What would a "medicare-for-all" system look like?

[deleted480308]

You need to stop watching "Parks & Recreation."

There's a reason why democracy exist. To protect the lower-class from the tyranny of the powerful.

Rights are the only thing that matters and that’s why we needed to stick to constitutional republic. A democracy is just giving the mob a club with which to oppress those they outnumber.

30% of your income seized by people who don’t put in that much and they still scream that the govt needs to take more from you? That’s tyranny

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[VA Hopeful Dr]

I can't match the elegance of Noam Chomsky, so I'll simply use his words:

"Libertarianism has a special meaning predominantly in the United States. In the United States, it means dedication to extreme forms of tyranny. They don’t call it that, but it’s basically corporate tyranny, meaning tyranny by unaccountable private concentrations of power, the worst kind of tyranny you can imagine. It picks up from the libertarian tradition one element, namely opposition to state power. But it leaves open all other forms of — and in fact favors — other forms of coercion and domination. So it’s radically opposed to the libertarian tradition, which was opposed to the master-servant relation."

I'd rather have tyranny by government ran by people who, in theory, we can vote in and vote out, than by plutocrats loyal only to their shareholders.

The whole text can be found here: Creating the Horror Chambers: Noam Chomsky on the tyranny of libertarianism, the need for media democracy, and Latin American resistance to US imperialism

Oh so you mean its bad in that we shouldn't completely replace our current government with pure libertarianism. Well duh. No one is suggesting that, even our resident Ron Burgundy.

 

[deleted480308]

Oh so you mean its bad in that we shouldn't completely replace our current government with pure libertarianism. Well duh. No one is suggesting that, even our resident Ron Burgundy.

I feel like people often describe anarchy, call it libertarianism, and then clutch their pearls pretty hard while defending a blatantly crappy govt policy/action

 

[VA Hopeful Dr]

I feel like people often describe anarchy, call it libertarianism, and then clutch their pearls pretty hard while defending a blatantly crappy govt policy/action

I find myself defending some positions I don't actually support because people go a bit nuts with what they think libertarians want.

 

[deleted480308]

I find myself defending some positions I don't actually support because people go a bit nuts with what they think libertarians want.

Yep.

“Progressive income tax is theft and oppression “ becomes.....

How the hell can you let a fetus work a 38hr shift in a polluted enron private prison camp!!!!!!!!

 

[762513]

Oh so you mean its bad in that we shouldn't completely replace our current government with pure libertarianism. Well duh. No one is suggesting that, even our resident Ron Burgundy.

That wasn’t really a response to my Chomsky quote. In the business world any increase in libertarian policies leads to the potential for corporate tyranny; just look at insulin prices if you want an example. Libertarianism doesn’t work, but is an awfully convenient set of moral principles for the wealthy to hold, just like socialism is pretty convenient for poor people. It’s all self serving.

 

[VA Hopeful Dr]

That wasn’t really a response to my Chomsky quote. In the business world any increase in libertarian policies leads to the potential for corporate tyranny; just look at insulin prices if you want an example. Libertarianism doesn’t work, but is an awfully convenient set of moral principles for the wealthy to hold, just like socialism is pretty convenient for poor people. It’s all self serving.

Yes, let's look at insulin prices:

novolin 70/30 relion - Walmart.com

Free 2-day shipping. Buy novolin 70/30 relion at Walmart.com

www.walmart.com

Those dastardly bastards, how dare they make insulin that costs less than a bag of dog food.

 

[762513]

Yes, let's look at insulin prices:

novolin 70/30 relion - Walmart.com

Free 2-day shipping. Buy novolin 70/30 relion at Walmart.com

www.walmart.com

Those dastardly bastards, how dare they make insulin that costs less than a bag of dog food.

And now for some reality... American Diabetes Association® Reaffirms Commitment to Insulin Access and Affordability for All--Transparency on Insulin Pricing Critical | BioSpace

"The average price of insulin nearly tripled between 2002 and 2013. The rising cost of and access to insulin ultimately impacts everyone and especially people with diabetes and their families, health care providers, insurers, employers and our national health care system. Current estimates project that diabetes was the most expensive chronic illness in the U.S. in 2017, at a total of more than $327 billion per year including $15 billion for insulin2."

Are you just trolling me or did you not know that working people who are making responsible choices are dying because they cannot afford their insulin? But by all means, lets have more private sector control of our healthcare system. Sounds like that's the solution.

 

[VA Hopeful Dr]

And now for some reality... American Diabetes Association® Reaffirms Commitment to Insulin Access and Affordability for All--Transparency on Insulin Pricing Critical | BioSpace

"The average price of insulin nearly tripled between 2002 and 2013. The rising cost of and access to insulin ultimately impacts everyone and especially people with diabetes and their families, health care providers, insurers, employers and our national health care system. Current estimates project that diabetes was the most expensive chronic illness in the U.S. in 2017, at a total of more than $327 billion per year including $15 billion for insulin2."

Are you just trolling me or did you not know that working people who are making responsible choices are dying because they cannot afford their insulin? But by all means, lets have more private sector control of our healthcare system. Sounds like that's the solution.

I honestly thought you were less ignorant than this reply makes you seem.

A vial of insulin costs $25 at Wal-Mart. If people are literally dying because they can't afford their insulin (which incidentally as a family doctor I've never seen), its because they aren't trying to find cheap insulin. Is 70/30 the best treatment? No. Can I get someone's diabetes under control with it? Absolutely, I do it regularly.

