“You call up doctors and ask the price…”

[FlyerInHi]

We do want to pay the bills. Republicans don’t; so it’s their job to explain to us and make good on their promises.

Obamacare, is an imperfect program to put more resources into covering more people. It succeeded

[no_such_reality]

No, at $19.8 Trillion in debt today and a debt increase of over $7 Trillion in the budgets Obama led and $9 Trillion since he took office, they really don’t.

It’s kind of like the complaints on the last tax cut proposal where Dems complain that the “rich” get 70% of the cuts.

Of course, that “rich” is people making over $100K. That same group pays 80% of the income tax.

[FlyerInHi]

NSR, your response is all semantics and undercut your own argument.

Getting a loan to buy a house or send your kids to college or paying for health care is paying the bills. Democrats always acknowledged that there would be deficits to fund needed programs. We can afford them and the free markets agree. Democrats want to increase taxes and balance the equation (your argument). Who the “rich” are is irrelevant to math.

Republicans don’t agree that we can afford deficits, and I can respect that. they keep on saying we need to balance the budget and pay down the debt. Ok fine. The hypocrisy is that they want to increase military spending and spend $1 trillion on infrastructure. Let them explain how

What’s more, Trump promised a terrific cheap health care for everyone. I’m afraid the Republicans have to balance the equation you laid out. Certainly a more complex equation…. but I’m afraid Trump supporters didn’t really do well in math. So they might get screwed.

[no_such_reality]

Again, I’m not arguing for Trump.

And there is difference between getting a mortgage and using a credit card for monthly expenses.

Our deficit spending has been using a credit card and not getting a mortgage for a major investment like a house, IMHO.

That’s not paying the bills.

The people like Warren Buffett are few and far between that are saying ‘my taxes should be raised”. The bulk is someone else should be paying more taxes.

As for ACA, it may have serious flaws, but those flaws aren’t any worse than the flawed system we had before and it could be improved. IMHO, the current Repubs won’t do that, they can’t because they’ve been so busy screaming it’s a disaster that they chugged a gallon beer and then superglued their cocks to the new third rail of politics.

Some minor changes would make a lot of difference IMO. Add a high deductible option to the available plans for everyone. Change the law so companies like Mylan can’t sextuple price and the offer coupon to cover the co-pay. Change other laws so that people like Shkreli can’t acquire treatments and then increase their costs 10X. Let the insurance companies compete by having Medicare offer the option for under 65 to buy in at cost.

Those are starts.

The replacement won’t be anything like that though. They’ve painted themselves in a corner.

[FlyerInHi]

Yep, you cannot argue for austerity and paying down the debt while spending at the same time.

We can disagree on the wisdom of spending, but the remedy must match the illness.

Math wise, other developed nations and even lower income countries such as Thailand, have universal health care at a lower spending to GDP, thanks to government run health care such as VA (Medicare is private). They are able to balance the equation, have longer life expectancy, and provide universal health care all at the same time.

If we, as a country, don’t want universal health care, we should just be honest and say “screw you” to those without. That’s the simplest math and logical argument.

[no_such_reality]

Yes, they balance the equation. NHS in the UK is planning on having their first two proton therapy centers in operation by 2018. Conversely, California at half the population has 3, err maybe 2 since one just filed for bankruptcy. The USA has 22 in operation and 18 under construction.

You can get proton therapy through NHS currently, certain patients deemed necessary are sent overseas for treatment.

The other half is simple too, take Mylan, one client in the UK, they don’t pay that. Mylan can choose, not sell it or take the lower rate. Guess which they do?

That’s the balance.

That’s the reality people don’t want to own up to on insurance and healthcare spending.

IMHO, insurance works best for those things that are rare (home fire, burglary, etc. i.e. your basic home insurance) or catastrophic.

They don’t work well for those things that are routine.

[FlyerInHi]

The equation should be solved for maximum aggregate health in a cost effective manner, not some technologies and drugs that we can point to and say “ah ha, we are the best.”

NSR, you said earlier that the buffet should not be unlimited. The Japanese all-you-can-eat places make you eat everything you order so you don’t waste food. It’s all you can eat, but you’re not allowed to waste.

As Obama said, if we were to start from scratch we would do it differently. We would decide what % of GDP to spend and how to most effectively allocate the resources.

[no_such_reality]

[quote=FlyerInHi]The equation should be solved for maximum aggregate health in a cost effective manner, not some technologies and drugs that we can point to and say “ah ha, we are the best.”

[/quote]

Those are death panels, LOL. JK, I agree with your sentiment, but that highlights the problem. Aggregate effectiveness is great until you’re on the secret VA patient waiting list or your kid is on the 4 year wait list in the Canadian Province for early childhood intervention.

The masses don’t like that because they’re *sure* it means they’ll get denied the treatment they need by Big Brother.

[quote]
NSR, you said earlier that the buffet should not be unlimited. The Japanese all-you-can-eat places make you eat everything you order so you don’t waste food. It’s all you can eat, but you’re not allowed to waste.

As Obama said, if we were to start from scratch we would do it differently. We would decide what % of GDP to spend and how to most effectively allocate the resources.[/quote]

My buffet analogy was poorly worded, I did say pile it on, what I really was thinking was pile on whatever I want. Which then of course gives of the Doctor, Patient, Insurance game of ‘justifying’ medical necessity.

And we have our 1 in basically 2 people with chronic conditions ranging from hypertension to diabetes. Unfortunately our system has made those incredibly expensive. Our insurers are paying out $10,000 more per person with diabetes compared to one without.

