2020 Policy Talk: Healthcare

[bad_teammate 13481]

The whole, "We can trick the private healthcare lobby!" logic makes no sense to me.

Does anyone seriously think they don't realize what is happening?

[Anastasis 23700]

Medicare as it stands today is not a single payer system. Even FFS is not a true single payer as you have regionalized coverage determinations when NCDs do not apply. Part C is a private opt in implementation by health insurers, and part d is administered by private PBMs. When we talk about Medicare for all as single payer system that entails a substantial recasting of Medicare. If you scrap part c, that will be seen as restricting choice and be met by political opposition by many seniors who prefer their private Medicare plan. You will have to throw them back into ffs against their wishes if you want a single payer implementation. Most of them won’t like that. You will also have to stand up a public Pbm or some functionally similar apparatus to administer the pharmacy benefit and implement your pharmaceutical pricing controls. And if you want a true streamlined single payer system I think that you have to you have to even make some changes I think to FFS and the way it is currently administered. Is the MAC network of private administrative contractors with regional coverage determination responsibilities kept in place?

I guess the point being, there are a lot of devils in the details. It’s not quite as simple as saying everybody gets single payer Medicare.  Medicare is not a single payer system even in its current implementation. I’d like to see some of the policy discussion around these issues play out. 

[Anastasis 23700]

29 minutes ago, Lurch said:

I hope something in any solution restores the mental health services that Reagan gutted.

If we are going to fundamentally reinvent the healthcare system we sure as shit better reinvent the mental healthcare system. 

[David Dennison 19441]

Just now, Anastasis said:

Medicare as it stands today is not a single payer system. Even FFS is not a true single payer as you have regionalized coverage determinations when NCDs do not apply. Part C is a private opt in implementation by health insurers, and part d is administered by private PBMs. When we talk about Medicare for all as single payer system that entails a substantial recasting of Medicare. If you scrap part c, that will be seen as restricting choice and be met by political opposition by many seniors who prefer their private Medicare plan. You will have to throw them back into ffs against their wishes if you want a single payer implementation. Most of them won’t like that. You will also have to stand up a public Pbm or some functionally similar apparatus to administer the pharmacy benefit and implement your pharmaceutical pricing controls. And if you want a true streamlined single payer system I think that you have to you have to even make some changes I think to FFS and the way it is currently administered. Is the MAC network of private administrative contractors with regional coverage determination responsibilities kept in place?

I guess the point being, there are a lot of devils in the details. It’s not quite as simple as saying everybody gets single payer Medicare.  Medicare is not a single payer system even in its current implementation. I’d like to see some of the policy discussion around these issues play out. 

Medicare Advantage isn't completely private. It's the federal government allowing private insurers to administer Medicare with tight regulation.

[bad_teammate 13481]

1 minute ago, Anastasis said:

I guess the point being, there are a lot of devils in the details.

Awesome post, Anastasis.

Absolutely, especially considering the political interests, lobbies, and powers involved.

Since no one is talking about a nationalized system, the private contracting world within the operation of the larger single-payer system wouldn't seem to be completely dismantled. MACs would, ostensibly, still coordinate between the Medicare mothership and the local providers, obviously with new regulations and purposes.

I don't know what role PBMs would really have. Greatly reduced, I'd imagine.

 

[Dahobbs 18193]

12 minutes ago, Anastasis said:

Medicare as it stands today is not a single payer system. Even FFS is not a true single payer as you have regionalized coverage determinations when NCDs do not apply. Part C is a private opt in implementation by health insurers, and part d is administered by private PBMs. When we talk about Medicare for all as single payer system that entails a substantial recasting of Medicare. If you scrap part c, that will be seen as restricting choice and be met by political opposition by many seniors who prefer their private Medicare plan. You will have to throw them back into ffs against their wishes if you want a single payer implementation. Most of them won’t like that. You will also have to stand up a public Pbm or some functionally similar apparatus to administer the pharmacy benefit and implement your pharmaceutical pricing controls. And if you want a true streamlined single payer system I think that you have to you have to even make some changes I think to FFS and the way it is currently administered. Is the MAC network of private administrative contractors with regional coverage determination responsibilities kept in place?