5 Lantus pens can be had for $149. Given how when I was in residency the price was $350 that's not too bad. You know what's changed since then? Competition. In residency there were 2 long acting insulins. Now there are 5. Funny how that works. With the drug company coupon, a vial of same is an even $99. Same prices for Apidra if you need a short acting.

The ADA looks at the cash price without insurance or discounts when writing those wonderful articles. In the real work, with a little effort, you can get these things for fairly cheap.

 

[762513]

I honestly thought you were smarter than this.

A vial of insulin costs $25 at Wal-Mart. If people are literally dying because they can't afford their insulin (which incidentally as a family doctor I've never seen), its because they aren't trying to find cheap insulin. Is 70/30 the best treatment? No. Can I get someone's diabetes under control with it? Absolutely, I do it regularly.

5 Lantus pens can be had for $149. Given how when I was in residency the price was $350 that's not too bad. You know what's changed since then? Competition. In residency there were 2 long acting insulins. Now there are 5. Funny how that works. With the drug company coupon, a vial of same is an even $99. Same prices for Apidra if you need a short acting.

The ADA looks at the cash price without insurance or discounts when writing those wonderful articles. In the real work, with a little effort, you can get these things for fairly cheap.

Fairly cheap to you is different than fairly cheap for me which is different from fairly cheap for a person making minimum wage and living paycheck to paycheck. Insulin should be free for type 1 diabetics. Full stop. I kinda thought you were smarter than this, too.

 

[VA Hopeful Dr]

Fairly cheap to you is different than fairly cheap for me which is different from fairly cheap for a person making minimum wage and living paycheck to paycheck. Insulin should be free for type 1 diabetics. Full stop. I kinda thought you were smarter than this, too.

Why's that exactly?

Also, I'm sorry but $50/month for life saving medicine is fairly cheap. Even at minimum wage that's at most 8 hours of work.

As for your snark, do keep in mind that of the 2 of us I'm the one who ran a successful cash only practice with mostly uninsured blue collar workers so I know what can be accomplished for reasonable prices. You're parroting inane talking points to someone that has actually done this.

 

[762513]

Why's that exactly?

Also, I'm sorry but $50/month for life saving medicine is fairly cheap. Even at minimum wage that's at most 8 hours of work.

As for your snark, do keep in mind that of the 2 of us I'm the one who ran a successful cash only practice with mostly uninsured blue collar workers so I know what can be accomplished for reasonable prices. You're parroting inane talking points to someone that has actually done this.

My snark simply exactly matches your snark. Reread your comment.

 

[VA Hopeful Dr]

My snark simply exactly matches your snark. Reread your comment.

I'm aware of that, but my snark comes from a) assuming you had given this any real thought and b) had read any of the reams of stuff I've written on this message board across multiple areas on this exact topic. So perhaps I should have worded it more like "I had thought you weren't this ignorant". I'll go edit that as I don't think you're stupid.

 

[762513]

I'm aware of that, but my snark comes from a) assuming you had given this any real thought and b) had read any of the reams of stuff I've written on this message board across multiple areas on this exact topic. So perhaps I should have worded it more like "I had thought you weren't this ignorant". I'll go edit that as I don't think you're stupid.

That works. Have a good day.

 

[VincentAdultman]

I honestly thought you were less ignorant than this reply makes you seem.

A vial of insulin costs $25 at Wal-Mart. If people are literally dying because they can't afford their insulin (which incidentally as a family doctor I've never seen), its because they aren't trying to find cheap insulin. Is 70/30 the best treatment? No. Can I get someone's diabetes under control with it? Absolutely, I do it regularly.

5 Lantus pens can be had for $149. Given how when I was in residency the price was $350 that's not too bad. You know what's changed since then? Competition. In residency there were 2 long acting insulins. Now there are 5. Funny how that works. With the drug company coupon, a vial of same is an even $99. Same prices for Apidra if you need a short acting.

The ADA looks at the cash price without insurance or discounts when writing those wonderful articles. In the real work, with a little effort, you can get these things for fairly cheap.

Do you have to have insurance to be able to get that 70/30 for 25 dollars? I have no idea tbh.

 

[762513]

I'm aware of that, but my snark comes from a) assuming you had given this any real thought and b) had read any of the reams of stuff I've written on this message board across multiple areas on this exact topic. So perhaps I should have worded it more like "I had thought you weren't this ignorant". I'll go edit that as I don't think you're stupid.

This is a news article by an endocrinologist which backs up my statements;

https://www.washingtonpost.com/outlook/insulin-is-too-expensive-for-many-of-my-patients-it-doesnt-have-to-be/2017/06/22/c5091c42-56cf-11e7-a204-ad706461fa4f_story.html?utm_term=.20da95ebe5a9

Additionally, in my short time in practice so far, I have also had patients who came in with A1C's over 10 who simply stated they would have loved to have taken their insulin but they could not afford it. Maybe you work in a very affluent area and have never seen this problem, but I do not. We both know how much a DKA hospital admission costs. There's a ton of data that backs up my statements;

https://www.washingtonpost.com/news/wonk/wp/2016/10/31/why-insulin-prices-have-kept-rising-for-95-years/?utm_term=.8d2a82503fb5

https://health.usnews.com/health-care/for-better/articles/2018-06-29/whats-behind-the-rising-costs-of-insulin

 

[VA Hopeful Dr]

Do you have to have insurance to be able to get that 70/30 for 25 dollars? I have no idea tbh.

