Democrat Strategy vs. Trump

[PopeyesPappy]

Granted, but while the ACA isn't perfect, it is functional.  It got me coverage for the first time in 15 years when it went active.  The alleged horrible premium increases that they wail about?  They affect only 3% of the population.  The ACA is not imploding, collapsing, or 'entering a death spiral', and just holding the line until adults can be put in charge in Washington will be vastly better than trying to work out a replacement under the current regime, whom we know by their own actions are not in the slightest interested in any useful reform whatsoever.

If the GOP has a plan for reining in medical costs, as far as I can see it's to hope that we all die before we're old enough to qualify for Medicaid -- or at least what's left of it by the time they're done raping it.

I'm skeptical of the affect only 3% of the population claim. They affect me, and I'm middle class so I don't see how they couldn't affect other middle income families.

I've been at my current job for 5 years. I'm lucky because I'm single, the company has decent medical insurance and pays 100% of the employees premiums. Those premiums have increased 300% in the five years I've been here. That increase affects every employee even if we don't pay them directly. There is less money available for salaries and other fringe benefits. There is less profit available for use by the impoverished American Indian tribe that owns us. The company pays nothing for dependent coverage. That 300% increase has put family coverage under our company policy out of reach for many of our employees. Those people are screwed.

My job is in no way guaranteed either. I could be out of work next month. I could probably go back to doing what I was doing before, but I'd be making half of what I make now. That would still be enough to make me ineligible for assistance under the ACA though. Five years ago I paid for my own health insurance. My policy was similar to what I have now. My annual premium was about $230 a month. A couple of weeks ago I pulled quotes for a similar policy. The monthly premium for someone my age 5 years ago was $967 a month. That's a 420% increase. A policy for someone my age now was over $1200 a month. That's a 522% percent increase in 5 years.

[Baruch]

I'm skeptical of the affect only 3% of the population claim. They affect me, and I'm middle class so I don't see how they couldn't affect other middle income families.

I've been at my current job for 5 years. I'm lucky because I'm single, the company has decent medical insurance and pays 100% of the employees premiums. Those premiums have increased 300% in the five years I've been here. That increase affects every employee even if we don't pay them directly. There is less money available for salaries and other fringe benefits. There is less profit available for use by the impoverished American Indian tribe that owns us. The company pays nothing for dependent coverage. That 300% increase has put family coverage under our company policy out of reach for many of our employees. Those people are screwed.

My job is in no way guaranteed either. I could be out of work next month. I could probably go back to doing what I was doing before, but I'd be making half of what I make now. That would still be enough to make me ineligible for assistance under the ACA though. Five years ago I paid for my own health insurance. My policy was similar to what I have now. My annual premium was about $230 a month. A couple of weeks ago I pulled quotes for a similar policy. The monthly premium for someone my age 5 years ago was $967 a month. That's a 420% increase. A policy for someone my age now was over $1200 a month. That's a 522% percent increase in 5 years.

You must be a liar ... the Obama-bots gave free everything, not just free health insurance, to one and all, and we can't see that because the Republicans are evil Svengalis ;-)

In my case, I have always paid part of the premium, and my company paid part.  After ACA .. our plan changed, and my monthly contribution doubled, and the deductible doubled.  To the Obama-bots, that can't be blamed on the ACA and the super-Dems ... my employer is to blame (for reducing our Cadillac Plan as per requirements of the ACA).  Right now the ACA is crashing into failure ... just not immediately this week.  One insurance catchment area at a time ... until you have only one ACA insurer, then none.

The model for health insurance is a failure, mathematically.  It can only survive by direct Treasure subsidy to billions of dollars per year, same as Medicare and Medicaid.  Having private companies as intermediaries, only complicates it and makes it more expensive.  Single payer will be simpler and cheaper, but it will still fail.  Infinite money is necessary to cover hypochondriac ape men.  People don't understand that this kind of insurance makes no mathematical sense, because they don't understand how the FED/Treasury does what it does either.

Another POV ... that the actual cost, averaged, is about $1 per say, so if the evil government just would cut everyone a check for $365 per year, and regulate/strangle the pharma companies and the AMA (let doctors work for $15 per hour) and the hospitals ... then actual health care can be paid for, not just insurance.  This is the Socialist conspiracy theory model.  Which is actually fed by the fact that Big Pharma is evil.

