(08-02-2019 01:53 PM)tanqtonic Wrote:  

(08-02-2019 12:36 PM)RiceLad15 Wrote:  

(08-02-2019 11:43 AM)Frizzy Owl Wrote:  

(08-02-2019 11:24 AM)Fountains of Wayne Graham Wrote:  

(08-02-2019 10:08 AM)Owl 69/70/75 Wrote:  Single-payer cuts costs for one reason. As a monopoly, THEY get to decide what health care you get, not you. If you're happy with letting someone else make your health care decisions, go for it. I'm not.

For many Americans, insurance companies are already doing this, right? If my doctor says I need a procedure and my insurance company decides not to cover it, my choices may be debt or death.

This is admittedly true. A few people are wealthy enough to afford expensive insurance on their own, or to cover the costs of procedures not covered. Most people who depend on their employer's coverage don't realistically have any more choice in their coverage than if the system was single-payer. For the millions of voters whose coverage is no better than Medicare, and who cannot afford to pay for a better plan on their own, what's the difference?

This is a problem that those opposed to single-payer prefer to evade, but if they don't address it, momentum for single-payer will continue to build.

Bingo. One of the biggest issues the right has in this debate is that they haven't been able to provide a cogent alternative to the Dems on the national, or even state, level. They run on "socialized medicine bad" when that is a better alternative to a lot of the insurance options out there for a number of people.

It would be nice to be able to choose between political parties offering truly competing ideas of how to fix problems in healthcare coverage, as opposed to choosing between the Dems' plan and just a repeal of the plan with no sound replacement.

One has to provide a 'cogent alternative' to "everything for everyone for free"? Seriously?

Given that, then the damn opposition hasnt provided a 'cogent alternative' to the concept of Santa Claus, either.

This is reminiscent of the bratty 4 year old yelling 'gimme' and 'mine', and there is a requirement for a 'cogent alternative' for that "grab everything on the table" mentality either.

The pushback is that the proponents of the "everything for everyone for free" option simply seem to share the same mindset of that bratty 4 year old relative to the the utter fing disregard of the obligations that that behavior requires in actual implementation.

Politically it is a beautiful solution: demand free **** for all time, then use the evil millionaires, billionaires, and corporations as the obligation sink. One gets a veritable daily double of free **** for all and a promotion of identity politics that the progressive cause views as their sustenance.

Single payer is a plan that can be implemented - you may disagree with it, or what its outcomes and effects would be - but it is possible, rather easy to explain, and funding it can be accomplished by raising taxes. So it isn't "everything for everyone for free," even if you want to call it that. And because it is a real, possible solution, then it becomes a better alternative to "let's kick what we've got and not provide an alternative."

(08-02-2019 01:27 PM)RiceLad15 Wrote:  

(08-02-2019 01:18 PM)Owl 69/70/75 Wrote:  

(08-02-2019 01:02 PM)RiceLad15 Wrote:  

(08-02-2019 12:50 PM)Owl 69/70/75 Wrote:  

(08-02-2019 12:36 PM)RiceLad15 Wrote:  Bingo. One of the biggest issues the right has in this debate is that they haven't been able to provide a cogent alternative to the Dems on the national, or even state, level. They run on "socialized medicine bad" when that is a better alternative to a lot of the insurance options out there for a number of people.
It would be nice to be able to choose between political parties offering truly competing ideas of how to fix problems in healthcare coverage, as opposed to choosing between the Dems' plan and just a repeal of the plan with no sound replacement.

That's why I've backed Bismarck, which is basically free market (or a lot more free than ours is now) universal health care. Government pays for a basic plan of your choosing (essentially something like single-payer or a bad HMO) either directly (France) or indirectly through a tax credit (Heritage). You are then free to supplement your coverage, and employers can offer upgrades as an employment incentive. Or you can purchase an alternative plan, using the government contribution (where the government pays directly) like a voucher. Alternatives can include high deductible plans coupled with health savings accounts, which is probably the most economically sensible approach.
Heritage proposed a Bismarck-type approach 25 years ago. I don't know why republicans didn't pass it when they controlled both houses. Bill Clinton would have signed it just so e could have his name on health care reform, and we would have avoided the whole Obamacare debacle.

What's the mechanism that keeps the supplemental private options? I'd imagine in a single payer program you would have the same options available if companies wanted to offer those options.

The mechanism that keeps the supplemental private options is demand in the marketplace.
No, you would not have the same options available in single-payer because you don't have companies to offer them. Single-payer means one payer. That's why it's called single-payer.

See bold above.
That's what led to my question. I was wondering how something like single payer differed from single payer and allowed for the private options. Would a Bismark-payer (let's just call it that to not be confusing) offer plans that would offer lower levels of coverage from a single payer program? That would drive the demand for supplemental insurance.

I meant that the basic plan works sort of like single-payer, with long waits and queues. If you don’t want to wait, you go the the “pay” side. The difference is that the”pay” side is an integral and intentional part of the system, whereas it is outlawed in single-payer systems and generally discouraged in single-provider systems.

