mandate, which prevents creation of full time entry level jobs, repealed.
The exchanges are already in a death spiral; tanking them a little faster or a little slower won't make much difference.
Warren’s comment above is illuminating. Twisting it somewhat, Obamacare can be seen as a bunch of mandates. The individual must contribute. The employer must contribute. The government must contribute. The Republicans seem to be against contributions.
If we keep the current health care system structure, we’ve got many payers. Obamacare is to a great extent an attempt to balance all these payers into something that works for the People. These mandates are an awkward kluge in part because the system is an awkward kluge. There are too many people who have profited off the existing system that don’t want to lose their milch cow. In order to get the many contributors contributing in a vaguely effective way you have to apply crowbars in awkward places.
Obamacare isn’t ideal. It’s a kluge. I don’t think anyone thinks it doesn’t need really big adjustments. There is just no agreement on what the adjustment is.
I think a base difference is whether one sees health care insurance as insurance. The way insurance generally works, everyone with a car buys auto insurance. Everyone with a building buys fire insurance. Often, these are required by the government. The general concept is that everyone contributes. Those that are lucky in a given year cover the expenses of the unlucky. You set prices so the unlucky survive without their lifestyle being destroyed.
In health care, under a multiple payer system, with different rules for how everybody contributes or doesn’t, you can always point a finger and say this isn’t fair, or that isn’t fair. If you’re full time, the company pays, if not, and you’re under 65, you pay, but over the government pays. That’s just the simplest high level summary. You can point a finger and say this detail isn’t right or that isn’t right really easily. Somebody will always complain.
And if you’re into the unravelling memes, the knee jerk response is to cut taxes, assume that the government will muck it up, that you want to reduce services to the people, and since you’ve got yours, it’s a fine thing to raise a finger at those who don’t. Yes, if you’re an individual, you hate the individual mandate. Yes, if you’re an employer, you hate the employer mandate. Yes, if you’re Republican, you hate government doing anything.
Meanwhile, the thought of going single payer, of solving the problem like everyone else is solving the problem, is anathema. You want to get rid of individual and employer mandates? Sure, let’s get rid of individual and employer mandates. Everybody else has.
So, yes, Obamacare is a kluge. Repeal it. Replace it. Alas, the Republicans have the congress and they seem more interested in the interests of the wealthy and healthy than providing health care for the American people. The people who have been in car accidents should pay for the car accidents? The companies that have had fires should pay for the fire damage? That’s not how insurance works. We should all contribute and all benefit should the time of need come. If we’re going to aim for a vaguely fair system, the contributions should come out of the general tax system rather than an ad hoc mess.
RE: ACA Repeal/Replace: Progressives Face Moral Dilemma - Eric the Green - 07-29-2017
(07-28-2017, 02:13 PM)tg63 Wrote: I suspect that the seven bought into the theory that by approving the repeal, a sense of urgency would have been created that would force a workable proposal to be negotiated.
The problem being that, among Republicans, nothing workable was going to be negotiated; just more of the same stuff that the Republicans could not themselves all agree on.
The only workable solution for now is going to have to be bipartisan. Repeal is not bipartisan.
RE: ACA Repeal/Replace: Progressives Face Moral Dilemma - Warren Dew - 07-29-2017
(07-28-2017, 08:15 PM)Bob Butler 54 Wrote: Twisting it somewhatAt least you're starting to admit it when you ignore the person you're posting and instead set up a straw man to attack.
RE: ACA Repeal/Replace: Progressives Face Moral Dilemma - Bob Butler 54 - 08-01-2017
(07-29-2017, 02:19 PM)Warren Dew Wrote:(07-28-2017, 08:15 PM)Bob Butler 54 Wrote: Twisting it somewhatAt least you're starting to admit it when you ignore the person you're posting and instead set up a straw man to attack.
I’ll argue against the main line red. I’ll grant you originality easily enough, or a clinging to ancient discredited theories in some cases. However, you’re not a typical average every day red. You’ve thought things through better than most. Not necessarily perfectly, but better. In finance matters, Mikebert is the better rebutter, and I’ll thankfully leave the financial rebuttal task to him. However, you aren’t the only red out there and haven’t drawn my full time attention.
