The unofficial Obamacare thread...

[The Human Q-Tip]

I do understand that "cripple" is not something you should generally call someone in person. One of my buddies jokingly refers to himself that way, but that's his choice. I personally see a difference between making a joking reference to third parties, and actually calling a particular person a name to their face.

I have been called a cripple so many times in my life it really does not bother me anymore. But If you call me handi-capable I'll fight you. FOR REAL.

Honestly curious -- did you ever see the "Handi-man" skit on In Living Color? The disabled superhero?

I remember a lot of controversy about it -- some people were really offended, others thought the willingness to make a joke meant it was actually treating disabled people without condescension. I think there was even an article in the WSJ about it.

 

[cavman]

I do understand that "cripple" is not something you should generally call someone in person. One of my buddies jokingly refers to himself that way, but that's his choice. I personally see a difference between making a joking reference to third parties, and actually calling a particular person a name to their face.



Honestly curious -- did you ever see the "Handi-man" skit on In Living Color? The disabled superhero?

I remember a lot of controversy about it -- some people were really offended, others thought the willingness to make a joke meant it was actually treating disabled people without condescension. I think there was even an article in the WSJ about it.

Yeah. I loved it. I miss in living color.

 

[caf]

They say when you go blind or deaf your other senses are heightened to compensate.

When you are crippled do your other appendages get heightened to compensate? Specifically your penis?

 

[cavman]

They say when you go blind or deaf your other senses are heightened to compensate.

When you are crippled do your other appendages get heightened to compensate? Specifically your penis?

I wish. You do level up fast in cunilingus.

 

[AZ_]

They say when you go blind or deaf your other senses are heightened to compensate.

When you are crippled do your other appendages get heightened to compensate? Specifically your penis?

 

[David.]

It's so hard to keep up with liberals and what we can call specific groups of people. We are all just purple penguins in their eyes.

Took seventy years to go from colored people to people of color

 

[The Human Q-Tip]

Everything I hear solidifies my view that single payer is the way to go and it is the corruption and dirty money influence in the two major parties that is preventing that from happening.

Then why hasn't a single one of the fifty states tried it? Many of them are essentially controlled by a single party. I can't really accept that in the entire history of this country, "corruption and dirty money influence" was sufficient to ensure that not a single state implemented it.

Vermont -- one of the most liberal states in the entire country, tried to do single payer. They couldn't, despite having strong majorities in both houses and the Governorship. And now, in California, also controlled overwhelmingly by Democrats....

California Assembly Speaker Anthony Rendon shelves single-payer healthcare bill, calling it 'woefully incomplete"
A high-profile effort to establish a single-payer healthcare system in California sputtered Friday when Assembly Speaker Anthony Rendon (D-Paramount) decided to shelve the proposal.
Rendon announced late Friday afternoon that the bill, Senate Bill 562 by state Sens. Ricardo Lara (D-Bell Gardens) and Toni Atkins (D-San Diego), would not advance to a policy hearing in his house, making it all but certain the measure will not be acted upon this year.

“SB 562 was sent to the Assembly woefully incomplete,” Rendon said in a statement. “Even senators who voted for SB 562 noted there are potentially fatal flaws in the bill, including the fact it does not address many serious issues, such as financing, delivery of care, cost controls, or the realities of needed action by the Trump administration and voters to make SB 562 a genuine piece of legislation.”

Under the measure, California would have paid the healthcare costs for all residents, eliminating premiums, copays and deductibles that are common fixtures in the current healthcare system.

Several key details were unresolved in the measure — most significantly how to pay for it. The program, which carried an estimated price tag of $330 billion to $400 billion, would have required new taxes to pay for it, but no sources of tax revenue were specified in the legislation.

http://www.latimes.com/newsletters/la-me-ln-essential-california-20170624-story.html

Obviously, the reason it was "incomplete" was that every financing scheme was DOA -- the costs are simply too high. That's not corruption or dirty money.

The reality that I don't think many want to grasp is that a great many Americans have gotten used to what some might consider "Cadillac" health care. Cutting edge treatment, ready access, doctor choice, etc... Pointing to single payer successes in other countries ignores very real cultural differences, and differences in terms of expectations. When you start trying to put together a single payer plan in this country, you are essentially telling the majority of the country that has good health care/insurance, and likes that way, that they're going to have give up some of that so that everyone can have single payer. Either that, or you give everyone all that choice and access, the costs go through the roof.

Personally, I'd prefer letting some individual states actually making it work first before foisting it on the rest of us.

 

[gourimoko]

Then why hasn't a single one of the fifty states tried it? Many of them are essentially controlled by a single party. I can't really accept that in the entire history of this country, "corruption and dirty money influence" was sufficient to ensure that not a single state implemented it.

Vermont -- one of the most liberal states in the entire country, tried to do single payer. They couldn't, despite having strong majorities in both houses and the Governorship. And now, in California, also controlled overwhelmingly by Democrats....