Nope, cash price

 

[VincentAdultman]

Nope, cash price

I thought it would be one thing if you had to pay a ridiculous premium for the privilege to spend so little bit that is...pretty good.

 

[VA Hopeful Dr]

This is a news article by an endocrinologist which backs up my statements;

https://www.washingtonpost.com/outlook/insulin-is-too-expensive-for-many-of-my-patients-it-doesnt-have-to-be/2017/06/22/c5091c42-56cf-11e7-a204-ad706461fa4f_story.html?utm_term=.20da95ebe5a9

Additionally, in my short time in practice so far, I have also had patients who came in with A1C's over 10 who simply stated they would have loved to have taken their insulin but they could not afford it. Maybe you work in a very affluent area and have never seen this problem, but I do not. We both know how much a DKA hospital admission costs. There's a ton of data that backs up my statements;

https://www.washingtonpost.com/news/wonk/wp/2016/10/31/why-insulin-prices-have-kept-rising-for-95-years/?utm_term=.8d2a82503fb5

https://health.usnews.com/health-care/for-better/articles/2018-06-29/whats-behind-the-rising-costs-of-insulin

Sigh.

First, that article is 2 years old. That's before the biosimilars hit the market which is when prices dropped to what I quoted.

Second, when patients say they can't afford insulin they're usually dealing with either the full cash price or their high deductible insurance price. I can almost guarantee that if you tell them to go get the Walmart 70/30 they will be able to afford it.

 

[VA Hopeful Dr]

I thought it would be one thing if you had to pay a ridiculous premium for the privilege to spend so little bit that is...pretty good.

Interestingly enough, that price is for OTC insulin. If you write for it, it's more.

 

[deleted480308]

This is a news article by an endocrinologist which backs up my statements;

https://www.washingtonpost.com/outlook/insulin-is-too-expensive-for-many-of-my-patients-it-doesnt-have-to-be/2017/06/22/c5091c42-56cf-11e7-a204-ad706461fa4f_story.html?utm_term=.20da95ebe5a9

Additionally, in my short time in practice so far, I have also had patients who came in with A1C's over 10 who simply stated they would have loved to have taken their insulin but they could not afford it. Maybe you work in a very affluent area and have never seen this problem, but I do not. We both know how much a DKA hospital admission costs. There's a ton of data that backs up my statements;

https://www.washingtonpost.com/news/wonk/wp/2016/10/31/why-insulin-prices-have-kept-rising-for-95-years/?utm_term=.8d2a82503fb5

https://health.usnews.com/health-care/for-better/articles/2018-06-29/whats-behind-the-rising-costs-of-insulin

Walk into a walmart and ask them how much their cheap insulin is.....then come back

 

[762513]

Walk into a walmart and ask them how much their cheap insulin is.....then come back

I don’t need a field trip. I’ll take vahopefuldocs word for it. Thanks for the suggestion though.

 

[BeautifulSmiles523]

How does libertarianism lead to tyranny? Tyrants cant exist without laws supporting them.

"If you look at the drug war from a purely economic point of view, the role of the government is to protect the drug cartel. That's literally true."

 

[Gyuji]

For those who want a libertarian economy - we already got it! It's called neoliberalism. That's the furthest libertarian economics can go in a democracy.

Milton Friedman, a known libertarian, knew his view of a libertarian economy will never be a reality again when Keynesian economics(regulated labor-based economy) was doing good for decades after the Great Depression and with the popularity of public programs/services(Social Security). Luckily, stagnation and inflation of oil prices in the 1970's and Jimmy Carter's influences, Carter being a business owner, of crippling labor unions' influences in the Democratic Party and to shift labor economy to a shareholder economy(neoliberalism) by shifting the Democratic Party from labor-left to center-right in economics. Thus lead to Carter's unpopularity, and future Democrats' "incompetence" of not able to address working-class' issues, and St. Reagan's presidency in the 1980's where St. Reagan did a massacre on labor unions and put neoliberalism to overdrive thanks to the influences of Friedman and Alan Greenspan. Doing so, the Democratic Party became more Wall Street in the 1980's when their leaders encouraged party members to accept corporate campaign donations and to abandon grassroot support. All this lead to the problems that we have today. Not only in the USA, but as well in the UK, aka Thatcherism, and the European Union latter adopting the ideology.

What is this invisible ideology of neoliberalism that you probably never heard of?

Neoliberalism is a resurgence of 19th Century ideas, associated with laissez-faire economic liberalism, in the 20th Century. These included extensive economic liberalization policies of privatization, fiscal austerity, deregulation, free trade(in other words - outsourcing jobs), and reductions in government spending in order to increase the role of the private sector in the economy and society.

Sounds like libertarianism. It works in theory.

But in reality, it failed - multiple times. In the past, 1929 crash. Even in recent times - mini-crash in Reagan's presidency, early-1990's recession, late-1980's Japan crash, 1994 Mexico crash, 1997 Asia market crash, 1998 Russia crash, 1999 Brazil crash, 2001 Turkey crash, 2002 Argentina crash 2011 Greece crisis and of course the 2008 Global Crash.

But yet, we keep pushing neoliberalism and hope it works. But hey, you want a libertarian economy, there's your answer in reality. Just crashes after crashed making people's lives miserable.

 

[deleted480308]

For those who want a libertarian economy - we already got it! It's called neoliberalism. That's the furthest libertarian economics can go in a democracy.

