Health care vote

User Forum Topic
Submitted by zk on June 20, 2017 - 4:57pm

I must confess ignorance.

The republicans are speeding toward voting to approve a health care bill that virtually nobody wants. It seems to me (but, like I said, I don't really know much about it, so I'm probably wrong) that there's nothing in this for republicans. Their base doesn't want it (although fox propaganda could change that). Con man don doesn't want it anymore. Anyway, he called it mean. Which I guess means he doesn't want it. Or maybe he just doesn't want to be held responsible for it. Even if con man don did want it, it wouldn't make sense to stick your neck out for him when he's shown a complete lack of desire to back you up when it's important. But he doesn't even want it!

I think it's silly when people go on the internet and ask questions to which the answers are easily googleable. You're on the internet, for god's sake! But I can't find the answer to this. Every article I read goes on and on about the conflict between trump and congress and the conflict within congress and how the public hates this bill (what little they know about it) and how the republicans are being opaque and how they're hiding this bill because they know it will be hated...well, everything except why the republicans are voting for this.

I'm not being snarky or trying to show how stupid the republicans are here (I do enough of that on other threads). I'm genuinely stumped as to why republicans are voting for this, and I'm extremely curious about it, and I hope somebody out there can enlighten me.

Submitted by scaredyclassic on June 20, 2017 - 6:02pm.

because they appear even more dumb by doing nothing?

the better approach, as in most things in life, would be to not do anything.

Submitted by ocrenter on June 20, 2017 - 6:58pm.

A lot of alcoholics must hit rock bottom before they finally wise up and seek the help they really need. One guy had to fall down the stairs a few times and it wasn't until he ended up in the ICU did he finally quit.

Looks like that's what it takes for us as a nation when it comes to health care too.

Submitted by harvey on June 20, 2017 - 8:26pm.

ocrenter wrote:
A lot of alcoholics must hit rock bottom before they finally wise up and seek the help they really need.

A lot of them do, but most of them just die from liver failure.

But I admire your optimism.

Submitted by FlyerInHi on June 21, 2017 - 5:42pm.

Republicans don't care about what's good for people.
But they can sell any vote as repeal or fulfilling a promise and their base will buy it. So why not?

Anyway, I'm no longer American in the sense of caring for my compatriots. Screw the red states. Let them have what they voted for. They'll be opioid addicted without healthcare. Serves them right!

The blue states will likely come up with something at the state level so it won't be as bad in California. Plus we have a large population with economies of scale.

Submitted by XBoxBoy on June 21, 2017 - 6:18pm.

zk wrote:
I'm genuinely stumped as to why republicans are voting for this, and I'm extremely curious about it, and I hope somebody out there can enlighten me.

The Republicans have got themselves in a bind on this one. It was easy and convenient when they were not in power to bad mouth Obamacare. It was even easier to rally their supporters with talk about how Obamacare was a mess, how they would repeal it, etc.

But now the tables have turned and the Republicans are in power and they have a simple choice. 1) Repeal and/or replace Obamacare or 2) Look incompetent and stupid for railing against a bad policy, promising to change it but then not doing so.

Obviously option 2 is a bad choice. You never want to look incompetent and stupid when you are in power.

Which leaves us with option 1, repeal and/or replace Obamacare. If they simply repeal Obamacare that's going to be unpopular because many who make up their base are actively enjoying the benefits of Obamacare and if you take that away, that will be unpopular.

If you want to replace Obamacare, then you probably want to try and fix the problems in it. And that's where things get really problematic. There are two issues with that. First are the ideological issues. Some Republicans are angry that the govt is now giving payments to pay for poor people's health care. Ending that doesn't play well in the news.

The second problem is that Obamacare forces people to buy health care. Which wouldn't be so bad except in case you hadn't noticed, health care costs have been climbing worse than housing costs in 2004. (Maybe that's not technically correct, but you get the idea)

So the Republicans need to figure out a way to limit the cost of health care. And that is a huge issue that there is no good answer to.

So here's the deal: The Republicans promised everyone they would repeal Obamacare and replace it with a great program that everyone would love. They used this repeatedly during their campaigning. Now they are in power they need to deliver on this promise. But there is no good way to do this.