(08-02-2019 02:09 PM)Owl 69/70/75 Wrote:  

(08-02-2019 01:27 PM)RiceLad15 Wrote:  

(08-02-2019 01:18 PM)Owl 69/70/75 Wrote:  

(08-02-2019 01:02 PM)RiceLad15 Wrote:  

(08-02-2019 12:50 PM)Owl 69/70/75 Wrote:  That's why I've backed Bismarck, which is basically free market (or a lot more free than ours is now) universal health care. Government pays for a basic plan of your choosing (essentially something like single-payer or a bad HMO) either directly (France) or indirectly through a tax credit (Heritage). You are then free to supplement your coverage, and employers can offer upgrades as an employment incentive. Or you can purchase an alternative plan, using the government contribution (where the government pays directly) like a voucher. Alternatives can include high deductible plans coupled with health savings accounts, which is probably the most economically sensible approach.
Heritage proposed a Bismarck-type approach 25 years ago. I don't know why republicans didn't pass it when they controlled both houses. Bill Clinton would have signed it just so e could have his name on health care reform, and we would have avoided the whole Obamacare debacle.

What's the mechanism that keeps the supplemental private options? I'd imagine in a single payer program you would have the same options available if companies wanted to offer those options.

The mechanism that keeps the supplemental private options is demand in the marketplace.
No, you would not have the same options available in single-payer because you don't have companies to offer them. Single-payer means one payer. That's why it's called single-payer.

See bold above.
That's what led to my question. I was wondering how something like single payer differed from single payer and allowed for the private options. Would a Bismark-payer (let's just call it that to not be confusing) offer plans that would offer lower levels of coverage from a single payer program? That would drive the demand for supplemental insurance.

I meant that the basic plan works sort of like single-payer, with long waits and queues. If you don’t want to wait, you go the the “pay” side. The difference is that the”pay” side is an integral and intentional part of the system, whereas it is outlawed in single-payer systems and generally discouraged in single-provider systems.

That makes sense. I'm far from a healthcare policy wonk, and really have no firm opinion on where we should go with healthcare, other than somewhere besides our current system. I wasn't aware that single payer systems expressly forbade private insurance plans, and had assumed most operated like you said - where private markets were available for more premium coverage.

(08-02-2019 02:06 PM)RiceLad15 Wrote:  

(08-02-2019 01:53 PM)tanqtonic Wrote:  

(08-02-2019 12:36 PM)RiceLad15 Wrote:  

(08-02-2019 11:43 AM)Frizzy Owl Wrote:  

(08-02-2019 11:24 AM)Fountains of Wayne Graham Wrote:  For many Americans, insurance companies are already doing this, right? If my doctor says I need a procedure and my insurance company decides not to cover it, my choices may be debt or death.

This is admittedly true. A few people are wealthy enough to afford expensive insurance on their own, or to cover the costs of procedures not covered. Most people who depend on their employer's coverage don't realistically have any more choice in their coverage than if the system was single-payer. For the millions of voters whose coverage is no better than Medicare, and who cannot afford to pay for a better plan on their own, what's the difference?

This is a problem that those opposed to single-payer prefer to evade, but if they don't address it, momentum for single-payer will continue to build.

Bingo. One of the biggest issues the right has in this debate is that they haven't been able to provide a cogent alternative to the Dems on the national, or even state, level. They run on "socialized medicine bad" when that is a better alternative to a lot of the insurance options out there for a number of people.

It would be nice to be able to choose between political parties offering truly competing ideas of how to fix problems in healthcare coverage, as opposed to choosing between the Dems' plan and just a repeal of the plan with no sound replacement.

One has to provide a 'cogent alternative' to "everything for everyone for free"? Seriously?

Given that, then the damn opposition hasnt provided a 'cogent alternative' to the concept of Santa Claus, either.

This is reminiscent of the bratty 4 year old yelling 'gimme' and 'mine', and there is a requirement for a 'cogent alternative' for that "grab everything on the table" mentality either.

The pushback is that the proponents of the "everything for everyone for free" option simply seem to share the same mindset of that bratty 4 year old relative to the the utter fing disregard of the obligations that that behavior requires in actual implementation.

Politically it is a beautiful solution: demand free **** for all time, then use the evil millionaires, billionaires, and corporations as the obligation sink. One gets a veritable daily double of free **** for all and a promotion of identity politics that the progressive cause views as their sustenance.

Single payer is a plan that can be implemented - you may disagree with it, or what its outcomes and effects would be - but it is possible, rather easy to explain, and funding it can be accomplished by raising taxes. So it isn't "everything for everyone for free," even if you want to call it that. And because it is a real, possible solution, then it becomes a better alternative to "let's kick what we've got and not provide an alternative."

Correct -- its not free. You just throw the obligations for everything on some other class/set of persons. Apparently that creation and shoving of obligations is so entirely inconsequential to you that you fing omit it entirely.

And I hate to tell you --- the plan includes the obligations that you create with it. Something that the progressives omit on a continuous basis. Or just fing lie about.

