2020 Democratic Nominee

[Bozo_Casanova 26277]

9 minutes ago, ChiTownDoc said:

Agree with Bozo.  Universal healthcare is the goal.  Depending on how you define M4A it may work.  For example, replacement plans?

Just yelling M4A over and over without getting into the details is a worthless convo.  But I bet BT still posts just that 20x in this one hour alone.  

You're rich, and therefore have no right to opine. Bend the knee!

 

4 minutes ago, washparkhorn said:

I know you have - what happened to the transition away from for profit insurance and "bending the cost curve?"  

Nothing. I'm still has open to single payer as I ever have been, I think it's almost as good as universal multipayer.  Why do you ask?

Edited February 15, 2020 by Bozo_Casanova

[Anastasis 23393]

16 minutes ago, bad_teammate said:

Wonderful timing from Yale epidemiologists in The Lancet

- Medicare 4 All would save $450B/year
- Medicare 4 All would prevent 68,000 deaths/year

By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services. Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households. Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1·73 million life-years every year compared with the status quo.

Please post the full text of the paper. I’d love to see the assumptions built in to their model to achieve a 13% reduction in NHE with universal coverage. Interesting that they would go to lancet with a paper focused on US policy and healthcare expenditures rather than a Top tier US journal. 

[ChiTownDoc 21098]

3 minutes ago, Anastasis said:

Please post the full text of the paper. I’d love to see the assumptions built in to their model to achieve a 13% reduction in NHE with universal coverage. Interesting that they would go to lancet with a paper focused on US policy and healthcare expenditures rather than a Top tier US journal. 

They’re assuming a perfect delivery system.  In theory the old VA system is bullet proof.  In reality it was total ass. I spent about 6 months in it during my residency and it was atrocious.  That was at 3 different VA hospitals.  

[washparkhorn 9935]

5 minutes ago, Bozo_Casanova said:

Nothing. I'm still has open to single payer as I ever have been, I think it's almost as good as universal multipayer.  Why do you ask?

But multipayer is not as good. It is wasteful and inefficient. It would save 68,000 lives each year. What are your priorities?

From the Yale study (Prof Alison P Galvani, Yale School of Public Health) referenced above:

"Improving the prognosis of health care in the USA

Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. . . .

By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services.

Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017).

The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations.

This shift to single-payer health care would provide the greatest relief to lower-income households.

Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68,000 lives and 1·73 million life-years every year compared with the status quo."

How is multi-payer - "almost as good?" I would like to understand the reason for your policy choice. Thanks.

[bad_teammate 13132]

18 minutes ago, ChiTownDoc said:

I think M4A can work in theory and have nothing against those fighting for it.  I’m glad the AMA is no longer fighting it, but waiting on the sidelines to support it...kind of where I’m at. 
 

Obviously there are hurdles needed to be cleared and mistakes to be avoided, and a system needs critical insight to thrive. Something that is beneficial is that the current progressive energy is in the grassroots, where an individual voice like yours could be heard and influential.

You've got experience and expertise, which are necessary for these things succeeding.

Do you think that if you were to jump in and put your shoulder to the wheel that you could have a bigger impact on making sure it is run correctly?

10 minutes ago, Anastasis said:

Please post the full text of the paper. I’d love to see the assumptions built in to their model to achieve a 13% reduction in NHE with universal coverage. Interesting that they would go to lancet with a paper focused on US policy and healthcare expenditures rather than a Top tier US journal. 

It's $32 for the article, my man, let me know if you buy it. You can share the PDF with me.

[Anastasis 23393]

1 minute ago, ChiTownDoc said:

They’re assuming a perfect delivery system.  In theory the old VA system is bullet proof.  In reality it was total ass. I spent about 6 months in it during my residency and it was atrocious.  That was at 3 different VA hospitals.  

The lack of details in regard to how m4a would actually work is by design. 

[bad_teammate 13132]

2 minutes ago, Anastasis said:

The lack of details in regard to how m4a would actually work is by design. 

I would be interested to know what outstanding questions exist not answered in the bill itself and the CMS procedures and policies currently utilized by Medicare.

Also, can you think of a plan that is more detailed than Medicare 4 All?

