Political Roundtable Part XIV

[cammac]

It's all in how you implement the regulations. Obama administration really overstepped their authority there, unnecessarily imo.

They can fix the ACA by making it a single-payer system.

The ACA is a Republican bill. That's why it's a complete failure.

ACA is a complete failure - should be repealed, got it.

But... a single payer would fail too - at least until they take care of the cost drivers. Agreed? Or is single payer the panacea that fixes healthcare?

Single payer isn't a panacea but it is the most responsible way to fund a health system for all.
But you are correct in that the drivers must be corrected as it has been done in successfully in other Western Democracies and provide superior services than the USA.It would require politions on both side od the isle to gets some gumption to fight special interest groups. It also requires the whole American public to realize the tax increases or status quo are not evil but getting value for your tax dollar is.

The obvious enemy of reform are:
Private hospitals with tax free status obviously all hospitals should be publically owned but unlikely to happen in the USA. But setting rates and having access to all citizens. If a hospital wants to remain private the tax exempt status removed and only people paying cash should be admitted.
Lawyers are always a bane of society so limitations on awards should be capped.
Big Pharma a national system will reduce the cost with basically one buyer and the use of more generics.
AMA the charges of doctors services are regulated.
Insurance companies are taken out of the picture for basic services.

Who pays?
Working American's and Employers through payroll deductions. It spreads the cost through a wide range of wage ages and is fair.
Initially a 5% tax on individuals with incomes of over $250,000
Inheritance Tax 5% to 25% on inheritance starting at $4,000,000
Possible VAT tax of 2 to 4%

The States run the programs with Federal guidelines and States are treated equally via population in the disbursement of money. So a resident is treated at the same rate in West Virginia as a resident in California.

[TGW]

It's all in how you implement the regulations. Obama administration really overstepped their authority there, unnecessarily imo.

They can fix the ACA by making it a single-payer system.

The ACA is a Republican bill. That's why it's a complete failure.

ACA is a complete failure - should be repealed, got it.

But... a single payer would fail too - at least until they take care of the cost drivers. Agreed? Or is single payer the panacea that fixes healthcare?

Single payer is financially the best options for the country. It allows the government to negotiate prices on behalf of the people. Because the government's best interest is to ensure the lowest price, they can force healthcare/drug prices to come down dramatically (ala Canada). Right now, the heathcare and pharma companies are making money hand over fist because they are no vehicles to force them to lower prices. Because of the mandate (with no public option to drive costs down) it just means the healthcare companies can continue to do business as usual, except now they'll just jack up rates on the people who are paying in to cover the ones who weren't. Bad system developed by right wing organizations (this is the Heritage/Romney plan) that Obama stupidly pushed through because he was trying to be "bi-partisan".

[Jamaaliver]

Jamaaliver's Tweet of the Day (a few days late):

Read on Twitter

These are mad, mad times.

[dckingsfan]

They can fix the ACA by making it a single-payer system.

The ACA is a Republican bill. That's why it's a complete failure.

ACA is a complete failure - should be repealed, got it.

But... a single payer would fail too - at least until they take care of the cost drivers. Agreed? Or is single payer the panacea that fixes healthcare?

Single payer is financially the best options for the country. It allows the government to negotiate prices on behalf of the people. Because the government's best interest is to ensure the lowest price, they can force healthcare/drug prices to come down dramatically (ala Canada). Right now, the heathcare and pharma companies are making money hand over fist because they are no vehicles to force them to lower prices. Because of the mandate (with no public option to drive costs down) it just means the healthcare companies can continue to do business as usual, except now they'll just jack up rates on the people who are paying in to cover the ones who weren't. Bad system developed by right wing organizations (this is the Heritage/Romney plan) that Obama stupidly pushed through because he was trying to be "bi-partisan".

Single payer itself doesn't allow for the government to negotiate prices on behalf of the people (same with Medicare/Medicaid).

If you want to fix that one (of many) cost driver(s), just allow pharmaceuticals to be imported. The pharma companies export pharma at lower costs to other countries. The reality there is that the rest of the world benefited from our subsidizing pharma development. We should stop that...

But you made my point indirectly - we need to address the cost drivers (like pharma) first. And that is the hard work and why both parties haven't wanted to address it...

[dckingsfan]

They can fix the ACA by making it a single-payer system.

