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Author Topic: American Health Care in Crisis  (Read 1080 times)
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joan1984
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« Reply #60 on: May 29, 2017, 08:59:23 PM »

Lois, If you like your Obamacare, you may keep your Obamacare!

Indeed, their free market based ideology makes it impossible for them to see that some things can be done more efficiently and better by the government. 
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Some people are like the 'slinky'. Not really good for much, but they bring a smile to your face as they fall down stairs.
Northwest
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« Reply #61 on: May 29, 2017, 09:11:49 PM »

Lois is right, of course, and Joan's silly troll makes it obvious she doesn't have an adequate response other than to attempt to divert attention.

Health care for profit is a fundamentally flawed idea because corporate profits will always be in opposition to the health of the users. It's that simple.
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Elizabeth
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« Reply #62 on: May 29, 2017, 11:57:02 PM »

It's cheaper for insurance companies to let you die, than to pay out huge sums of money to keep you alive.
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Lois
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« Reply #63 on: June 03, 2017, 04:02:10 AM »

Economist shows that single-payer health care in California would protect business and save the public money
A new analysis offers a counter narrative to existing propaganda
STEVEN ROSENFELD, ALTERNET

The California Senate Appropriations Committee has vastly overstated the new costs of creating a single-payer health system for the Golden State, according to a national authority on healthcare spending.

Last week, the Committee released its analysis of SB 562, The Healthy California Act. It said the total cost of providing health care to all 37 million Californians was $400 billion a year. Half of that comes from an array of government programs — Medicaid, Medicare, Obamacare, etc. That means Californians would have to raise the payroll tax by 15 percent to pay for the difference, it reported.

“About $200 billion in additional tax revenues would be needed to pay for the remainder of the total program cost. Assuming that this cost was raised through a new payroll tax (with no cap on wages subject to the tax), the additional payroll tax rate would be about 15% of earned income,” the Appropriations analysis said. “It is important to note that the overall cost of those new tax revenues would be offset to a large degree by reduced spending on health care coverage by employers and employees. Therefore, total new spending required under the bill would be between $50 and $100 billion per year.”

That assessment filled a void in the political debate surrounding SB 562, because the bill does not specify a revenue stream and its sponsors have not released their analysis of how Californians would pay for it and gain health security under a single-payer system. But according to Gerald Friedman, a University of Massachusetts economist who conducted that very analysis for a single-payer system in New York and has studied health costs in other large states, California’s analysts erred by understating health care cost savings and failing to subtract current health care spending from their projected payroll tax increase.

“I read the legislature’s analysis and was disappointed,” he said. “First, it has a high number for total costs because it assumes no savings from bulk purchasing of drugs and medical devices even though the rest of the world buys these at barely 70 percent what Americans pay, and the VA [Veterans Administration] buys drugs at 59 percent. Second, it assumes very small savings from lower administration (among both providers and insurers).  Finally, it assumes a very large increase in utilization, which is a cost but also a benefit since going to the doctor saves lives, and barriers to access are associated with about 200,000 extra deaths in the U.S. each year. (This figure is from a county-level analysis of mortality versus the proportion reporting they could not go to a doctor because of costs.)”

But the analysts’ bigger mistake was on the spending side — by omitting any mention that Californians would subtract current health spending from any tax increase. For example, the average Californian earned $64,500 in 2015. At first glance, a 15 percent payroll tax increase appears to add an additional tax of $9,675 a year or $806.25 monthly. However, if one is already paying $650 or so monthly for a health plan and several thousands more on deductibles and co-pays, then one can see how that current figure is actually more expensive than what would need to be raised under a single payer system. Friedman said this omission was crucial.

“The analysis does not discuss the different burden of health care with a payroll tax (or an income tax) compared with the current system which works like a lump-sum tax: everyone pays the same amount regardless of income,” he said. “In California in 2015, family insurance premiums (employer and employee) cost $18,045. For a worker earning $64,500, that is 28 percent of earnings, plus the cost of co-pays and deductibles. Indeed, at $18,000, workers would do better even with a 15 percent payroll tax up to earnings of $120,000. And, if we assume the employer plan had an actuarial value of 90 percent, and out-of-pocket costs are $2,000, workers are better off with a 15 percent payroll tax up to $133,333.”

Friedman said single-payer would save the public and businesses money via cutting bureaucratic costs and negotiating for drugs.

“The major criticism of these single payer plans is that we won’t get the savings that we anticipate from reducing administration—and I think that’s just crazy,” he said. “Because why would people employ all these people in billing and insurance processing if all you have to do is swipe a card in the right type of reader and it all goes to Sacramento where somebody will type in the diagnostic code and cut a check. In Toronto General Hospital, they have about 400 beds. It’s the size of Massachusetts General Hospital. And they have two people who do billing. Massachusetts General has about 400 people doing billing. That’s about one person per bed . . . I don’t see why we wouldn’t get large savings. Maybe not as large as I am anticipating. But much larger than they’re talking about.”