[Anastasis 23393]

7 minutes ago, bad_teammate said:

I would be interested to know what outstanding questions exist not answered in the bill itself and the CMS procedures and policies currently utilized by Medicare.

Also, can you think of a plan that is more detailed than Medicare 4 All?

How restrictive will the UM and formulary under m4a be? How will benefits be administered? Will the current system of MACs and LCDs be maintained? How will the pharmacy benefit be administered? Are we setting up a public PBM? Basically all of the technical details are left very vague in the bill. The devil is in the details on these and any number of other outstanding issues related to real world implementation. 

[washparkhorn 9935]

3 minutes ago, Anastasis said:

The lack of details in regard to how m4a would actually work is by design. 

Sorry - needed to check back on the Pollin work on the cost savings of M4A and the Yale study.  Hope this helps.

The author of the Yale work endorsed the assumptions in Pollin's work:

Quote

Alison Galvani, Director, Center for Infectious Disease Modeling and Analysis and Burnett and Stender Families’ Professor of Epidemiology, Yale School of Public Health

"Americans pay more for healthcare than any other country, whether measured on a per capita basis, as a national total or even in terms of comparable medical procedures and pharmaceuticals. However, excessive costs have not translated into superior quality of care, as evidenced by poor clinical outcomes and life expectancy compared to countries that spend much less on their healthcare. To remedy this crisis, Senator Sanders has proposed the U.S. Medicare for All Act of 2017. The act details a single-payer healthcare system that would provide insurance for every resident of the US. This report by Pollin et al. offers a comprehensive economic analysis of the proposed health insurance program. Primary components of the study include calculating the projected budget of Medicare for All, predicting the distribution of economic impacts for businesses, families and healthcare practitioners and formulating approaches to generate the required federal revenue.

This stellar economic analysis of a single-payer, universal healthcare system for the U.S. is the first to sufficiently document each step of the calculations, enabling reproducibility of the findings. It is also the first study that thoroughly addresses the transition to and financing of a universal healthcare system for the U.S. Underlying the analysis is an interdisciplinary evidence base that has been compiled from literature spanning economics, health policy and clinical care both within the US and internationally. The methodology is sound and the assumptions are conservative with regard to their conclusions. Specifically, lower-end figures from the expert literature are used in the calculation of savings, whereas anticipated expenditures are based on the higher end of empirical distributions. Despite stacking the deck against Medicare for All, this analysis convincingly demonstrates the substantial improvements in cost efficiency that could be achieved by Medicare for All. Overall, Medicare for All is expected to reduce national health expenditures….

I am confident that the Pollin et al. study will become recognized as the seminal analysis of a single-payer universal healthcare system for the US."

 

Here are the brass tacks of who M4A costs far less than our current plans:

Pollin:  

• System Costs as Share of GDP. We estimated that Health Consumption Expenditures, at $2.93 trillion, would equal 15.8 percent of U.S. GDP for 2017.
• We further estimate that, under Medicare for All, total U.S. health care costs could remain roughly constant as a share of GDP, that is, remaining at 15.8 percent of GDP over 2017 – 2026.
• We then work from the GDP projections of the Centers for Medicare and Medicaid Services (CMS) to establish the level of Health Consumption Expenditures that will take place under Medicare for All relative to continuing to operate U.S. health care through our existing system.
• Working with these CMS projections for 2017 – 2026, we conclude that Medicare for All would produce savings of $5.11 trillion relative to our existing system—that is, the CMS projection of total costs under our existing system would be $42.90 trillion over 2017 – 2026, whereas we project Medicare for All would cost $37.79 trillion. 

Hope that helps Ana

[Anastasis 23393]

19 minutes ago, bad_teammate said:

I would be interested to know what outstanding questions exist not answered in the bill itself and the CMS procedures and policies currently utilized by Medicare.

Also, this is nonsensical. The current administrative infrastructure of Medicare is incompatible with Bernies M4A rhetoric. 

[bad_teammate 13132]

6 minutes ago, Anastasis said:

How restrictive will the UM and formulary under m4a be? How will benefits be administered? Will the current system of MACs and LCDs be maintained? How will the pharmacy benefit be administered? Are we setting up a public PBM? Basically all of the technical details are left very vague in the bill. The devil is in the details on these and any number of other outstanding issues related to real world implementation. 