And no, ACA may be renamed, but it won't be repealed.  The bipartisan position, is to destroy the American people.  We are the Vietnamese, and any President we have is LBJ.  The war is against most Americans and all other "little people".  I can't wait for the final extermination of humanity ... if I am right.  I hope I am wrong, but it increasingly seems I am right ;-((

[reasonist]

there is no such thing as an attack on Trump's intellect. He really is that stupid.

Tax cuts on the wealthy has yet to produce any benefit for regular folk.

I read the ACA. Some things seemed kinda dumb until I learned that the idiot democrats allowed insurance companies to write most of it. The 80/20 rule for medical insurance is a good thing. It should also be applied to hospitals. Without prosecuting big pharma for profiteering and putting price controls on their crap, there will never be affordable health care. It is also about 90% improbable that we can have affordable health care while insurance companies are given a seat at the table when fixing the health care laws.

The investigation of Trump's connection to Russia that started before the election are still on going. Eventually Congress may become suspicious enough to order him to hand over his tax papers. Not going to count on that though. Paul Ryan said a couple weeks ago that he wasnt required to release his tax papers and that they wouldn't ask him to. If he is forced to release his taxes, it could be a game changer for his reelection

Why not approach health care like ALL other developed countries that have universal health care? Privatized health care will never work because it is for profit. It's a business where shareholders have to be kept happy. That means to maximize profits and patient care suffers. It is impossible to have maximum profits AND the best care for the sick. It's either one or the other.
The US is spending almost 18% of it's GDP on health care (and yet has the lowest life expectancy, highest infant mortality and highest drug prices). That amounts to 3.5 trillion dollars a year! Canada and the EURO region spends 10.4% of their GDP on health care (France which has the best health care in the world spends 11.5). If the US would adapt universal health care it surely would bring down the percentage to international levels, say 11% average. That would mean savings of 1.3 trillion dollars a year!!!
The US is the ONLY developed country without universal health care and it shows. Double the money spent and less coverage and care. It just makes no sense at all! While systems in other (developed) countries are not perfect, they are still far superior to the US! Somebody has to have the balls to point that out in the public discourse!

[PopeyesPappy]

Why not approach health care like ALL other developed countries that have universal health care? Privatized health care will never work because it is for profit. It's a business where shareholders have to be kept happy. That means to maximize profits and patient care suffers. It is impossible to have maximum profits AND the best care for the sick. It's either one or the other.
The US is spending almost 18% of it's GDP on health care (and yet has the lowest life expectancy, highest infant mortality and highest drug prices). That amounts to 3.5 trillion dollars a year! Canada and the EURO region spends 10.4% of their GDP on health care (France which has the best health care in the world spends 11.5). If the US would adapt universal health care it surely would bring down the percentage to international levels, say 11% average. That would mean savings of 1.3 trillion dollars a year!!!
The US is the ONLY developed country without universal health care and it shows. Double the money spent and less coverage and care. It just makes no sense at all! While systems in other (developed) countries are not perfect, they are still far superior to the US! Somebody has to have the balls to point that out in the public discourse!

Implementing a single payer system in the US would probably be a lot harder than most think it would be. For one thing just eleminating the profits of the insurance providers, hospitals and drug companies might help bring down costs a little but it wouldn't be enough. We'd still be spending a lot more on healthcare than most other countries. Too much to afford.

Only 18% of American Hospitals operate as for profit enterprises. 20% are government facilities, and 62% of American hospitals operate as non-profits. So in 82% of our hospitals there are no profit margins to cut. The 18% that do operate as for profits average a little less than a 9% margin. That means the most savings you could see cutting the profits of hospitals would be 1.62% of the total. Reality is it would be a lot less than that because hospital revenue doesn't account for 100% of the total cost.

Insurance companies operate at a lower margin than hospitals. According to some sources as low as 3.3%. But once again health insurance revenues aren't even close to 100% of the total so zeroing out those margins altogether might save another 1.6% of the total. Best case scenario we'd probably be looking at a 3% savings by getting rid of hospital and health insurance profits. Maybe none at all if the government can't manage billing and payments at least as efficiently as the for profits.

US pharmaceutical companies averaged a 23.5% margin last year, but drug costs account for less than 10% of total healthcare expenditures. So at the most we'd be looking at a 2.35% savings off the bottom line. Add all those profits together and we'd be looking at a maximum savings of maybe 6%. That would have brought last years per capita healthcare expansive down from $10,335 to $9,715. It is something but not nearly enough to supply healthcare to Americans that don't currently get any without raising the overall cost.