So why vote? Well, they sort of have to. It's like the political world has double dared them. But note that they are all scrambling for cover as they prepare to vote. No one wants to own responsibility for whatever gets passed.

The bottom line is that the Republicans will probably be hurt by the vote, but they'll be hurt even more if they don't vote. It's a choice of the lesser of two evils.

Submitted by zk on June 21, 2017 - 6:54pm.

XBoxBoy wrote:
zk wrote:
I'm genuinely stumped as to why republicans are voting for this, and I'm extremely curious about it, and I hope somebody out there can enlighten me.

The Republicans have got themselves in a bind on this one. It was easy and convenient when they were not in power to bad mouth Obamacare. It was even easier to rally their supporters with talk about how Obamacare was a mess, how they would repeal it, etc.

But now the tables have turned and the Republicans are in power and they have a simple choice. 1) Repeal and/or replace Obamacare or 2) Look incompetent and stupid for railing against a bad policy, promising to change it but then not doing so.

Obviously option 2 is a bad choice. You never want to look incompetent and stupid when you are in power.

Which leaves us with option 1, repeal and/or replace Obamacare. If they simply repeal Obamacare that's going to be unpopular because many who make up their base are actively enjoying the benefits of Obamacare and if you take that away, that will be unpopular.

If you want to replace Obamacare, then you probably want to try and fix the problems in it. And that's where things get really problematic. There are two issues with that. First are the ideological issues. Some Republicans are angry that the govt is now giving payments to pay for poor people's health care. Ending that doesn't play well in the news.

The second problem is that Obamacare forces people to buy health care. Which wouldn't be so bad except in case you hadn't noticed, health care costs have been climbing worse than housing costs in 2004. (Maybe that's not technically correct, but you get the idea)

So the Republicans need to figure out a way to limit the cost of health care. And that is a huge issue that there is no good answer to.

So here's the deal: The Republicans promised everyone they would repeal Obamacare and replace it with a great program that everyone would love. They used this repeatedly during their campaigning. Now they are in power they need to deliver on this promise. But there is no good way to do this.

So why vote? Well, they sort of have to. It's like the political world has double dared them. But note that they are all scrambling for cover as they prepare to vote. No one wants to own responsibility for whatever gets passed.

The bottom line is that the Republicans will probably be hurt by the vote, but they'll be hurt even more if they don't vote. It's a choice of the lesser of two evils.

I'll buy that. Thanks.

I get that there's no answer to the health care problem that would make republicans look good (or even not bad). But why wouldn't it be a less-bad option than voting for the current bill to write a bill that, while not perfect or even good, at least eschews huge tax cuts for the rich while at the same time not screwing quite so many poor people? I mean, are they really that beholden to rich donors that they'd rather look completely heartless while pissing off almost the entire country than piss off their rich donors? That's not a rhetorical question. Maybe they're not that beholden. I don't know. I'm asking. Maybe I'm missing something.

Submitted by FlyerInHi on June 21, 2017 - 8:58pm.

xbox' analysis is very fair.

Republicans are more beholden to their ideologies than anything. I don't believe the big donors care about health care so long as they get lower taxes.

Problem with health care is that the markets don't work for a social need. The only answer is not single payer, but government run health care for the poorest to average American, with private insurance for the better off. People should be able to just show their social security card at a state clinic to get care. No need for insurance.

I personally have a lot of fun with my Republicans friends. When they bitch about something I use laissez faire profit motive reasoning to make my point. They are so beholden to ideology that they will shut up rather than contradict free market economics even on grounds of compassion or human rights. They will never admit that free markets don't solve all problems, and are appropriate only in some circumstances.

I have most fun with Republicans who bitch about the cost of housing. If you can't afford it, it means the free markets (as is they were a law of nature) decided you don't deserve it.

Submitted by harvey on June 28, 2017 - 10:27pm.

XBoxBoy wrote:
So the Republicans need to figure out a way to limit the cost of health care. And that is a huge issue that there is no good answer to.