Obviously you know more about these things than me, but how many of these questions are based on the assumption that we will not simply be enrolling everyone in the existing Medicare system? Are these questions not already answered by today's Medicare practices?

In particular "will MACs and LCDs be maintained" seems to make a presumption that M4A won't use the current CMS systems already in place and I wonder why you use that assumption.

[bad_teammate 13132]

Just now, Anastasis said:

Also, this is nonsensical. The current administrative infrastructure of Medicare is incompatible with Bernies M4A rhetoric. 

Specifics, please.

[Bozo_Casanova 26277]

30 minutes ago, washparkhorn said:

But multipayer is not as good. It is wasteful and inefficient. It would save 68,000 lives each year. What are your priorities?

From the Yale study (Prof Alison P Galvani, Yale School of Public Health) referenced above:

"Improving the prognosis of health care in the USA

Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. . . .

By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services.

Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017).

The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations.

This shift to single-payer health care would provide the greatest relief to lower-income households.

Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68,000 lives and 1·73 million life-years every year compared with the status quo."

How is multi-payer - "almost as good?" I would like to understand the reason for your policy choice. Thanks.

uh, could it be that you don't know what ""universal multipayer" is?

Spoiler

yes it could

 

[Zavala 1384]

28 minutes ago, Anastasis said:

The lack of details in regard to how m4a would actually work is by design. 

worked with obamba care! 

[Js1 85095]

 

[washparkhorn 9935]

Sorry BC - you link goes to a Wiki article on single payer.

Common Dreams on commercial multi-payer v. single payer: https://www.commondreams.org/views/2017/04/30/health-care-reform-commercial-multi-payer-vs-public-single-payer-health-insurance

Washington health reform proposals, including the Affordable Care Act, are built around the most costly, inefficient model – that is, multiple commercial insurances that drive wasteful complexity and high administrative costs. Commercial multi-payer health insurances rely on public subsidies to preserve private insurance profits. The private health insurance and pharmaceutical industries together siphon off tens of billions of public dollars annually, to boost their profits.

Commercial health insurers further protect their bottom line by increasing premiums, copays and deductibles, while limiting benefits and shrinking provider networks - thus shifting costs and risks to the insured. Health insurance middlemen practicing “Denial Management” deny and delay claims in order to cut costs and increase their profits, while greatly adding to billing costs for providers, who often are required to submit a single claim multiple times. The uncertainty leaves too many Americans one illness or accident away from financial disaster.

You must be referencing something else. Headed out, but I would love to know your thoughts on how it is moral to pay a lot more for less coverage and 68,000 deaths a year with our current for-profit system?  Thank you - sincerely. You have a strong voice on this issue. 

Edited February 15, 2020 by washparkhorn
Link to Common Dreams quote.

[Js1 85095]

 

[bad_teammate 13132]

Pete/Mike/Joe 2020!!

[triplehorn 2664]

21 minutes ago, Js1 said:

 

Nevada caucuses: “Check-in will open at 10 am PT and caucuses will be called to order at 12 pm PT.”

—-> looks more like energizer bunny multitasking.  NV starts early voting this week and will be done early enough Saturday for her to make appearances then head up the west coast by that evening.

 

Edited February 15, 2020 by triplehorn

[MaybeACoordinator 8349]

On 2/14/2020 at 10:04 AM, GSU&UT said:

Florida has moved solidly GOP too, just enormous amounts of old whites that keep moving there, read up about The Villages .The only possible saving grace is restoring felon voting rights but the Florida Supreme Court is Red and probably going to basically make that impossible for many.

Enormous amounts of Trump-loathing Puerto Ricans have washed ashore in Florida, too, though their numbers have yet to be reflected at the ballot box.

On 2/14/2020 at 11:44 AM, Aqua Buddha said:

Exactly.  A M4A candidate would be a death sentence there.  Trump will spend the 10 months scaring the olds.

Which could be counteracted by hammering home the message that Trump wants to take away their social security and medicare. Like Carville said, it's not rocket science.