The UK spends about $4000…

Hence we expect the buffet to take those chronic conditions and pay for them, because we’ve made them too expensive to pay for ourselves.

[FlyerInHi]

NSR, your argument is inconsistent.

In order to make make the math work, we need a good mechanism to ration care, administratively or market wise. That’s the way it is with everything.

What the right does very very well is make people very afraid of death panels or terrorism. With that there discard their own belief that nothing is 100% safe. The cost to get to 100% are simply too great and freedom killing.

But they don’t program to encourage better lifestyle habits. Or they don’t like the EPA or environmental regulations that improve health.

BTW, people in Canada are satisfied with their health care. My Canadian friend/neighbor in Vegas who can afford to leave his condo empty most is year had to wait 1 year for knee surgery. He was administratively rescheduled several times. When I told him premiums in USA would be north of $1000 his reaction was “Good God!, I’ll stick with my wait.” Nothing prevents him from paying extra for private insurance.

NSR, just talk to people who are older, independent contractors, small business people or their employees, or even younger retirees who don’t get Medicare. They’d be in a world of hurt if ACA were repealed.

[no_such_reality]

Again, I’m not saying ACA should be repealed. I’m saying why the current congress won’t be able to fix it.

AKA, they’ve glue their nuts to the third rail.

We as a people want Caesar’s Bacchanal Buffet, but we want to pay the Port O’ Call price.

So your statement [quote]In order to make make the math work, we need a good mechanism to ration care, administratively or market wise. That’s the way it is with everything.[/quote] is correct.

And that is what will make people scream bloody murder.

If we don’t do that, and we keep the stuff people want, guaranteed coverage, no gouging sickies, your ‘kid’ can ride your plan until they’re 26, its costs $$$$. Oh wait people don’t like it costing $$$$.

Anecdotally, I know people in Canada that were very happy with their health care, the they weren’t. The reason is simple, they hit one of the gaps.

For years I’ve been saying we ration healthcare, we’ve just been choosing to let for profit insurance do it under the guise of low cost insurance.

Again, we need to focus on the cost bending part of the equation. Government entering as an insurance provider is one way to do and leverage medicare and VA buying to drive costs down.

Changing laws to prevent Epi-pen gouging is another. Changing others to prevent Shrkeli is more.

Simplifying the administrative burden is a third.

And making people pay, is the forth.

And finally, change the law so the the providers need to publish a cash up front price and frankly, that price needs to be lower than insurance provided rate (which conflicts with laws on Medicare and other things). What we have today is backwards. You want outpatient surgery? The hospital charges are $30,000. It’s $20,000 if you pay cash up front. And if you have insurance, the insurance will pay $15,000 and you have $1500 co-pay… Broken.

[Anonymous]

The “cash up front” portion of healthcare spending is insignificant to the debate. The market prices will always be determined by the large payers: government and insurance companies. There’s no credible solution that will not be structured around these large players.

Very few consumers are ever going to effectively negotiate the cost for their services. It doesn’t happen in any developed nation with modern healthcare. Talking about the “cash price” of care is a waste of time.

Any credible solution must provide group coverage for everyone: Everyone is in a risk pool and everyone benefits from group negotiating power. Groups can be defined by government or private insurance, but nobody should be isolated from a risk pool.

There are lots of other details to work out, but group coverage has to be the foundation of the approach.

Yes we know what we had eight years ago was broken. And we know that ACA was an imperfect but substantial move toward a system that is far less broken. Undoing ACA removes the foundation and replaces it with nothing.

And we know that the Republican changes, when we ever see them, will be a step backward. The only thing they could do that to improve healthcare would effectively be “ACA plus” – but they cannot do that now because they dumped so much poison the Obamacare foundation.

[FlyerInHi]

NSR here’s an interesting read about health care Thailand, a poor country. It shows how screwed up we are; and we are RICH!
http://www.worldbank.org/en/news/feature/2012/08/20/thailand-sustaining-health-protection-for-all

I’m lucky enough to have good insurance through other means, but what if I were an independent contractor? What if you’re a 60 year old family farmer with some employees, or a computer consultant with a chronic condition without Obamacare. Fine if you’re making plenty of money, but health care is a hardship for those trying to make ends meet.

Actually to relate to real estate, I’d be interested in knowing how realtors get health insurance, if not through a spouse or some other employment. Maybe they belong to some association

Oh, on NHS in UK, people voted for Brexit because they want to spend more money on NHS. Voters were promised that money sent to Brussels would instead go to NHS. I wonder if Trump voters really want an NHS type system here.

[no_such_reality]

I’m curious what you think that article is telling us?

[an]

[quote=no_such_reality]We as a people want Caesar’s Bacchanal Buffet, but we want to pay the Port O’ Call price.[/quote]Way over priced for mediocre food. Perfect analogy though. I would much rather eat at Mon Ami Gabi. Much much better food and is cheaper.

[FlyerInHi]

Let’s forget about what anyone of us think should be.

What about the latest republican plan? Workable or not?

IMO, the tax credits won’t work. And the plan for the Federal government to advance the money to insurers overly complex.

https://www.washingtonpost.com/powerpost/new-details-emerge-on-gop-plans-to-repeal-and-replace-obamacare/2017/03/06/04751e3e-028f-11e7-ad5b-d22680e18d10_story.html?hpid=hp_hp-top-table-main_obamacare-415pm-winner%3Ahomepage%2Fstory&utm_term=.3e875d7ab40d

[Author]

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