(08-02-2019 02:14 PM)RiceLad15 Wrote:  

(08-02-2019 02:09 PM)Owl 69/70/75 Wrote:  

(08-02-2019 01:27 PM)RiceLad15 Wrote:  

(08-02-2019 01:18 PM)Owl 69/70/75 Wrote:  

(08-02-2019 01:02 PM)RiceLad15 Wrote:  What's the mechanism that keeps the supplemental private options? I'd imagine in a single payer program you would have the same options available if companies wanted to offer those options.

The mechanism that keeps the supplemental private options is demand in the marketplace.
No, you would not have the same options available in single-payer because you don't have companies to offer them. Single-payer means one payer. That's why it's called single-payer.

See bold above.
That's what led to my question. I was wondering how something like single payer differed from single payer and allowed for the private options. Would a Bismark-payer (let's just call it that to not be confusing) offer plans that would offer lower levels of coverage from a single payer program? That would drive the demand for supplemental insurance.

I meant that the basic plan works sort of like single-payer, with long waits and queues. If you don’t want to wait, you go the the “pay” side. The difference is that the”pay” side is an integral and intentional part of the system, whereas it is outlawed in single-payer systems and generally discouraged in single-provider systems.

That makes sense. I'm far from a healthcare policy wonk, and really have no firm opinion on where we should go with healthcare, other than somewhere besides our current system. I wasn't aware that single payer systems expressly forbade private insurance plans, and had assumed most operated like you said - where private markets were available for more premium coverage.

I don’t think most people who claim to want “single-payer” really want true single-payer. True single-payer is like Canada (or like Canada was, they’ve backed away a lot because it was not working)—only the government can pay for health care. You cannot get any health care that the government will not pay for. It’s illegal for you to pay a doc out of-pocket, and it is illegal for docs to accept such payment. Single-provider (UK) means there is a single government agency that provides health care. Private docs are allowed but discouraged. Health insurance to pay private docs is either outlawed or severely limited.

(08-02-2019 02:18 PM)tanqtonic Wrote:  

(08-02-2019 02:06 PM)RiceLad15 Wrote:  

(08-02-2019 01:53 PM)tanqtonic Wrote:  

(08-02-2019 12:36 PM)RiceLad15 Wrote:  

(08-02-2019 11:43 AM)Frizzy Owl Wrote:  This is admittedly true. A few people are wealthy enough to afford expensive insurance on their own, or to cover the costs of procedures not covered. Most people who depend on their employer's coverage don't realistically have any more choice in their coverage than if the system was single-payer. For the millions of voters whose coverage is no better than Medicare, and who cannot afford to pay for a better plan on their own, what's the difference?

This is a problem that those opposed to single-payer prefer to evade, but if they don't address it, momentum for single-payer will continue to build.

Bingo. One of the biggest issues the right has in this debate is that they haven't been able to provide a cogent alternative to the Dems on the national, or even state, level. They run on "socialized medicine bad" when that is a better alternative to a lot of the insurance options out there for a number of people.

It would be nice to be able to choose between political parties offering truly competing ideas of how to fix problems in healthcare coverage, as opposed to choosing between the Dems' plan and just a repeal of the plan with no sound replacement.

One has to provide a 'cogent alternative' to "everything for everyone for free"? Seriously?

Given that, then the damn opposition hasnt provided a 'cogent alternative' to the concept of Santa Claus, either.

This is reminiscent of the bratty 4 year old yelling 'gimme' and 'mine', and there is a requirement for a 'cogent alternative' for that "grab everything on the table" mentality either.

The pushback is that the proponents of the "everything for everyone for free" option simply seem to share the same mindset of that bratty 4 year old relative to the the utter fing disregard of the obligations that that behavior requires in actual implementation.

Politically it is a beautiful solution: demand free **** for all time, then use the evil millionaires, billionaires, and corporations as the obligation sink. One gets a veritable daily double of free **** for all and a promotion of identity politics that the progressive cause views as their sustenance.

Single payer is a plan that can be implemented - you may disagree with it, or what its outcomes and effects would be - but it is possible, rather easy to explain, and funding it can be accomplished by raising taxes. So it isn't "everything for everyone for free," even if you want to call it that. And because it is a real, possible solution, then it becomes a better alternative to "let's kick what we've got and not provide an alternative."

Correct -- its not free. You just throw the obligations for everything on some other class/set of persons. Apparently that creation and shoving of obligations is so entirely inconsequential to you that you fing omit it entirely.

And I hate to tell you --- the plan includes the obligations that you create with it. Something that the progressives omit on a continuous basis. Or just fing lie about.

Aannddd this is why I have stayed quiet recently.

First, I clearly noted that obligations are shifted by because I mentioned raising taxes - in what world does that not imply that the obligation to pay is shifted onto whoever the tax payers might be?

Second, as I told Owl#s, I'm not advocating for single payer. I responded to you because I do disagree with your previous comment, that responded to my dissatisfaction with the current state of the healthcare debate. Single-payer is very obviously a real option, not a fairy tale. I was responding to your claim that single-payer isn't a cogent solution and how Dems moving toward single-payer is a better option to many than the alternative that is not being presented by the other mainstream political party.

