ACA Repeal/Replace: Progressives Face Moral Dilemma

[Odin]

(01-15-2017, 10:56 AM)Warren Dew Wrote:

(01-14-2017, 11:03 PM)Odin Wrote:

(01-14-2017, 10:18 AM)flbones too Wrote: I don't understand why politicians are making this health care thing more complicated than it needs to be. Just expand Medicare for everyone. it's not that complicated.

A lot of people already get insurance through their employer and those people don't want to pay the higher taxes needed for a single payer system. It's "I've got mine, fuck you".

More like, "I'd rather keep paying for my efficient private insurance than pay more for an inferior public monopoly like the VA or NHS."

Medicare as it currently exists can't even survive retirement of the full baby boom; even now, it has gotten sufficiently inadequate that supplemental insurance is pretty much required.

I have to agree with David, here, Medicare is vastly superior to private insurance. Your ideology is blinding you, Warren.

[Odin]

(01-15-2017, 07:35 PM)Classic-Xer Wrote:

(01-15-2017, 04:08 PM)David Horn Wrote:

(01-15-2017, 01:36 PM)Classic-Xer Wrote: You're getting a hell of a deal and you are receiving a hell of deal because you are in a specific age group (fully retired workers) in a government system that's limited to your specific age group. I hope when I'm 69, I can get a hell of deal like you are getting now too. Do I expect to receive the hell of a deal that you are now? No, I expect to pay more money to receive less than you are entitled/accustomed to receiving and having available to you now. As I told you before, you should be thanking us for your healthcare because we are the ones who are paying for it and covering/taking on the debt associated with your losses. Where is your sense of gratitude? Did you loose it or didn't you ever have one? Didn't your parents or at least one of your parents ever tell you to shut up and be grateful for what you have?

If you kill the system you never will.  Like most systems built on actuarial models, Medicare, and Social Security, require future recipients to pay for current ones, so the next gen can pay for them.  It isn't rocket science, but it does require adherence to good actuarial practice.  We have many pension plans in the US that are drastically underfunded, because short term returns looked good enough to allow the plans to reduce deposits ... including most 401ks and IRAs.  SS and Medicare avoided those traps.  A quick overview of the alternatives shows how truly excellent these two programs really are.

So I paid plenty for the GIs and Silents.  I paid when it cost me much more than I could afford.  Now it's your turn.  Quit whining.

1 wasn't whining. Shame on you, you keep screwing up and approaching me as if I'm a kid or something.  I was trying to teach you some respect for those like me who are supporting you now. Like everything, obligations only extend so far and only last for so long.

Your angry, toxic bitterness is sad.

[SomeGuy]

Quote:1 wasn't whining. Shame on you, you keep screwing up and approaching me as if I'm a kid or something.  I was trying to teach you some respect for those like me who are supporting you now. Like everything, obligations only extend so far and only last for so long.

What would you do, stop paying payroll taxes?  Lemme know how that works out for ya. 

[Warren Dew]

(01-15-2017, 07:35 PM)Classic-Xer Wrote:

(01-15-2017, 04:08 PM)David Horn Wrote:

(01-15-2017, 01:36 PM)Classic-Xer Wrote: You're getting a hell of a deal and you are receiving a hell of deal because you are in a specific age group (fully retired workers) in a government system that's limited to your specific age group. I hope when I'm 69, I can get a hell of deal like you are getting now too. Do I expect to receive the hell of a deal that you are now? No, I expect to pay more money to receive less than you are entitled/accustomed to receiving and having available to you now. As I told you before, you should be thanking us for your healthcare because we are the ones who are paying for it and covering/taking on the debt associated with your losses. Where is your sense of gratitude? Did you loose it or didn't you ever have one? Didn't your parents or at least one of your parents ever tell you to shut up and be grateful for what you have?

If you kill the system you never will.  Like most systems built on actuarial models, Medicare, and Social Security, require future recipients to pay for current ones, so the next gen can pay for them.  It isn't rocket science, but it does require adherence to good actuarial practice.  We have many pension plans in the US that are drastically underfunded, because short term returns looked good enough to allow the plans to reduce deposits ... including most 401ks and IRAs.  SS and Medicare avoided those traps.  A quick overview of the alternatives shows how truly excellent these two programs really are.