[Cavebear]

Implementing a single payer system in the US would probably be a lot harder than most think it would be. For one thing just eleminating the profits of the insurance providers, hospitals and drug companies might help bring down costs a little but it wouldn't be enough. We'd still be spending a lot more on healthcare than most other countries. Too much to afford.

Only 18% of American Hospitals operate as for profit enterprises. 20% are government facilities, and 62% of American hospitals operate as non-profits. So in 82% of our hospitals there are no profit margins to cut. The 18% that do operate as for profits average a little less than a 9% margin. That means the most savings you could see cutting the profits of hospitals would be 1.62% of the total. Reality is it would be a lot less than that because hospital revenue doesn't account for 100% of the total cost.

Insurance companies operate at a lower margin than hospitals. According to some sources as low as 3.3%. But once again health insurance revenues aren't even close to 100% of the total so zeroing out those margins altogether might save another 1.6% of the total. Best case scenario we'd probably be looking at a 3% savings by getting rid of hospital and health insurance profits. Maybe none at all if the government can't manage billing and payments at least as efficiently as the for profits.

US pharmaceutical companies averaged a 23.5% margin last year, but drug costs account for less than 10% of total healthcare expenditures. So at the most we'd be looking at a 2.35% savings off the bottom line. Add all those profits together and we'd be looking at a maximum savings of maybe 6%. That would have brought last years per capita healthcare expansive down from $10,335 to $9,715. It is something but not nearly enough to supply healthcare to Americans that don't currently get any without raising the overall cost.

I think you are ignoring the costs of uninsured people who routinely depend on Emergency Rooms for basic medical help.  That is a very expensive way to provide medical care to the poor.

[SGOS]

If universal health insurance is too expensive for the government to provide, does it get cheaper because a corporation provides it?  The first issue, usually of interest to conservatives, is how does it affect your personal wealth and the wealth of others?  If you are paying $14,000/year and additional $3000 more in deductibles and co-pays to a corporation, does it cost you more to pay for healthcare in taxes than it does as corporate premiums?  Those who get insurance through their employers, might think it's not costing them a dime, but somebody is paying it.  And its a burden to whoever that is.

The second issue is insurer chiseling, refusing to pay certain things, and the numerous exceptions that are not covered because it drives down the corporate target for the annual increase in profits. 

Remember the feared "death panels" invented by the Republicans when health care started to gain traction?  Those things are not fabrications.  They already exist in the corporate accounting departments.  Of course it's an exaggeration, just as the idea of government death panels was in 2008.

According to the Republicans, it only exists when the government pays the bills.  This is a claim for which I have never seen an ounce of evidence, yet it concerns every insured paying for private insurance.  The government Death Panels were brought up continually throughout the 2008 campaign, but was never once supported.  It became an article of common knowledge based on repetition and gullibility.  And the odd thing is that it has always been a part of the corporate structure, but somehow gets ignored by those who are ideologically opposed to a government service.

[Cavebear]

If universal health insurance is too expensive for the government to provide, does it get cheaper because a corporation provides it?  The first issue, usually of interest to conservatives, is how does it affect your personal wealth and the wealth of others?  If you are paying $14,000/year and additional $3000 more in deductibles and co-pays to a corporation, does it cost you more to pay for healthcare in taxes than it does as corporate premiums?  Those who get insurance through their employers, might think it's not costing them a dime, but somebody is paying it.  And its a burden to whoever that is.

The second issue is insurer chiseling, refusing to pay certain things, and the numerous exceptions that are not covered because it drives down the corporate target for the annual increase in profits. 

Remember the feared "death panels" invented by the Republicans when health care started to gain traction?  Those things are not fabrications.  They already exist in the corporate accounting departments.  Of course it's an exaggeration, just as the idea of government death panels was in 2008.

According to the Republicans, it only exists when the government pays the bills.  This is a claim for which I have never seen an ounce of evidence, yet it concerns every insured paying for private insurance.  The government Death Panels were brought up continually throughout the 2008 campaign, but was never once supported.  It became an article of common knowledge based on repetition and gullibility.  And the odd thing is that it has always been a part of the corporate structure, but somehow gets ignored by those who are ideologically opposed to a government service.

Yeah, the corporations have to make a profit for the owners, the government doesn't. And the govt can specify (as in ACA) , that certain basic services like pregnancy and pre-existing conditions be included.