Lad - this board is my favorite place to be mad online and your pleas for civility and good faith discussion are really messing that up

(08-02-2019 02:53 PM)Fountains of Wayne Graham Wrote:  Lad - this board is my favorite place to be mad online and your pleas for civility and good faith discussion are really messing that up

lol.

(08-02-2019 02:38 PM)RiceLad15 Wrote:  

(08-02-2019 02:18 PM)tanqtonic Wrote:  

(08-02-2019 02:06 PM)RiceLad15 Wrote:  

(08-02-2019 01:53 PM)tanqtonic Wrote:  

(08-02-2019 12:36 PM)RiceLad15 Wrote:  Bingo. One of the biggest issues the right has in this debate is that they haven't been able to provide a cogent alternative to the Dems on the national, or even state, level. They run on "socialized medicine bad" when that is a better alternative to a lot of the insurance options out there for a number of people.

It would be nice to be able to choose between political parties offering truly competing ideas of how to fix problems in healthcare coverage, as opposed to choosing between the Dems' plan and just a repeal of the plan with no sound replacement.

One has to provide a 'cogent alternative' to "everything for everyone for free"? Seriously?

Given that, then the damn opposition hasnt provided a 'cogent alternative' to the concept of Santa Claus, either.

This is reminiscent of the bratty 4 year old yelling 'gimme' and 'mine', and there is a requirement for a 'cogent alternative' for that "grab everything on the table" mentality either.

The pushback is that the proponents of the "everything for everyone for free" option simply seem to share the same mindset of that bratty 4 year old relative to the the utter fing disregard of the obligations that that behavior requires in actual implementation.

Politically it is a beautiful solution: demand free **** for all time, then use the evil millionaires, billionaires, and corporations as the obligation sink. One gets a veritable daily double of free **** for all and a promotion of identity politics that the progressive cause views as their sustenance.

Single payer is a plan that can be implemented - you may disagree with it, or what its outcomes and effects would be - but it is possible, rather easy to explain, and funding it can be accomplished by raising taxes. So it isn't "everything for everyone for free," even if you want to call it that. And because it is a real, possible solution, then it becomes a better alternative to "let's kick what we've got and not provide an alternative."

Correct -- its not free. You just throw the obligations for everything on some other class/set of persons. Apparently that creation and shoving of obligations is so entirely inconsequential to you that you fing omit it entirely.

And I hate to tell you --- the plan includes the obligations that you create with it. Something that the progressives omit on a continuous basis. Or just fing lie about.

Aannddd this is why I have stayed quiet recently.

First, I clearly noted that obligations are shifted by because I mentioned raising taxes - in what world does that not imply that the obligation to pay is shifted onto whoever the tax payers might be?

Second, as I told Owl#s, I'm not advocating for single payer. I responded to you because I do disagree with your previous comment, that responded to my dissatisfaction with the current state of the healthcare debate. Single-payer is very obviously a real option, not a fairy tale. I was responding to your claim that single-payer isn't a cogent solution and how Dems moving toward single-payer is a better option to many than the alternative that is not being presented by the other mainstream political party.

I get it. The entirety of the opposite side of the equation is completely satisfied by your three-worder of 'taxes will rise'. Sounds good to me.

Kind of the cost-bearing equivalent short shrift of 'some people did something to some other people'.

Or how about this: a cogent solution to N. Korea is to H-bomb the country. If all is said is the equivalent three word short shrift of 'people will die' that should be sufficient for that side of the equation in that rationale.

None of the two (my comment about N Korea, nor your short shrift about 'taxes will rise') come *anywhere* close to recognizing the fundamental scope of the obligations imposed, do they? Not anywhere near the slightest, actually.

(08-02-2019 02:06 PM)RiceLad15 Wrote:  

(08-02-2019 01:53 PM)tanqtonic Wrote:  

(08-02-2019 12:36 PM)RiceLad15 Wrote:  

(08-02-2019 11:43 AM)Frizzy Owl Wrote:  

(08-02-2019 11:24 AM)Fountains of Wayne Graham Wrote:  For many Americans, insurance companies are already doing this, right? If my doctor says I need a procedure and my insurance company decides not to cover it, my choices may be debt or death.

This is admittedly true. A few people are wealthy enough to afford expensive insurance on their own, or to cover the costs of procedures not covered. Most people who depend on their employer's coverage don't realistically have any more choice in their coverage than if the system was single-payer. For the millions of voters whose coverage is no better than Medicare, and who cannot afford to pay for a better plan on their own, what's the difference?
This is a problem that those opposed to single-payer prefer to evade, but if they don't address it, momentum for single-payer will continue to build.

Bingo. One of the biggest issues the right has in this debate is that they haven't been able to provide a cogent alternative to the Dems on the national, or even state, level. They run on "socialized medicine bad" when that is a better alternative to a lot of the insurance options out there for a number of people.
It would be nice to be able to choose between political parties offering truly competing ideas of how to fix problems in healthcare coverage, as opposed to choosing between the Dems' plan and just a repeal of the plan with no sound replacement.