There's no good answer only if you ignore the approach used by the rest of the developed world.

So yeah, Republicans have no good answer.

Submitted by moneymaker on June 29, 2017 - 4:31am.

I find it very ironical that the US has the most expensive health care that is revered all around the world and yet when I read peoples experiences on medicine.net or other health care sites, doctors are constantly misdiagnosing people. I think most of you out there know what I'm talking about. So wouldn't it be better to build a better health care system that can get it right the first time and thus be more efficient. I think this approach really applies to everything out there and not just health care, car repair, cable companies, plumbers. 10 minutes with a patient just is not going to be enough time for a doctor to get it right most of the time, a more holistic approach would be better.

Submitted by ocrenter on June 29, 2017 - 6:57am.

moneymaker wrote:
I find it very ironical that the US has the most expensive health care that is revered all around the world and yet when I read peoples experiences on medicine.net or other health care sites, doctors are constantly misdiagnosing people. I think most of you out there know what I'm talking about. So wouldn't it be better to build a better health care system that can get it right the first time and thus be more efficient. I think this approach really applies to everything out there and not just health care, car repair, cable companies, plumbers. 10 minutes with a patient just is not going to be enough time for a doctor to get it right most of the time, a more holistic approach would be better.

Not to make excuses for those doctors, but patients frequently come in with a list of 5-10 problems expecting them to be addressed within a 15-20 minute visit, essentially expecting a 2 minute per problem efficiency and 100% accuracy. And don't forget the "oh-by-the-way" bomb on the way out that they expect fully addressed by the doorway.

The problem is the way things are structured. Someone is paying thousands of dollars for the insurance. Then another $50 for the copay. Of course they feel they are entitled to hit the doctor with as much questions as they can squeeze in. Which then lead to medical mistakes and excessive labs and studies, driving up cost even more.

This is a vicious cycle.

Bring the cost down with a single payer system, and people are not going to feel the need to milk that 20 minute visit for everything they got, and they might actually get good advice and more accurate diagnosis.

Submitted by livinincali on June 30, 2017 - 9:34am.

Nobody wants to fix health care because it will be bad politically. You need to address the cost side of the equation. If you do you instantly create a recession or possibly worse a depression. Health care represents about 20% of GDP right now. If you cut in half you probably put 2 to 3 million people out of a job in the short term. It would be good in the long run as those people would find other jobs that were more productive but it wouldn't be good in the short term. The problem is you face reelection in the short term. The one hope you might have from somebody like Trump is maybe he doesn't really care about reelection and might do something politically bad in the short term to fix the long term.

Submitted by harvey on June 30, 2017 - 11:13am.

livinincali wrote:
The one hope you might have from somebody like Trump is maybe he doesn't really care about reelection and might do something politically bad in the short term to fix the long term.

Lol, Trump is now as impotent as he is ignorant.

That's one of the core misconceptions of the Trump voter: that the president can just manate change.

Trump capitalized on the ignorance of of people who don't understand how our government works. He positioned himself as all wise and all powerful. People believed that the president simply needed to be "strong" to make things happen.

Trump's doing his job as if he were the CEO of a company he owned. That's why he's failing. He needs to be a leader, not a dictator. He doesn't know how to do that.

Submitted by treehugger on June 30, 2017 - 11:30am.

I agree with the perplexing nature of this health care bill. What I don't understand is why they don't have an Adaptive Management Plan? Have a roundtable of the brightest minds in the world from healthcare industry, social workers, doctors, etc. Bring in folks from all over the world that have government managed healthcare (Canada and Australia come to mind, I mean we speak the same language) Kaiser, blue-cross, United, whoever and review the existing bill highlight what works and put it in one pile then highlight what doesn't and put it in another. Keep and expand upon what works and move forward tweak or delete what doesn't and set up a committee of the best and brightest and at first they may meet daily, monthly, then quarterly, then annually. Continue to reform and adapt the plan to expand what works and delete or tweak what doesn't. yes it will probably take decades, but it would be progress.

I know I am naïve, but I am really tired of the stupidity that is my government.