Milton Friedman, a known libertarian, knew his view of a libertarian economy will never be a reality again when Keynesian economics(regulated labor-based economy) was doing good for decades after the Great Depression and with the popularity of public programs/services(Social Security). Luckily, stagnation and inflation of oil prices in the 1970's and Jimmy Carter's influences, Carter being a business owner, of crippling labor unions' influences in the Democratic Party and to shift labor economy to a shareholder economy(neoliberalism) by shifting the Democratic Party from labor-left to center-right in economics. Thus lead to Carter's unpopularity, and future Democrats' "incompetence" of not able to address working-class' issues, and St. Reagan's presidency in the 1980's where St. Reagan did a massacre on labor unions and put neoliberalism to overdrive thanks to the influences of Friedman and Alan Greenspan. Doing so, the Democratic Party became more Wall Street in the 1980's when their leaders encouraged party members to accept corporate campaign donations and to abandon grassroot support. All this lead to the problems that we have today. Not only in the USA, but as well in the UK, aka Thatcherism, and the European Union latter adopting the ideology.

What is this invisible ideology of neoliberalism that you probably never heard of?

Neoliberalism is a resurgence of 19th Century ideas, associated with laissez-faire economic liberalism, in the 20th Century. These included extensive economic liberalization policies of privatization, fiscal austerity, deregulation, free trade(in other words - outsourcing jobs), and reductions in government spending in order to increase the role of the private sector in the economy and society.

Sounds like libertarianism. It works in theory.

But in reality, it failed - multiple times. In the past, 1929 crash. Even in recent times - mini-crash in Reagan's presidency, early-1990's recession, late-1980's Japan crash, 1994 Mexico crash, 1997 Asia market crash, 1998 Russia crash, 1999 Brazil crash, 2001 Turkey crash, 2002 Argentina crash 2011 Greece crisis and of course the 2008 Global Crash.

But yet, we keep pushing neoliberalism and hope it works. But hey, you want a libertarian economy, there's your answer in reality. Just crashes after crashed making people's lives miserable.

What we have isn’t libertarianism

And crashes are appropriate if people get crazy, govt shouldn’t take over an economy to stop that

 

[Osminog]

For those who want a libertarian economy - we already got it! It's called neoliberalism. That's the furthest libertarian economics can go in a democracy.

Milton Friedman, a known libertarian, knew his view of a libertarian economy will never be a reality again when Keynesian economics(regulated labor-based economy) was doing good for decades after the Great Depression and with the popularity of public programs/services(Social Security). Luckily, stagnation and inflation of oil prices in the 1970's and Jimmy Carter's influences, Carter being a business owner, of crippling labor unions' influences in the Democratic Party and to shift labor economy to a shareholder economy(neoliberalism) by shifting the Democratic Party from labor-left to center-right in economics. Thus lead to Carter's unpopularity, and future Democrats' "incompetence" of not able to address working-class' issues, and St. Reagan's presidency in the 1980's where St. Reagan did a massacre on labor unions and put neoliberalism to overdrive thanks to the influences of Friedman and Alan Greenspan. Doing so, the Democratic Party became more Wall Street in the 1980's when their leaders encouraged party members to accept corporate campaign donations and to abandon grassroot support. All this lead to the problems that we have today. Not only in the USA, but as well in the UK, aka Thatcherism, and the European Union latter adopting the ideology.

What is this invisible ideology of neoliberalism that you probably never heard of?

Neoliberalism is a resurgence of 19th Century ideas, associated with laissez-faire economic liberalism, in the 20th Century. These included extensive economic liberalization policies of privatization, fiscal austerity, deregulation, free trade(in other words - outsourcing jobs), and reductions in government spending in order to increase the role of the private sector in the economy and society.

Sounds like libertarianism. It works in theory.

But in reality, it failed - multiple times. In the past, 1929 crash. Even in recent times - mini-crash in Reagan's presidency, early-1990's recession, late-1980's Japan crash, 1994 Mexico crash, 1997 Asia market crash, 1998 Russia crash, 1999 Brazil crash, 2001 Turkey crash, 2002 Argentina crash 2011 Greece crisis and of course the 2008 Global Crash.

But yet, we keep pushing neoliberalism and hope it works. But hey, you want a libertarian economy, there's your answer in reality. Just crashes after crashed making people's lives miserable.

Every single economic crisis that you listed was caused primarily by government intervention in the economy, not by laissez-faire policies.

At this point in time, we don't have to talk about libertarianism "in theory." We can talk about it in practice. Look at Singapore. Look at Macau. Look at Hong Kong. These are perfect case studies in the effectiveness of libertarian policies—low corporate taxes, free trade, small public sector. Are all of their policies libertarian? Of course not. Do these places have zero problems? Of course not. But overall, their systems are pro-free market, and they are some of the most economically prosperous areas in Asia.

Libertarianism works in theory, but it also works in practice. Economic freedom—allowing people to freely associate and trade with one another—leads to general economic prosperity. That's what the historical record shows, and that's what we see when we look at the state of the world today.

 

[Gyuji]

What we have isn’t libertarianism

And crashes are appropriate if people get crazy, govt shouldn’t take over an economy to stop that

Look, nobody isn't going to vote for pure libertarianism of open-border, little-to-no labor laws, massive deregulations, fully cutting public programs, abolishing several government agencies like EPA and FDA. Just face it. Be like Milton Friedman and Ed Koch, who ran for VP in 1980 on a Libertarian Party ticket with a horror house of a platform, join the Republicans and embrace them. The only type of libertarianism people will accept is left-libertarianism which focus on social issues, like gay marriage and drug usage, and foreign-intervention which something politicians with different ideologies can agree on alas, Bernie Sanders and Ron Paul did in the 2000's by forming coalition on several reforms and laws.