One has to provide a 'cogent alternative' to "everything for everyone for free"? Seriously?
Given that, then the damn opposition hasnt provided a 'cogent alternative' to the concept of Santa Claus, either.
This is reminiscent of the bratty 4 year old yelling 'gimme' and 'mine', and there is a requirement for a 'cogent alternative' for that "grab everything on the table" mentality either.
The pushback is that the proponents of the "everything for everyone for free" option simply seem to share the same mindset of that bratty 4 year old relative to the the utter fing disregard of the obligations that that behavior requires in actual implementation.
Politically it is a beautiful solution: demand free **** for all time, then use the evil millionaires, billionaires, and corporations as the obligation sink. One gets a veritable daily double of free **** for all and a promotion of identity politics that the progressive cause views as their sustenance.

Single payer is a plan that can be implemented - you may disagree with it, or what its outcomes and effects would be - but it is possible, rather easy to explain, and funding it can be accomplished by raising taxes. So it isn't "everything for everyone for free," even if you want to call it that. And because it is a real, possible solution, then it becomes a better alternative to "let's kick what we've got and not provide an alternative."

No, it can’t be implemented now. It really can’t. You’d have docs leaving the system en masse. You’d have hospitals closing down en masse. Why? Because the economics would no longer work. One thing that has been proposed on the Gulf Coast is converting old offshore oil platforms beyond the three-mile limit into international waters hospitals. Another idea I’ve seen floated (literally) is hospital ships that would perform treatment in international waters. I suppose there would be a new health care center spring up on the Caymans, as they are quite adept at creating profitable niches to fill in the holes in American systems.

Think about it this way. You’ve got some 30 year old with $300,000 of med school debt and you’re going to pay him/her a salary of $65,000? How’s that going to work? What do you expect him/her to do?

(08-02-2019 03:44 PM)Owl 69/70/75 Wrote:  

(08-02-2019 02:06 PM)RiceLad15 Wrote:  

(08-02-2019 01:53 PM)tanqtonic Wrote:  

(08-02-2019 12:36 PM)RiceLad15 Wrote:  

(08-02-2019 11:43 AM)Frizzy Owl Wrote:  This is admittedly true. A few people are wealthy enough to afford expensive insurance on their own, or to cover the costs of procedures not covered. Most people who depend on their employer's coverage don't realistically have any more choice in their coverage than if the system was single-payer. For the millions of voters whose coverage is no better than Medicare, and who cannot afford to pay for a better plan on their own, what's the difference?
This is a problem that those opposed to single-payer prefer to evade, but if they don't address it, momentum for single-payer will continue to build.

Bingo. One of the biggest issues the right has in this debate is that they haven't been able to provide a cogent alternative to the Dems on the national, or even state, level. They run on "socialized medicine bad" when that is a better alternative to a lot of the insurance options out there for a number of people.
It would be nice to be able to choose between political parties offering truly competing ideas of how to fix problems in healthcare coverage, as opposed to choosing between the Dems' plan and just a repeal of the plan with no sound replacement.

One has to provide a 'cogent alternative' to "everything for everyone for free"? Seriously?
Given that, then the damn opposition hasnt provided a 'cogent alternative' to the concept of Santa Claus, either.
This is reminiscent of the bratty 4 year old yelling 'gimme' and 'mine', and there is a requirement for a 'cogent alternative' for that "grab everything on the table" mentality either.
The pushback is that the proponents of the "everything for everyone for free" option simply seem to share the same mindset of that bratty 4 year old relative to the the utter fing disregard of the obligations that that behavior requires in actual implementation.
Politically it is a beautiful solution: demand free **** for all time, then use the evil millionaires, billionaires, and corporations as the obligation sink. One gets a veritable daily double of free **** for all and a promotion of identity politics that the progressive cause views as their sustenance.

Single payer is a plan that can be implemented - you may disagree with it, or what its outcomes and effects would be - but it is possible, rather easy to explain, and funding it can be accomplished by raising taxes. So it isn't "everything for everyone for free," even if you want to call it that. And because it is a real, possible solution, then it becomes a better alternative to "let's kick what we've got and not provide an alternative."

No, it can’t be implemented now. It really can’t. You’d have docs leaving the system en masse. You’d have hospitals closing down en masse. Why? Because the economics would no longer work. One thing that has been proposed on the Gulf Coast is converting old offshore oil platforms beyond the three-mile limit into international waters hospitals. Another idea I’ve seen floated (literally) is hospital ships that would perform treatment in international waters. I suppose there would be a new health care center spring up on the Caymans, as they are quite adept at creating profitable niches to fill in the holes in American systems.

Think about it this way. You’ve got some 30 year old with $300,000 of med school debt and you’re going to pay him/her a salary of $65,000? How’s that going to work? What do you expect him/her to do?

How about we just have the government pay them 90k a year as a subsidy. All we have to do is raise taxes. Think of it as "Red Cross Reparations" and you can get everyone on board. Or better yet lets tax any corporations grossing over 500k 2% of the gross. Label it the "remove evil profits for a healthy society initiative". Insto Presto we are there.