Submitted by FlyerInHi on June 30, 2017 - 12:48pm.

livinincali wrote:
Nobody wants to fix health care because it will be bad politically. You need to address the cost side of the equation. If you do you instantly create a recession or possibly worse a depression. Health care represents about 20% of GDP right now. If you cut in half you probably put 2 to 3 million people out of a job in the short term. It would be good in the long run as those people would find other jobs that were more productive but it wouldn't be good in the short term. The problem is you face reelection in the short term. The one hope you might have from somebody like Trump is maybe he doesn't really care about reelection and might do something politically bad in the short term to fix the long term.

Haha, nobody is even proposing such.

that's like hoping Repuclicans would cut spending and pay down the debt from the savings.

Submitted by livinincali on June 30, 2017 - 1:05pm.

FlyerInHi wrote:
livinincali wrote:
Nobody wants to fix health care because it will be bad politically. You need to address the cost side of the equation. If you do you instantly create a recession or possibly worse a depression. Health care represents about 20% of GDP right now. If you cut in half you probably put 2 to 3 million people out of a job in the short term. It would be good in the long run as those people would find other jobs that were more productive but it wouldn't be good in the short term. The problem is you face reelection in the short term. The one hope you might have from somebody like Trump is maybe he doesn't really care about reelection and might do something politically bad in the short term to fix the long term.

Haha, nobody is even proposing such.

that's like hoping Repuclicans would cut spending and pay down the debt from the savings.

That's exactly the point and why I don't see the government ever fixing the health care issue in this country. We're never going to get to single payer because it would create a massive recession in the short term. A president could indeed choose to enforce Sherman and Clayton acts laws against health care providers that make it illegal to charge different people for the same services. That would help as you could probably force health care providers to adopt the approved medicare rates for all patients. It would simplify the billing procedure and they'd likely respond by laying off hundreds of thousands of administrator jobs related to billing and dealing with insurance rate negotiation. It would definitely help with the cost side of the equation but it would also probably put us in a recession.

So instead we get this nonsense that the republicans are working on right now. I.e. were going to act like were doing something without actually doing anything.

Submitted by FlyerInHi on June 30, 2017 - 4:47pm.

Livin', i woulld be happy with basic universal coverage and capping the growth of health care as the economy grows in the years ahead. Same with military spending.

Submitted by SK in CV on June 30, 2017 - 6:24pm.

livinincali wrote:

That's exactly the point and why I don't see the government ever fixing the health care issue in this country. We're never going to get to single payer because it would create a massive recession in the short term.

I don't buy the recession thing. Wouldn't happen. Health care jobs won't disappear. Health care admin jobs won't disappear. Both will increase. Dramatically.

Submitted by spdrun on June 30, 2017 - 7:03pm.

If the government can provide health care less expensively than the private mish-mosh we have, people would have more money in their pockets. Hardly recessionary.

Submitted by Reality on June 30, 2017 - 8:33pm.

SK in CV wrote:
livinincali wrote:

That's exactly the point and why I don't see the government ever fixing the health care issue in this country. We're never going to get to single payer because it would create a massive recession in the short term.

I don't buy the recession thing. Wouldn't happen. Health care jobs won't disappear. Health care admin jobs won't disappear. Both will increase. Dramatically.

Health systems and doctors make their money off private insurance. They are doing good to break even treating members of government payers (Medicare and Medicaid). Many doctors won't see these patients because they lose money on them.

Health systems would be put on a serious diet with single payer. Loss of jobs would be unavoidable.

Submitted by SK in CV on June 30, 2017 - 8:54pm.

Reality wrote:

Health systems and doctors make their money off private insurance. They are doing good to break even treating members of government payers (Medicare and Medicaid). Many doctors won't see these patients because they lose money on them.

Health systems would be put on a serious diet with single payer. Loss of jobs would be unavoidable.

True with regards to Medicaid for Doctors. Not for non-profit hospitals. They will trade uninsured for Medicaid patients in a heart beat. Check the financial status of non-profit hospitals in states that expanded Medicaid v. those that did not for evidence to support my claim.

