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What kind of health care system do you want? (Poll)

Discussion in 'BBS Hangout: Debate & Discussion' started by ThatBoyNick, Jul 26, 2019.

?

If you could pick one health care system to be enacted by the 2020 president

  1. Medicare for all

  2. Medicare buy in option

  3. Keep Obamacare as is, with incremental improvements

  4. Whatever the hell Trump and the right are proposing

Results are only viewable after voting.
  1. ThatBoyNick

    ThatBoyNick Member

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    Just curious where this board sits on this issue. It's a pretty big one for the 2020 election and we seem to have roughly 4 options being proposed across the different candidates.
     
  2. jcf

    jcf Member
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    I think Obamacare with incremental changes will sell better.
     
  3. ThatBoyNick

    ThatBoyNick Member

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    I'd rather this thread be about what you actually want over what you particularly think will sell better or will be more realistic to get passed etc.

    Although, I personally disagree that Obamacare with incremental changes sells well. People seem to be pretty mad at our current system on both ends of the table. A portion of America seems to hate Obamacare, wants it to be replaced with whatever Trump is saying (honestly don't have a clue at this point, maybe nothing?) and the majority seems to want a significant improvement with a medicare buy-in option or some version of Medicare for all. At least that's what I'm seeing through my lens.
     
  4. ryan_98

    ryan_98 Memberberry
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    Public option/medicare buy in. Makes healthcare available for everyone without forcing people in to something they don't want.

    Getting rid of insurance and forcing people on to a government program is too far over the line for a great number of reasons.

    The obvious concern with incrrased government involvement is more waste and inefficiencies. Though that is minor compared to improving or saving lives.
     
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  5. jcf

    jcf Member
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    My vote stays the same. (Although admittedly it is hard to separate out what I think is feasible from the analysis.).
     
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  6. jcf

    jcf Member
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    Delete. Accidental post.
     
  7. ThatBoyNick

    ThatBoyNick Member

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    How many people do you honestly think don't want healthcare though?

    I would say "forced off insurance" is incorrect wording. Everybody who has private insurance would still have insurance. It's just swapping private insurance for public insurance, nobody is being forced off of insurance.

    Overhead for private insurance is much more expensive than overhead for medicare though?


    Then we get to the point, that many Americans would still not be able to afford a buy-in option, tens of millions would still be left entirely uninsured. How much does this option fix really?

    It takes people who can afford to buy personal health insurance... and offers them a medicare choice. Now I'm not going to say that's not a benefit to some people, like your's truly. All the private health insurance options that I can afford have very high deductibles and copays, very low coverage. They simply aren't worth it. So in all likeliness, a medicare buy-in option would be a very welcomed choice for an independent contractor like me...but again, for those tens of millions who can't afford a buy-in... this does basically nothing for them.

    On top of all that, MANY politicians that say medicare buy-in, are actually only talking medicare buy-in for 50+ year olds. This would do nothing for me as a man in his 20's, nor would it do anything for me for an additional 25+ years.

    Let's just pretend we don't care about those who are uninsured (and I know this likely isn't the case for either of us, and the majority of others) ... I still absolutely hate having a 2 tier health care system with a deep, deep passion.... and I'll explain in with why with a very personal experience if you care to read.


    My wife just had a pregnancy, she had two private health insurances plans via her parent's employers (she's under 26), as well as Medicaid (all pregnant women are eligible for some level of Medicaid while being pregnant). Hospitals that accepted Medicaid would not accept us due to her particular private health insurance plans, Hospitals that accepted the private health insurance plans would not accept her Medicaid, leaving us with the only option of using her private plans, that had very high deductibles and co-payments. Medicaid would have given us a 100% free birth.

    The hospitals that accepted Medicaid claimed the only way she could receive care is if she canceled her private insurance plans. Which we tried to do. The companies that provided her private insurance (her parents employers) would not cancel her private plans due it being "outside of the time period that they accept or cancel plans", the actual private health insurance companies would not let us personally cancel her plans with them, they claimed that only the employers who are paying for her plan can actually cancel them.

