Sanders to introduce single payer medicare for all bill

[Jhhnn]

Any of you MDs or midlevels who have to deal with actually providing care? Medicare is a PITA to deal with (to be fair, some private insurance is as well) and the incentives are all wrong.

Medicare and Medicaid suck and are lousy for patients, for doctors, and for taxpayers. Yeah they're better than nothing, but with all the hoops we have to jump through and all the unnecessary diagnostic work we *HAVE* to order before we can get them approval to get what they really need... waste of money, waste of time, waste of resources. And that's without mentioning the mountain of supporting documentation we need... Government bureaucrats (and office workers in general) deciding what is medically "necessary" from their air-conditioned offices 2000 miles away REALLY grinds my gears.

We provide FREE care once a week for the working poor who do not qualify for Medicare or Medicaid (or for whatever other reason, can't afford a doctor). These patients despite their absurd wait times to be seen (see: once per week) get seen more promptly and taken care of better than some Medicare patients due to the friggin' bureaucracy and the lack of providers willing to take new Medicare patients. And I don't blame them! A Medicare annual visit eats up as much time as seeing two patients, pays less, and you can't even address all their new health issues in the visit! Which brings me to my main points:

The answer IMO isn't more government distribution of healthcare (i.e. my time and other providers' time) - it's:
1) reducing the paperwork and bureaucratic burden
2) letting doctors decide what is medically necessary
3) tort reforms
4) reducing the role of insurance in general to more of a catastrophic coverage - see below for why:

When I get out of training I'm probably going to go to a direct primary care model. By cutting out the middleman (insurance/gov't) we can actually provider BETTER care, faster, and cheaper. All the basic lab work, preventative care, and routine diagnostic procedures (e.g. pap smears) can be included in a monthly fee with a certain # of patients assigned to each provider. Because we don't need to wait for friggin' insurance/Medicare, with a large enough group we can have our own pharmacy, lab, etc. and meet all patients' basic medical needs. We can do a lot of same day appointments and we're highly motivated to keep people healthy and well - because people needing to see us less frequently means we can keep our schedules open for same day visits and even housecalls - a real patient satisfier. Combined with a med/high deductible/"catastrophic" coverage plan the patients *AND* insurance companies can save money as well by catching things earlier. And we can set aside a portion of the subscriber fee to be used to care for people in our community who would otherwise be unable to see a doctor. Yeah probably some details I'm leaving out, but I really think for primary care the answer is not more Medicare.

See:
http://www.aafp.org/practice-management/payment/dpc.html

P.S. I semi-retired from a lucrative career to pursue medicine so IDGAF about physician reimbursements. I'll see patients regardless of their ability to pay. But we need a better and more sustainable model - and that model is not Medicare.

Which doesn't explain Kaiser's strong efforts to acquire medicare patients in the slightest.

 

[s0me0nesmind1]

He's been doing it for decades and we are no closer politically than we were then. Clearly what the public thinks doesn't matter, otherwise we'd have gun control and higher taxes on the wealthy.
No matter how good your ideas are its irrelevant if you have no path to move them forward through Congress. He has no path. His legislative record is bare because he has a history of not having a way to get his ideas implemented.

All I'm saying is that if you are relying on Bernie to get things done, history shows you will be disappointed.

If everything was up to "the people" they would tax the rich at 95% and vote to redistribute it to themselves. That's why we have elected officials, so these types of dumb fucks don't get the ultimate say, but rather an educated represented say.

 

[Jaskalas]

How in the Hell did the ACA demonstrate more harm than good when it covered nearly 20M more people than what came before?

Because it is mandated coverage without actually paying for it. Insurance companies are in chaos and dropping like flies. They cannot handle the job that was mandated of them. Only the US dollar is large enough to soak those costs. In the midst of the penalty, skyrocketing premiums, and disruption to existing plans... people are NOT better off than they were before.

"But those 20M". Yeah, go ahead and bank elections on those 20 million. That is exactly what has gutted Democrats since 2010. A minority was helped at the expense of the majority. Actually, ARE they helped? You say insured... okay they have a plan. Can they actually AFFORD to use it? Good F'ing luck to them. There's no way in hell the majority saw benefits. The ACA is materially presented as causing personal damage to many people.

When crying out for help on healthcare, that is NOT what they voted for. And far more than 20 million will vote against it. Which brings me back to what people will vote for. A New Deal. It's the perfect response to the Trump implosion of the GOP. America's boil has burst open... it's time for a policy to clean house. And that does not mean shrinking away from paying for medical costs.