Complete fallacy with regards to Medicare for docs in most specialties. Fallacy with regards to all hospitals and virtually all other allied health professions with regards to Medicare.

There is no way that adding 20 million to the insured ranks will decrease the number of health care providers or their income. Not. A. Chance. From the emergence of health insurance 100 years ago, it's rapid expansion to union workers in the 40's, to Medicare in 1963 and Medicaid in 1965, to the ACA a few years ago, every single change that increased the number of insured, has also increased the number of workers and their income in all medical fields. Every damn time. A move to single payer can't possibly be any different.

Submitted by FlyerInHi on July 1, 2017 - 7:47pm.

What was this Muslim doctor thinking, moving to Trump country? He should have known that people raised on certain values are irredeemable.

https://www.washingtonpost.com/national/...

Submitted by Reality on July 1, 2017 - 11:24pm.

SK in CV wrote:

True with regards to Medicaid for Doctors. Not for non-profit hospitals. They will trade uninsured for Medicaid patients in a heart beat. Check the financial status of non-profit hospitals in states that expanded Medicaid v. those that did not for evidence to support my claim.

It doesn't support your claim. Trading uninsured for government insured is one thing. Trading rich private insurance for government insurance is another. Providers would take a big hit.

Submitted by SK in CV on July 2, 2017 - 7:50am.

Reality wrote:
SK in CV wrote:

True with regards to Medicaid for Doctors. Not for non-profit hospitals. They will trade uninsured for Medicaid patients in a heart beat. Check the financial status of non-profit hospitals in states that expanded Medicaid v. those that did not for evidence to support my claim.

It doesn't support your claim. Trading uninsured for government insured is one thing. Trading rich private insurance for government insurance is another. Providers would take a big hit.

What claim did I make that it does not support?

Submitted by spdrun on July 2, 2017 - 8:46am.

It doesn't support your claim. Trading uninsured for government insured is one thing. Trading rich private insurance for government insurance is another. Providers would take a big hit.

Under any system that would pass in the US, private/supplemental insurance (think "Medigap") would also exist.

Submitted by SK in CV on July 2, 2017 - 9:42am.

spdrun wrote:

It doesn't support your claim. Trading uninsured for government insured is one thing. Trading rich private insurance for government insurance is another. Providers would take a big hit.

Under any system that would pass in the US, private/supplemental insurance (think "Medigap") would also exist.

Absolutely. And with only insignificant exceptions, Medicare is NOT a losing proposition for health care providers.

Submitted by livinincali on July 5, 2017 - 10:56am.

SK in CV wrote:
livinincali wrote:

That's exactly the point and why I don't see the government ever fixing the health care issue in this country. We're never going to get to single payer because it would create a massive recession in the short term.

I don't buy the recession thing. Wouldn't happen. Health care jobs won't disappear. Health care admin jobs won't disappear. Both will increase. Dramatically.

Well then you didn't fix the cost side of the equation. Why is health care so expensive in this country. Most of the money spent is going into somebody's pocket somewhere. If we're spending 3 trillion per year on health care and change that number to 2 trillion via single payer or whatever mechanism you can come up with, that's 1 trillion less dollars going into some person's pocket. Yeah the economy will reallocate the jobs and spending over time but it won't happen immediately. Health care spending is included in GDP. If I reduce health care spending dramatically via some solution or change then I've reduced GDP as well.

If what you say comes to pass and we increase the number of jobs in the medical sector how exactly will health care costs come down.

Submitted by ocrenter on July 5, 2017 - 12:00pm.

livinincali wrote:
SK in CV wrote:
livinincali wrote:

That's exactly the point and why I don't see the government ever fixing the health care issue in this country. We're never going to get to single payer because it would create a massive recession in the short term.

I don't buy the recession thing. Wouldn't happen. Health care jobs won't disappear. Health care admin jobs won't disappear. Both will increase. Dramatically.

Well then you didn't fix the cost side of the equation. Why is health care so expensive in this country. Most of the money spent is going into somebody's pocket somewhere. If we're spending 3 trillion per year on health care and change that number to 2 trillion via single payer or whatever mechanism you can come up with, that's 1 trillion less dollars going into some person's pocket. Yeah the economy will reallocate the jobs and spending over time but it won't happen immediately. Health care spending is included in GDP. If I reduce health care spending dramatically via some solution or change then I've reduced GDP as well.