The ACA is a Republican bill. That's why it's a complete failure.

ACA is a complete failure - should be repealed, got it.

But... a single payer would fail too - at least until they take care of the cost drivers. Agreed? Or is single payer the panacea that fixes healthcare?

Single payer isn't a panacea but it is the most responsible way to fund a health system for all.
But you are correct in that the drivers must be corrected as it has been done in successfully in other Western Democracies and provide superior services than the USA.It would require politions on both side od the isle to gets some gumption to fight special interest groups. It also requires the whole American public to realize the tax increases or status quo are not evil but getting value for your tax dollar is.

The obvious enemy of reform are:
Private hospitals with tax free status obviously all hospitals should be publically owned but unlikely to happen in the USA. But setting rates and having access to all citizens. If a hospital wants to remain private the tax exempt status removed and only people paying cash should be admitted.
Lawyers are always a bane of society so limitations on awards should be capped.
Big Pharma a national system will reduce the cost with basically one buyer and the use of more generics.
AMA the charges of doctors services are regulated.
Insurance companies are taken out of the picture for basic services.

Who pays?
Working American's and Employers through payroll deductions. It spreads the cost through a wide range of wage ages and is fair.
Initially a 5% tax on individuals with incomes of over $250,000
Inheritance Tax 5% to 25% on inheritance starting at $4,000,000
Possible VAT tax of 2 to 4%

The States run the programs with Federal guidelines and States are treated equally via population in the disbursement of money. So a resident is treated at the same rate in West Virginia as a resident in California.

If you addressed the cost drivers you wouldn't need to raise taxes. If you don't address the cost drivers - those taxes won't come close to covering the costs.

[cammac]

ACA is a complete failure - should be repealed, got it.

But... a single payer would fail too - at least until they take care of the cost drivers. Agreed? Or is single payer the panacea that fixes healthcare?

Single payer is financially the best options for the country. It allows the government to negotiate prices on behalf of the people. Because the government's best interest is to ensure the lowest price, they can force healthcare/drug prices to come down dramatically (ala Canada). Right now, the heathcare and pharma companies are making money hand over fist because they are no vehicles to force them to lower prices. Because of the mandate (with no public option to drive costs down) it just means the healthcare companies can continue to do business as usual, except now they'll just jack up rates on the people who are paying in to cover the ones who weren't. Bad system developed by right wing organizations (this is the Heritage/Romney plan) that Obama stupidly pushed through because he was trying to be "bi-partisan".

Single payer itself doesn't allow for the government to negotiate prices on behalf of the people (same with Medicare/Medicaid).

If you want to fix that one (of many) cost driver(s), just allow pharmaceuticals to be imported. The pharma companies export pharma at lower costs to other countries. The reality there is that the rest of the world benefited from our subsidizing pharma development. We should stop that...

But you made my point indirectly - we need to address the cost drivers (like pharma) first. And that is the hard work and why both parties haven't wanted to address it...

You premise is slightly off base in that that yes a single payer can negotiate especially the Federal Government in that they also control the number of years on patent protection.

[dckingsfan]

Single payer is financially the best options for the country. It allows the government to negotiate prices on behalf of the people. Because the government's best interest is to ensure the lowest price, they can force healthcare/drug prices to come down dramatically (ala Canada). Right now, the heathcare and pharma companies are making money hand over fist because they are no vehicles to force them to lower prices. Because of the mandate (with no public option to drive costs down) it just means the healthcare companies can continue to do business as usual, except now they'll just jack up rates on the people who are paying in to cover the ones who weren't. Bad system developed by right wing organizations (this is the Heritage/Romney plan) that Obama stupidly pushed through because he was trying to be "bi-partisan".

Single payer itself doesn't allow for the government to negotiate prices on behalf of the people (same with Medicare/Medicaid).

If you want to fix that one (of many) cost driver(s), just allow pharmaceuticals to be imported. The pharma companies export pharma at lower costs to other countries. The reality there is that the rest of the world benefited from our subsidizing pharma development. We should stop that...

But you made my point indirectly - we need to address the cost drivers (like pharma) first. And that is the hard work and why both parties haven't wanted to address it...

You premise is slightly off base in that that yes a single payer can negotiate especially the Federal Government in that they also control the number of years on patent protection.

I'm not off at all. The Medicare Modernization Act of 2003 (MMA), which established Medicare Part D, included a ban on such negotiation.

