Market politics

[JRP3]

It didn't get any Republican votes so it's failure is 100% owned by the Democrats. Maybe it was designed to fail so we can finally get M4A or a public option.

It was certainly weaker than it could have been. However that "failure" did allow millions of previously uninsured people to be covered. It was not a failure for them.

 

[dmunjal]

It was certainly weaker than it could have been. However that "failure" did allow millions of previously uninsured people to be covered. It was not a failure for them.

That’s not a good measure when the first word in the bill is “Affordable.” After the ACA passed, the national healthcare system is more fragile and at risk of collapse than ever before. As I said, we wouldn’t be talking about M4A in 2020 if ACA did what is was supposed to do. Of course, it didn’t. By design, I believe. Maybe it was just incompetence and corruption. But premiums doubling in less than 10 years is absurd and is a failure by any measure.

 

[bkp_duke]

It was certainly weaker than it could have been. However that "failure" did allow millions of previously uninsured people to be covered. It was not a failure for them.

As I've said time and time again. Health Insurance (i.e. coverage) =/ Healthcare.

I'm out of practice, have been several years. But still hear my colleagues complain almost daily about the ACA. Read this the other day, not surprised in the least: https://www.investors.com/politics/editorials/doctor-shortages-obamacare-ehr/

The entire crux of the article is this quote:
"It's had the opposite effect. A Mayo Clinic survey found that the EHR mandate is reducing efficiency, increasing costs and paperwork hassles, and pushing more doctors to quit or retire early."

Medicare for All will simply be the ACA on steroids. It won't reduce complexity, it will increase it.


EDIT - and this quote as well stuck out to me:
"ObamaCare continued what had been a long and sorry trend in health care. Government-imposed rules designed to fix some problem in the system instead generated mountains of new administrative work."

 

[JRP3]

Medicare for All will simply be the ACA on steroids. It won't reduce complexity, it will increase it.

It shouldn't if it's done properly.

 

[dmunjal]

It shouldn't if it's done properly.

Agreed. But when has that ever happened when the government and lobbyists are involved?

 

[bkp_duke]

It shouldn't if it's done properly.

The government NEVER does anything properly or efficiently. Especially anything complicated like healthcare.

 

[JRP3]

Biden showing thin skin again

 

[wdolson]

I've heard you mention this point many times. The ACA was not weakened because of Republicans. It was weakened because of Obama. Like Dodd-Frank before it, it was written by lobbyists for lobbyists.

ObamaCare Enriches Only The Health Insurance Giants and Their Shareholders

Obama and the Democrats were trying to wheel and deal to get a deal through. The medical lobby is very strong and they needed to be bought off to move things forward. It was the "some improvement beats where we are now" approach.

It didn't get any Republican votes so it's failure is 100% owned by the Democrats. Maybe it was designed to fail so we can finally get M4A or a public option.

It didn't get any Republican votes by design. The Republicans have demanded slavish adherence to the party leaders on important votes since the Gingrich days. This is another example of where they are all politics and no policy. Obama and the Democrats gave them ample opportunity to come to the table and contribute, but all they did was play games. When it came time to vote they ensured not a single Republican would vote for it so they could campaign on that fact.

They don't care about the US, the laws, or the people anymore. It's all about winning elections and causing as much chaos as possible. Party first, everyone and everything else can go hang.

Show me how much Russia spent on helping Bernie vs. what Hillary spent ($2B) and how much support she had from the mainstream media, Hollywood, academia, etc. It was a rounding error in the larger scheme of things.

Russia's effort to convince Bernie Sanders voters to support Trump was 'central' to their strategy to beat Hillary Clinton, according to a new study

Revealed: Russian support for Bernie began during NH primary

The Democrats still have superdelegates. They will end up deciding the nominee in the second round if it gets that far. Which it likely will.

The last brokered convention was 1952. They used to be relatively common, but since primaries and caucuses have become the tool to choose the nominee rather than party bosses in the proverbial smoke filled rooms, the closest thing to a brokered convention was the 1976 Republican convention, but Ford was able to scrape together enough uncommitted delegates to win on the first ballot.

What will likely happen if nobody has a clear majority going into the convention is behind the scenes the superdelegates will tell the candidates in contention who they are for and pressure the candidates who are most likely to lose to commit their delegates to the chosen winner and make a big show of it on TV. That way there is a good TV moment of party unity and the losers throw their weight behind the nominee. It happened in 2008 when Hillary Clinton committed her delegates to Obama and it happened again in 2016 when Bernie did the same.