I also see myself as speaking truthfully, even if the real reds might make more meaningful and sympathetic arguments for their perspective. The red proposal on heath care, for example, cut coverage to many and strives to remove mandates from the healthy and wealthy. This is right in line with the unraveling memes and tribal thinking. Yes, people can make different arguments for doing that, and they can strive to make it smell prettier, but what the red folk strive to do still waddles, swims and quacks like a duck. More money for the healthy and wealthy is seemingly much more important to some than UDHR 25’s notion of accessible health care. That’s different priorities. It isn’t going to shift easily. From here, however one tries to excuse it, some people would rather see people suffer and die while pocketing the money.
You know, if we had an inclusive economy were everyone could afford what modern health care has become, we could talk about all the single payer options. If most everybody were employed full time, and you needed to provide the benefit to attract decent workers, we could still have the old employer based health care. If everyone could find employment at a living age, the government could bow out and let individuals handle everything. I just don’t see either of those approaches as viable in the economy as it exists today. We seem to be stuck leaving folks uncovered or the current implausible system of mixed mandates definitely in need of no small amount of tweaking. And, as the international community as shown, a nanny state government system can be made to work.
Anyway, I’d like to chat about it. That’s what forums like these are for. Snark and silence to me doesn’t impress.
RE: ACA Repeal/Replace: Progressives Face Moral Dilemma - David Horn - 08-01-2017
(07-28-2017, 04:45 PM)Warren Dew Wrote:(07-28-2017, 12:56 PM)Eric the Green Wrote: What puzzled me is why 9 senators voted down the repeal and replace bill, and then only 2 of them (plus McCain who had voted FOR the repeal and replace bill) voted against the skinny repeal bill in hopes of something better emerging out of a conference with the House. But what could have emerged except another bill like they had already voted down? Especially since the House bill was much worse.
Only 3 of the 49 voted for "skinny repeal" because they hoped something better would emerge. Probably most to all of the other 46 actually preferred "skinny repeal" to any of the alternatives offered.
I mean, seriously:
- Medicaid expansion untouched, which gave the moderate Republicans everything they could hope for.
- The individual mandate, hated by all, repealed.
- The employer mandate, which prevents creation of full time entry level jobs, repealed.
The exchanges are already in a death spiral; tanking them a little faster or a little slower won't make much difference.
I heard Jeff Flake saying much the same on Morning Joe this morning. The only problem: it's totally unworkable. Once mandates are removed, the healthy young avoid insurance, or buy something so thin that it's of little value. Those needing insurance then see their insurance costs go through the roof, because the heath care system, as opposed to the insurance market, still eats 18% of GDP. The money doesn't just rain down from heaven.
FWIW, no one likes the mandates, but they are what makes the system work -- even as poorly as it currently does. If it's OK with you that the not-quite-elderly are left to die so the young can have shit jobs, then I guess it works at that level.
RE: ACA Repeal/Replace: Progressives Face Moral Dilemma - Bob Butler 54 - 08-01-2017
(08-01-2017, 09:24 AM)David Horn Wrote: I heard Jeff Flake saying much the same on Morning Joe this morning. The only problem: it's totally unworkable. Once mandates are removed, the healthy young avoid insurance, or buy something so thin that it's of little value. Those needing insurance then see their insurance costs go through the roof, because the heath care system, as opposed to the insurance market, still eats 18% of GDP. The money doesn't just rain down from heaven.
FWIW, no one likes the mandates, but they are what makes the system work -- even as poorly as it currently does. If it's OK with you that the not-quite-elderly are left to die so the young can have shit jobs, then I guess it works at that level.
Too much truth there. The way things are trending, eventually the young and the old together will outnumber those in the sweet zone in the middle. Will self interest overcome partisanship?
RE: ACA Repeal/Replace: Progressives Face Moral Dilemma - Warren Dew - 08-01-2017
(08-01-2017, 09:24 AM)David Horn Wrote:(07-28-2017, 04:45 PM)Warren Dew Wrote:(07-28-2017, 12:56 PM)Eric the Green Wrote: What puzzled me is why 9 senators voted down the repeal and replace bill, and then only 2 of them (plus McCain who had voted FOR the repeal and replace bill) voted against the skinny repeal bill in hopes of something better emerging out of a conference with the House. But what could have emerged except another bill like they had already voted down? Especially since the House bill was much worse.