[montestewart]

Single payer itself doesn't allow for the government to negotiate prices on behalf of the people (same with Medicare/Medicaid).

If you want to fix that one (of many) cost driver(s), just allow pharmaceuticals to be imported. The pharma companies export pharma at lower costs to other countries. The reality there is that the rest of the world benefited from our subsidizing pharma development. We should stop that...

But you made my point indirectly - we need to address the cost drivers (like pharma) first. And that is the hard work and why both parties haven't wanted to address it...

You premise is slightly off base in that that yes a single payer can negotiate especially the Federal Government in that they also control the number of years on patent protection.

I'm not off at all. The Medicare Modernization Act of 2003 (MMA), which established Medicare Part D, included a ban on such negotiation.

Yes, the most powerful drug cartel in the world, the US pharma cartel, has put a lot of drug money in congressional pockets. What would it take to repeal that law? Shame clearly does not work.

PS: It's my understanding that Medicare is guaranteed the lowest rate in the US, which sounds good until you see what everyone else in the US is charged.

[TGW]

You premise is slightly off base in that that yes a single payer can negotiate especially the Federal Government in that they also control the number of years on patent protection.

I'm not off at all. The Medicare Modernization Act of 2003 (MMA), which established Medicare Part D, included a ban on such negotiation.

Yes, the most powerful drug cartel in the world, the US pharma cartel, has put a lot of drug money in congressional pockets. What would it take to repeal that law? Shame clearly does not work.

PS: It's my understanding that Medicare is guaranteed the lowest rate in the US, which sounds good until you see what everyone else in the US is charged.

Exactly. That clause was put in there to allow big pharma to continue their price gouging, plain and simple.

[popper]

I think R's would be wise to propose a national healthcare program based on the Canadian model (with many tweaks of course). It has proven to work relatively well there over time.

[TGW]

I think R's would be wise to propose a national healthcare program based on the Canadian model (with many tweaks of course). It has proven to work relatively well there over time.

aka Medicare for All aka Bernie Sanders' plan.

Some republicans are on board. The ones who do the bidding of corporate donors are not (that includes the Dems).

[Zonkerbl]

When I set aside my irrational hatred of guns from my childhood traumatizing event, it's obvious that there is an externality to society associated with widespread gun ownership - for example, police *have* to assume they could die at any moment, because the entire country is awash in guns, handguns in particular. Also, the widespread ownership of handguns means it is much easier in the United States than elsewhere for teenage kids to commit suicide. I think we can all agree that these are bad things. And there is a solution - estimate the "non-internalized" costs of gun ownership nationwide, and add a Pigouvian tax to gun sales that is high enough to force people buying guns to consider the added costs they are imposing on the rest of us by buying a gun. Handguns cost about $500 - I imagine a tax on the order of cigarettes would be approximately correct, so add on, say, another $500 to that. You can't set the tax too high because people will start circumventing it, so something reasonably high but not prohibitively so. Then use the revenue generated to fund buyback programs and start melting guns down to scrap. Or whatever is the cheapest way to get rid of old guns. The goal isn't to ban guns entirely but just reduce the overall inventory to a manageable level, so cops at least don't have to be afraid for their life every time they pull someone over. And a kid who wants to kill himself doesn't have a 100% chance of having a friend who's dad keeps a gun unsecured under his bed.

Or localities where guns are particularly problematic can set their own taxes. I think that's perilous because you can't guarantee they won't try to charge a prohibitive tax.

These "externalities" as you call them are precisely the reason to regulate... anything! Including guns.

At the same time, b/c we are unlikely to be smart enough to see all externalities (some can be positive, of course) of any issue, & are certainly not smart enough to have a 100% understanding of the full truth about any one of them, or about their interaction, we need to be careful about how we regulate stuff. (side note to Popper: the preceding sentence is an example of a *conservative* position)

Isn't that what Zonk is advocating - but with a twist, regulating with a tax vs. just a flat regulation? Cigarettes would be a good example - it seems to have worked pretty well here?

Exactly. As rabidly anti-gun as I am, I can't in good conscience support the absolutely useless gun control legislation that has been proposed by the Dems. Completely pointless. Slap a pigouvian tax on that mug and you're doneso.