No, crashes are not appropriate. People do not want an economic crisis. No one does. To have a steady economic growth, you need regular people(labor) to control the economy, not corporations and uber-wealthy. Even old school Republicans like George H.W. Bush and Rockafeller Republicans knew this.

 

[Gyuji]

Every single economic crisis that you listed was caused primarily by government intervention in the economy, not by laissez-faire policies.

At this point in time, we don't have to talk about libertarianism "in theory." We can talk about it in practice. Look at Singapore. Look at Macau. Look at Hong Kong. These are perfect case studies in the effectiveness of libertarian policies—low corporate taxes, free trade, small public sector. Are all of their policies libertarian? Of course not. Do these places have zero problems? Of course not. But overall, their systems are pro-free market, and they are some of the most economically prosperous areas in Asia.

Libertarianism works in theory, but it also works in practice. Economic freedom—allowing people to freely associate and trade with one another—leads to general economic prosperity. That's what the historical record shows, and that's what we see when we look at the state of the world today.

Hong Kong and Singapore have public(government-run) healthcare sectors as well with a private sector.

 

[deleted480308]

Look, nobody isn't going to vote for pure libertarianism of open-border, little-to-no labor laws, massive deregulations, fully cutting public programs, abolishing several government agencies like EPA and FDA. Just face it. Be like Milton Friedman and Ed Koch, who ran for VP in 1980 on a Libertarian Party ticket with a horror house of a platform, join the Republicans and embrace them. The only type of libertarianism people will accept is left-libertarianism which focus on social issues, like gay marriage and drug usage, and foreign-intervention which something politicians with different ideologies can agree on alas, Bernie Sanders and Ron Paul did in the 2000's by forming coalition on several reforms and laws.

No, crashes are not appropriate. People do not want an economic crisis. No one does. To have a steady economic growth, you need regular people(labor) to control the economy, not corporations and uber-wealthy. Even old school Republicans like George H.W. Bush and Rockafeller Republicans knew this.

You are confusing election strategy with accurately labeling libertarian principles. I’m not talking about winning elections, I’m talking about what is appropriate

 

[Osminog]

Hong Kong and Singapore have public(government-run) healthcare sectors as well with a private sector.

Right. That's why I said: "Are all of their policies libertarian? Of course not." There is no anarcho-capitalist/perfectly libertarian society in existence, nor will there likely ever be. These are just societies that, overall, have more economic freedom than a vast majority of countries, including our own.

 

[KeikoTanaka]

This conversation is way off track. You're debating political and economic theory, not discussing what a Medicare for all system could look like.

Can we all agree that Medicare for all isn't going to be accepted by everyone, but, can we theorize what it would look like IF EVERYONE WAS ON BOARD WITH IT? Whether or not it is good or bad isn't what the OP was asking. How it would effect various medical proffessions and specialties? What are things we can do to protect salaries?

The way I see it, Doctors can make it work for Doctors, or Government will make it work for Government. I do feel like in one way shape or form something is going to give given the cultural shift we're seeing, and it is inevitably going to happen. So how can we make it work in the best interest of the patients and physicians?

 

[deleted480308]

This conversation is way off track. You're debating political and economic theory, not discussing what a Medicare for all system could look like.

Can we all agree that Medicare for all isn't going to be accepted by everyone, but, can we theorize what it would look like IF EVERYONE WAS ON BOARD WITH IT? Whether or not it is good or bad isn't what the OP was asking. How it would effect various medical proffessions and specialties? What are things we can do to protect salaries?

The way I see it, Doctors can make it work for Doctors, or Government will make it work for Government. I do feel like in one way shape or form something is going to give given the cultural shift we're seeing, and it is inevitably going to happen. So how can we make it work in the best interest of the patients and physicians?

You can’t because it is a bad idea.

 

[KeikoTanaka]

You can’t because it is a bad idea.

Yes, our country has NEVER done something that was a bad idea...

 

[deleted480308]

Yes, our country has NEVER done something that was a bad idea...

Crappy idea in past isn’t a defense for crappy future idea

 

[KeikoTanaka]

Crappy idea in past isn’t a defense for crappy future idea

Not saying it is, but their track record isn't good, and therefore we can predict they'll propose crappy future ideas. So atleast if Doctors were the ones calling the shots in healthcare reform we could probably lessen the blow and make a better system than they'll inevitably come up with.

 

[deleted480308]

Not saying it is, but their track record isn't good, and therefore we can predict they'll propose crappy future ideas. So atleast if Doctors were the ones calling the shots in healthcare reform we could probably lessen the blow and make a better system than they'll inevitably come up with.

But there just isn’t a way for that to never to not suck and doctors are certainly not in charge either.

But we can go through the mental exercise for you... how do you make it not suck?

 

[KeikoTanaka]

But there just isn’t a way for that to never to not suck and doctors are certainly not in charge either.

But we can go through the mental exercise for you... how do you make it not suck?

I think first and foremost we need to place more emphasis on primary care. This would result in less need for emergent and specialty services in the long run, which can help cut down on costs. One big way to do this would be to fund more free clinics where doctors are paid a basement salary for seeing just about anyone that walks through the door, similar to an emergency doctor. But, compliance would be mandatory - only compliant individuals would be able to gain access to such a clinic.