The GOP controls so much, yet can do so little. It's time to drive the knife in and twist with real beneficial policy.

 

[JSt0rm]

Because it is mandated coverage without actually paying for it. Insurance companies are in chaos and dropping like flies. They cannot handle the job that was mandated of them. Only the US dollar is large enough to soak those costs. In the midst of the penalty, skyrocketing premiums, and disruption to existing plans... people are NOT better off than they were before.

"But those 20M". Yeah, go ahead and bank elections on those 20 million. That is exactly what has gutted Democrats since 2010. A minority was helped at the expense of the majority. Actually, ARE they helped? You say insured... okay they have a plan. Can they actually AFFORD to use it? Good F'ing luck to them. There's no way in hell the majority saw benefits. The ACA is materially presented as causing personal damage to many people.

When crying out for help on healthcare, that is NOT what they voted for. And far more than 20 million will vote against it. Which brings me back to what people will vote for. A New Deal. It's the perfect response to the Trump implosion of the GOP. America's boil has burst open... it's time for a policy to clean house. And that does not mean shrinking away from paying for medical costs.

The GOP controls so much, yet can do so little. It's time to drive the knife in and twist with real beneficial policy.

fuck the sick.

 

[Puffnstuff]

Trump has officially called Bernie's plan a curse.
https://www.nbcnews.com/politics/co...-health-care-plan-would-bring-curse-u-n801421

 

[brandonbull]

Anyone who's been buying health insurance knows that the larger the group is the cheaper the plan gets.

Really? What if your large group is a bunch of high risk individuals?

 

[ch33zw1z]

Really? What if your large group is a bunch of high risk individuals?

Then you end up with the south east and Midwest problems.

 

[Puffnstuff]

Really? What if your large group is a bunch of high risk individuals?

They go into their own group and it is still cheaper than if they were not part of the group.

 

[WackyDan]

Repeat after me.

We can't have effective and ethical gov't policies and that includes single payer UNTIL we have meaningful campaign finance reform. We can't have meaningful campaign finance reform when the congresspeople are the ones writing those laws.

 

[jmagg]

Single payer is the only way to quell the greed.

 

[Jhhnn]

Because it is mandated coverage without actually paying for it. Insurance companies are in chaos and dropping like flies. They cannot handle the job that was mandated of them. Only the US dollar is large enough to soak those costs. In the midst of the penalty, skyrocketing premiums, and disruption to existing plans... people are NOT better off than they were before.

"But those 20M". Yeah, go ahead and bank elections on those 20 million. That is exactly what has gutted Democrats since 2010. A minority was helped at the expense of the majority. Actually, ARE they helped? You say insured... okay they have a plan. Can they actually AFFORD to use it? Good F'ing luck to them. There's no way in hell the majority saw benefits. The ACA is materially presented as causing personal damage to many people.

When crying out for help on healthcare, that is NOT what they voted for. And far more than 20 million will vote against it. Which brings me back to what people will vote for. A New Deal. It's the perfect response to the Trump implosion of the GOP. America's boil has burst open... it's time for a policy to clean house. And that does not mean shrinking away from paying for medical costs.

The GOP controls so much, yet can do so little. It's time to drive the knife in and twist with real beneficial policy.

The only reason the ACA doesn't work a helluva lot better is because Repubs have refused to implement & fund critical parts of the program. If they won't pay for that it's obvious they won't pay a Helluva lot more for single payer.

While we're at it-

https://www.cnbc.com/2016/05/24/high-satisfaction-levels-with-obamacare-as-2017-prices-emerge.html

The high satisfaction levels put the lie to your other contentions entirely.

 

[ivwshane]

Single payer is the only way to quell the greed.

Not true, many countries have universal health care but aren't using a single payer system.

What would work in any system is price controls, imo.

 

[1sikbITCH]

If everything was up to "the people" they would tax the rich at 95% and vote to redistribute it to themselves. That's why we have elected officials, so these types of dumb fucks don't get the ultimate say, but rather an educated represented say.

"If everything was up to the people" you seem to think that people in general are dumb fucks and therefore the rich need to control us through the government. It's for our own good.

edit - I concede the first point

 

[woolfe9998]

Not true, many countries have universal health care but aren't using a single payer system.

What would work in any system is price controls, imo.

True, but single payer - which almost by definition involves price controls - offers substantial savings in cutting bureaucracy versus any system with multiple payers.