On 2/14/2020 at 12:30 PM, mchookem said:

jfc

i'm deep in Trump country, visiting my dad in NE Texas.

he is 'no fan' of Trump, as he puts it. but he watches Fox non-stop, just has it on constantly in the background. 

anyway, he's reachable...he hates all things Clinton with the hate of a thousand burning suns and says he would have voted for Sanders. i doubt it...but i used that as an opening to try and discuss Democratic options last night.

he's a veteren and ALWAYS favors CiC with military experience.

(sidenote: we had a giant screaming fight back in 2012 bc he was railing on Obama 'avoiding' military experience and i let loose a tirade about Romney's FOUR SONS who were eligible who all somehow avoided it as well... let's just say one of us stormed out of my house in anger, and it wasn't me).

anyway...he had NO IDEA Pete was a veteran (or Tulsi for that matter). how is that even possible. fucking Fox. Pete drops that nugget literally daily. he was like 'really?? well i'll be...'

anyway...i tried to talk up Sanders, Pete, and Amy. he asked about the latter two being 'more moderate' lol. didn't have anything terrible to say about any of them..except Biden, who he also hates.

he might be reachable. not likely, but maybe. *sigh*

 

My story from my NE Texas kin: Cousin Suzanne, the one who's dying of cirrhosis of the many basket cases in that wing of the family, dared defend Mitt's vote against Trump on her Facebook page, thereby riling up a lynch mob. She didn't even say she wasn't a Republican, only that she admired Mitt for voting his conscience. She did have one and only one fellow Trump-hater defending her. Was this guy a Democrat? No, he has found a way to hate Trump from the right. He even claimed that Trump was another Minion of Soros, and told all the other rednecks that they were sheeple for following Trump.

19 hours ago, Pasken said:

How do you think Trump would spin it if he won the popular vote but lost the electoral college? He would def try to stay president. 

His head would be on a pike next to Chris Matthews's after Bernie's cadres swept through en route to burning the White House, pulling down the Washington Monument, and dynamiting the Jefferson Memorial. 

[Anastasis 23393]

1 hour ago, washparkhorn said:

Sorry - needed to check back on the Pollin work on the cost savings of M4A and the Yale study.  Hope this helps.

The author of the Yale work endorsed the assumptions in Pollin's work:

Here are the brass tacks of who M4A costs far less than our current plans:

Pollin:  

• System Costs as Share of GDP. We estimated that Health Consumption Expenditures, at $2.93 trillion, would equal 15.8 percent of U.S. GDP for 2017.
• We further estimate that, under Medicare for All, total U.S. health care costs could remain roughly constant as a share of GDP, that is, remaining at 15.8 percent of GDP over 2017 – 2026.
• We then work from the GDP projections of the Centers for Medicare and Medicaid Services (CMS) to establish the level of Health Consumption Expenditures that will take place under Medicare for All relative to continuing to operate U.S. health care through our existing system.
• Working with these CMS projections for 2017 – 2026, we conclude that Medicare for All would produce savings of $5.11 trillion relative to our existing system—that is, the CMS projection of total costs under our existing system would be $42.90 trillion over 2017 – 2026, whereas we project Medicare for All would cost $37.79 trillion. 

Hope that helps Ana

Can you spoiler tag the full text of the lancet article?

[bad_teammate 13132]

Are there studies of any proposed programs that don't assume they will be well-run?

I'd be fascinated to see the Wyden-Bennett proposal that says, "Here's what it would look like run incompetently."

Seems like a pretty bad faith critique of this study.

[triplehorn 2664]

I haven't crunched numbers or taken a hard look at limitations on M4A or universal multipayer vs our current system, so I've got blind spots.  In a political sense, this stuff is hard to communicate effectively from the stump because of cudgel counter-attacks like "death panels!"  But does part of having a more balanced, affordable, and available health care system involve capping spending with potentially necessary accompanying changes in the psyche of Americans about what they are entitled to and what constitutes good health care?  I can see a hybrid where there is a big boost in universal M4A availability of primary care coverage, scripts, and mental health and chemical dependency treatment, but other medical expenditure domains, i.e end of life care scenarios and long term care for dementia, being covered by choosing separate private insurance to cover those areas.  The caveat would be that private add-on insurances would be excluded from covering primary care and other major M4A covered domains.  Again, at some level it would likely require a shift thinking about the upper limit on costs every person is entitled to absent add-on private insurance.