Only 3 of the 49 voted for "skinny repeal" because they hoped something better would emerge. Probably most to all of the other 46 actually preferred "skinny repeal" to any of the alternatives offered.
I mean, seriously:
- Medicaid expansion untouched, which gave the moderate Republicans everything they could hope for.
- The individual mandate, hated by all, repealed.
- The employer mandate, which prevents creation of full time entry level jobs, repealed.
The exchanges are already in a death spiral; tanking them a little faster or a little slower won't make much difference.
I heard Jeff Flake saying much the same on Morning Joe this morning. The only problem: it's totally unworkable. Once mandates are removed, the healthy young avoid insurance, or buy something so thin that it's of little value.
The mandates aren't saving the PPACA. Premiums are skyrocketing; insurers are withdrawing right and left. Let's face it: the PPACA is totally unworkable with or without the mandates. So why drag everyone down with it?
Quote:Those needing insurance then see their insurance costs go through the roof, because the heath care system, as opposed to the insurance market, still eats 18% of GDP. The money doesn't just rain down from heaven.
The reason it's so expensive isn't because it's needed. It's because third party payer causes prices to skyrocket, because there is no one to make a tradeoff between costs and benefits. As a result, the medical system - as opposed to health - has a strong incentive to use the most expensive treatments possible, and a strong disincentive to keep people healthy, since healthy people consumer little in the way of medical care. More here:
https://medium.com/@RosenthalHealth/how-economic-incentives-have-created-our-dysfunctional-us-medical-market-b681c51d6436
Quote:If it's OK with you that the not-quite-elderly are left to die so the young can have shit jobs, then I guess it works at that level.
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.
RE: ACA Repeal/Replace: Progressives Face Moral Dilemma - Warren Dew - 08-01-2017
(08-01-2017, 01:46 AM)Bob Butler 54 Wrote:(07-29-2017, 02:19 PM)Warren Dew Wrote:(07-28-2017, 08:15 PM)Bob Butler 54 Wrote: Twisting it somewhatAt least you're starting to admit it when you ignore the person you're posting and instead set up a straw man to attack.
I’ll argue against the main line red....
Anyway, I’d like to chat about it.
No you wouldn't. If you did want that, you'd discuss it with me, without twisting it into a straw man "main line red" that doesn't resemble any actual person, and is just built out of the left's bigoted prejudices.
RE: ACA Repeal/Replace: Progressives Face Moral Dilemma - Eric the Green - 08-01-2017
(08-01-2017, 04:19 PM)Warren Dew Wrote:(08-01-2017, 09:24 AM)David Horn Wrote: I heard Jeff Flake saying much the same on Morning Joe this morning. The only problem: it's totally unworkable. Once mandates are removed, the healthy young avoid insurance, or buy something so thin that it's of little value.
The mandates aren't saving the PPACA. Premiums are skyrocketing; insurers are withdrawing right and left. Let's face it: the PPACA is totally unworkable with or without the mandates. So why drag everyone down with it?
The mandates made the Obamacare system worked, which it did in those red states that cut off their own funds by rejecting medicaid funding.
Quote:Of course health care is needed. Unless you want to go back to medieval times. What isn't needed is the free market medical system. The free market provides incentives for doctors and insurance companies to charge whatever the market will bear. Result: sky-high costs and bad service. If insurance is governed in a single-payer or national system, then overcharging and over-treatment can be regulated. Sarah Palin might object and call this "death panels," but the fact is that Medicare works and keeps costs down because of its pricing power in the market and its ability to approve or disapprove treatments. Private insurance provides a motive of greed to the insurance companies, who over-charge.Quote:Those needing insurance then see their insurance costs go through the roof, because the heath care system, as opposed to the insurance market, still eats 18% of GDP. The money doesn't just rain down from heaven.
The reason it's so expensive isn't because it's needed. It's because third party payer causes prices to skyrocket, because there is no one to make a tradeoff between costs and benefits. As a result, the medical system - as opposed to health - has a strong incentive to use the most expensive treatments possible, and a strong disincentive to keep people healthy, since healthy people consumer little in the way of medical care. More here:
Quote:Quote:If it's OK with you that the not-quite-elderly are left to die so the young can have shit jobs, then I guess it works at that level.