 

[ivwshane]

True, but single payer - which almost by definition involves price controls - offers substantial savings in cutting bureaucracy versus any system with multiple payers.

No doubt!

 

[alcoholbob]

Huh? How is advocating for a single payer plan going to put them in a worse position? Which countries that have gone universal reversed?

I think Australia has gone from private markets to national health care, then back to private, then back to national health care, then to a multi payer system.

 

[hal2kilo]

If everything was up to "the people" they would tax the rich at 95% and vote to redistribute it to themselves. That's why we have elected officials, so these types of dumb fucks don't get the ultimate say, but rather an educated represented say.

So you don't think deplorables should vote then.

 

[Jhhnn]

If everything was up to "the people" they would tax the rich at 95% and vote to redistribute it to themselves. That's why we have elected officials, so these types of dumb fucks don't get the ultimate say, but rather an educated represented say.

Nah. Most people aren't nearly as greedy as the top .1%. They'll settle for decent lives & a sense of faith in the future for themselves & their children.

 

[theeedude]

Democrats should come out for universal single payer, and stick with it. The country will come around, GOP has no working ideas on health care, plus employer based health care will be tenuous with automation taking away jobs.

 

[Jhhnn]

Democrats should come out for universal single payer, and stick with it. The country will come around, GOP has no working ideas on health care, plus employer based health care will be tenuous with automation taking away jobs.

Peachy. Now draw out the map of how we get from here to there.

 

[Victorian Gray]

Peachy. Now draw out the map of how we get from here to there.

If no one tries, it will never happen. Most of the party movers and shakers seem now to have either moved to support some type of single payer or are in the process of. You're falling behind your own party on this one.

 

[theeedude]

Peachy. Now draw out the map of how we get from here to there.

Simple, stake out UHC as party position. Republicans are going to bash it, fine. Let them, they'll bash it for a few years, but in the meantime, they have no better ideas, status quo is not working that great already, and automation is going to kick in big time, throwing millions off employer based insurance. So eventually, people will want a solution, not bashing, and GOP has nothing to offer, so if Democrats stick with UHC, it's only a matter of time.

 

[brycejones]

Simple, stake out UHC as party position. Republicans are going to bash it, fine. Let them, they'll bash it for a few years, but in the meantime, they have no better ideas, status quo is not working that great already, and automation is going to kick in big time, throwing millions off employer based insurance. So eventually, people will want a solution, not bashing, and GOP has nothing to offer, so if Democrats stick with UHC, it's only a matter of time.

But death panels and killing granny because reasons and communism.

 

[Jhhnn]

Simple, stake out UHC as party position. Republicans are going to bash it, fine. Let them, they'll bash it for a few years, but in the meantime, they have no better ideas, status quo is not working that great already, and automation is going to kick in big time, throwing millions off employer based insurance. So eventually, people will want a solution, not bashing, and GOP has nothing to offer, so if Democrats stick with UHC, it's only a matter of time.

Please. The ACA was intended as UHC or nearly so. It would be if Repub states weren't allowed to avoid the Medicaid expansion. It would also work a helluva lot better if insurors could be certain of the payments they're due from Congress. It would function even better if we could redistribute more income from the tippy-top to support it, lowering monthly payments for plan participants.

That last part is what single payer would demand a lot more of & Repubs are buying none of it.

Meanwhile, Dems would discredit their own plan that's really only been in effect for 5 years, inviting further Repub sabotage.

Yeh, sure, I'll agree that UHC is the ultimate goal. The ACA put us on our way to getting there & will serve as a vehicle to do so, but not if we discard it ourselves in favor of what we won't get anyway, certainly not for the time being.

 

[theeedude]

Please. The ACA was intended as UHC or nearly so. It would be if Repub states weren't allowed to avoid the Medicaid expansion. It would also work a helluva lot better if insurors could be certain of the payments they're due from Congress. It would function even better if we could redistribute more income from the tippy-top to support it, lowering monthly payments for plan participants.

That last part is what single payer would demand a lot more of & Repubs are buying none of it.

Meanwhile, Dems would discredit their own plan that's really only been in effect for 5 years, inviting further Repub sabotage.

Yeh, sure, I'll agree that UHC is the ultimate goal. The ACA put us on our way to getting there & will serve as a vehicle to do so, but not if we discard it ourselves in favor of what we won't get anyway, certainly not for the time being.

UHC is far more likely if GOP repeals ACA. Sanders is premature with his bill.