California Assembly Speaker Anthony Rendon shelves single-payer healthcare bill, calling it 'woefully incomplete"
A high-profile effort to establish a single-payer healthcare system in California sputtered Friday when Assembly Speaker Anthony Rendon (D-Paramount) decided to shelve the proposal.
Rendon announced late Friday afternoon that the bill, Senate Bill 562 by state Sens. Ricardo Lara (D-Bell Gardens) and Toni Atkins (D-San Diego), would not advance to a policy hearing in his house, making it all but certain the measure will not be acted upon this year.

“SB 562 was sent to the Assembly woefully incomplete,” Rendon said in a statement. “Even senators who voted for SB 562 noted there are potentially fatal flaws in the bill, including the fact it does not address many serious issues, such as financing, delivery of care, cost controls, or the realities of needed action by the Trump administration and voters to make SB 562 a genuine piece of legislation.”

Under the measure, California would have paid the healthcare costs for all residents, eliminating premiums, copays and deductibles that are common fixtures in the current healthcare system.

Several key details were unresolved in the measure — most significantly how to pay for it. The program, which carried an estimated price tag of $330 billion to $400 billion, would have required new taxes to pay for it, but no sources of tax revenue were specified in the legislation.

http://www.latimes.com/newsletters/la-me-ln-essential-california-20170624-story.html

Obviously, the reason it was "incomplete" was that every financing scheme was DOA -- the costs are simply too high. That's not corruption or dirty money.

The reality that I don't think many want to grasp is that a great many Americans have gotten used to what some might consider "Cadillac" health care. Cutting edge treatment, ready access, doctor choice, etc... Pointing to single payer successes in other countries ignores very real cultural differences, and differences in terms of expectations. When you start trying to put together a single payer plan in this country, you are essentially telling the majority of the country that has good health care/insurance, and likes that way, that they're going to have give up some of that so that everyone can have single payer. Either that, or you give everyone all that choice and access, the costs go through the roof.

Personally, I'd prefer letting some individual states actually making it work first before foisting it on the rest of us.

Q-Tip, perhaps you may not realize it, but the bolded statement actually works against an argument opposed to the principle of single-payer.

The California single-payer system died because we're a state that has already existing budget issues and an already difficult set of choices as to how to keep the state afloat. We cannot afford to take on a project with the scope of a single-payer plan; regardless of it's benefit to Californians.

It's just too risky for California, and I personally am opposed to the idea.... I think it's bad for for the State, and I don't think California should essentially triple it's liabilities for such a project.

California can't print money, and cannot as easily shift around revenues to make up for shortfalls. California can't run up deficits in times of unfavorable economic conditions, let alone recession; and the strength and stability of the Californian economy is a lot less robust than that of the United States as a whole.

That doesn't mean the idea of single-payer is poorly thought out, though. Going back to what I stated above; the $330B figure you cited would actually represent an average savings of 21.5% over the median cost of care annually for the average American, and this would largely be split by employers and employees with the average Californian saving around 9-10% annually on their personal contribution.

This effect is cumulative over time; such that, in 10 years, variance between single-payer's increasing costs and that of either Obamacare or the totally private system that proceeded it, adds up to an additional 10% in savings.

There would also be the elimination of the Medi-Cal program, which accounts for roughly 50% of California's budget.

With all that being said, yes, single-payer would save Californians money -- thousands of dollars per family over the next 10 years. It would also massively improve the quality of life and the degree of access for all Californians. It'd be great... But we can't take financial risks like that as a state; especially in the current political climate.

Anyway, we've talked about this before and why single-payer does not make sense on the state level, but does make sense on the federal level. I think this latest policy proposal and why it was tabled actually works to answer those questions.

 

[Whittaker]

Then why hasn't a single one of the fifty states tried it?

I don't think it can work in a single state.
The state system would conflict with the federal system in a way that would rob the state of their share of federal subsidies and other moneys.
The same thing would happen if a state went their own way on education. They would lose so many federal dollars that they would be at a huge disadvantage.
If the federal govt. agreed to block grant back all medical subsidies and other healthcare spending(on a per capita basis) to an individual state if that state covered all healthcare, it might possible work.

Then you have the problem of high-cost people migrating in.
If California enacted single payer, tens of thousands of people would probably travel there to get free "high cost" medical treatment...then move back home.
If I needed a high cost procedure it would be pretty easy to use my relative's home in California to "establish" residency for 6 months or whatever is required. It is especially easy for retired seniors to relocate to California and they are a very high cost segment of healthcare.

Like it or not, the federal govt is so intertwined with all aspects of healthcare it is probably not possible for a state to have a stand-alone system. And that is the way the federal govt wants it to be. Most of the money flows to the people who hold the power.
Who has to lobby, donate and generally kiss the asses of our federal lawmakers to ensure they are protected and rewarded?
Hospitals
Medical professional organizations(doctors, nurses, techs)
Health and Disability Insurance companies
Medical equipment companies
Medical research universities
Drug manufacturers
Rehab facilities
Malpractice, disability and personal injury attorneys
Vaccine manufacturers

That's alot of money pouring into lawmaker's coffers.
If the federal govt gave up control of healthcare there would be no need to line their pockets.
We have the terrible system we have because that is the system that is most beneficial for the people we elect.