[reasonist]

Simple math: the US is spending 18% of it's GDP on health care with miserable results. The countries with universal healthcare spend around 10-11% of their GDP and EVERYBODY is covered for EVERYTHING! In numbers, the US would safe 1.4 trillion dollars a year with the same concept.
Too bad for insurance companies and their shareholders. Taking care of the sick should never be a 'business' in the first place!

[Baruch]

Why not approach health care like ALL other developed countries that have universal health care? Privatized health care will never work because it is for profit. It's a business where shareholders have to be kept happy. That means to maximize profits and patient care suffers. It is impossible to have maximum profits AND the best care for the sick. It's either one or the other.
The US is spending almost 18% of it's GDP on health care (and yet has the lowest life expectancy, highest infant mortality and highest drug prices). That amounts to 3.5 trillion dollars a year! Canada and the EURO region spends 10.4% of their GDP on health care (France which has the best health care in the world spends 11.5). If the US would adapt universal health care it surely would bring down the percentage to international levels, say 11% average. That would mean savings of 1.3 trillion dollars a year!!!
The US is the ONLY developed country without universal health care and it shows. Double the money spent and less coverage and care. It just makes no sense at all! While systems in other (developed) countries are not perfect, they are still far superior to the US! Somebody has to have the balls to point that out in the public discourse!

Yes, make an intelligent choice about private vs public sector.  Sorry, will never happen in the US.  The Americans are European rejects who got kicked to a new continent filled will hostiles.

[Baruch]

I think you are ignoring the costs of uninsured people who routinely depend on Emergency Rooms for basic medical help.  That is a very expensive way to provide medical care to the poor.

That used to not happen.  Before the 1980s emergency rooms could refuse care.  It was government intervention that changed that ... for the worse.  The best cure for the poor is to not have any ... either achieve the American Dream, or export the poor to the British Navy for pleasure cruises on the HMS Bounty.

[Baruch]

Simple math: the US is spending 18% of it's GDP on health care with miserable results. The countries with universal healthcare spend around 10-11% of their GDP and EVERYBODY is covered for EVERYTHING! In numbers, the US would safe 1.4 trillion dollars a year with the same concept.
Too bad for insurance companies and their shareholders. Taking care of the sick should never be a 'business' in the first place!

One good thing, when heath care spending reaches 100% of GDP, there won't be any more money for wars ;-)  Also the EU vs US or Canada vs US comparison is apples and oranges.  Our nations are not similar.  I do wish the US were more like Canada ... but not going to happen, eh?

[SGOS]

I had never heard of identity politics or thought about it until someone mentioned it as a reason why Democrats have done so poorly in the recent elections.  The idea behind identity politics is noble, but as a political strategy, it might be questionable.  It may be the weakness of the ACA.  It benefits a selected group and ignores everyone from the lower middle class up.  The only benefit to the population at large was that it would supposedly lower the cost of medical care by keeping the poor out of the emergency rooms, but I don't know of any studies that show it has worked that way.

It has been said that Social Security, and Medicare are insolvent.  That may or may not be true at current funding levels. But insolvent is often just a synonym for "I don't want to pay for it," and things have a way of becoming affordable when you need them.  But insolvent or not, SS and Medicare are politically successful because everyone gets to participate in them, not just the very poor.  Take away a Republican's Social Security and he's not going to like it.  "Keep your Hands Off My Social Security" posters at T-Bagger rallies attest to its popularity.

Everyone would benefit from a single payer government operated health insurance not just the poor or the youth.  Consequently, it should be more popular as long as it costs less than private insurance.  And when people complained about how much healthcare would increase taxes (Which it would because there really are no free lunches), I never heard any figure, even from the loudest opponents, that put the tax dollar increase anywhere near the ballpark of the current private costs.  I would hear things like, "Healthcare would increase taxes by $2000 a year.  I'd say to Hell with Government Health care if private insurers would sell it to me that cheap.  Well, maybe not. There are actually two issues to consider, cost and quality, and private insurance is not that good at either.

[PopeyesPappy]

I think you are ignoring the costs of uninsured people who routinely depend on Emergency Rooms for basic medical help.  That is a very expensive way to provide medical care to the poor.

I ignored over use of expensive emergency room services because I was specifically addressing how much savings we could expect if we cut the profits of hospitals, insurance providers and pharmaceutical companies from the equation. The answer to that question is there is some potential for for savings there but probably not as much as some would like to think. Eliminating profits alone isn't going to save our healthcare system. We are going to have to find savings in other areas too.