And if we let the insurance companies pay for these free clinic doctor salaries, it could be their way of "giving back" to communities with their millions of dollars of profit each year.

It's just an idea, and I'm sure there's 100 reasons why it's bad, and many reasons why it's good. But at least it starts a conversation about how we can increase access and begin to cut down on costs.

Another thing would be to pass laws allowing the government to negotiate pharmaceutical prices.

These are both "Government-legislation" to control free companies - So I know already you won't like it, but it would at least be benign compared to a full-outright single payer system

 

[deleted480308]

I think first and foremost we need to place more emphasis on primary care. This would result in less need for emergent and specialty services in the long run, which can help cut down on costs. One big way to do this would be to fund more free clinics where doctors are paid a basement salary for seeing just about anyone that walks through the door, similar to an emergency doctor. But, compliance would be mandatory - only compliant individuals would be able to gain access to such a clinic.

And if we let the insurance companies pay for these free clinic doctor salaries, it could be their way of "giving back" to communities with their millions of dollars of profit each year.

It's just an idea, and I'm sure there's 100 reasons why it's bad, and many reasons why it's good. But at least it starts a conversation about how we can increase access and begin to cut down on costs.

Another thing would be to pass laws allowing the government to negotiate pharmaceutical prices.

These are both "Government-legislation" to control free companies - So I know already you won't like it, but it would at least be benign compared to a full-outright single payer system

It’s not benign at all, the ones running to the ED are the noncompliant people already. Your plan takes compliant primary care patients (the ones most likely to be paying for it) and makes it a govt tax funded service and still leaves us with all the crap expense of wasted ED time except now with you paying primary care docs less.....no thanks

“Letting” insurance companies pay for it crap and you know it, they’ll close or raise their rates or cut some other payout. They exist to make money providing a service and now all you’ve done is added a layer of govt to manage the inappropriate expense you want to change the insurance company

 

[KeikoTanaka]

The plan does take compliant primary care patients - but they're not paying for it because these clinics would only be for individuals who don't currently have insurance and therefore can't be compliant because they currently have no medical plan to be compliant to. The only PCPs who would be making less would be the ones working in these clinics, and we can just give them student loan forgiveness for working in one for 4-5 years. Yes, you would still have non-compliant patients going to the ED, but as long as EMTALA is a law, that will always be the case. If people were given the chance to be compliant by finally having access to a Doctor, I think there would be a reduction in useless ED visits (which we're paying for anyways) - and a hell of a lot more than we would be paying if they just saw a PCP.

Paying for it, you're right, would be the challenge (but any change is going to require you to work through that challenge). But perhaps if the uninsured were given insurance that at least afforded them primary care, then we can start cutting down on costs elsewhere and eventually leading to a net 0 change in healthcare spending, but at least utilization of resources would be better and overall health of the population could improve, which would lead to less sick days and less productivity loss for other economic sectors.

 

[deleted480308]

The plan does take compliant primary care patients - but they're not paying for it because these clinics would only be for individuals who don't currently have insurance and therefore can't be compliant because they currently have no medical plan to be compliant to. The only PCPs who would be making less would be the ones working in these clinics, and we can just give them student loan forgiveness for working in one for 4-5 years. Yes, you would still have non-compliant patients going to the ED, but as long as EMTALA is a law, that will always be the case. If people were given the chance to be compliant by finally having access to a Doctor, I think there would be a reduction in useless ED visits (which we're paying for anyways) - and a hell of a lot more than we would be paying if they just saw a PCP.

Paying for it, you're right, would be the challenge (but any change is going to require you to work through that challenge). But perhaps if the uninsured were given insurance that at least afforded them primary care, then we can start cutting down on costs elsewhere and eventually leading to a net 0 change in healthcare spending, but at least utilization of resources would be better and overall health of the population could improve, which would lead to less sick days and less productivity loss for other economic sectors.

There is a difference between coverage and care, the uninsured can still afford primary care

 

[KeikoTanaka]

There is a difference between coverage and care, the uninsured can still afford primary care

Not really? That's like saying the uninsured can afford gym memberships, or organic foods, and it's all their fault they can't because of poor spending. Yeah, maybe they can afford one of those things, but not ALL the things, which are all vitally important aspects of health. Not saying we need to start paying people for those things too, but when Healthcare is costing us exponentially more for worse outcomes, something needs to change. And by uninsured affording primary care, i'm not really so sure about that. Not when you start factoring in the cost of lab work, imaging, and pharmaceuticals.

 

[deleted480308]

Not really? That's like saying the uninsured can afford gym memberships, or organic foods, and it's all their fault they can't because of poor spending. Yeah, maybe they can afford one of those things, but not ALL the things, which are all vitally important aspects of health. Not saying we need to start paying people for those things too, but when Healthcare is costing us exponentially more for worse outcomes, something needs to change. And by uninsured affording primary care, i'm not really so sure about that. Not when you start factoring in the cost of lab work, imaging, and pharmaceuticals.

We really aren’t that worse on outcomes at all

And primary care absolutely can be cheap... @VA Hopeful Dr

 

[KeikoTanaka]

We really aren’t that worse on outcomes at all

And primary care absolutely can be cheap... @VA Hopeful Dr

It CAN be cheap.. but not when you're a poor family trying to save for so many other things as well. And what happens if you need it not for yourself, but for your spouse, and 2 kids?

