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#310775 - 02/06/19 04:33 PM Re: Healthcare [Re: NW Ponderer]
Jeffery J. Haas Offline

It's the Despair Quotient!
Pooh-Bah

Registered: 08/03/04
Posts: 14002
Loc: Whittier, California
Originally Posted By: NW Ponderer
There are a number of Medicare-for-all plans out there. I think the 2020 race is going to be the public debate over them. The two that I think make the most sense are the "public option" ones and the "Medicare at 55" plans, because they do a good job of boiling the frog. But we shouldn't mistake Medicare for a universal healthcare plan, any more than the ACA. The ACA has gotten a bad rap because it is actually too close to Medicare, in reality.

Medicare really isn't "single-payer," since there are many costs to the recipient: premiums, co-payments, cost-shares, deductibles. (I just paid $346 yesterday for one medication for my wife.) Medicare costs for 2019 and, according to Kaiser family health, 34 percent of enrollees are in a "Medicare advantage" plan: Medicare vs. Medicare Advantage. There are also Medicare supplement, or "Medigap", insurance plans. So, private insurance is a big part of "Medicare" as it exists in the real world, and Medicare is far from "free health care". It is subsidized healthcare. Medicaid-for-all is closer to what many advocates want, but that doesn't have the same good reputation.


Imagine how much you could save if Medicare was allowed to negotiate prescription drug prices.
Look, I've priced medigap plans because I know they're in my future, a lot of people have. On the whole, it boils down to a much more affordable arrangement than what I would have if I had to be in the marketplace right now. I know what my older brother paid prior to his 65th birthday, which was in 2016.
_________________________
The only people pushing the Athenian Straw Man Nonexistent Threat of Slippery Slope Windyfoggery (ASMNSSW) RE DEMOCRACY are people who have a misunderstanding/problem or hatred of democracy. (See AUTHORITARIANS)

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#310777 - 02/06/19 07:25 PM Re: Healthcare [Re: chunkstyle]
jgw Offline
enthusiast

Registered: 05/22/06
Posts: 2534
Loc: Port Angeles, WA
Because its a cop out. Medicare for all would bankrupt the country in no time. Drugs can't be negotiated, everybody couldn't afford the co-pays,etc.

A VA for all would make more sense as they actually have already cut the costs of healthcare by something between 25% and 50% (the figures move depending on who is offering them and has much to do with the ongoing, and kind of disasterous, efforts to privatize).

I should probably also add that a lot of the VA problems stemmed from the inability of managers to fire (congress did that one I think). Anyway, that is fixed. They also had lousy oversite which, I think, has got better. The simple fact is that single payer is the really fair way to do this. Gov CAN run stuff well, if they get the oversite they also need (not unlike most agencies and congress is the oversite, when it works)

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#310778 - 02/06/19 07:40 PM Re: Healthcare [Re: jgw]
jgw Offline
enthusiast

Registered: 05/22/06
Posts: 2534
Loc: Port Angeles, WA
Continuing with any part of a for profit healthcare system is just nuts. Its not working now and its not going to work in the future as good old fashioned American greed just gets in the way. Same with Medicare which has a pretty bad history of controlling things. The nation needs a better deal. Our for profit healthcare system is also waaaay too expensive! All this talk of socialism is just wrong. The Dems did that one all on their own and some of the newly elected don't even understand what real socialism is (gov own ALL production sources).

All we will hear, from the Right, is "Socialism". The left has to change its vocabulary instead of waving red flags. "for profit healthcare is BAD" (and too expensive, and failing, and needs serious oversite) might help. "Socially responsible gov actions" followed by others that are in place and work, ie. police, firemen, public schools, libraries, food stamps, etc. Some work better than others or could work better but that is an ongoing thing with them all! The trick, of course, is to set it up, make the rules, watch it like a hawk, and seriously resist any rules and/or regulations that are political. I firmly believe that we, and gov, can do better.

When we see the rest of the developed world providing better healthcare at, at least, half of our cost the it just makes sense to study what they are doing, cherry pick and build one of our own. This is not socialism, its just a social responsibility that we all need to understand.

I feel the same way about the war on drugs - The nation of Portugal solved that one almost 20 years ago!!!

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#310779 - 02/06/19 07:50 PM Re: Healthcare [Re: jgw]
NW Ponderer Offline
Moderator
Carpal Tunnel

Registered: 09/09/11
Posts: 16814
I do imagine that. I do that a lot.

On a separate, but important, line, I have been following an exchange/debate that arose from a congressional hearing:

Quote:
AOC on Pharma & Public Funding
Posted by Lisa Ouellette
Congresswoman Alexandria Ocasio-Cortez has already gotten Americans to start teaching each other about marginal taxation, and now she has started a dialog about the role of public funding in public sector research:
here's how it started:

Quote:
This week I conducted my first-ever line of questioning at an Oversight committee hearing, which focused on the skyrocketing costs of pharmaceuticals.

Hereís what happened
AOC Twitter post

And here's where it went:

how it really works;

Ocasio-Cortez fires back;

Written Description (blog).

If you have the time, this is an important discussion to deal with.