So I paid plenty for the GIs and Silents.  I paid when it cost me much more than I could afford.  Now it's your turn.  Quit whining.

1 wasn't whining. Shame on you, you keep screwing up and approaching me as if I'm a kid or something.  I was trying to teach you some respect for those like me who are supporting you now. Like everything, obligations only extend so far and only last for so long.

Expecting welfare and entitlement recipients to have respect for taxpayers is like expecting slaveowners to have respect for their slaves.

[Warren Dew]

(01-15-2017, 08:23 PM)Odin Wrote:

(01-15-2017, 10:56 AM)Warren Dew Wrote:

(01-14-2017, 11:03 PM)Odin Wrote:

(01-14-2017, 10:18 AM)flbones too Wrote: I don't understand why politicians are making this health care thing more complicated than it needs to be. Just expand Medicare for everyone. it's not that complicated.

A lot of people already get insurance through their employer and those people don't want to pay the higher taxes needed for a single payer system. It's "I've got mine, fuck you".

More like, "I'd rather keep paying for my efficient private insurance than pay more for an inferior public monopoly like the VA or NHS."

Medicare as it currently exists can't even survive retirement of the full baby boom; even now, it has gotten sufficiently inadequate that supplemental insurance is pretty much required.

I have to agree with David, here, Medicare is vastly superior to private insurance. Your ideology is blinding you, Warren.

More likely yours is blinding you.

[SomeGuy]

(01-15-2017, 10:58 PM)Warren Dew Wrote:

(01-15-2017, 07:35 PM)Classic-Xer Wrote:

(01-15-2017, 04:08 PM)David Horn Wrote:

(01-15-2017, 01:36 PM)Classic-Xer Wrote: You're getting a hell of a deal and you are receiving a hell of deal because you are in a specific age group (fully retired workers) in a government system that's limited to your specific age group. I hope when I'm 69, I can get a hell of deal like you are getting now too. Do I expect to receive the hell of a deal that you are now? No, I expect to pay more money to receive less than you are entitled/accustomed to receiving and having available to you now. As I told you before, you should be thanking us for your healthcare because we are the ones who are paying for it and covering/taking on the debt associated with your losses. Where is your sense of gratitude? Did you loose it or didn't you ever have one? Didn't your parents or at least one of your parents ever tell you to shut up and be grateful for what you have?

If you kill the system you never will.  Like most systems built on actuarial models, Medicare, and Social Security, require future recipients to pay for current ones, so the next gen can pay for them.  It isn't rocket science, but it does require adherence to good actuarial practice.  We have many pension plans in the US that are drastically underfunded, because short term returns looked good enough to allow the plans to reduce deposits ... including most 401ks and IRAs.  SS and Medicare avoided those traps.  A quick overview of the alternatives shows how truly excellent these two programs really are.

So I paid plenty for the GIs and Silents.  I paid when it cost me much more than I could afford.  Now it's your turn.  Quit whining.

1 wasn't whining. Shame on you, you keep screwing up and approaching me as if I'm a kid or something.  I was trying to teach you some respect for those like me who are supporting you now. Like everything, obligations only extend so far and only last for so long.

Expecting welfare and entitlement recipients to have respect for taxpayers is like expecting slaveowners to have respect for their slaves.

What would "respect" actually look like in this case?

[SomeGuy]

(01-15-2017, 10:59 PM)Warren Dew Wrote:

(01-15-2017, 08:23 PM)Odin Wrote:

(01-15-2017, 10:56 AM)Warren Dew Wrote:

(01-14-2017, 11:03 PM)Odin Wrote:

(01-14-2017, 10:18 AM)flbones too Wrote: I don't understand why politicians are making this health care thing more complicated than it needs to be. Just expand Medicare for everyone. it's not that complicated.

A lot of people already get insurance through their employer and those people don't want to pay the higher taxes needed for a single payer system. It's "I've got mine, fuck you".

More like, "I'd rather keep paying for my efficient private insurance than pay more for an inferior public monopoly like the VA or NHS."

Medicare as it currently exists can't even survive retirement of the full baby boom; even now, it has gotten sufficiently inadequate that supplemental insurance is pretty much required.

I have to agree with David, here, Medicare is vastly superior to private insurance. Your ideology is blinding you, Warren.

More likely yours is blinding you.