One of the biggest reasons we're seeing ever-worsening racial disparities in wealth today that is worse than in the 1980s is because of very small reasons like this. That poor family can never begin to even set aside or begin saving money because of the inflation of cost-of-living, and disproportionate wage increases. Black families can't save up to get their kid a car, so he can't get a job, but they never could save up for college either, so you get a high school graduate with nothing to do, and unfortunately healthcare does play a large role in that because one bad accident or sickness and you lose your ability to work, or are slapped with a huge medical bill that throws your whole budget out of whack, when you were already living pay-check to pay-check.

And you might be able to say well they shouldn't have had kids in the first place if they cant afford it, and it's not your problem to deal with someone else's financial status, which I would agree with, but at the end of the day more and more of the middle class is being strained and losing their jobs to outsourcing and automation, and eventually the "have nots" will outnumber the "haves" - and some bad **** happens at that point - that's how the world works.. But, if more people were able to get ahead because one huge burden (Cost of healthcare) is slightly lifted, maybe it could help millions of people from slipping.

And I get it, you might make the argument that it wouldn't end there, that people would just keep wanting more. Well, like you, I believe the government has very specific roles, and unfortunately it acts out of its scope of what I think the government should do. I believe the government should only be responsible for very specific things:

1. Infrastructure (Highways, Traffic Lights, Hospitals, EMS, Bridges)
2. Public Safety (Police, Border Patrol, Military, Firefighters, FEMA, prisons)
3. Education (Public schools, teachers)
4. Healthcare (Public Health Initiatives, CDC, FDA)
*5. NASA (And other programs that help assert U.S. dominance over competition)

The government grossely misspends their money and this disables them from doing a good job on things that actually requires the governmental infrastructure, such as providing meaningful public education reform and having proper roads and bridges to drive on. Healthcare doesn't need to be 3 trillion a year, I'm not asking for private insurance to go away - Just like I would never say Private Schools can't exist just because you pay for Public Schools as well, but if we had some system in place that could unite various healthcare agencies together, our system could be more efficient and cost effective and start to work on gaps in care where disparities exist.

 

[KeikoTanaka]

Unfortunately to implement healthcare, our entire government would need to be built again from the ground-up. We have so much excess and waste, we need to really get our priorities straightened out and begin working towards solutions for things that matter... so much for draining the swamp ~~

 

[deleted480308]

It CAN be cheap.. but not when you're a poor family trying to save for so many other things as well. And what happens if you need it not for yourself, but for your spouse, and 2 kids?

One of the biggest reasons we're seeing ever-worsening racial disparities in wealth today that is worse than in the 1980s is because of very small reasons like this. That poor family can never begin to even set aside or begin saving money because of the inflation of cost-of-living, and disproportionate wage increases. Black families can't save up to get their kid a car, so he can't get a job, but they never could save up for college either, so you get a high school graduate with nothing to do, and unfortunately healthcare does play a large role in that because one bad accident or sickness and you lose your ability to work, or are slapped with a huge medical bill that throws your whole budget out of whack, when you were already living pay-check to pay-check.

And you might be able to say well they shouldn't have had kids in the first place if they cant afford it, and it's not your problem to deal with someone else's financial status, which I would agree with, but at the end of the day more and more of the middle class is being strained and losing their jobs to outsourcing and automation, and eventually the "have nots" will outnumber the "haves" - and some bad **** happens at that point - that's how the world works.. But, if more people were able to get ahead because one huge burden (Cost of healthcare) is slightly lifted, maybe it could help millions of people from slipping.

And I get it, you might make the argument that it wouldn't end there, that people would just keep wanting more. Well, like you, I believe the government has very specific roles, and unfortunately it acts out of its scope of what I think the government should do. I believe the government should only be responsible for very specific things:

1. Infrastructure (Highways, Traffic Lights, Hospitals, EMS, Bridges)
2. Public Safety (Police, Border Patrol, Military, Firefighters, FEMA, prisons)
3. Education (Public schools, teachers)
4. Healthcare (Public Health Initiatives, CDC, FDA)
*5. NASA (And other programs that help assert U.S. dominance over competition)

The government grossely misspends their money and this disables them from doing a good job on things that actually requires the governmental infrastructure, such as providing meaningful public education reform and having proper roads and bridges to drive on. Healthcare doesn't need to be 3 trillion a year, I'm not asking for private insurance to go away - Just like I would never say Private Schools can't exist just because you pay for Public Schools as well, but if we had some system in place that could unite various healthcare agencies together, our system could be more efficient and cost effective and start to work on gaps in care where disparities exist.

#4 is a big reach sir/ma’am

 

[KeikoTanaka]

#4 is a big reach sir/ma’am

It's not a big reach per se - The Centers for Medicare and Medicaid Services was under the Social Security Administration when it first started in 1966 and became it's own Government agency later on. We already have the government paying for certain aspects of healthcare. So, if we're already spending money on this system, I think we should be getting better results from it at least

 

[deleted480308]

It's not a big reach per se - The Centers for Medicare and Medicaid Services was under the Social Security Administration when it first started in 1966 and became it's own Government agency later on. We already have the government paying for certain aspects of healthcare. So, if we're already spending money on this system, I think we should be getting better results from it at least

You’re going the wrong direction, govt should get out of that. It’s been a mess

 

[KeikoTanaka]