[dckingsfan]

I think R's would be wise to propose a national healthcare program based on the Canadian model (with many tweaks of course). It has proven to work relatively well there over time.

aka Medicare for All aka Bernie Sanders' plan.

Some republicans are on board. The ones who do the bidding of corporate donors are not (that includes the Dems).

And you understand why this would fail too unless you took on the cost drivers first? Bernie knows this - but he hasn't been willing to do the hard work either... just saying.

[TGW]

I think R's would be wise to propose a national healthcare program based on the Canadian model (with many tweaks of course). It has proven to work relatively well there over time.

aka Medicare for All aka Bernie Sanders' plan.

Some republicans are on board. The ones who do the bidding of corporate donors are not (that includes the Dems).

And you understand why this would fail too unless you took on the cost drivers first? Bernie knows this - but he hasn't been willing to do the hard work either... just saying.

No offense, dcK, cause I like you but the costs of MFA have been debated ad-nauseum. Even though the CBO hasn't scored Bernie's MFA bill, we know from looking at other western countries with a similar universal healthcare program in place on average pay 40% per person LESS than the United States. Payroll tax will go up 5% across the board.

http://www.medicareforall.org/pages/Tax

The lower costs of MFA are not debatable, and our politicians know this. The argument that our (bought) politicians make is that the service isn't as good as our system now. Well, quality is only good if you actually can afford the service...if you can't, you're SOL.

I've had several family members who've literally lost homes and declared bankruptcy because of medical bills. The biggest cause of bankruptcies in the US is medical debt...under MFA, that will no longer be the case.

[dckingsfan]

Hey TGW, thanks and agreed - good conversation.

But what Bernie ignored in the MFA were the cost drivers. Don't get me wrong, single payer, MFA, ACA, AHCA - all of them could be feasible if you take on the cost drivers - Bernie doesn't and hasn't (he says that there will be negotiations with Drug companies (great), cutting federal healthcare bureaucracy (do you believe that?), improving efficiencies (do you believe that one?)). He doesn't take on trial lawyers, he doesn't take on the AMA or many of the other cost drivers.

There is a reason there is no specific proposal to be scored - he would get skewered.

If Bernie or the Ds or the Rs really want to "fix" the situation, there would be bi-partisan work (giving each other cover) in order to take on pharma, trial lawyers, hospital monopolies, AMA, etc.

There is a battle for minds between ACA, AHCA, MFA/single payer - and that really isn't the battle... it is just smoke around the real battle.

I think you make one really good point. The defenders of the status quo have a lot to lose - literally trillions. They are terrific at obfuscating the conversation. If the conversation was about pharma, trial lawyers, AMA, etc. you would hear some real screaming - and we would be getting somewhere.

[cammac]

Hey TGW, thanks and agreed - good conversation.

But what Bernie ignored in the MFA were the cost drivers. Don't get me wrong, single payer, MFA, ACA, AHCA - all of them could be feasible if you take on the cost drivers - Bernie doesn't and hasn't (he says that there will be negotiations with Drug companies (great), cutting federal healthcare bureaucracy (do you believe that?), improving efficiencies (do you believe that one?)). He doesn't take on trial lawyers, he doesn't take on the AMA or many of the other cost drivers.

There is a reason there is no specific proposal to be scored - he would get skewered.

If Bernie or the Ds or the Rs really want to "fix" the situation, there would be bi-partisan work (giving each other cover) in order to take on pharma, trial lawyers, hospital monopolies, AMA, etc.

There is a battle for minds between ACA, AHCA, MFA/single payer - and that really isn't the battle... it is just smoke around the real battle.

I think you make one really good point. The defenders of the status quo have a lot to lose - literally trillions. They are terrific at obfuscating the conversation. If the conversation was about pharma, trial lawyers, AMA, etc. you would hear some real screaming - and we would be getting somewhere.

The problem is expecting either party to take a rational stand is futile and it looks like consensus by most on the board that change needs to be made. The reality is that many representatives could very well be vulnerable on both sides of the political spectrum. A ground swell of Americans can change how at least the balance of both major parties and could ally for change. Obviously the libertarian or green party aren't the answer. More like the Liberal Party in Canada. I know it is a pipe dream but the reality needed for a change.