All the candidates have made it fairly clear that if they are not the nominee, they will throw their weight behind whoever is the nominee. I can't think of any of the top tier candidates who have not either solidly committed to made noises to that effect. Everyone knows that the Democrats need to be more united than they were in 2016 and that means everyone working towards the same goal. There is no reason why Bernie won't be on board too if he isn't the nominee. He campaigned for Hillary in 2016 and repeatedly told his followers to vote for her. If anything he feels it's more imperative this year.

If there was someone as broken as Donald Trump in the Democratic mix, they would force a brokered convention if they could because Donald Trump only cares about himself. If the party won't play with him, he'll blow it up and never have a second thought about it. There is nobody who has any real shot at the Democratic nomination who is as self centered as Trump, or even close. All of the top tier candidates are team players. The top three have all been in the Senate a while.

Now it is possible if there are two candidates who are very close in delegate count that the second place person might be made VP as a consolation prize, or given a high cabinet position as Hillary Clinton was. In 2016 Hillary and Bernie may have had a deal to give Bernie a cabinet post, but we may never know for sure. He may have been content to go back to the Senate.

I see a brokered convention as fairly remote with the Democrats. If something happens on the Republican side and Trump is out of the running requiring selection of a candidate on that side, I could see the convention being much more contentious. The Republicans are not as good with compromise as the Democrats and there is now a very deep and nasty fault line running down the middle of the party that will open wide as soon as Trump is out of the picture. The MAGA-bots will try to keep the party going with a new stand in for Trump and the establishment people will try to get the party back from them.

 

[bkp_duke]

It didn't get any Republican votes by design. The Republicans have demanded slavish adherence to the party leaders on important votes since the Gingrich days. This is another example of where they are all politics and no policy. snip

No, it didn't get any Republican votes because it was/is a steaming turd of legislation. As I pointed out a few posts ago, it made an already complicated process like health insurance, even more complicated (typical for any government intervention).

You accuse the Republicans of "slavish adherence" to the party line, but fail to acknowledge that any unbiased observer can say the exact same thing about the Democrats (ahem, impeachment). Democrats are just as guilty of the "politics and no policy" accusation by your standards. Republicans have policy, you just don't agree with it. That would be an honest admission.

The extremely heavy-handed nature of your posts makes it harder and harder to give any credence to the content of them. You hold up one side of a dirty coin as "pristine" and condemn the other. In reality, both parties have their (unforgivable) sins and both are filthy. As the saying goes "no honest man (or woman) goes into politics".

 

[Fermi Paradox]

The government NEVER does anything properly or efficiently. Especially anything complicated like healthcare.

This US healthcare debate honestly seems so weird to almost every non-US citizens. I agree, pretty much every industry should be run by private institutions. However, the healthcare industry deals with consumers that are very vulnerable and have absolutely no bargaining power. This unequal power between buyer and supplier obviously drives up prices.

This behavior was captured in the ACA by design. There is a reason that the individual mandate was originally a Republican idea from the Heritage Foundation (Health insurance mandate - Wikipedia). This makes sense, given that it is the market-oriented answer to a single-payer system.

Also regarding the whole Biden/Bernie vs. Trump debate. It's fascinating to see how some here tend to ignore Trump's strategy and talking points against Clinton. He constantly used her corruption, her support for Iraq and Lybia, and her support for the trade deals as arguments. These obviously resonated with people in the rust belt.

The exact same arguments can be utilized against Biden. The whole Hunter story and Biden's connections to the credit card industry are perfect examples for the corruption aspect. He has even more baggage than Clinton regarding the war in Iraq (Trump understands the power of this argument, which is why I believe he didn't escalate tensions with Iran after the assassination). And, lastly, he has the same baggage regarding the trade deals.

Bernie, on the other hand, is not only immune to those three attacks, he can use those three arguments against Trump himself without being hypocritical. Yes, the "socialist" argument might have more merit (even though he really is a social democrat), but the GOP has been using that argument ad nauseam. In my view, it's not even close as to who would be more vulnerable in a general election.

The leaked tape of Trump underlines this. He was scared of Bernie and welcomed the idea of Biden as a candidate.

 

[bkp_duke]

This US healthcare debate honestly seems so weird to almost every non-US citizens. I agree, pretty much every industry should be run by private institutions. However, the healthcare industry deals with consumers that are very vulnerable and have absolutely no bargaining power. This unequal power between buyer and supplier obviously drives up prices.

This behavior was captured in the ACA by design. There is a reason that the individual mandate was originally a Republican idea from the Heritage Foundation (Health insurance mandate - Wikipedia). This makes sense, given that it is the market-oriented answer to a single-payer system.