I mean, *that* seems to be the surfical level of discussion that passes for 'cogent alternative' these days.

(08-02-2019 10:11 AM)Fountains of Wayne Graham Wrote:  

(08-02-2019 09:58 AM)tanqtonic Wrote:  I guess if you get a woodie with the mention of a requirement of a national wealth tax -- this one is for you.

Graham, I would suggest you actually engage in some commentary as opposed to 'whack a mole' link combined with a dumb ass gif posting. You might be taken a tad more seriously.

Or take that style to the Spin Room elsewhere on this site. Oops, forgot, they actually kiboshed that there as well.....

Thanks Tanq! I'm still workshopping my brand, so this feedback is really helpful.

What kind of content do you think we need more of in this forum?

Absolutely not the type that posts a link and says 'go'. If you want to discuss something, discuss it.

but what do I know.... (hint)

(08-02-2019 12:02 PM)Owl 69/70/75 Wrote:  

(08-02-2019 11:24 AM)Fountains of Wayne Graham Wrote:  

(08-02-2019 10:08 AM)Owl 69/70/75 Wrote:  Single-payer cuts costs for one reason. As a monopoly, THEY get to decide what health care you get, not you. If you're happy with letting someone else make your health care decisions, go for it. I'm not.

For many Americans, insurance companies are already doing this, right? If my doctor says I need a procedure and my insurance company decides not to cover it, my choices may be debt or death.

It's not "they decide not to cover it." It's you enter into a contract that describes what is covered and what isn't. And in a truly competitive and transparent market (which we don't have, thanks largely to government intervention), you would be able to shop multiple policies for what they covered and what they didn't.

And while it may not be attractive, you do have the debt option. With single-payer, you don't. And you have the debt-and-sue-the-insurance-company option, which often leads to they cover it after all.

This. I get so tired of the old idea that insurance companies just sit around and decide... hey, let's fight THIS one.

Treatment for the past decade at least has been about diagnosis codes and DRGs. When you contract for coverage, the insurers can give you a list of the ICD-10 codes that are covered (there are about 40,000 of them iirc) and those that aren't. There CAN be some gray area as there is in any contract.... but it's far and away the exception rather than the rule, and most often the result of some new means of testing or treating something which hasn't worked its way into the system yet.

I went to my pcp for an annual. They originally coded it as a visit to request lab work done... which was rejected. They PROPERLY re-coded it as a well check with labs for someone my age and it was covered, and paid them more. Insurance didn't reject it because they didn't want to pay... they rejected it because they don't cover someone just deciding... hey, I think I want my liver checked

(08-02-2019 04:03 PM)Hambone10 Wrote:  

(08-02-2019 10:11 AM)Fountains of Wayne Graham Wrote:  

(08-02-2019 09:58 AM)tanqtonic Wrote:  I guess if you get a woodie with the mention of a requirement of a national wealth tax -- this one is for you.

Graham, I would suggest you actually engage in some commentary as opposed to 'whack a mole' link combined with a dumb ass gif posting. You might be taken a tad more seriously.

Or take that style to the Spin Room elsewhere on this site. Oops, forgot, they actually kiboshed that there as well.....

Thanks Tanq! I'm still workshopping my brand, so this feedback is really helpful.

What kind of content do you think we need more of in this forum?

Absolutely not the type that posts a link and says 'go'. If you want to discuss something, discuss it.

but what do I know.... (hint)

(08-02-2019 12:02 PM)Owl 69/70/75 Wrote:  

(08-02-2019 11:24 AM)Fountains of Wayne Graham Wrote:  

(08-02-2019 10:08 AM)Owl 69/70/75 Wrote:  Single-payer cuts costs for one reason. As a monopoly, THEY get to decide what health care you get, not you. If you're happy with letting someone else make your health care decisions, go for it. I'm not.

For many Americans, insurance companies are already doing this, right? If my doctor says I need a procedure and my insurance company decides not to cover it, my choices may be debt or death.

It's not "they decide not to cover it." It's you enter into a contract that describes what is covered and what isn't. And in a truly competitive and transparent market (which we don't have, thanks largely to government intervention), you would be able to shop multiple policies for what they covered and what they didn't.

And while it may not be attractive, you do have the debt option. With single-payer, you don't. And you have the debt-and-sue-the-insurance-company option, which often leads to they cover it after all.

This. I get so tired of the old idea that insurance companies just sit around and decide... hey, let's fight THIS one.

Treatment for the past decade at least has been about diagnosis codes and DRGs. When you contract for coverage, the insurers can give you a list of the ICD-10 codes that are covered (there are about 40,000 of them iirc) and those that aren't. There CAN be some gray area as there is in any contract.... but it's far and away the exception rather than the rule, and most often the result of some new means of testing or treating something which hasn't worked its way into the system yet.