[cammac]

Trumps reply's to NAFTA many are ludicrous:
1.To eliminate a tribunal that oversees disputes the reason in the past most of tariffs USA has set are overturned ie: softwood lumber
2. To give easier access to government contracts in both Canada and Mexico & at the same time restricting companies from Canada & Mexico from getting USA government contracts.
3. Trump wants to reduce balance of payments but put up errornious figures on Canada which at the moment is running a deficit of about 5 billion. To be factual Canada does usually has a surplus in trade mainly due to energy exports to USA.
4. Some things are factual Canada does have marketing boards on dairy and eggs that inflates the prices of those items in Canada but still pales to American farm subsidies.Canadian public doesn't agree with the marketing boards in general.
5. Much of the new industry especially European & Japanese investments have been bought by various states basically givinging huge benefits to those companies. The only time Canada got involved was in co-ordination of baling out GM & Chrysler with President Obama with both the Federal Government & the Province Of Ontario

Canada will negotiate in good faith and has strong support in many USA states that depend on Canadian trade.

[dckingsfan]

Trumps reply's to NAFTA many are ludicrous:
1.To eliminate a tribunal that oversees disputes the reason in the past most of tariffs USA has set are overturned ie: softwood lumber
2. To give easier access to government contracts in both Canada and Mexico & at the same time restricting companies from Canada & Mexico from getting USA government contracts.
3. Trump wants to reduce balance of payments but put up errornious figures on Canada which at the moment is running a deficit of about 5 billion. To be factual Canada does usually has a surplus in trade mainly due to energy exports to USA.
4. Some things are factual Canada does have marketing boards on dairy and eggs that inflates the prices of those items in Canada but still pales to American farm subsidies.Canadian public doesn't agree with the marketing boards in general.
5. Much of the new industry especially European & Japanese investments have been bought by various states basically givinging huge benefits to those companies. The only time Canada got involved was in co-ordination of baling out GM & Chrysler with President Obama with both the Federal Government & the Province Of Ontario

Canada will negotiate in good faith and has strong support in many USA states that depend on Canadian trade.

Hmmm, thinking you might be overblowing Trump's response. It is an opening salvo to correct the trade imbalance. Canada and Mexico are happy to leave things as they are - and for good reason.

[cammac]

Trumps reply's to NAFTA many are ludicrous:
1.To eliminate a tribunal that oversees disputes the reason in the past most of tariffs USA has set are overturned ie: softwood lumber
2. To give easier access to government contracts in both Canada and Mexico & at the same time restricting companies from Canada & Mexico from getting USA government contracts.
3. Trump wants to reduce balance of payments but put up errornious figures on Canada which at the moment is running a deficit of about 5 billion. To be factual Canada does usually has a surplus in trade mainly due to energy exports to USA.
4. Some things are factual Canada does have marketing boards on dairy and eggs that inflates the prices of those items in Canada but still pales to American farm subsidies.Canadian public doesn't agree with the marketing boards in general.
5. Much of the new industry especially European & Japanese investments have been bought by various states basically givinging huge benefits to those companies. The only time Canada got involved was in co-ordination of baling out GM & Chrysler with President Obama with both the Federal Government & the Province Of Ontario

Canada will negotiate in good faith and has strong support in many USA states that depend on Canadian trade.

Hmmm, thinking you might be overblowing Trump's response. It is an opening salvo to correct the trade imbalance. Canada and Mexico are happy to leave things as they are - and for good reason.

Again much of the trade imbalance with Canada was energy since Canada is the only safe supplier of energy to the USA or would you rather get it from Saudi Arabia? About 40% of USA natural gas is supplied by Canada and a large % of oil imports. Sometimes numbers lie huge difference in $100 oil and $40 oil.

[Zonkerbl]

What are the cost drivers in the ACA?

I know that single payer would lower the *level* of costs, but it wouldn't do anything about cost *growth.* What's making health care costs *rise* so fast?

I'm pretty sure it's that our system is profit driven, and so we focus our attention on what people are willing to pay for, like cures to cancer and so on. Other countries do research but only to reduce costs, not to address OH MY GOD MOM IS DYING OF CANCER DO SOMETHING ANYTHING. So we funnel our research towards the cures that people really, really want and, to be brutally honest about it, the rest of the world free rides on our research.

I think single payer might succeed in slowing health care cost growth by choking off the incentive to research the deadliest diseases. Frankly I'm not sure it's such a good idea. Maybe we should get the rest of the world to pay their fair share of our research costs?