    We were left having to pay $350 dollars for every checkup appointment, which starts as once a month, then twice a month as the pregnancy progresses, then every week within the last month of pregnancy as part of the birth plan. Don't have the 350? Can't come for the checkup. A total of 4,550 dollars that MUST be paid in full before the birth, or else they simply would not perform the birth. On top off all that, my wife was having a very difficult pregnancy that needed multiple additional visits, that cost additional co-payments that we simply couldn't afford. Again, we were eligible for a 100% free pregnancy and birth through Medicaid, we simply could not access it whatsoever due to her private plans.

    This story in real-time for me and my family was immensely more stressful, and flat out much darker then what I just laid out. Needless to say as someone who works full time doing roof inspections with no health insurance, and as someone who's been through my wife's pregnancy situation, I'm deeply dissatisfied with the current health system, am an avid medicare for all fan. Everybody (including those who can't afford a buy-in option) needs comprehensive healthcare, and we need it in a 1 tier system IMO.
     
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  8. dachuda86

    dachuda86 Member

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    Universal for citizens. Illegals must pay and face deportation. Valid visa, then we can talk. Perhaps increase the visa fees to cover this.
     
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  9. finalsbound

    finalsbound Contributing Member

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  10. iconoclastic

    iconoclastic Member

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    What's the difference between Medicare for all and Medicare buy in option? Wouldn't even the poorest people be eligible for Medicaid either way?
     
  11. txtony

    txtony Member

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    Medicare for all.

    Private ins as supplemental ins or even replacement for those that do not want federal negotiated pricing and services.
     
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  12. Air Langhi

    Air Langhi Contributing Member

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    The biggest issue is cost. The US government is already the largest healthcare provider in the US by far and has the best rates. Also you can't do balanced billing with medicare. If medicare is offered as a public option it will become the de facto option. That is why the republicans are so against the public option.
     
  13. dobro1229

    dobro1229 Contributing Member

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    I’d run on “Secure and Expand”.

    Meaning immediately put a bill up in Congress to reinstate and add measures to protect the ACA provisions.

    Then put into committee a bill to expand coverage to a public or Medicare buy in option.

    I think thats the most politically smart approach in the general election, and the most pragmatic to actually get done in the next 5 years. Don’t allow Trump to make a M4A vs free market case to the voters even though Trump is still a horrible messenger on health care cause he doesn’t care and only wants to run on racism. Still.. Republicans in Congress will have an easier time muddying the water in a healthcare debate, and if for some reason a Dem wins the White House, but McConnell still runs the Senate, there’s no way in hell a vote even comes up on anything unless it has strong support from moderate Republicans. Even then he still might not bring it up cause he’s Moscow Mitch.
     
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  14. txtony

    txtony Member

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    I think med for all is free to all. Buy in is not free, but cost can be reduced for poorer folks (to the point of being free).
     
  15. Air Langhi

    Air Langhi Contributing Member

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    It wouldn't be free. You would have to increase taxes to pay for it, but it should be cheaper than normal insurance. Medicare has much lower overhead and gets much better rates for treatments.
     
    ryan_98 likes this.
  16. Major

    Major Member

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    Keep in mind that something like 70% of Americans get their healthcare through their employer or Medicare/Medicaid rather than what we think of as Obamacare. A ton of big employers give pretty decent coverage at very low cost as far as the employee knows (the employer subsidizes it by paying them less, but they don't see this directly). As a result, a majority of those are happy with their healthcare as-is, and are opposed to being forced into Medicare.

    What Obamacare was meant to address are largely those people that don't have good employer coverage or government coverage now, but that's a small part of the country. So these big overhauls are going to scare a lot more people that don't see benefits as clearly and may end up with something worse than they feel they currently have. Current distribution of health coverage:

    https://www.kff.org/other/state-ind...0&sortModel={"colId":"Location","sort":"asc"}

    Employer-Based: 49%
    Medicaid: 21%
    Medicare: 14%

    Individual Coverage: 7%
    Uninsured: 9%

    Chunks or all of first 3 groups have various reasons to see less value in or outright oppose Medicare-for-All, and that is 83% of the country.