Also regarding the whole Biden/Bernie vs. Trump debate. It's fascinating to see how some here tend to ignore Trump's strategy and talking points against Clinton. He constantly used her corruption, her support for Iraq and Lybia, and her support for the trade deals as arguments. These obviously resonated with people in the rust belt.

The exact same arguments can be utilized against Biden. The whole Hunter story and Biden's connections to the credit card industry are perfect examples for the corruption aspect. He has even more baggage than Clinton regarding the war in Iraq (Trump understands the power of this argument, which is why I believe he didn't escalate tensions with Iran after the assassination). And, lastly, he has the same baggage regarding the trade deals.

Bernie, on the other hand, is not only immune to those three attacks, he can use those three arguments against Trump himself without being hypocritical. Yes, the "socialist" argument might have more merit (even though he really is a social democrat), but the GOP has been using that argument ad nauseam. In my view, it's not even close as to who would be more vulnerable in a general election.

The leaked tape of Trump underlines this. He was scared of Bernie and welcomed the idea of Biden as a candidate.

I've covered this before in this thread. Healthcare in the US is akin to a Monopoly system, because there is ZERO price transparency. If you actually made healthcare providers and health insurance companies and pharma companies compete against one another, this would be a completely different story. Prices are always high in a monopoly. I'm not surprised at that graph.

Fortunately or unfortunately, Socialist medicine as seen in other countries is NOT the solution. That will (within one year or less) devolve into RATIONED care, as it has in many of those countries. I posted a similar article months ago in this thread:
Hospitals cancelling urgent surgery despite NHS bosses' orders

Force price transparency, force competition (between hospitals, between EMR companies - EMRs are horrible to use for doctors, between pharma companies, etc.) and you have a totally different ecosystem.

A perfect example of this is cosmetic medicine in the US. It is NOT covered by insurance, prices are advertised, and the quality has gone up over the past 20 years and the cost continually down.


Mark my words: socialized medicine will lead to WORSE OUTCOMES with more government bureaucracy.

I'm all for a better solution, but M4A is not that solution. It's all the turds of the ACA polished up and made bigger.

 

[Fermi Paradox]

I've covered this before in this thread. Healthcare in the US is akin to a Monopoly system, because there is ZERO price transparency. If you actually made healthcare providers and health insurance companies and pharma companies compete against one another, this would be a completely different story. Prices are always high in a monopoly. I'm not surprised at that graph.

Fortunately or unfortunately, Socialist medicine as seen in other countries is NOT the solution. That will (within one year or less) devolve into RATIONED care, as it has in many of those countries. I posted a similar article months ago in this thread:
Hospitals cancelling urgent surgery despite NHS bosses' orders

Force price transparency, force competition (between hospitals, between EMR companies - EMRs are horrible to use for doctors, between pharma companies, etc.) and you have a totally different ecosystem.

A perfect example of this is cosmetic medicine in the US. It is NOT covered by insurance, prices are advertised, and the quality has gone up over the past 20 years and the cost continually down.


Mark my words: socialized medicine will lead to WORSE OUTCOMES with more government bureaucracy.

I'm all for a better solution, but M4A is not that solution. It's all the turds of the ACA polished up and made bigger.

That argument is not consistent, though. If your worry is a monopolistic market behavior, wouldn't that mean that a single-payer system is the ultimate monopoly? However, if you look at the graph, Canada's single-payer system is incredibly cost-efficient compared to the United States.

Also, regarding rationing: Yes, that is a popular argument against a government health insurance. This assumes that there is no rationing in the US. For example, in my country, Germany, we ration based on need. If you need help now, on average, you get it immediately. Of course no system is perfect and heavy underfunding can lead to outliers with the wrong kind of rationing as displayed by the NHS in your linked article. However, the US also has rationing. That rationing is based on the size of your wallet. If you are wealthy, the US is, indeed, a fantastic country healthcare-wise. For the average person, however, it is incredibly cruel. If you explained the concept of 'deductibles' to any German, they'd think you'd be joking - it's that bizarre to a non-US citizen.

Also, cosmetic medicine is not a strong argument. I outlined the lack of bargaining power of the buyer as they either get the necessary health care or they die/get sicker. There is not such a strong necessity in cosmetic medicine, hence the bargaining power is a lot better on the buyer side.

Lastly, a single-payer system would reduce bureaucracy. By definition, the administrative work gets easier as doctors and hospitals can always use the standardized procedure. A reduction in administrative costs is among the main cost-reduction drivers in M4A. Study Shows Medicare for All Could Save US $600 Billion Annually on Paperwork and Other 'Useless Bureaucracy'

 

[bkp_duke]

That argument is not consistent, though. If your worry is a monopolistic market behavior, wouldn't that mean that a single-payer system is the ultimate monopoly? However, if you look at the graph, Canada's single-payer system is incredibly cost-efficient compared to the United States.