I guess the point being, there are a lot of devils in the details. It’s not quite as simple as saying everybody gets single payer Medicare.  Medicare is not a single payer system even in its current implementation. I’d like to see some of the policy discussion around these issues play out. 

I don't see any reason why the various medicare for all plans would require scrapping or changing part C. If anything, expansion of part C is the carrot for the existing insurance industry. Nor do I see a hugely compelling reason to scrap the framework that medicare has grown up with. It certainly isn't a necessary action in order to expand medicare access. And it isn't an action we should take merely to satisfy your semantic dissatisfaction with calling medicare for all a single payer solution. Ultimately, there is a single payer at the core of Medicare, the federal government. 

[David Dennison 19441]

Is it really Medicare for All if there are no premiums? Will they be eliminating all current Medicare premiums?

[EuroHorn 3287]

Cost, Quality, Universal coverage.  Pick two...

Edited March 19, 2019 by EuroHorn

[Larry T. Spider 1747]

Well that would be better than now. We currently have one.

[Grandioso 2592]

16 hours ago, bad_teammate said:

Dan Pfeiffer - GoFundMe VP of Communications

Dan Pfeiffer - Pod Save America

lol

I actually like Dan Pfeiffer [/runs and dives from explosion generated by anti-establishment ire]. 

[Dahobbs 18193]

9 minutes ago, Larry T. Spider said:

Well that would be better than now. We currently have one.

Is that one cost? As in, it costs a lot?

[bad_teammate 13481]

9 minutes ago, Grandioso said:

I actually like Dan Pfeiffer [/runs and dives from explosion generated by anti-establishment ire]. 

I'm sending an ANTIFA death squad over to your place of residence immediately where they will paint "NEOLIBS GET THE BULLET, TOO!" across your front door in your own blood.

[Larry T. Spider 1747]

8 minutes ago, Dahobbs said:

Is that one cost? As in, it costs a lot?

The quality is good...if you can access it and afford it. I would give us mediocre (at best) marks for universality. Very poor for affordability.

[Brian Fantana 6856]

35 minutes ago, EuroHorn said:

Cost, Quality, Universal coverage.  Pick two...

We have one or arguably none of those so that would be a start. Also you're a fucking idiot.

[Anastasis 23700]

34 minutes ago, Dahobbs said:

I don't see any reason why the various medicare for all plans would require scrapping or changing part C. If anything, expansion of part C is the carrot for the existing insurance industry. Nor do I see a hugely compelling reason to scrap the framework that medicare has grown up with. It certainly isn't a necessary action in order to expand medicare access. And it isn't an action we should take merely to satisfy your semantic dissatisfaction with calling medicare for all a single payer solution. Ultimately, there is a single payer at the core of Medicare, the federal government. 

I agree with regard to part c, and the carrot aspect wrt political viability. I disagree that pushing back from calling it single hater is semantics. Federally subsidized healthcare with a public option and a variety of opt in private plan options in the mold of part c is not a single payer system. Which means some of the hypothetical efficiencies of a single payer system are not realized. There are other market  “efficiencies” that will be realized in such a system, but it is not a single payer system. And as far as the carrot goes, it will be jnteresting see the industry response if such a plan is put forth. This would not be well received by companies like centene and Molina and other niche narrow network plans that have taken a nice little foothold on the exchanges and in managed Medicaid. The industry winners under such a system would be the players that have tried to move towards broader integration of healthcare delivery to compete in the MA market, the kaisers, United’s and Humanas. 

 

No matter how this ultimately plays out, this is going to be an interesting debate over the next 6 years and a fun topic for discussion throughout implementation. 

[David Dennison 19441]

1 hour ago, EuroHorn said:

Cost, Quality, Universal coverage.  Pick two...

Or all three. Other countries manage to do it.