I dunno, Warren, the experience of other developed nations seems to suggest that, in the absence of a genuinely free market system (which would likely raise its own issues, albeit not the same ones), some form of universal insurance* would probably be cheaper and provide at least as good outcomes.

* An actual public monopoly along the lines cited by you (VA, NHS, etc.), less so.

[Classic-Xer]

(01-15-2017, 08:23 PM)Odin Wrote:

(01-15-2017, 10:56 AM)Warren Dew Wrote:

(01-14-2017, 11:03 PM)Odin Wrote:

(01-14-2017, 10:18 AM)flbones too Wrote: I don't understand why politicians are making this health care thing more complicated than it needs to be. Just expand Medicare for everyone. it's not that complicated.

A lot of people already get insurance through their employer and those people don't want to pay the higher taxes needed for a single payer system. It's "I've got mine, fuck you".

More like, "I'd rather keep paying for my efficient private insurance than pay more for an inferior public monopoly like the VA or NHS."

Medicare as it currently exists can't even survive retirement of the full baby boom; even now, it has gotten sufficiently inadequate that supplemental insurance is pretty much required.

I have to agree with David, here, Medicare is vastly superior to private insurance. Your ideology is blinding you, Warren.

It's way more cheaper for someone his age that's for sure. I don't think its vastly superior to the private insurance that I've had available to me as an employee and later provided for my employees.

[Warren Dew]

(01-15-2017, 11:05 PM)SomeGuy Wrote:

(01-15-2017, 10:59 PM)Warren Dew Wrote:

(01-15-2017, 08:23 PM)Odin Wrote:

(01-15-2017, 10:56 AM)Warren Dew Wrote:

(01-14-2017, 11:03 PM)Odin Wrote: A lot of people already get insurance through their employer and those people don't want to pay the higher taxes needed for a single payer system. It's "I've got mine, fuck you".

More like, "I'd rather keep paying for my efficient private insurance than pay more for an inferior public monopoly like the VA or NHS."

Medicare as it currently exists can't even survive retirement of the full baby boom; even now, it has gotten sufficiently inadequate that supplemental insurance is pretty much required.

I have to agree with David, here, Medicare is vastly superior to private insurance. Your ideology is blinding you, Warren.

More likely yours is blinding you.

I dunno, Warren, the experience of other developed nations seems to suggest that, in the absence of a genuinely free market system (which would likely raise its own issues, albeit not the same ones), some form of universal insurance* would probably be cheaper and provide at least as good outcomes.

* An actual public monopoly along the lines cited by you (VA, NHS, etc.), less so.

Three points here.

First, perhaps the main reason they are cheaper is that alll the drug research is paid for by us, and they only pay the costs of manufacture.  Legalizing reimportation of drugs would fix that, making them pay their fair share of the research costs, and reducing the share we have to pay.

Second, their systems aren't like Medicare.  The most successful of the European systems, which is questionably more cost effective than our private insurance system after adjusting for drug prices mentioned above, essentially has the government paying for private insurance selected by the individual, and not paying the providers directly.  So the idea that Medicare for all is the way to go is highly questionable.

Third, if we're going to have a major revamp of the system, why not move to a genuinely free market system, or at least closer to it?

[Classic-Xer]

(01-15-2017, 11:05 PM)SomeGuy Wrote:

(01-15-2017, 10:59 PM)Warren Dew Wrote:

(01-15-2017, 08:23 PM)Odin Wrote:

(01-15-2017, 10:56 AM)Warren Dew Wrote:

(01-14-2017, 11:03 PM)Odin Wrote: A lot of people already get insurance through their employer and those people don't want to pay the higher taxes needed for a single payer system. It's "I've got mine, fuck you".

More like, "I'd rather keep paying for my efficient private insurance than pay more for an inferior public monopoly like the VA or NHS."

Medicare as it currently exists can't even survive retirement of the full baby boom; even now, it has gotten sufficiently inadequate that supplemental insurance is pretty much required.

I have to agree with David, here, Medicare is vastly superior to private insurance. Your ideology is blinding you, Warren.

More likely yours is blinding you.

I dunno, Warren, the experience of other developed nations seems to suggest that, in the absence of a genuinely free market system (which would likely raise its own issues, albeit not the same ones), some form of universal insurance* would probably be cheaper and provide at least as good outcomes.

* An actual public monopoly along the lines cited by you (VA, NHS, etc.), less so.