I went to my pcp for an annual. They originally coded it as a visit to request lab work done... which was rejected. They PROPERLY re-coded it as a well check with labs for someone my age and it was covered, and paid them more. Insurance didn't reject it because they didn't want to pay... they rejected it because they don't cover someone just deciding... hey, I think I want my liver checked

Are there not cases where a doctor prescribes a specific treatment and someone's insurance doesn't cover that treatment?

In a similar vein, there are in/out of network mixups that can create a headache, and it would be nice to find a way to deal with these more effectively. I know that there are situations where people either misunderstand themselves, or are misinformed about who is in/out of network, leading to massive bills that they have to either fight or negotiate down.

(08-02-2019 04:03 PM)Hambone10 Wrote:  

(08-02-2019 10:11 AM)Fountains of Wayne Graham Wrote:  

(08-02-2019 09:58 AM)tanqtonic Wrote:  I guess if you get a woodie with the mention of a requirement of a national wealth tax -- this one is for you.

Graham, I would suggest you actually engage in some commentary as opposed to 'whack a mole' link combined with a dumb ass gif posting. You might be taken a tad more seriously.

Or take that style to the Spin Room elsewhere on this site. Oops, forgot, they actually kiboshed that there as well.....

Thanks Tanq! I'm still workshopping my brand, so this feedback is really helpful.

What kind of content do you think we need more of in this forum?

Absolutely not the type that posts a link and says 'go'. If you want to discuss something, discuss it.

but what do I know.... (hint)

(08-02-2019 12:02 PM)Owl 69/70/75 Wrote:  

(08-02-2019 11:24 AM)Fountains of Wayne Graham Wrote:  

(08-02-2019 10:08 AM)Owl 69/70/75 Wrote:  Single-payer cuts costs for one reason. As a monopoly, THEY get to decide what health care you get, not you. If you're happy with letting someone else make your health care decisions, go for it. I'm not.

For many Americans, insurance companies are already doing this, right? If my doctor says I need a procedure and my insurance company decides not to cover it, my choices may be debt or death.

It's not "they decide not to cover it." It's you enter into a contract that describes what is covered and what isn't. And in a truly competitive and transparent market (which we don't have, thanks largely to government intervention), you would be able to shop multiple policies for what they covered and what they didn't.

And while it may not be attractive, you do have the debt option. With single-payer, you don't. And you have the debt-and-sue-the-insurance-company option, which often leads to they cover it after all.

This. I get so tired of the old idea that insurance companies just sit around and decide... hey, let's fight THIS one.

Treatment for the past decade at least has been about diagnosis codes and DRGs. When you contract for coverage, the insurers can give you a list of the ICD-10 codes that are covered (there are about 40,000 of them iirc) and those that aren't. There CAN be some gray area as there is in any contract.... but it's far and away the exception rather than the rule, and most often the result of some new means of testing or treating something which hasn't worked its way into the system yet.

I went to my pcp for an annual. They originally coded it as a visit to request lab work done... which was rejected. They PROPERLY re-coded it as a well check with labs for someone my age and it was covered, and paid them more. Insurance didn't reject it because they didn't want to pay... they rejected it because they don't cover someone just deciding... hey, I think I want my liver checked

Another issue that is a strong negative (at least for us on the side of economics) is that the implementation of a single payer requires the government to act as a price setter.

Why would anyone with a rational mind want government price control? Over 20-20% of the national economy?

But..... I forget that the progressives have already ditched the idea of a free market economy with the strong love that they show for the ideal of governmental price setting in terms of rent controls.

And the same people squawk that that path 'isnt socialism' because 'the government doesnt own the underlying means of production.' Well, when you have price by diktat for the *entire* market that goes hand in hand with the concept of single payer, what is the effective difference?

(08-02-2019 04:24 PM)RiceLad15 Wrote:  Are there not cases where a doctor prescribes a specific treatment and someone's insurance doesn't cover that treatment?

Of course, but whether or not it is covered is in the contract, and NOT a decision made on a case by case basis.

You guys act as though insurance companies have some special board that meets tp degide if they will cover this or that today. The Chairman asks "How do we feel today about colonoscopies? The board choruses "They are a pain in the ass! Deny them all, except for my brother in law."

Nothing shows ignorance more than thinking insurance companies decide what to pay for.

(08-02-2019 05:11 PM)OptimisticOwl Wrote:  

(08-02-2019 04:24 PM)RiceLad15 Wrote:  Are there not cases where a doctor prescribes a specific treatment and someone's insurance doesn't cover that treatment?

Of course, but whether or not it is covered is in the contract, and NOT a decision made on a case by case basis.

You guys act as though insurance companies have some special board that meets tp degide if they will cover this or that today. The Chairman asks "How do we feel today about colonoscopies? The board choruses "They are a pain in the ass! Deny them all, except for my brother in law."

Nothing shows ignorance more than thinking insurance companies decide what to pay for.

I wish many of you would be more generous in your reading of comments by those you perceive as the political enemy instead of ending every post with "your ignorance or bias is showing."

Anyway, perhaps this is a semantic disagreement. Yes, one signed a contract with an insurance company about what is and is not covered, but the interpretation and dispersal of those benefits by a claims department requires judgement. And that judgement is absolutely influenced by the company's bottom line.