“And the other thing is the drug purchasing,” Friedman said. “California is the world’s seventh largest economy. If you guys just broke off, you would be as large as Italy. And Italy negotiates drug prices and drugs in Italy cost about half of what they cost in the United States. I don’t see why California wouldn’t get savings.”

What the legislative analysts should have done was compared what people now pay for their healthcare costs to the figure that would be needed to supplement the government’s subsidies for the poor, elderly, children, people with disabilities and veterans, he said. If they did that, they would have found that paying 15 percent of one’s income for health care is a very good deal.

“Fifteen percent [for a payroll tax increase] — I think that number’s too high, but 15 percent is less than what employer-provided coverage now costs in most states,” he said. “When you add in co-pays and deductibles, I would rather pay 15 percent than what I and my employer are now paying, because most people will be saving money. And people will have more security because they’ll get the care they need.”
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Northwest
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« Reply #64 on: June 19, 2017, 09:45:52 PM »

In the next week, or so, Senate leaders are going to try to put a bill on the floor, and vote on it immediately; before anyone has had a chance to read it, understand it or comment on it. This will be a remake of the rules which determine how one sixth of the economy works, and they want to make radical changes based only on backroom agreements by a handful of carefully selected politicos.

Sure...you can throw their asses out at the next election, after you find out what they have done to you and your health care. But think about how long it took Democrats to get the circumstances right that they were able to pass Obamacare to begin with. In our system of government, a very few players can prevent anything from moving forward, and we might be stuck with a terrible health care plan for a generation...or more.

It only takes three Republican no votes, or abstentions to defeat what's coming. If you live in a state where your Senator is on the fence about backing TrumpCare, let them know your feelings.


Senate leaders plan to rush a health-care bill to a vote, and there’s nothing Democrats can do about it


https://img.washingtonpost.com/wp-apps/imrs.php?src=https://img.washingtonpost.com/rf/image_960w/2010-2019/WashingtonPost/2017/05/26/National-Politics/Images/313838046_0-7.jpg&w=480

When the Republican-led Senate Rules Committee briefly flirted with the idea of restricting television interviews in the hallways of the Capitol last week, it became only the most obvious manifestation of how the party’s leaders were handling the development of a bill to overhaul Obamacare: out of the public eye.

While that effort was quickly sidelined after some outcry, the Republican leadership in the Senate was otherwise unfazed in its push to craft a bill that would expose its members to as little negative public attention as possible. No repeat of the town hall meetings that drew angry constituents who yelled at House Republicans and, they clearly hope, no weeks and weeks of swamped office phone lines.

In an article for the Monkey Cage, George Washington University’s Sarah Binder explained the four ways in which the Senate effort was unusually secretive. Sure, members of Congress would always rather pass legislation without dealing with negative criticism, but rarely have they gone so dark on such a big effort.

[Are Republicans leading the most secretive health-care bill process ever?]

The question that arises, though, is what Democrats could actually do about it. Binder told me that the answer was probably a simple one.

Nothing.

“I have a hard time seeing a real avenue for successful obstruction by the Democrats,” Binder said. The situation is unusual enough that making hard and fast predictions is tricky, she said, but “Republicans have been so aggressive on procedure here that I’d expect them to … get this through without any heed of what the Democrats were raising.”

In particular, Binder addressed a proposal outlined in a series of tweets last week by Ezra Levin, a former deputy policy director for House Democrats. Levin suggested that the Democrats could introduce an almost infinite number of amendments that would choke the Senate calendar indefinitely until they got what they wanted.

The plan hinges on the way in which the bill is being moved through the Senate. To avoid the need for Democratic votes — which the Republican majority wouldn’t get — the Obamacare replacement is being advanced using what’s known as the reconciliation process. That process involves a special set of rules that are meant to fast-track debate over the budget, but, given that it also means legislation can avoid a filibuster in the Senate, it has also been used to pass controversial bills. (Several fixes essential to the passage of Obamacare were moved using the reconciliation process, for example.)

Those rules, defined by law, include allowing only 20 hours for debate but it also includes a process called “vote-a-rama,” in which amendments may be proposed and must be voted on before the final passage of the bill. That’s where Levin’s idea comes in: He proposed introducing tens of thousands of amendments that would need to be voted on before the Senate’s bill could be passed. In theory, Levin figured, Democrats could introduce enough amendments to shut down the Senate for a year.

Binder disagrees.

“In reality, that’s not going to happen,” she said. What was more likely, she said, is that someone would make a point of order that the Democrats were being “dilatory” — that is, slowing down the process unnecessarily. The presiding officer — the Republican senator on duty to manage floor debate — would be asked to rule on whether that was the case and would likely agree. Democrats could appeal the decision, but a majority vote would end the process.

It’s not just partisan politics that would lead to that outcome, either, Binder said. If the presiding officer were to appeal to the Senate parliamentarian — the resident expert on the rules of order — the recommendation would likely be the same. “The parliamentarian’s job is really to make the Budget Act work, and everybody knows that the Budget Act has time limits in it,” she said. An infinite vote-a-rama might be in keeping with the letter of the law, but not, importantly, the spirit.