Also, regarding rationing: Yes, that is a popular argument against a government health insurance. This assumes that there is no rationing in the US. For example, in my country, Germany, we ration based on need. If you need help now, on average, you get it immediately. Of course no system is perfect and heavy underfunding can lead to outliers with the wrong kind of rationing as displayed by the NHS in your linked article. However, the US also has rationing. That rationing is based on the size of your wallet. If you are wealthy, the US is, indeed, a fantastic country healthcare-wise. For the average person, however, it is incredibly cruel. If you explained the concept of 'deductibles' to any German, they'd think you'd be joking - it's that bizarre to a non-US citizen.

Also, cosmetic medicine is not a strong argument. I outlined the lack of bargaining power of the buyer as they either get the necessary health care or they die/get sicker. There is not such a strong necessity in cosmetic medicine, hence the bargaining power is a lot better on the buyer side.

Lastly, a single-payer system would reduce bureaucracy. By definition, the administrative work gets easier as doctors and hospitals can always use the standardized procedure. A reduction in administrative costs is among the main cost-reduction drivers in M4A. Study Shows Medicare for All Could Save US $600 Billion Annually on Paperwork and Other 'Useless Bureaucracy'

I've covered this argument before, but the Canadian healthcare system is also plagued by long wait times. Just like every other social medicine system, it becomes rationed care. I have a cousin by marriage that is a Dr. in Canada and he's confirmed this (although both their liberal media and the US media try to keep it under wraps). The long wait times for certain critical specialties are literally why there are TWO medical systems in Canada (a public system, and then a private one that takes cash or select insurance).

If the US system was so bad for the average person, as you say it is, then why is "keeping your employeer-sponsored health plan" one of the most popular ideas in the US? These are not wealthy people saying this, these are low-income to middle class individuals.
Poll: Most Americans want universal healthcare but don't want to abolish private insurance

I'm all for a social safety net, but M4A is poorly thought out and will simply add to the complexity of an already over-complex medical system.


Honestly, however, this is an "academic" argument. M4A has shown to be so insanely costly that it will never become law here. We should all be looking for an alternative, such as removing the inefficiencies as they are now and fostering competition, than something like this.

Oh, and don't get me started on how many Drs. you will see retire if M4A ever did become law. Most docs hate Medicare as it is now. This isn't because we are "greedy bastards", but simply because of math: almost every Medicare/Medicaid patient I ever saw cost my practice more money that I ever got back in reimbursement from the government. Navigating that system, also, was at least as hard as the private insurance system. This is the underlying reason so many Drs. have stopped taking Medicare patients. You want to see a true national health crisis, M4A would usher that in quickly due to mass physician retirements. And despite what people may tell you, it's REALLY hard to replace doctors. It takes about a decade to train each one before they go into practice.

 

[bkp_duke]

Lastly, a single-payer system would reduce bureaucracy. By definition, the administrative work gets easier as doctors and hospitals can always use the standardized procedure. A reduction in administrative costs is among the main cost-reduction drivers in M4A. Study Shows Medicare for All Could Save US $600 Billion Annually on Paperwork and Other 'Useless Bureaucracy'

This is simply false. Sorry, but we were all sold the same "bill of goods" with the Affordable Healthcare Act, and that turned out to be patently false. The ACA ushered in MORE Bureaucracy:
https://www.investors.com/politics/editorials/doctor-shortages-obamacare-ehr/

"ObamaCare continued what had been a long and sorry trend in health care. Government-imposed rules designed to fix some problem in the system instead generated mountains of new administrative work.

The result has been that while the number of physicians in the country has climbed modestly over the past three decades, the number of health care administrators exploded."

 

[dmunjal]

This is simply false. Sorry, but we were all sold the same "bill of goods" with the Affordable Healthcare Act, and that turned out to be patently false. The ACA ushered in MORE Bureaucracy:
https://www.investors.com/politics/editorials/doctor-shortages-obamacare-ehr/

"ObamaCare continued what had been a long and sorry trend in health care. Government-imposed rules designed to fix some problem in the system instead generated mountains of new administrative work.

The result has been that while the number of physicians in the country has climbed modestly over the past three decades, the number of health care administrators exploded."

Here's the chart that backs that up.