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#310784 - 02/07/19 10:26 AM Re: Healthcare [Re: jgw]
pondering_it_all Offline
veteran

Registered: 02/27/06
Posts: 8644
Loc: North San Diego County
That's how it works on state-of-art cancer drugs sometimes. The drug companies have to try lots of things to get a good one. But think about Tecfidera instead:

Dimethyl Fumerate had been used for psoriasis treatment for decades and was generic. A drug company thought "Why don't we see if it works for other autoimmune diseases?" They didn't have to try lots of variations, because they could just buy it right off pharmacy shelves. It's toxicity was known already. They could just run some trials where they gave it to patients with Rheumatoid Arthritus, Sjogren's Syndrome, Multiple Sclerosis, and so on. Did they pay those patients a lot of money? Probably not. In fact, I bet they paid them nothing. Also, I assume they made their own Dimethyl Fumerate since it is easy and costs about $5.00 to make one patient's for one year. So then they just sat back and collected data. After a few years, they looked at the data, and low and behold it seemed to work pretty well for MS.

So then they expanded their trial and gave it to a lot more MS patients. A few more years and it proved to work pretty well and just a couple of people died of a brain virus. (It is an immune system suppressant.) Then they got FDA approval for prescribing for MS and voila: A drug that they can charge $65,000.00 a year for. It works as well as the other MS drugs and unlike most of them it's just a cheap twice a day capsule. So they make millions of dollars (billions?) because the insurance companies have to pay something near the full price and Medicare has to pay full price. They get exclusivity for some number of years, and even better for some reason they get to sell it to all the psoriasis patients at full price, even though they were getting it dirt cheap for decades before!

There are lots of drugs that are NOT brand new magic cancer bullets. Like EpiPens: Two dollars worth of epinephrine in an autoinjector. Let's jack up the price to $300! We'll make some real dough, even though it costs us nothing in new development costs. And even though syringes suitable for epinephrine injection cost about 35 cents.

BTW, I actually worked in medical research at a major university medical center for 11 years. Those "huge costs" to do the work? I never made more than $35K per year. I see people with my last job level are now making about $47K per year.

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#310785 - 02/07/19 12:08 PM Re: Healthcare [Re: jgw]
chunkstyle Offline
member

Registered: 10/02/07
Posts: 1594
Originally Posted By: jgw
some of the newly elected don't even understand what real socialism is (gov own ALL production sources).


You keep equating state capitalism with socialism. A common mistake.

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#310786 - 02/07/19 12:11 PM Re: Healthcare [Re: jgw]
chunkstyle Offline
member

Registered: 10/02/07
Posts: 1594
Originally Posted By: jgw
Because its a cop out. Medicare for all would bankrupt the country in no time. Drugs can't be negotiated, everybody couldn't afford the co-pays,etc.


So allow Medicare to negotiate drug prices

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#310787 - 02/07/19 12:15 PM Re: Healthcare [Re: jgw]
chunkstyle Offline
member

Registered: 10/02/07
Posts: 1594
Anyone notice that healthcare debate has focused on drug pricing, much like Pelosi wants it.......
That's odd

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#310790 - 02/07/19 03:18 PM Re: Healthcare [Re: jgw]
rporter314 Offline
old hand

Registered: 03/18/03
Posts: 6741
Loc: Highlands, Tx
it is only one aspect of the cost driven industry. Here area couple of stats ... drugs account for 18% of HC costs and more specifically account for 12% in cancer treatments. The reader can find their own stats, as I use these as a relative indicator. Like wise one can find stats on other cost drivers like hospitals, doctors, and possibly one overlooked variable, over-utilization. Questions of newer high tech treatments versus traditional outcomes, is the cost worth it? or to look at it another way, don't compare costs if you want the enhanced outcomes despite the higher costs.

This is far more complicated than simply thinking we should have affordable HC.
_________________________
ignorance is the enemy
without equality there is no liberty

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#310791 - 02/07/19 04:25 PM Re: Healthcare [Re: rporter314]
NW Ponderer Offline
Moderator
Carpal Tunnel

Registered: 09/09/11
Posts: 16814
I do think the considerations need to be holistic. Whenever there are major changes to a "system" there are lots of unintended consequences, or "second- and third-order effects" as we would call them in military planning. For example: More people going to doctors means demands for doctors goes up, they're busier so demand more pay, wait times get longer, med schools have to recruit more, etc., etc., and down the chain. The job of legislators is to consider as many of these possibilities as possible, and adjust to real world conditions.

When the ACA was set up, many of these effects were anticipated. Others were not. But, over all, they did pretty well. Ideology got in the way, though, and A LOT of disingenuous arguments were made, countereffective strategies were enlisted, and adjustments were thwarted. The result was a godawful mess.

We can anticipate a similar pattern for any future plans, especially in this ideology-driven, fact-phobic environment. The question put to Kamala Harris about private health insurance is a good example. It wasn't just putting the cart before the horse, it was jumping the shark. There isn't even a concept on the table, yet!

That's why I prefer the "public option" approach. We can expand the availability of a known process (e.g., Medicare) to a discrete population and observe the result. Based on observations, we can expand the population affected (e.g., 55-64 year olds). By these steps, we can make adjustments as needed, with the clear goal of eventual universal coverage, sooner than later.

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