“The weight of the law here is toward no filibusters,” she said. But she also noted that there was no “hard and fast precedent” for such a scenario since, normally, the two parties agree in advance on how long the process will extend.

Asked if the Democrats had any other recourse, Binder was skeptical.

“I don’t really see an escape valve for Democrats to delay it,” she said. The only question is whether the Senate bill — once it’s finalized — meets the rules for reconciliation and if the House accepts it as written. If it’s not eligible for reconciliation or if the House doesn’t want to agree to the Senate bill as written, then more traditional minority obstruction efforts might kick in. If, however, the Senate Republicans pass a measure that the House Republicans agree to in whole cloth, that’s it.

Senate Majority Leader Mitch McConnell (R-Ky.) is no doubt very well aware of his options. He’s betting that drafting the bill in secret and pushing it through the Senate with limited debate will give his caucus enough cover to vote yes — and that the House will agree to the bill. If he’s right, that means that only one group could stand in his way: Republicans on Capitol Hill, by defecting in the Senate or objecting in the House. The Democrats can probably only watch.

https://www.washingtonpost.com/news/politics/wp/2017/06/19/senate-leaders-plan-to-rush-a-health-care-bill-to-a-vote-and-theres-nothing-democrats-can-do-about-it/
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Northwest
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« Reply #65 on: June 21, 2017, 04:46:32 PM »

GOP's secret Trumpcare bill will impact a sixth of the U.S. economy. What could possibly go wrong?
The Times Editorial Board



Senate Majority Leader Mitch McConnell (R-Ky.) is pushing for a vote next week on a bill to repeal and replace Obamacare despite having held no public hearings, obtained no feedback from budget analysts and taken no testimony from doctors, patients or hospitals.

That’s a recipe for disaster.

Senate Republicans have been inundated with complaints about the secret negotiations over the bill, which took as a starting point the House Republican leadership’s execrable American Health Care Act. So far, their negotiators have not been deterred by the accusations of recklessness (healthcare spending accounts for about a sixth of the massive U.S. economy), heedlessness (dozens of groups representing doctors, hospitals and other healthcare professionals say their input has been ignored) and hypocrisy (this is, after all, a group that complained for years about Democrats “rushing” the passage of the Affordable Care Act in 2010 after months of hearings and weeks of debate on the Senate floor).

This bill needs maximum public exposure and scrutiny, not the see-no-evil treatment it’s getting from the Senate GOP.

Instead, the only thing holding the Republicans up has been the splits within their own caucus over a few key policy issues, such as how much of the cost of healthcare to shift onto the states and their taxpayers. There’s no point in involving Democrats — or the public — in shaping the bill, some Republicans say, because only Republicans will vote for it at the end of the day. Funny, but Republicans were involved in much of the wrangling over the bill that became the Affordable Care Act, even though Democrats saw early on that Republicans were determined to vote no.

This time around, the process has not only been maddeningly partisan, but it’s also been willfully blind to the real problems in the U.S. healthcare system, as well as the steps insurers and providers have been taking to address those problems. As a consequence, Senate Republicans are on the verge of moving the country backward, and significantly so, when it comes to reducing healthcare costs, improving quality and broadening availability.

McConnell said Tuesday that a “discussion draft” of the bill would be released this week, first to Republican senators, then to the public. Still, we already know that the bill won’t simply repeal Obamacare or magically restore the healthcare market to what it had been before — a market plagued by rapidly rising costs, double-digit increases in insurance premiums and a large and growing population of Americans without coverage. That’s largely because the legislative shortcut the Republicans are taking to prevent a lethal Democratic filibuster also prevents them from changing any provision of the Affordable Care Act that doesn’t directly affect the federal budget. But it’s also true because Republicans want to cut the taxes the ACA imposed — on high-income Americans and an assortment of health industry groups — while offering their own version of subsidies to help consumers pay for insurance.

In order to do that, they have to cut something else. And that would be Medicaid, the health insurance program for impoverished Americans. Like their House counterparts, Senate Republicans are reportedly seeking to end the federal government’s promise to cover at least half the cost of Medicaid enrollees’ healthcare expenses, shifting instead to block grants tied to population and state healthcare spending. It’s a huge change in policy that’s fraught with risk for the poor and state governments, especially ones like California’s that have already pushed through reforms to cut spending per enrollee. And rather than give the industry more incentive to improve the quality of care, it would simply give states an incentive to offer fewer services to fewer people — including optional services such as in-home care that actually save money over the long term.

The Senate GOP also appears wedded to the House’s approach to lowering insurance premiums for those not covered by a health plan at work. Rather than trying to lower the cost of care, the focus is on letting insurers offer less coverage and cheaper plans that attract only healthy customers. Doing so would reverse efforts within the industry to spread risks and control costs, which is exactly the opposite of what Republicans say they’re trying to accomplish. These sorts of fundamental flaws are exactly why this bill needs maximum public exposure and scrutiny, not the see-no-evil treatment it’s getting from the Senate GOP.

http://www.latimes.com/opinion/editorials/la-ed-senate-secret-healthcare-bill-20170621-story.html
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