[Dahobbs 18193]

7 minutes ago, Anastasis said:

I agree with regard to part c, and the carrot aspect wrt political viability. I disagree that pushing back from calling it single hater is semantics. Federally subsidized healthcare with a public option and a variety of opt in private plan options in the mold of part c is not a single payer system. Which means some of the hypothetical efficiencies of a single payer system are not realized. There are other market  “efficiencies” that will be realized in such a system, but it is not a single payer system. And as far as the carrot goes, it will be jnteresting see the industry response if such a plan is put forth. This would not be well received by companies like centene and Molina and other niche narrow network plans that have taken a nice little foothold on the exchanges and in managed Medicaid. The industry winners under such a system would be the players that have tried to move towards broader integration of healthcare delivery to compete in the MA market, the kaisers, United’s and Humanas. 

 

No matter how this ultimately plays out, this is going to be an interesting debate over the next 6 years and a fun topic for discussion throughout implementation. 

It is semantics. Medicare Part C is funded by the federal government via monthly capitated payments to the plan sponsor (i.e., set payments based on the number of enrollees with periodic adjustments). Yes, administration of the claims process is farmed out to multiple entities (whether we are discussing part C or Parts A&B), but the federal government has ultimate control. As a result, you have a single entity with the leverage to negotiate on behalf of the entire medicare population. That, to me, is single payer. If it isn't, then no "single payer" system exists because the system is too large for one person to handle. I fail to see a meaningful distinction for these purposes between assigning claims administration tasks to employees vs separate entities. Either system will result in some variability as the agents of the primary entity exercise some amount of individual judgment in the administration of claims. That doesn't make it any less of a single payer system as ultimate authority and accountability comes back to a single entity. Medicare Part C only slightly deviates from that formula in so far as plan sponsors are on the hook for cost overages.

If the efficiencies you are focusing on relate to overhead as opposed to negotiating leverage, you may be correct. Although I note that even within single business entities you're going to have overhead bloat, particularly when dealing with a project of this magnitude. I'm not convinced that any practical efficiency is lost by the division of labor in the medicare system. 

I think you are right to point out the complexities of the system, but focusing on whether or not that system meets some criteria for true "single payer" is pointless in my opinion. (Yes, I realize there is no small bit of irony here). 

[Mole 4338]

I’m a dumb guy when it comes to health insurance and healthcare. Has anyone walked through some projections of costs to these types of plans? Maybe look at other countries that transitioned? Surely there’s data out there to make reasonable projections.

-taxes go up

-out of pocket costs down or away

-overall cost of healthcare nationwide maybe goes down 

-if employers are no longer covering the cost of insurance, how much of that on average ends up in my paycheck? Insurance is currently part of our compensation, so if that need goes away, how much, if any, do wages rise?

-access?

 

[hpslugga 4096]

26 minutes ago, David Dennison said:

Or all three. Other countries manage to do it.

AMERICAN EXCEPTIONALISM!!!!

[elfenix 34659]

10 minutes ago, hpslugga said:

AMERICAN EXCEPTIONALISM!!!!

we're the bestest people ever, with the worstest government ever, made up of people picked from us, the bestest people, by us, the bestest people.

[Lurch 5949]

Cost, Quality, Universal coverage.  Pick two...

The framework middle managers incorrectly use when they suck at their job and don’t understand that while the triad shows relationships between three things it doesn’t require the exclusion of one due to the other two.

On. Point.

[Anastasis 23700]

1 hour ago, Dahobbs said:

As a result, you have a single entity with the leverage to negotiate on behalf of the entire medicare population.

Except that’s not how part c works. It’s more than just administrative services only for CMS. The plans take the cap payment subsidy and whatever premium they set and take on full risk. They have leeway within cms guidleines on benefit design and coverage. The use their networks, rates, clinical programs, utilization management and negotiate with providers and pharma based on their membership. Their is no single entity leverage. That’s largely why I wouldn’t call it single payer. It is federally subsidized private insurance. The government isn’t taking on the risk exposure the insurance company is (there are some part d caveats wrt catastrophic phase that complicate this, but it is generally true). 

 

Oh and fuck the quote function on this software;

Quote

I think you are right to point out the complexities of the system, but focusing on whether or not that system meets some criteria for true "single payer" is pointless in my opinion. (Yes, I realize there is no small bit of irony here). 