    Of the choices you listed, I would pick the Obamacare w/ Improvements, but the big improvement I would theoretically want is to get people off employer coverage and all onto individual plans. That creates a far more vibrant and transparent health insurance market, employers can get out of the health care business which is an absurd relic of wage controls, and people can get coverage that suits their individual needs instead of their employer's needs. That said, that would piss off the 49%, so the compromise there was Ron Wyden's Amendment, which would have let employees opt-out of employer plans and get that as take-home pay to use on their own health coverage. Combine that with a public-option alternative, and you have a pretty good system in place to build from. None of these things really address underlying costs, though - and that's still the biggest issue to be addressed.
     
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  17. Deckard

    Deckard Blade Runner
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    The Canadian system is public healthcare, and many, including an old friend of mine who moved to BC in the early '70's, purchase a supplemental insurance policy. The basic system without supplemental insurance means that everyone is covered. He says it's cheaper than private healthcare in the US, even with the supplemental, and the supplemental insurance solves what we would consider the flaws Canada's public healthcare system has. Example? You avoid the wait to get non-critical healthcare (in other words, there's no wait if you want immediate care for an optional procedure), and you have more options about the doctor you see, with the result being more like private insurance here, costing less. The topper? Drugs are much, much cheaper than here for the same medications. That's how it was the last time we talked about it, which has been a few years.
     
  18. fchowd0311

    fchowd0311 Contributing Member

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    Insurance is cheaper when the risk is distributed to a larger population pool. If everyone has medicare for their primary coverage, the risk is distributed to the entire tax paying public.

    In our current system we are paying the profit motive for two entities and are being paid less by our employer because they have to subsidize health insurance for their employees.

    I just never get the facination with that system. Why are we so willingly paying for the profit motives of the hospitals/private clinics etc AND insurance companies?
     
  19. xcrunner51

    xcrunner51 Contributing Member

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    As a young physician, I can say that most of my colleagues don't have a great understanding of the business side of medicine. I do not either.

    What I have seen universally in my training (state-hospital system, county-based hospital system, quaternary referral center) and job (community physician) is that every place claimed it could not operate on a public-option only system. Every place courted private insurance heavily to just stay afloat.

    Making healthcare freely available to everyone would fundamentally change nearly every aspect of health care. Like it or not, the current system is semi-functional because the current supply of physicians somewhat approximates the demand. Even then, there are current physician/nursing shortages and worse expected future shortages. Adding everyone into the healthcare system will strain the system in a way I can't even comprehend.

    Does the fee-for-service model go away too? Does any financial incentive to go into medicine disappear? There are so many questions with such as drastic change.
     
  20. txtony

    txtony Member

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    I like the idea above, providing options for the mass and we can see what will eventually win out.

    There is a huge difference in how much private insurers vs Medicare pay physician and hospital. It's so large that it needs to be part of the "underlying costs" debate. Some numbers below.

    I don't know why it's so different, and under a MFA (medicare for all) with no private insurer or Medicare as an option if the payments stay the same, go down due to a larger customer base and thus stronger negotiate power, or it would actually go up because physicians and hospital simply cannot operate at the lower payments at a larger scale.

    But if Medicare much lower costs stick as it scale up to serve more customers, I think it will eventually win out, or drive the private insurers to dramatically lower their costs and be competitive.


    CBO, in 2017 reviewed 21 frequent and costly services:
    - They found that private ins pays much more to physicians than Medicare, on average 200% higher.
    - A big issue that faces ALL American under private insurance is the huge out-of-network (OON) cost compared to in-network (IN). CBO found that Medicare Advantage plans (private plans that supplement Medicare) don't charge much more for OON compared to IN.
    - For hospital inpatient services, private ins rates were 89% higher on avg than Medicare rates.
     
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