It would be nice if those developed nations weren't so reliant upon us for their national security and so forth. How many large global commitments and defense agreements does the government France or any of the other developed nations have tied to them financially?

[Bob Butler 54]

(01-16-2017, 02:08 AM)Classic-Xer Wrote: It's way more cheaper for someone his age that's for sure. I don't think its vastly superior to the private insurance that I've had available to me as an employee and later provided for my employees.

I've shifted from health care as a work benefit, to Romneycare, to Obamacare.  The actual health care product seems pretty much the same.  I've gotten to chose my on primary health care provider, who has provided the same service without noticeable change.

The difference is in bureaucracy, paperwork and overhead.  My company sending payments to the insurance company was transparent.  Romneycare and Obamacare involved extra paperwork proving levels of income, residence, etc...  However, I ended up dealing with two levels of bureaucracy, the government and the insurance company.  The insurance companies work for profit, and take their cut off the top.  I'd as soon cut out one layer of overhead that provides no value added that I can see.

But the insurance companies seem to believe that taking a cut and adding to all medical expenses is their right.  Given a corrupt government that will favor business interests, getting rid of the extra layer of expense and overhead will be difficult.

[Bob Butler 54]

Trump is making some strong promises regarding the hypothetical TrumpCare.

CNN Wrote:Trump is making some big promises: His insurance reform will cover more people and cost less money.

"We're going to have insurance for everybody," Trump told The Washington Post. "There was a philosophy in some circles that if you can't pay for it, you don't get it. That's not going to happen with us."

"[They] can expect to have great health care. It will be in a much simplified form. Much less expensive and much better," he said.

But no details on what it looks like yet. I vaguely recall Hillary being similarly optimistic early on during her husband's time in office, at least before she encountered the realities of Congress. Can Trump's calling himself a Republican change anything?

Nice promises... or is it so much gaslight?

[Bob Butler 54]

(01-16-2017, 06:06 AM)Bob Butler 54 Wrote: Trump is making some strong promises regarding the hypothetical TrumpCare.

CNN Wrote:Trump is making some big promises: His insurance reform will cover more people and cost less money.

"We're going to have insurance for everybody," Trump told The Washington Post. "There was a philosophy in some circles that if you can't pay for it, you don't get it. That's not going to happen with us."

"[They] can expect to have great health care. It will be in a much simplified form. Much less expensive and much better," he said.

But no details on what it looks like yet.  I vaguely recall Hillary being similarly optimistic early on during her husband's time in office, at least before she encountered the realities of Congress.  Can Trump's calling himself a Republican change anything?

Nice promises... or is it so much gaslight?

The more I think on it, the more it feels like a Trump ploy similar to his threat to cancel the F 35.  "If you approve my health secretary, I will come out in favor of a real health plan initiative." The way he keeps promises, color me dubious?  

Still in wait and see mode.

[SomeGuy]

Quote:Three points here.

Ok, shoot.

Quote:First, perhaps the main reason they are cheaper is that alll the drug research is paid for by us, and they only pay the costs of manufacture.  Legalizing reimportation of drugs would fix that, making them pay their fair share of the research costs, and reducing the share we have to pay.

Agreed.

Quote:Second, their systems aren't like Medicare.  The most successful of the European systems, which is questionably more cost effective than our private insurance system after adjusting for drug prices mentioned above, essentially has the government paying for private insurance selected by the individual, and not paying the providers directly.  So the idea that Medicare for all is the way to go is highly questionable.

I meant simply as a way to go from here to there.  A Medicare as is for all would run into enormous fiscal pressures.  The payments would need to be reformed, and it is an open question how that would play out.

As for those European systems, hey, if it works, relies on private insurance and private care providers, why fix it?

Quote:Third, if we're going to have a major revamp of the system, why not move to a genuinely free market system, or at least closer to it?

I'd be curious to see what you had in mind.  Not that I am necessarily opposed, mind you.

Quote:It would be nice if those developed nations weren't so reliant upon us for their national security and so forth. How many large global commitments and defense agreements does the government France or any of the other developed nations have tied to them financially?

Xer,
French global committments might surprise you, most of the others?  Probably not so much.  Of course, since they (pretty much all of them) actually spend LESS as a fraction of their GDP on healthcare, and much of our national security spending over at least the past 15 years has been a bit of boondoggle, I'd say it's not really relevant, is it?