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.
Social insurance means we all pay into the system, so that it's there when we need it. So all generations need to contribute. When they don't, that's when health care systems go bankrupt. And we get what we had before Obamacare: a system that throws people off insurance, provides insurance that won't cover your illness, charges too much money, etc.
Quote: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.
The Republicans wanted to cut out preventive care from the system. I agree about what keeps us healthy, at least much of the time, but just telling people that won't make much difference. And older people have health problems anyway. The health care system needs to support doctors and professionals who also provide holistic services and diet/lifestyle advice.
RE: ACA Repeal/Replace: Progressives Face Moral Dilemma - Bob Butler 54 - 08-13-2017
I’m seen the main values clash as a blue leaning towards inclusive care against a red leaning towards economic values. That seems the main disconnect, where the goals of the two groups go flying by one another without comprehension or contact. I’ve been trying to peg the blue perspective on positive rights, Freedom from Want and UDHR 25. I haven’t as clear an opposing concept other than a bunch of bills which leave fewer people covered… the opposite of inclusion.
To a great degree, there is no breaking that clash. One either cares for one’s fellow man and seeks to share the burden, or not. If one is strong into economic values, one can find a way of saying this way of sharing the burden or that is unfair and should be eliminated. By the time you eliminate everything ‘unfair’, the system collapses.
I’m reasonably confident something fair could be implemented if folks were willing to contribute. Other nations have made reasonable attempts. Massachusetts was doing well enough under Romneycare.
The other question is how to make it cheaper and still effective. This might almost be a separate set of questions.
Part of it is the partisan distrusts. Blue leaning folks look dubiously at insurance companies seeking profit. That is often seen as a layer of overhead and profiteering that returns nothing. Red folks are often dubious of anything approaching government takeover. Both I believe have reason to be dubious, but something has to be found that works.
Then it seems like the medical culture is changing as health care evolves. My father’s best friend was a general practitioner with rights at the local hospital should he need them. He was pretty much his own man, doing his own thinking, making home visits and knowing his patients well.
The modern structure seem more like corporate medicine, cookbook medicine. The insurance companies almost write the cookbooks. You still are assigned a general practitioner, but he has a specialty and as soon as you leave his specialty you are off to visit a specialist. In recent years I’ve visited a skin specialist, who froze off certain pre cancerous growths, a digestive specialist, who used a laser to burn certain polyps out of my intestines, and several others. I got the impression that they repeated the same specialty procedures regularly, several times a day, scheduled by a specialist secretary who does it by rote.
Perhaps the new style is an effective one, with people doing what they know and do best.
Perhaps the new style is driven by lawyers. If you have this symptom, if this test isn’t run, if that drug isn’t administered, if that procedure isn’t performed, and if something bad happens, we live in a nation of lawyers. Money moves around. The style of the medicine is in part driven by the style of the legal system.
Until recently, I was upset by the overly active lawyers upping the cost and complication of the medicine. I more recently got to witness a real world case. The doctors prescribed a medicine that was clearly listed as allergic on a friend’s medical records. The doctors clearly made potentially and nearly deadly mistake. The facts of the case were crystal clear, unquestioned. The result? Lawyers lawyers everywhere, but in a system that was rigged for the rich and the doctors. If you could afford to keep feeding money to your own lawyer, you got justice… or at least financial compensation. If you were poor and could not afford to enrich the lawyers, you were dumped to the wayside. It would be impossible to buck the system unless you were rich enough to be part of the system. My role has been to contribute enough funds to buck the system. Bucking the system is not a cheap hobby.
Can the government impose change upon the medical community, legal community and insurance industry? That is not easy given the lobbying industry. The voices of those profiting off people’s suffering drowns out the voices of the people suffering. The voices of those with economic values seems to drown out the unhealthy.
And this has me wondering about my experience with modern medicine. Did those intestinal pylons and skin pre-cancers have to be removed? To what extent does an ounce of prevention save both larger health problems and the greater expenses that follow? How hard do we look at the notion that the ounce of prevention only helps a few, and we can save money by letting those few suffer? Are we back to inclusive vs. economic values?