 The point on terminology from my perspective is not semantical navel gazing. Policy discussions require precise and common understanding of the terminology to communicate the issues clearly. I do appreciate that there may be a certain political value in framing it differently. 

 

Edited March 19, 2019 by Anastasis

[Grandioso 2592]

Damn it's getting wonky in here. Who knew healthcare could be so complicated?

[Dahobbs 18193]

20 minutes ago, Anastasis said:

Except that’s not how part c works. It’s more than just administrative services only for CMS. The plans take the cap payment subsidy and whatever premium they set and take on full risk. They have leeway within cms guidleines on benefit design and coverage. The use their networks, rates, clinical programs, utilization management and negotiate with providers and pharma based on their membership. Their is no single entity leverage. That’s largely why I wouldn’t call it single payer. It is federally subsidized private insurance. The government isn’t taking on the risk exposure the insurance company is (there are some part d caveats wrt catastrophic phase that complicate this, but it is generally true). 

Yes, the plan sponsors take on risk. I'm just not seeing why that is meaningful when the government is charge of determining what Medicare does and does not cover and how much it pays. Due to the individual sponsor variation you identified (networks, rates, etc.), there are regional (or smaller scale) leverage points, but that doesn't mean that the federal government itself doesn't also wield additional (and I'd argue the primary) nationwide leverage for controlling costs. If CMS decides to cut rates by 50%  across the board, Medicare Advantage sponsors are going to have respond in kind precisely because of the risk they inherited. That is single payer control. One entity is responsible for the overall costs of the system. 

[Tom 2960]

17 hours ago, Gil Bang said:

nursing shortages my ass. 

At one point, my favorite watering hole in Dana Point CA had 3....THREE Registered Nurses waiting tables, because they couldn't find jobs. They would have sucked my dick to get a job in one of our surgery centers, but none of them had the necessary experience. 

 

Honestly, that's completely on you.  It's not brain surgery.  You can always teach the inexperienced ones to not use teeth.

[Dnaguy 12575]

11 hours ago, bad_teammate said:

But when they turn 18... they can just rot?

If you can get sent to death row or off to war, the. You can cover your healthcare premiums.

 

But why are you trying to deny children healthcare? You want to poke holes in my plan, a plan that would help inicent babies, children with disabilities, and mothers working just to make ends meat?

i spoke with a mother just yesterday. Her name was Elsa Clamput. She told me that she works 2 jobs just to afford childcare and her son’s cancer medicine...

 

You see where I’m going with this?

[Anastasis 23700]

On 3/19/2019 at 1:37 PM, Dahobbs said:

Yes, the plan sponsors take on risk. I'm just not seeing why that is meaningful when the government is charge of determining what Medicare does and does not cover and how much it pays. Due to the individual sponsor variation you identified (networks, rates, etc.), there are regional (or smaller scale) leverage points, but that doesn't mean that the federal government itself doesn't also wield additional (and I'd argue the primary) nationwide leverage for controlling costs. If CMS decides to cut rates by 50%  across the board, Medicare Advantage sponsors are going to have respond in kind precisely because of the risk they inherited. That is single payer control. One entity is responsible for the overall costs of the system. 

If Medicare were to cut rates today by 50% across the board, beside kamakazing the healthcare system, you would see a broad downward move in rates across the board. Large and small employer sponsored group, individual exchange plans, ma, etc. It appears that you are arguing that this is the result of "single payer control". This is not evidence of a single payer healthcare system.  If it was, it would mean that we already operate in a single payer environment, rendering the current discussion largely irrelevant. It is however evidence of how the government has pervasively fucked up the inputs determining healthcare pricing. 

Edited March 22, 2019 by Anastasis

[Anastasis 23700]

Moving this over from the Bern thread since we are getting into the weeds with M4A.