Would we still have corruption and incompetence with the federal govt as the single payer?
Yes.
But I think the guarantee of necessary healthcare for everyone and the economics of scale outweighs the negatives.
In my mind, the feds already regulate healthcare so completely that they are running it now. Might as well make them completely responsible for the system.

 

[AZ_]

Guess it wasn't a mischaracterization.

Shocker.

View: https://twitter.com/brianstelter/status/878927023913271296

 

[CleveRocks]

Vermont -- one of the most liberal states in the entire country, tried to do single payer. They couldn't, despite having strong majorities in both houses and the Governorship. And now, in California, also controlled overwhelmingly by Democrats....

Cant speak to California, but I have experienced VT directly.

Vermont health care is the best system I have ever seen operationally. I believe the state will go to single payer eventually. But Vermont has some advantages, such as a single healthcare entity, and a small population. Single payer also has serious support in the wealthy community there. Opposition came from the big employers such as IBM, which is no longer there for the most part.

That said, implementing single payer nationally is a much longer putt.. in Ohio alone there are more than 20 Independent Health Care Systems. Getting single pair to work is going to mean melding those systems together in a way that's never been done.

Also I think the aspect of single-payer that nobody really wants to talk about is that we can't pay for everything so what do we pay for and what don't we pay for. This is also the problem with the affordable Care Act. I don't think there's a clear consensus on what it should pay for and what it should not somewhere someone has to make a decision as to win that support Runs Dry. Are we going to set up a death panel that says oh you're 84 and this life-saving surgery will only extend your life by another 2 years? Or yes will pay the $100,000 it's going to take 2 provide the surgery and extend your life for 2 years. I think this is the point that we struggle with.

 

[The Human Q-Tip]

Also I think the aspect of single-payer that nobody really wants to talk about is that we can't pay for everything so what do we pay for and what don't we pay for.

Hey, that's all I've been talking about.

 

[The Human Q-Tip]

I don't think it can work in a single state.
The state system would conflict with the federal system in a way that would rob the state of their share of federal subsidies and other moneys....

....If the federal govt. agreed to block grant back all medical subsidies and other healthcare spending(on a per capita basis) to an individual state if that state covered all healthcare, it might possible work.

The ACA permitted states to opt-out, and they could keep at least some of the subsidies. Pre-ACA, Medicaid permitted the same thing -- that's how Massachusetts financed Romneycare. They took Medicaid funds and were permitted to use them differently.

That being said, to the extent it doesn't exist already, I absolutely support a federalized system that would permit block-granting of existing health care subsidies so that states could come up with whatever system they wanted. Medicare/Medicaid are funded by payroll taxes, so it shouldn't be too difficult to simply send that money to the state in which it is paid rather than funneling it through the federal government at all. Far more efficient, and I strongly suspect you'd be able to get a lot of GOP buy-in for that idea.

Then you have the problem of high-cost people migrating in.
If California enacted single payer, tens of thousands of people would probably travel there to get free "high cost" medical treatment...then move back home.

If I needed a high cost procedure it would be pretty easy to use my relative's home in California to "establish" residency for 6 months or whatever is required. It is especially easy for retired seniors to relocate to California and they are a very high cost segment of healthcare.

Seniors could still be covered under Medicare so the incentive for them to relocate would be far less. And if you make the penalties for false residency high enough, and have better vetting procedures, you could minimize a lot of it.

Actually, I think the greater risk isn't people trying to fraudulently claim California residence temporarily, because even that would work a hardship on a lot of people - but rather more poor people actually moving there permanently.

Of course, given the state of our borders, doing this on a national level would just make us a bigger magnet for those seeking freebies.

 

[The Human Q-Tip]

The California single-payer system died because we're a state that has already existing budget issues and an already difficult set of choices as to how to keep the state afloat. We cannot afford to take on a project with the scope of a single-payer plan; regardless of it's benefit to Californians....

California can't print money.....

And that's is the entire reason this should not be done at the federal level. Also, it's the primary reason most Democrats don't want it at the state level. Because the federal government can print money, and run deficits indefinitely, so there is no requirement that the cost of a federal single payer plan be balanced by revenues. We aren't even close to paying for the long-term costs of our current major entitlement programs, and you guys want to add a fourth. The political pressures are always going to be in the direction of people wanting more, without having to pay for it. And if Republicans try to restrain costs, they'll be accused of killing people.

Push it down to the state level, and block grant whatever subsidies they'd otherwise get. If it truly is the "better care for less for everyone!" solution that its supporters claim, then the states that implement it should thrive. Talented people should flock there for the better care, and businesses will be beating down the state's borders to rush in and have their employees get great health care without employers having to worry about it.

Isn't that how it works?

 

[AZ_]