There are no easy answers, but I genuinely think the problem should be talked about. My own values still wrap around positive rights and HDHR 25. The health system should be inclusive. I expect to run head on into those with strong economic values attempting to frustrate the positive rights. That’s where I see the main conflict.
One of the few certainties is that the current ‘system’ is messed up.
RE: ACA Repeal/Replace: Progressives Face Moral Dilemma - Kinser79 - 08-13-2017
(07-28-2017, 04:41 PM)Warren Dew Wrote:(06-09-2017, 10:32 AM)X_4AD_84 Wrote: Sorry to hear you are in a tight spot. My wife and I remember past times like that. We live as if we are in a tight spot. We buy huge bags of organically grown greens, cruciform veg, as well as week's worth of tofu, yogurt, as well, from Costco, for example. High veg protein, high veg, low carb and most of all .... cheap!
Those big bags of greens ... throw 'em in the microwave with a garnish of vinegar and herbs ... good stuff!!!
If you're buying organically grown anything, you're not living as if you are in a tight spot.
If you're buying your produce at "Whole Paycheck" true. However, if you instead go to the local farmer's market, and nearly every city of any size has one [you just have to actually look--google/bing/Duckduckgo will help you out] not so much. The vast majority of produce we eat is organic, and I'm only growing half of it.
I have neither the space nor the talent for squashes or mellons for some reason. I strongly suspect it is because my neighbor sprays his lawns with god knows what and kills the local wild bee populations and the city won't issue me a beekeeping permit because I'm not a business.
RE: ACA Repeal/Replace: Progressives Face Moral Dilemma - Kinser79 - 08-13-2017
(08-01-2017, 10:45 AM)X_4AD_84 Wrote:(08-01-2017, 09:24 AM)David Horn Wrote:(07-28-2017, 04:45 PM)Warren Dew Wrote:(07-28-2017, 12:56 PM)Eric the Green Wrote: What puzzled me is why 9 senators voted down the repeal and replace bill, and then only 2 of them (plus McCain who had voted FOR the repeal and replace bill) voted against the skinny repeal bill in hopes of something better emerging out of a conference with the House. But what could have emerged except another bill like they had already voted down? Especially since the House bill was much worse.
Only 3 of the 49 voted for "skinny repeal" because they hoped something better would emerge. Probably most to all of the other 46 actually preferred "skinny repeal" to any of the alternatives offered.
I mean, seriously:
- Medicaid expansion untouched, which gave the moderate Republicans everything they could hope for.
- The individual mandate, hated by all, repealed.
- The employer mandate, which prevents creation of full time entry level jobs, repealed.
The exchanges are already in a death spiral; tanking them a little faster or a little slower won't make much difference.
I heard Jeff Flake saying much the same on Morning Joe this morning. The only problem: it's totally unworkable. Once mandates are removed, the healthy young avoid insurance, or buy something so thin that it's of little value. Those needing insurance then see their insurance costs go through the roof, because the heath care system, as opposed to the insurance market, still eats 18% of GDP. The money doesn't just rain down from heaven.
FWIW, no one likes the mandates, but they are what makes the system work -- even as poorly as it currently does. If it's OK with you that the not-quite-elderly are left to die so the young can have shit jobs, then I guess it works at that level.
Irony. The right wing radio machine which I used to imbibe from a lot, circa Obama's first term, stated the following conspiracy theory. The theory was that Obama-care was designed to fail, so that we'd want single payer. The irony is, what is going on now (and not Obama-care), is likely to lead to a failure that will make a substantial majority of Americans want single payer.
Alphabet, some of us have said that same thing, at the time in my case from the Left. Myself, I have long advocated that we have all one thing or all the other. Right now the reason American Healthcare and Healthcare insurance is such a mess is that while most countries has one system that more or less works, we have at least three none of which works all that well except for maybe medicare.
Myself I would prefer a national insurance model. Leave the providers private, but socialize the healthcare insurance structure.
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/models.html
Truth is there are four main models, the US needs to pick one. Or failing that on a national level, we should let the states pick one--but they would have to pick one.
RE: ACA Repeal/Replace: Progressives Face Moral Dilemma - Bob Butler 54 - 08-13-2017
(08-13-2017, 04:56 PM)Kinser79 Wrote: Truth is there are four main models, the US needs to pick one. Or failing that on a national level, we should let the states pick one--but they would have to pick one.