You’re going the wrong direction, govt should get out of that. It’s been a mess

If medicare was completely abolished tomorrow, how would any of those patients access any healthcare? Do you mind if I ask what type of physician you are and how much of your revenue stream is Medicare? Trump has said he wanted to "remove state lines" for insurance companies to instill competition and drive down prices, but I don't think I've seen any impact whatsoever from that. Also you have the whole mess of companies paying for people's insurance. More and more companies are hiring people at sub-full-time just to get out of having to provide employee benefits and insurance. There's so many intricacies with private insurance companies that make it difficult to obtain and pay for, unless you are in the minority of people who have a very good job with a company that provides it. Why are we relying on companies? If it was affordable, it wouldn't have to be offered in this way and people could just afford it, but I don't see that being the thing. I lost my insurance when I turned 26 (My parent is a teacher) so I had to get onto my school insurance. If I didn't have school insurance, I have no idea what I would even do as a student with no income? I tried to go to the Dentist the other month and they wanted 900$ for a "deep cleaning" that wasn't covered because it was dental, and my school doesn't offer that, but they're like "oh you can just make monthly payments toward it" - but that's a lot of money and I have a fixed amount of money afforded to me, not some stream of income. And I know its an anecdotal example, but I'm sure there are many other people just trying to access regular healthcare, not dental, that also run into those blocks. And if a deep cleaning is 900$ out of pocket, I can't imagine what an Appendectomy, Rotator Cuff tear, AAA repair, or other emergent surgeries cost that prevent people from working in jobs that don't even offer them healthcare.

 

[deleted480308]

If medicare was completely abolished tomorrow, how would any of those patients access any healthcare? Do you mind if I ask what type of physician you are and how much of your revenue stream is Medicare? Trump has said he wanted to "remove state lines" for insurance companies to instill competition and drive down prices, but I don't think I've seen any impact whatsoever from that. Also you have the whole mess of companies paying for people's insurance. More and more companies are hiring people at sub-full-time just to get out of having to provide employee benefits and insurance. There's so many intricacies with private insurance companies that make it difficult to obtain and pay for, unless you are in the minority of people who have a very good job with a company that provides it. Why are we relying on companies? If it was affordable, it wouldn't have to be offered in this way and people could just afford it, but I don't see that being the thing. I lost my insurance when I turned 26 (My parent is a teacher) so I had to get onto my school insurance. If I didn't have school insurance, I have no idea what I would even do as a student with no income? I tried to go to the Dentist the other month and they wanted 900$ for a "deep cleaning" that wasn't covered because it was dental, and my school doesn't offer that, but they're like "oh you can just make monthly payments toward it" - but that's a lot of money and I have a fixed amount of money afforded to me, not some stream of income. And I know its an anecdotal example, but I'm sure there are many other people just trying to access regular healthcare, not dental, that also run into those blocks. And if a deep cleaning is 900$ out of pocket, I can't imagine what an Appendectomy, Rotator Cuff tear, AAA repair, or other emergent surgeries cost that prevent people from working in jobs that don't even offer them healthcare.

No company should be required to offers insurance, it’s an individual responsibility to figure out how to buy your care. We are an employer based insurance system because of govt interference with wage control in the war and now moreso because govt is forcing companies to buy for employees. It is so expensive because of all the crap the govt requires to be covered

My specialty is irrelevant. I do openly admit a lot of specialties would get a pay cut if we finally stopped govt in healthcare, and that’s fine. We should make what the market will pay for our skills.

Surgeries are expensive, that’s why people should carry catastrophic insurance.

 

[KeikoTanaka]

No company should be required to offers insurance, it’s an individual responsibility to figure out how to buy your care. We are an employer based insurance system because of govt interference with wage control in the war and now moreso because govt is forcing companies to buy for employees. It is so expensive because of all the crap the govt requires to be covered

My specialty is irrelevant. I do openly admit a lot of specialties would get a pay cut if we finally stopped govt in healthcare, and that’s fine. We should make what the market will pay for our skills.

Surgeries are expensive, that’s why people should carry catastrophic insurance.

So the government forced health insurance to sky rocket.. just like they did with student loans and tuition. But the only way to fix that problem then is to reformat the whole system. Just out of curiosity, I have no knowledge of actual prices since I haven't had to buy insurance ever in my life (Yay having workings parents and getting accepted to school before 26!) but what is the cheapest insurance plan one could buy, if Medicare was abolished tomorrow?

According to eHealth.com, the cost for a single-person coverage healthcare is generally ~$440 / month. For a family, 1,160$ a month. That's 13,920$ a year. The average household income is 60,000$ pre-tax. 22% tax rate leaves you with 46,000$. I live in NY so 6.33% tax rate = 42k / year.

14,000 is 33% of your household income to health insurance.
900$/month for rent = 9600$ / year = 22% of household income.
12k / year for food = 29% of your household income for a family.

That leaves the average American household with only 6.6k a year. I haven't even factored in gas, car insurance, heating and cooling, internet, cell phone, all things the average American needs to live, get to work, and function in a society that demands you to be "connected" at all times - Doctors aren't the only people that take call or work extra hours at home, so internet and cell phone are essentials.

Basically, this leaves the average American will extremely very tight wiggle room to even begin saving. I didn't even factor student loans that I'm sure the parents are paying off either!

Btw the 14,000 for a family is one of the cheapest plans possible. I don't know what this covers, but you better pray you don't ACTUALLY get sick and need a sudden visit to the ER or get into a car accident, you'll be in debt for a very long time. And you can't really have a rainy day fund because where in the budget was a savings even possible?

33% of your income for the average American for the LOWEST plan is ridiculous. And the average income salary of 60,000 is probably even high for a lot of people.