If what you say comes to pass and we increase the number of jobs in the medical sector how exactly will health care costs come down.

Huge % of cost is in pharmaceutical and specialty cost.

Let's say right now 5/10 patients with knee pain goes to the orthopedic surgeon directly. And orthopedic surgeon is charging $100 per visit instead of the $50 per visit at the generalist. If you force the 10 patients to all see the generalist, and only the one needing surgery is referred to the specialist, that would be a difference of $600 vs $750.

Now let's say instead of 5/10 of these patients all getting an MRI, which is say $1000 (you got to pay the radiologist), only 2 of the 10 got the MRI, now the difference is $2600 vs $5750.

Next, let's say 5 of the patients got a steroid injection at $30 each, vs the Synvisc injection at $300 each, the difference is now $2750 vs $7250.

FYI, Synvisc injections are not proven to help any more than steroid injections. Further more, most MRIs are done as therapeutic treatment of patient's anxiety about their particular joint pain.

I can go on and on about the potential savings. Does changes like the above reduce income for the local orthopedic surgeon and radiologist, you bet, but they are not going to be in the poorhouse, that I can guarantee. But true impact on jobs would be minimal, except the drug company pusher that provides the free lunch and luxury box seat to the local sporting event, he or she will certainly get the axe.

Submitted by harvey on July 5, 2017 - 1:32pm.

If efficiencies and cost savings led to recessions then most of economic history would have been a recession.

Submitted by ocrenter on July 5, 2017 - 2:08pm.

harvey wrote:
If efficiencies and cost savings led to recessions then most of economic history would have been a recession.

Health care doesn't lend itself to unbridled free market forces. It is beyond easy to scare the client into doing a whole bunch of expensive and worthless treatments and procedures. In fact, client expectation is the expensive stuff. Efficiency can only come about from single payer forcing discipline in cost control.

Submitted by livinincali on July 6, 2017 - 6:00am.

ocrenter wrote:
harvey wrote:
If efficiencies and cost savings led to recessions then most of economic history would have been a recession.

Health care doesn't lend itself to unbridled free market forces. It is beyond easy to scare the client into doing a whole bunch of expensive and worthless treatments and procedures. In fact, client expectation is the expensive stuff. Efficiency can only come about from single payer forcing discipline in cost control.

Free markets could solve a lot but not all of the cost side. For example allowing somehow to open an MRI imaging facility assuming they hired the necessary licensed personal would lower the cost of MRIs but Certificate of Need licensing prevents that from happening. Forcing medical providers to post prices would allow customers to shop around.

Forcing medical providers to eat the costs of their own mistakes would help. I.e. if I elect to have knee surgery for an aching knee if I get an infection while under the care of said hospital they would eat the cost of treating the infection and extra days in the hospital but instead they currently get to charge people for that.

Allowing a business that is licensed to purchase drugs in India or somewhere else where the drug company sets them much lower and re-import them here would drastically lower the price of drugs here. These are all free market forces that would lower the cost of health care here.

Forcing health care providers to post prices and always charge that price would effectively lower health care costs. If you want Medicare patients you bill everybody the Medicare price or you choose not to have any medicare patients. If you can't make if with the medicare patients or without them because you have a lot of debt or outlays you go out of business and somebody buys your assets for pennies on the dollar and can make a profit at the medicare rates.

All of those free market forces would work to lower health care costs. Single payer is just an alternative to that and one that's likely less efficient. It would probably work and it might involve slightly less disruption.

In the end though Health Care revenue is a component of GDP. If you lower the cost of health care you've lower health care revenue and GDP. By definition lower GDP means we're in recession. Health care primarily is a service provided by people. If you materially reduce health care costs you are most certainly are either laying people off or reducing their salaries by a material amount. This is math not theory.

Comment viewing options

Select your preferred way to display the comments and click "Save settings" to activate your changes.