Good short answer. Alas, too many people are profiting off the current kluge.
I might have a fifth model. In my grandfather's time, on the rare occasion someone was sick that he couldn't do out of pocket, he would go to the guy doing lone sharking, alcohol smuggling, the numbers racket and similar stuff. Mafiacare? I think the guy running the old depression era local speakeasy had a better reputation than either the modern government or insurance companies.
RE: ACA Repeal/Replace: Progressives Face Moral Dilemma - Kinser79 - 08-13-2017
(08-13-2017, 06:44 PM)Bob Butler 54 Wrote:(08-13-2017, 04:56 PM)Kinser79 Wrote: Truth is there are four main models, the US needs to pick one. Or failing that on a national level, we should let the states pick one--but they would have to pick one.
Good short answer. Alas, too many people are profiting off the current kluge.
I might have a fifth model. In my grandfather's time, on the rare occasion someone was sick that he couldn't do out of pocket, he would go to the guy doing lone sharking, alcohol smuggling, the numbers racket and similar stuff. Mafiacare? I think the guy running the old depression era local speakeasy had a better reputation than either the modern government or insurance companies.
Taking out a loan from someone of that nature would still fall under Out-of-pocket. I imagine that, at least, some of the "black money" problem in India may be going to medical practitioners.
RE: ACA Repeal/Replace: Progressives Face Moral Dilemma - David Horn - 08-14-2017
(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.
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.
RE: ACA Repeal/Replace: Progressives Face Moral Dilemma - Kinser79 - 08-14-2017
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.
RE: ACA Repeal/Replace: Progressives Face Moral Dilemma - Bob Butler 54 - 08-14-2017
(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.
RE: ACA Repeal/Replace: Progressives Face Moral Dilemma - Warren Dew - 08-15-2017
(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.
RE: ACA Repeal/Replace: Progressives Face Moral Dilemma - Bob Butler 54 - 08-15-2017
(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.
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.
Currently, one of the many mandates that form Obamacare says if you are sick enough for the emergency room, the emergency room has to take you. It is almost tempting to say that the emergency room does not take those who opt out. Currently, the healthy and wealthy can gamble with their health, and it’s a decent gamble often profitable. If they are unlucky though, if they develop a condition, the kluge of Obamacare bales them out. It seems proper that those who do not pay into a system do not get the benefits of the system.
Warren’s faith in diet and lifestyle can produce decent profitable gambles. The question is whether the public is expected to bail him out if his gambles fail.
Currently, there are tax penalties if one hasn’t health coverage, attempting to collect enough funds to pay for the gambles that don’t luck out. Can we reverse that, reward those with no health coverage lower taxes, but not be expected to bail out those who do not contribute? Let those who want to gamble pay the stiff cost of gambling?
While there might be a default normal level of health care, should and could there be a cheaper variation that does not cover certain procedures? Again, if you do not want to pay for certain procedures, you are stuck with the bill should those procedures have been helpful.
If one wants extended coverage above the default, should a variety of supplemental plans be available?
I can see that folks like a christian scientist or Warren might be dissatisfied with the modern norm. Hey, I’m not thrilled with the modern norm myself. However, if we humor such eccentrics the modern norm doesn’t get implemented. Their values are utterly incompatible with most. Their thinking seems pretty far out to me. The healthy and wealthy, willing to gamble, perhaps believers is some type of holistic medicine, might be allowed to set up their own system but not expect more normal folk to bail them out when trouble hits. Statistically, it will hit a certain percentage of them. If they want to risk their life being ruined by absurd expenses, should we let it happen?
Myself, I’d rather look at health insurance like fire or automobile insurance. Everybody contributes. If you’re one of the unlucky one, the contribution of the lucky ones cover it. I’m not the sort of gambler and rejector of modern medicine as some. Warren seems to reject the idea of spreading risks. I don’t mind him gambling, but I don’t want him forcing everyone to gamble, I don’t want him preventing others from sharing risk.
Given the the 4 choices listed by Kinser’s PBS web page, my own preference would be starting from Beveride or National Insurance models. Those are risk sharing systems suitable for single payer. That encourages one size fits all coverage, equal for all. Obviously, this isn’t the ideal system for the gamblers. Is it worth giving them the choice to opt out?