The costs of treatment in areas like primary care, mental health, and chemical dependency is an area where costs could be dropped considerably over what the current market bears.  Govt could fund its own staff and facilities (non-tertiary care) in those areas pretty efficiently.  Covering and expanding access to mental health and CD services in particular seems like the biggest bang for the buck from a standpoint of reducing overall population morbidity, lost workplace productivity, and long term collateral medical costs.  They're also the areas where people tend to struggle the most across all ages getting insurance to adequately cover sufficient treatment let alone having timely access.

Edited February 15, 2020 by triplehorn

[6th Street 6355]

Very few people would surrender a quality PPO for a govt run plan

[F250 28680]

32 minutes ago, 6th Street said:

Very few people would surrender a quality PPO for a govt run plan

Agree, but what percentage of people have a quality PPO plan?

I have no idea how many people are on affordable high quality plans but if isn't a majority of the electorate then it may not matter what some people are willing to surrender.

 

[Bozo_Casanova 26277]

3 hours ago, washparkhorn said:

Sorry BC - you link goes to a Wiki article on single payer.

Common Dreams on commercial multi-payer v. single payer: https://www.commondreams.org/views/2017/04/30/health-care-reform-commercial-multi-payer-vs-public-single-payer-health-insurance

Washington health reform proposals, including the Affordable Care Act, are built around the most costly, inefficient model – that is, multiple commercial insurances that drive wasteful complexity and high administrative costs. Commercial multi-payer health insurances rely on public subsidies to preserve private insurance profits. The private health insurance and pharmaceutical industries together siphon off tens of billions of public dollars annually, to boost their profits.

Commercial health insurers further protect their bottom line by increasing premiums, copays and deductibles, while limiting benefits and shrinking provider networks - thus shifting costs and risks to the insured. Health insurance middlemen practicing “Denial Management” deny and delay claims in order to cut costs and increase their profits, while greatly adding to billing costs for providers, who often are required to submit a single claim multiple times. The uncertainty leaves too many Americans one illness or accident away from financial disaster.

You must be referencing something else. Headed out, but I would love to know your thoughts on how it is moral to pay a lot more for less coverage and 68,000 deaths a year with our current for-profit system?  Thank you - sincerely. You have a strong voice on this issue. 

Spare me. My link does not go to a wiki article on single payer. It goes to the wikipedia article on healthcare in Germany, which is an example of "universal multi-payer", which both this post and your previous on the topic do not address. "Universal Multi-payer" refers to what they have in most western countries such as the UK, Germany, France, Australia and so on: a hybrid combination of a government payer and private insurance.

"Single payer" does not mean what you think it means, which is a Republican political construct - the term in this context refers to the distinction between something like Canada and what they do in continental Europe, with the UK system having mostly liberalized towards Europe with good result.  But even Canada isn't nearly as "single" as what Sanders is proposing.
So spare me the homilies, will you? I'm not defending our  current system when I say "universal multipayer". That's not what that is. I'm advocating something much better and more effective, in addition to cheaper and more practical. 

Edited February 15, 2020 by Bozo_Casanova

[Anastasis 23393]

3 hours ago, bad_teammate said:

Specifics, please.

Bernie says he will eliminate all non m4a health plans and private insurers. FFS Medicare is administered by private insurers basically acting as ASO’s with enhanced ability to make local coverage determinations when a national coverage determination does not supersede. MA is administered by private insurers operating at risk under a capitated payment model. All part D plans are administered by private PBMs/insurers. Bernie wants to do away with all of this infrastructure. Which is fine. But somebody should take the time to sketch out what the replacement infrastructure looks like. 

Edited February 15, 2020 by Anastasis

[GSU&UT 1798]

38 minutes ago, Bozo_Casanova said:

Spare me. My link does not go to a wiki article on single payer. It goes to the wikipedia article on healthcare in Germany, which is an example of "universal multi-payer", which both this post and your previous on the topic do not address. "Universal Multi-payer" refers to what they have in most western countries such as the UK, Germany, France, Australia and so on: a hybrid combination of a government payer and private insurance.