 

[Fermi Paradox]

I've covered this argument before, but the Canadian healthcare system is also plagued by long wait times. Just like every other social medicine system, it becomes rationed care. I have a cousin by marriage that is a Dr. in Canada and he's confirmed this (although both their liberal media and the US media try to keep it under wraps). The long wait times for certain critical specialties are literally why there are TWO medical systems in Canada (a public system, and then a private one that takes cash or select insurance).

If the US system was so bad for the average person, as you say it is, then why is "keeping your employeer-sponsored health plan" one of the most popular ideas in the US? These are not wealthy people saying this, these are low-income to middle class individuals.
Poll: Most Americans want universal healthcare but don't want to abolish private insurance

I'm all for a social safety net, but M4A is poorly thought out and will simply add to the complexity of an already over-complex medical system.


Honestly, however, this is an "academic" argument. M4A has shown to be so insanely costly that it will never become law here. We should all be looking for an alternative, such as removing the inefficiencies as they are now and fostering competition, than something like this.

Oh, and don't get me started on how many Drs. you will see retire if M4A ever did become law. Most docs hate Medicare as it is now. This isn't because we are "greedy bastards", but simply because of math: almost every Medicare/Medicaid patient I ever saw cost my practice more money that I ever got back in reimbursement from the government. Navigating that system, also, was at least as hard as the private insurance system. This is the underlying reason so many Drs. have stopped taking Medicare patients. You want to see a true national health crisis, M4A would usher that in quickly due to mass physician retirements. And despite what people may tell you, it's REALLY hard to replace doctors. It takes about a decade to train each one before they go into practice.

The argument that the system is painful for the average American was not based on opinion polls asking people about scary change, but based on the number of deaths in the US healthcare system (~30k per year) and the number of families that go bankrupt due to medical debt (~500,000 per year). These figures don't really exist in, for example, Canada or here in Germany.

Anyway, I'm happy to agree to disagree on this. Especially on perhaps one of the most important days for Tesla (and TSLA) in quite a while. The earnings should be certainly interesting.

 

[gene]

The government NEVER does anything properly or efficiently. Especially anything complicated like healthcare.

Medicare funds are 3% administrative and 97% actual healthcare. Sounds extremely efficient vs. insurance companies 30% profits and 70% healthcare.

 

[bkp_duke]

The argument that the system is painful for the average American was not based on opinion polls asking people about scary change, but based on the number of deaths in the US healthcare system (~30k per year) and the number of families that go bankrupt due to medical debt (~500,000 per year). These figures don't really exist in, for example, Canada or here in Germany.

Anyway, I'm happy to agree to disagree on this. Especially on perhaps one of the most important days for Tesla (and TSLA) in quite a while. The earnings should be certainly interesting.

Those are a bit cherry-picked. I would point out that in a rationed healthcare system like Canada or Germany, that because resources are not determined by market forces, and therefore finite and do not adjust easily to demand, that people literally die while waiting to see specialists. When your sickest patients die before being seeing by a physician and treatment(s) started, it is obviously going to keep costs lower than what you see here.

Canada: nearly 20 weeks to see a specialist (that's ATROCIOUS):
You are being redirected...

Germany: Cannot find exact numbers, but the German government last year "forced" Drs to offer more appointment hours because of wait times.
https://www.thelocal.de/20190412/pu...-to-receive-doctors-appointments-more-quickly
"On Friday morning, the Bundesrat (upper house of parliament) will be putting a law into place which stipulates that medical practitioners must in future offer at least 25 instead of 20 hours of appointments a week dedicated to patients with statutory health insurance (gesetzliche Krankenversicherung).

The law comes amid complaints from many public health insurance patients that they are forced to wait weeks for an appointment, or don't receive appointments at "patient friendly" hours, such as at the weekend."

Germany, btw, is also a dual medical system. There is the public option (which my research online says there is a co-pay for to see a Dr., your experience may be different), and then private insurance as well.

I'm not opposed to a dual medical system, but M4A with no private option a disaster waiting to happen.

 

[bkp_duke]

Medicare funds are 3% administrative and 97% actual healthcare. Sounds extremely efficient vs. insurance companies 30% profits and 70% healthcare.

This is a bit misleading. Medicare piggybacks off Social Security for the bulk of it's administrative costs. Most studies don't attribute that real cost to the system. This IS EFFICIENT because Medicare and SS cover the same population (seniors).

Expanding to M4A will lose a lot of that efficiency because non-retirement age workers don't interact much with the SS system.

 

[JRP3]

However, the healthcare industry deals with consumers that are very vulnerable and have absolutely no bargaining power. This unequal power between buyer and supplier obviously drives up prices.

One of the worst abuses of this disparity is the funeral home business. Distraught people forced to accept a $4,000+ bill just to dispose of a body. It's criminal.