Reducing use of emergency room services is an area that is certainly worth looking at but would it really help the overall picture? I don't know the answer to that, but one of the members at AF.com recently linked to a study that fond no it wouldn't. According to their conclusions the reason it wouldn't reduce overall cost is simple. Giving access to healthcare services to people who currently don't have it results in those people using more healthcare services. So even though they are using less expensive healthcare services they use so many services that it more than offsets any savings from using the more expensive emergency room services.

Another area of possible savings is the cost of medical malpractice. Aroura linked a Forbes article on AF.com that said total annual cost of malpractice was $55 billion. They say that was 2.4% of expenditures for the year. Eliminate that altogether and add it to savings from eliminating profits and we are still looking at maximum savings of less than 8.5% of the total.

Baruch suggested (sarcastically I hope, but with Baruch I never can tell) that we pay doctors $15 an hour. That wouldn't work but there are ways we could look into to reduce their overhead expenses. One of these would be to reduce the expense of their education. When many doctors graduate from school they have hundreds of thousands of dollars in loans they have pay for. If we could reduce that expense we could reduce what they have to charge in order to earn a living. Just letting the government pay for it isn't really a solution because it just moves the expense from one area of the economy to another. In order to make it actually work we have to reduce the total cost of a medical education. That is a separate problem that is every bit as hard as reducing the cost of medical care.

We have to reduce the overall cost of our healthcare system because the current model is not sustainable. Actually doing that though isn't as easy as just proclaiming we are going to go to a single payer system.

[Baruch]

The problem with all Socialisms .. is that when people realize that they won't benefit, but their neighbor will (instead of all benefiting) ... they aren't so keen on it, and try to escape it (Brexit).  And yes, knowing when I mean what I say, and am merely pulling chains (as opposed to calling people %&$^% like Etienne) or just covering a bitter pill with humor (Cavebear lost his during his Winter nap) is how I operate.

You want people to be healthy?  Forget tinkering with insurance.  Then vote for dictatorship by Jack LaLanne.  That guy was crazy healthy into his senior years.  Make him dictator, and you can all pull a boat, by your teeth, while swimming in frigid San Fran Bay.  Everyone runs 5K every day.  No alcohol, no drugs, no sex, no tobacco, no weed ... full HS athlete stuff, 24x7.  No more eating wrong ... it is health food 3x a day.  No more staying up late.  No more missing doctor appointments or dental appointments.  See you can have nice things .. if you simply will give up your stupid freedom your ridiculous individuality.  As many Europeans have tried, several times.  And yes, in a dicatorship, doctors and everyone else, will do what they are told, and payed what the dictator chooses to pay them.  They will be considered lucky if the get $15 per hour.  See y'all notice Shiranu's draconian SJW solutions .. but you just aren't Marxist-Leninist enough (unlike Etienne).  Think of Lenin as a health/fitness nut.  Of course once you have your chosen dictator (Emperor Haile Obama) ... you don't get to unselect him.  If you like your MIC dictator, you can keep your MIC dictator.  And there is plenty of freedom .. the freedom to obey.  This is what happens when people ignore Benjamin Franklin.  To gain a rising standard of living, or avoid a declining standard of living, y'all are willing to have a cage strapped to your face, with a crazed rat in it ;-(

https://www.youtube.com/watch?v=IzjaUsIjsN4

[reasonist]

One good thing, when heath care spending reaches 100% of GDP, there won't be any more money for wars ;-)  Also the EU vs US or Canada vs US comparison is apples and oranges.  Our nations are not similar.  I do wish the US were more like Canada ... but not going to happen, eh?

Why not? Same humans, same diseases, same cures (or not). The problem is that the health of your citizens has been politicized. Too many interest groups, too many corporations lobbying for profit. It has become a partisan issue.
There are still 27 million people uninsured in the US, a disgrace for the most powerful nation on Earth! Despite that, 18 trillion dollars are spent every year on health care. Double the percentage of the GDP other nations spend where everybody is covered! Why? Because none of the parties in power has/had the gonads to say to hell with big corporations in the health care business, we take over and save over a trillion a year and have everybody covered!
The events of last week alone show very clearly that the system is not working. Obamacare is not working in the long run and the GOP can't even agree internally on an alternative. The people, who suffer through their wallet or being untreated at all, are the ones who put these clowns in power positions. They deserve better.
If something works in all other (developed) countries maybe it's time to reconsider the approach and adapt a similar system? To treat the sick for profit, is sick in itself!