"Single payer" does not mean what you think it means, which is a Republican political construct - the term in this context refers to the distinction between something like Canada and what they do in continental Europe, with the UK system having mostly liberalized towards Europe with good result.  But even Canada isn't nearly as "single" as what Sanders is proposing.
So spare me the homilies, will you? I'm not defending our  current system when I say "universal multipayer". That's not what that is. I'm advocating something much better and more effective, in addition to cheaper and more practical. 

I've said this before but do you seriously think a system that still enables private insurance is going to somehow work out magically for us? These companies are just going to accept a smaller role? Unless we strip then of virtually all their power I don't want them to have a seat at the table, they've shown literally nothing that would convince me they would play along. It's almost as if those European countries don't have decades of history where private health insurers became the most powerful entities in their respective countries. Cigna has to be knee-capped, not offered a seat at a new table.

Edited February 15, 2020 by GSU&UT

[GSU&UT 1798]

 

[Anastasis 23393]

3 minutes ago, GSU&UT said:

 

Can you post the full text of the lancet article?

[GSU&UT 1798]

Account says they're working on sharing access to it.

[bad_teammate 13132]

27 minutes ago, Anastasis said:

Bernie says he will eliminate all non m4a health plans and private insurers. FFS Medicare is administered by private insurers basically acting as ASO’s with enhanced ability to make local coverage determinations when a national coverage determination does not supersede. MA is administered by private insurers operating at risk under a capitated payment model. All part D plans are administered by private PBMs/insurers. Bernie wants to do away with all of this infrastructure. Which is fine. But somebody should take the time to sketch out what the replacement infrastructure looks like. 

Regarding PBMs and the management of formularies, Section 614 of the posted bill discusses this.

Regarding the administration FFS Medicare via private MACs today, I'm not clear but it seems evident that they will continue to use the regional administration that exists now. The issue with "private insurers" has to do with selling insurance direction to customers, not CMS working with private industry to administer M4A. An unanswered question, AFAIK, but I'm ignorant.

As for Medicare Advantage, it seems that would only exist in the transition period and all of its coverages would simply become "Medicare".

[washparkhorn 9935]

16 minutes ago, Anastasis said:

Can you post the full text of the lancet article?

Unfortunately no - publishers and their "all rights reserved" is the law.

Do you have log in rights through your post-graduate work?

It's 10 pages if you just want to know whether it has been read. The pharma section is there. 

[Anastasis 23393]

1 hour ago, bad_teammate said:

Regarding PBMs and the management of formularies, Section 614 of the posted bill discusses this.

Exemplary of my point in terms of the lacking details. This doesn’t discuss administration of the rx benefit at all. What I do see, I interpret as a closed formulary using step therapy and prior authorization protocols to favor generic utilization with restricted access to non preferred treatments. Which is fine.  These are exactly the same tools used by private insurers that create abrasion points. Generics should be preferred and cost effective treatments should be staged in advance of more costly treatments. I read this as requiring people to come out of pocket for treatments not covered by the formulary or meeting the UM requirements. But in this model these tools will be deployed by a government bureaucracy, likely in a uniform national framework that does not allow for regional variation in treatment patterns or various approaches to promote quality of care outcomes. Of course, somebody could prove me wrong. But that would require somebody to actually articulate details of the implementation. 

[bad_teammate 13132]

51 minutes ago, Anastasis said:

Exemplary of my point in terms of the lacking details. This doesn’t discuss administration of the rx benefit at all. What I do see, I interpret as a closed formulary using step therapy and prior authorization protocols to favor generic utilization with restricted access to non preferred treatments. Which is fine.  These are exactly the same tools used by private insurers that create abrasion points. Generics should be preferred and cost effective treatments should be staged in advance of more costly treatments. I read this as requiring people to come out of pocket for treatments not covered by the formulary or meeting the UM requirements. But in this model these tools will be deployed by a government bureaucracy, likely in a uniform national framework that does not allow for regional variation in treatment patterns or various approaches to promote quality of care outcomes. Of course, somebody could prove me wrong. But that would require somebody to actually articulate details of the implementation. 