 

2 hours ago, GSU&UT said:

This is such an odd example, we literally just went through this with my daughter. After a certain threshold of ear infections, any good pediatrician is going to recommend tubes. We had several and had our daughter's hearing test and she had fluid buildup in her middle ear. Now getting tubes plus about 5 minutes of anesthesia is going to cost us around $1500 (haven't gotten the final bill yet) because we haven't hit her deductible and have a "low" deductible plan with our health insurance. The fucking prescription ear drops we were given was going to cost something like $200 without having a particular "coupon" the drug company gives you since there is no generic yet. If all I had to pay for OOP throughout all this was $50 I'd be ecstatic.

Ciprodex pricing is criminal IMO. According to my reading of the  M4A Senate bill (https://www.congress.gov/bill/115th-congress/senate-bill/1804/text?format=txt), which is admittedly more of an aspirational rather than operational document, I see three possible outcomes for a medication like Ciprodex or similar: 

1) On formulary, zero cost sharing

2) On formulary, mid range ($50-100) cost sharing

3) Off formulary, no coverage, but available if you pay full out of pocket costs. 

 

#2 is most likely scenario in my opinion.  I think that the current list price would be negotiated down for formulary placement and it would get covered with a cost share.  I will also add that I do not see how a $200 aggregate annual cost share cap is tenable with a large open formulary. I would wager a bit that that $200 cap never sees actual implmentation, or that the reality is that the formulary is going to have to be closed and highly preferential to generic products.  It's one thing to talk about placement of something like a $200 treatment for an acute illness.  It is quite another when you start letting the actuaries run numbers on something like very expensive biologicals for treatment of a highly prevalent chronic condition like hyperlipidemia. Price negotiations leveraging formulary placement alone aren't going to make the numbers work. Clearly I have an interest in the area, but I think that this is the least well developed portion of the health care policies being discussed.  How we manage drug pricing and access under this "no copays, no deductibles, no premiums, ever" mantra. 

Edited March 27, 2019 by Anastasis

[bad_teammate 13481]

4 minutes ago, Anastasis said:

Clearly I have an interest in the area, but I think that this is the least well developed portion of the health care policies being discussed.  How we manage drug pricing and access under this "no copays, no deductibles, no premiums, ever" mantra. 

Scenario 1: Each individual customer is his/her own agent negotiating against the drug companies.
Scenario 2: Each individual customer chooses an insurance company and plan then those insurance companies and plans negotiate against the drug companies.
Scenario 3: The government negotiates against the drug company as literally the only significant market for sales.

Which one of the 3 seems like the strongest bargaining position most likely to negotiate costs downward?

[Anastasis 23700]

Pulling another topic over from the Bern thread.

6 hours ago, bad_teammate said:

They aren't. You could actually contribute to the discussion by attempting an explanation and answering simple questions. That would be cool.

- What does "catastrophic coverage" mean, in this context?

There is the Medicare Part D concept which is about making sure co-pays/co-insurance is low after a spending threshhold. But there is also the ACA concept which relates to providing the wider array (the 10 pillars) of healthcare coverage instead of just relating to prescription drugs.

I don't know why it's so upsetting to you that you're asked to talk about your ideas.

- What do you mean by "safety net"?

- What about people who don't/can't/won't work? How do they pay for health insurance?

I see a whole lot of bureaucracy involved with your ideas. Perhaps even more than currently exists.

In the context of the approach I have outlined in this vein:

 I have outlined this in greater detail previously, but I think that we can get there "quite simply" by converting Medicare into a universal catastrophic coverage program, decoupling (what would now be) supplemental private insurance coverage from employment to create a functional market that all Americans can access, extending access to HSA accounts to all Americans, providing a robust safety net for individuals living in poverty, require price transparency, reform aspects of the FDA and patent law, make smart public health investments in comparative effectiveness and cost effectiveness research, etc.  There are functional solutions that can merge a universal coverage backstop with a private free market dynamic.  Problem is, too many entrenched interests with deep lobby pockets and a totally dysfunctional political system.     

 

 

Catastrophic coverage refers to coverage that kicks in under certain extreme and infrequently occurring situations, typically based on certain spending thresholds set by actuaries. I think that a blend of annual and lifetime limits would be workable.  Alternatively, you can formulate catastrophic coverage that would kick in when certain high cost conditions are diagnosed (e.g., ESRS, transplant, etc.).