[David Horn]

(01-15-2017, 05:42 PM)Warren Dew Wrote: Actually there are more and more doctors that do not accept Medicare.  With the current cost control system, which mostly consists of reducing reimbursements, it won't be too long before only hacks accept it.  You may not live long enough to see that, but I likely will.

So you are predicting that healthcare will cost even more in the future, because more for the providers has to come from somewhere.  You can't have low cost insurance with high payouts, unless you print the missing money or tax somebody to get it.

[David Horn]

(01-15-2017, 07:35 PM)Classic-Xer Wrote: 1 wasn't whining. Shame on you, you keep screwing up and approaching me as if I'm a kid or something.  I was trying to teach you some respect for those like me who are supporting you now. Like everything, obligations only extend so far and only last for so long.

I paid until the day I retired, last April 1st.  I didn't like paying either, but I understand the generational transfer concept.  You receive benefits when you need them, but pay for them when you can.  If you want to change the formula to reset the eligibility age to zero, count me in.  I'm not sure how to get there, but it is where we need to go.

[David Horn]

(01-15-2017, 10:58 PM)Warren Dew Wrote: Expecting welfare and entitlement recipients to have respect for taxpayers is like expecting slave owners to have respect for their slaves.

Seriously?  I only started to collect after 50 years of paying-in.  You may have the same option if you live long enough and don't go brain dead and refuse.

[David Horn]

(01-15-2017, 11:05 PM)SomeGuy Wrote: I dunno, Warren, the experience of other developed nations seems to suggest that, in the absence of a genuinely free market system (which would likely raise its own issues, albeit not the same ones), some form of universal insurance* would probably be cheaper and provide at least as good outcomes.

* An actual public monopoly along the lines cited by you (VA, NHS, etc.), less so.

The NHS gets pretty high marks.  I know very few Brits who would opt for other choices, and I know a lot of Brits.  The VA has always had funding issues (the free-market types hate it), so evaluating it in honest terms is impossible.

[David Horn]

(01-16-2017, 02:08 AM)Classic-Xer Wrote:

(01-15-2017, 08:23 PM)Odin Wrote: I have to agree with David, here, Medicare is vastly superior to private insurance. Your ideology is blinding you, Warren.

It's way more cheaper for someone his age that's for sure. I don't think its vastly superior to the private insurance that I've had available to me as an employee and later provided for my employees.

I had Cadillac coverage through my last employer, and Medicare with Medigap is better.  Other than my premiums, my total out of pocket is $166 a year, and there is no such thing as "out of network".

[David Horn]

(01-16-2017, 02:20 AM)Warren Dew Wrote: Three points here.

OK

Warren Dew Wrote:First, perhaps the main reason they are cheaper is that all the drug research is paid for by us, and they only pay the costs of manufacture.  Legalizing re-importation of drugs would fix that, making them pay their fair share of the research costs, and reducing the share we have to pay.

But we selectively disallowed that as Big Pharma made sure it was excluded.  I agree, lowering drug prices would be a big plus, but re-importation is not the way.  Just negotiate directly.

Warren Dew Wrote:Second, their systems aren't like Medicare.  The most successful of the European systems, which is questionably more cost effective than our private insurance system after adjusting for drug prices mentioned above, essentially has the government paying for private insurance selected by the individual, and not paying the providers directly.  So the idea that Medicare for all is the way to go is highly questionable.

What systems are those?  Only the Swiss and the Japanese do that, and neither is the best-of-the-best.  The two best are typically the Italians and French.  I'm less familiar with the Italian system, but the French employ private providers but pay a fixed rate for services.  I believe they also use private concerns for billing, which is not what you described.

Warren Dew Wrote:Third, if we're going to have a major revamp of the system, why not move to a genuinely free market system, or at least closer to it?

There is no such thing as a free market in healthcare, any more than there is in policing -- and for the same reason. The market is good at providing goods and services we desire, but mandatory demand services are not part of that model. How do you shop around for the best emergency room following a car accident or heart attack? You don't! How do you shop for services you don't really understand, when the entire knowledge base resides with the providers? You don't! What is the price of a new hip? You don't know, and, apparently, the providers don't either. The 'price' can vary by several hundred percent.

Why you neoliberals seem unable to understand that is beyond me.