FFS Medicare (which is most analogous to what M4A will become) as run today already allows for regional variation via MACs, which are an extant part of Medicare and which we have no indication of being dissolved. You're choosing to act like that framework is going to be dissolved because it suits the argument you wish to make, not because it logically follows.

Will the number of geographic areas for MACs shrink? Grow? Stay the same? We don't know, but for you to just act like the CMS is going to erase everything they have when M4A hits is silly and disingenuous.

Section 502 of the bill specifically mentions geographic disparities as a consideration. You're asking for a lot of documentation that you clearly aren't even reading.

[Anastasis 23393]

Nothing in that response addresses the RX benefit as outlined in section 614, the focus of my response. I will take that as an acknowledge of my point that the m4a bill lacks sufficient substantive detail in that regard to debate its merits. 

As far as MACs, MACs are private insurers who perform ASO+ like services for CMS. Bernie says he wants to do away with private insurers. I am not acting like the framework will be dissolved because it suits my argument. I am acting like it will be dissolved because that is what the author of the bill has said. Which leaves a void in the administration of the plan. Which needs to be addressed. 
 

The reality is that the m4a concept is vague and lacks sufficient detail to debate the specifics of its implementation, or to accurately project its economic impact and quality of care outcomes. 

[washparkhorn 9935]

4 minutes ago, Anastasis said:

Nothing in that response addresses the RX benefit as outlined in section 614, the focus of my response. I will take that as an acknowledge of my point that the m4a bill lacks sufficient substantive detail in that regard to debate its merits. 

 

614 is an example of how laws are written in the modern era. It goes to the agencies for promulgation of regs. That is the sausage making. Perfect, no. 

Did you see anything at all that you liked?

[bad_teammate 13132]

2 minutes ago, Anastasis said:

Nothing in that response addresses the RX benefit as outlined in section 614, the focus of my response. I will take that as an acknowledge of my point that the m4a bill lacks sufficient substantive detail in that regard to debate its merits. 

It's a closed formulary and in Section 202 it outlines cost-sharing for drugs. They will not exceed $200 per person, so even medications outside the formulary will be dramatically capped.

Quote

As far as MACs, MACs are private insurers who perform ASO+ like services for CMS. Bernie says he wants to do away with private insurers. I am not acting like the framework will be dissolved because it suits my argument. I am acting like it will be dissolved because that is what the author of the bill has said. Which leaves a void in the administration of the plan. Which needs to be addressed. 

This is a disingenuous interpretation, because a mass audience doesn't know what the hell a MAC is and certainly isn't thinking, "Well, hmm, what about MACs?" when Bernie is speaking to an audience of 5,000 normal people about private insurer. You know what the fuck he means.

Disingenuous as hell.

[Anastasis 23393]

28 minutes ago, bad_teammate said:

It's a closed formulary and in Section 202 it outlines cost-sharing for drugs. They will not exceed $200 per person, so even medications outside the formulary will be dramatically capped.

This is a disingenuous interpretation, because a mass audience doesn't know what the hell a MAC is and certainly isn't thinking, "Well, hmm, what about MACs?" when Bernie is speaking to an audience of 5,000 normal people about private insurer. You know what the fuck he means.

Disingenuous as hell.

A closed formulary is incompatible with a 200 dollar cap on an oop which includes non formulary drugs. What you are saying here is nonsensical. A closed formulary provides no coverage for non formulary drugs. I do agree that what we are dealing with in bernies M4A proposal is likely a closed formulary with tight UM. Section 614 b 4 provides the end around on the 200 oop cap.  

And to the second paragraph, Bernie or someone else could easily rectify by clarifying exactly how they see m4a being implemented and addressing the various real complexities that are left unaddressed by their aspirational legislation and rhetoric.

The reality that cannot be escaped is that m4a will perpetuate most of the abrasion points that exist in the current system, with likely more restrictive control over utilization. This will be balanced out by universal access, with uncertain but probably easily anticipated impacts on quality of care and satisfactin with care. The economics of the plan will hinge on exactly how much they are able to leverage favorable pricing from hospitals, providers, and pharma. And that will feedback into the quality and access dynamic. 

[Anastasis 23393]

34 minutes ago, washparkhorn said:

614 is an example of how laws are written in the modern era. It goes to the agencies for promulgation of regs. That is the sausage making. Perfect, no. 