A safety net in this context is coverage provided to low income individuals to provide pre-catastrophic coverage for those that cannot otherwise afford to purchase coverage.

In context of my thinking on the issue, work status is not relevant. Insurance is decoupled from employment. 

 

 

 

[Anastasis 23700]

11 minutes ago, bad_teammate said:

Scenario 1: Each individual customer is his/her own agent negotiating against the drug companies.
Scenario 2: Each individual customer chooses an insurance company and plan then those insurance companies and plans negotiate against the drug companies.
Scenario 3: The government negotiates against the drug company as literally the only significant market for sales.

Which one of the 3 seems like the strongest bargaining position most likely to negotiate costs downward?

Scenario 3 has the strongest leverage in negotiating price.  Scenario 1 offers the least leverage, but arguably the best environment to stoke a transparent market where consumers are empowered in their decision making and market forces based on competition can drive down costs. Scenario 2 balances aspects of both with the addition of laying off a level of risk borne by the consumer in Scenario 1 and the government in Scenario 3. 

[bad_teammate 13481]

Just now, Anastasis said:

... but arguably the best environment to stoke a transparent market where consumers are empowered in their decision making and market forces based on competition can drive down costs.

Why would this environment encourage more transparency than, say, negotiating with a government agency that makes costs public?

[Incredulity 11861]

7 minutes ago, bad_teammate said:

Why would this environment encourage more transparency than, say, negotiating with a government agency that makes costs public?

You can’t possibly be that naive.

Governments can enforce transparency.  Governments are notoriously poor at being transparent.

 

But, I am sure this one would be different.

[Anastasis 23700]

I am not really sure that that is the pivotal advantage under the scenario.  

[bad_teammate 13481]

There are instances of transparency and opacity in both the public and private sectors.

Any argument that hinges on "private is always better than public" is asinine and barely worth addressing in those terms.

[Texas Jeff 1998]

On 3/19/2019 at 12:06 PM, Mole said:

-if employers are no longer covering the cost of insurance, how much of that on average ends up in my paycheck? Insurance is currently part of our compensation, so if that need goes away, how much, if any, do wages rise?

Well, maybe none if your employer just pockets the money .... but if they do some other employer might want to talk to you about a new job with a raise.  Also, lots of folks who have enough to stop working but need the healthcare might quit, making space for younger people to move up the ladder.

Some others might quit because they've always had some idea of a business to start, but the need for healthcare coverage kept them at a big employer.  With the link between employment and healthcare severed, you might end up at an innovative startup.

So, no guarantee of a higher paycheck but I think you'll see eventual higher pay and more innovation once companies don't have to think about healthcare for their employees.

[Incredulity 11861]

5 hours ago, bad_teammate said:

There are instances of transparency and opacity in both the public and private sectors.

Any argument that hinges on "private is always better than public" is asinine and barely worth addressing in those terms.

Read it again.

There are two paths to transparency, the market or regulation.

Government entities are NEVER transparent.

[Anastasis 23700]

How did this thread not batsignal @Bozo_Casanova ?

[UncleCharlie 334]

On 3/19/2019 at 10:08 AM, Asithappens said:

We don't have to reinvent the wheel here.

Start with what Germany does.

We're gonna have to kill a lot of Jews if we go that route...

[American Swindle 102]

Go back to what we had before the ACA was passed. Allow competition in the drug market (allow imports from UK, Mexico and Canada).  Mandate all hospitals and clinics publish their costs for common procedures/surgeries/drugs etc. 

Incentivize hospitals to help those less fortunate by allowing them to write off pro-bono surgeries/procedures at what the insurance company's would bill for said procedure.   

Edited March 28, 2019 by American Swindle

[Bozo_Casanova 26773]

1 hour ago, Anastasis said:

How did this thread not batsignal @Bozo_Casanova ?

[bad_teammate 13481]

Some relevant political info.

DC is corrupt. The Democrats are no exception; they're better than the Republicans (by far), but they're still a corrupt organization.