Did you see anything at all that you liked?

Sure. I like the notion that we should promote a system favoring cost effective, evidence based health care. 

[Brandywine 1312]

14 hours ago, washparkhorn said:

Thanks for the Never-Trumper/Republican/Trump talking points.

Who are you supporting in 2020, just out of curiosity?  Thanks.

I like Pete, Bloomberg, Klobuchar and Kamala. 

Edited February 16, 2020 by Brandywine

[TexEx15 17456]

What will be done with the Medicare fee schedule under MFA?

[bad_teammate 13132]

I don't think that's an end-around. 202b2 states that the only way the $200 is surpassed is for off-formula name brands when generics are available.

[washparkhorn 9935]

1 hour ago, Anastasis said:

Sure. I like the notion that we should promote a system favoring cost effective, evidence based health care. 

Cool. Were you able to read the Lancet article? Thoughts?

I sense skepticism on your part on the fix, but can we (all) agree: 

• We should repair a system that causes approximately 68,000 unnecessary deaths a year?
• We are paying more for the current system than we would with Medicare for all?

And for you specifically Ana - is your concern more centered on doctors and professionals losing earning capacity (a rational and relevant concern)?

 

[Bozo_Casanova 26277]

15 hours ago, GSU&UT said:

I've said this before but do you seriously think a system that still enables private insurance is going to somehow work out magically for us? These companies are just going to accept a smaller role? Unless we strip then of virtually all their power I don't want them to have a seat at the table, they've shown literally nothing that would convince me they would play along. 

Is this the part where progressives start mansplaining why literally all the working models in the western world to emulate actually CAN'T work here? Let me get this straight: according you, it's somehow impossible to create ANY form of universal multi-payer system because the private insurers are too powerful and entrenched, but it is possible to shut them out of the market altogether. Do I have that right?  

15 hours ago, GSU&UT said:

 It's almost as if those European countries don't have decades of history where private health insurers became the most powerful entities in their respective countries. 

Switzerland would like a word with you. 

Edited February 16, 2020 by Bozo_Casanova

[Anastasis 23393]

10 hours ago, washparkhorn said:

Cool. Were you able to read the Lancet article? Thoughts?

I skimmed the article but spent more time with the appendix.

It’s not a novel analysis. It’s a piece describing the parameters and base case justifications of an online modeling tool. It tends toward a policy opinion piece in parts and lacks substantive discussion of limitations. The tool being described was conceived by an “informal” advisor to the Sanders campaign, also the lead author.

The tool is available at this link: http://shift.cidma.us

The tool appears to be useful for testing the impact of various parameters included. It does not appear to allow for adjustment of certain important factors and omits others. Looks like the authors hard coded ER and hospital service use reductions among currently insured, which is not a good assumption based on experience under ACA. They omit, for example, increased Rx service use by currently insured under m4a. I think that they underestimate the extent of increases in utilization overall, including the un and underinsured which are capped in the model. The base case estimates of increased fraud detection and pharmaceutical price negotiations are ambitious at best. I think that the anticipated overhead reductions used in the base model will not be fully realized. I can’t speak to the assumptions on provider and facility rate reductions, but suffice to say they take haircuts from current levels in the base model.

Its a useful tool even if I don’t think that the base case reductions are fully realized and that impacts to utilization are not fully captured. I don’t think that we see 13% reductions in NHE with full implementation of m4a. I’ll take the under on that one all day. 

[bad_teammate 13132]

"mansplaining"

Swiss private insurers are not allowed, by law, to make a profit off of their basic insurance services. Stripping AETNA and BCBS and United of their profits strips them off their power and lessens their role in healthcare policy, just like GSU&UT said.

Sure, we could have a non-profit insurer system. Cool, who is proposing it? Who is pushing it? What are you doing to make it happen? Where is it?

I'm sure we coulda won state and thrown a football over them mountains, too.

[NoRagrets 1125]

BCBS entities already are non-profit.

[bad_teammate 13132]

14 minutes ago, NoRagrets said:

BCBS entities already are non-profit.

Yeah, right.

It's not profit, it's... uh... surplus.

[Anastasis 23393]

Kaiser, group health, geissinger.