 

[52-80 19374]

On 3/18/2019 at 11:02 PM, CooterBrown said:

 

If you consider the elimination of health insurance costs and out of pocket health expenses, it’s probably a decrease in overall costs even if technically your taxes go up.

It'll cost more net because everyone will be liable to pay for all those emaciated vegan democrats

[Bozo_Casanova 26773]

On 3/19/2019 at 10:41 AM, EuroHorn said:

Cost, Quality, Universal coverage.  Pick two...

Nonsense. Here in the united States we have chosen "none of the above". 

[Horn Under a Bad Sign 20838]

After Trump pivots to healthcare and calls for GOP to create healthcare plan, there is none in the works:

https://www.washingtonpost.com/politics/for-trumps-party-of-health-care-there-is-no-health-care-plan/2019/03/30/b4005bd0-5264-11e9-8d28-f5149e5a2fda_story.html?utm_term=.d78c026ebcf7

[bad_teammate 13481]

1 minute ago, Horn Under a Bad Sign said:

After Trump pivots to healthcare and calls for GOP to create healthcare plan, there is none in the works:

https://www.washingtonpost.com/politics/for-trumps-party-of-health-care-there-is-no-health-care-plan/2019/03/30/b4005bd0-5264-11e9-8d28-f5149e5a2fda_story.html?utm_term=.d78c026ebcf7

PPACA/Obamacare is the center-right healthcare policy, but they can't embrace it.

Medicare for America is the center, and they definitely can't embrace that.

The Democrat 90s/00s move was, "We'll adopt the Republican platform for them so they won't have any policies and the voters will punish them for not having policies. Ha! We win forever!"

Republicans: "Hold my turtle's beer."

[Skyline 325]

 

[Skyline 325]

2 hours ago, bad_teammate said:

PPACA/Obamacare is the center-right healthcare policy, but they can't embrace it.

Medicare for America is the center, and they definitely can't embrace that.

The Democrat 90s/00s move was, "We'll adopt the Republican platform for them so they won't have any policies and the voters will punish them for not having policies. Ha! We win forever!"

Republicans: "Hold my turtle's beer."

This is why the GOP's best bet was shoring up the ACA and then preventing any sort of leftward pull. It would've been the sound long-term strategy. 

There's very few people who actively want to go back to the Pre-ACA days, but those are the loudest voices. 

[ChiTownDoc 21325]

On 3/19/2019 at 10:28 AM, bad_teammate said:

Awesome post, Anastasis.

Absolutely, especially considering the political interests, lobbies, and powers involved.

Since no one is talking about a nationalized system, the private contracting world within the operation of the larger single-payer system wouldn't seem to be completely dismantled. MACs would, ostensibly, still coordinate between the Medicare mothership and the local providers, obviously with new regulations and purposes.

I don't know what role PBMs would really have. Greatly reduced, I'd imagine.

 

See you can make total sense when you want.  😉

[Horn Dog 10156]

Horndog, Inc.  is proud to announce the first MAGA compliant health care plan!  As our favorite president previously proclaimed  it will cost $17 a month, cover preexisting conditions and will MAKE AMERICA GREAT AGAIN!  How?  Simple:

— premiums $17 a month

— deductible:  NONE!

Benefits:

— America was great in the 1950’s.  At that time one could visit  a doctor in exchange for a chicken and be admited to the hospital cfor $15.  The MAGA plan will provide 1 chicken per year for doctors visits and up to $15 per year for hospital visits!

— After 10 years of completed payments, and with a additinal 20 year commitment, MAGA plan will provide a lifetime benefit of $500 for your medical expenses! NO DEDUCTIBLE!!  Your preexisting conditions are also covered under this $500 lifetime limit!  In the 1950’s $500 could buy a car! 

FAQ:

— What if I exceed my $500 lifetime limit?

Mexico will pay for it.

— What if my doctor won’t accept a chicken for payment?

Call him a elitist liberal.

— What if this plan fails to meet my family’s medical needs and my spouse or child dies?

Everyone dies.