(08-03-2019 11:00 AM)Fountains of Wayne Graham Wrote:  

(08-02-2019 05:11 PM)OptimisticOwl Wrote:  

(08-02-2019 04:24 PM)RiceLad15 Wrote:  Are there not cases where a doctor prescribes a specific treatment and someone's insurance doesn't cover that treatment?

Of course, but whether or not it is covered is in the contract, and NOT a decision made on a case by case basis.

You guys act as though insurance companies have some special board that meets tp degide if they will cover this or that today. The Chairman asks "How do we feel today about colonoscopies? The board choruses "They are a pain in the ass! Deny them all, except for my brother in law."

Nothing shows ignorance more than thinking insurance companies decide what to pay for.

I wish many of you would be more generous in your reading of comments by those you perceive as the political enemy instead of ending every post with "your ignorance or bias is showing."

Anyway, perhaps this is a semantic disagreement. Yes, one signed a contract with an insurance company about what is and is not covered, but the interpretation and dispersal of those benefits by a claims department requires judgement. And that judgement is absolutely influenced by the company's bottom line.

Physician, heal thyself.

If the contract says your operation is covered, it is covered. Period.

No decision needed. No need to interpret the words "Kidney transplant".

(08-03-2019 11:00 AM)Fountains of Wayne Graham Wrote:  

(08-02-2019 05:11 PM)OptimisticOwl Wrote:  

(08-02-2019 04:24 PM)RiceLad15 Wrote:  Are there not cases where a doctor prescribes a specific treatment and someone's insurance doesn't cover that treatment?

Of course, but whether or not it is covered is in the contract, and NOT a decision made on a case by case basis.

You guys act as though insurance companies have some special board that meets tp degide if they will cover this or that today. The Chairman asks "How do we feel today about colonoscopies? The board choruses "They are a pain in the ass! Deny them all, except for my brother in law."

Nothing shows ignorance more than thinking insurance companies decide what to pay for.

I wish many of you would be more generous in your reading of comments by those you perceive as the political enemy instead of ending every post with "your ignorance or bias is showing."

Anyway, perhaps this is a semantic disagreement. Yes, one signed a contract with an insurance company about what is and is not covered, but the interpretation and dispersal of those benefits by a claims department requires judgement. And that judgement is absolutely influenced by the company's bottom line.

As for the bolded, not in the modern medical practice for the most part (i.e. 98%+). This is absolutely for massive part as close to a ministerial function as opposed to a discretionary one, that you seemingly make the case for.

If you are wanting to believe that the outcome of the plain, mundane portions for the vast majority of claims are driven by a 'bottom line' intent, you are more than free to do so.

You would be correct that pretty much all the issues one hears about in the news are de rigeuer for the industry; they are not. Think about how you heard about them, then think to yourself about what makes great news, and what makes great examples to beat an opposition up with moralistically. They aren't the 99.9 per cent that are disposed of regularly --- they are by far the outliers; i.e. the definition of 'good news stories' and 'great stories to beat up the opposing viewpoint with'.

If you really think that vast, vast, vast majority of monies and claims are not disposed of regularly --- as your post seems to provide a basis for -- I would say you are horribly mistaken.

So tell me, which is more likely to occur --- a) the insurance company pay the coded treatment for a broken arm; or b) the insurance company provides written instructions to every single disbursement requiring a thorough review and a kick back and refusal of benefits based on 'stretched' interpretations; resulting in a .05% change in the bottom line.

One is legal and hassle free; one almost requires the company violate civil conspiracy and racketeering laws, in addition to the consumer protection laws of every state covered by the contract, and review by the FTC.

Hate to tell you, the insurance companies tried that in the late 80's to mid 90's. I would surmise they learned some very expensive lessons in the process via the legal system.

Sorry, I just dont buy that massive assumption you put out there.

(08-02-2019 01:27 PM)RiceLad15 Wrote:  

(08-02-2019 01:18 PM)Owl 69/70/75 Wrote:  

(08-02-2019 01:02 PM)RiceLad15 Wrote:  

(08-02-2019 12:50 PM)Owl 69/70/75 Wrote:  

(08-02-2019 12:36 PM)RiceLad15 Wrote:  Bingo. One of the biggest issues the right has in this debate is that they haven't been able to provide a cogent alternative to the Dems on the national, or even state, level. They run on "socialized medicine bad" when that is a better alternative to a lot of the insurance options out there for a number of people.
It would be nice to be able to choose between political parties offering truly competing ideas of how to fix problems in healthcare coverage, as opposed to choosing between the Dems' plan and just a repeal of the plan with no sound replacement.

That's why I've backed Bismarck, which is basically free market (or a lot more free than ours is now) universal health care. Government pays for a basic plan of your choosing (essentially something like single-payer or a bad HMO) either directly (France) or indirectly through a tax credit (Heritage). You are then free to supplement your coverage, and employers can offer upgrades as an employment incentive. Or you can purchase an alternative plan, using the government contribution (where the government pays directly) like a voucher. Alternatives can include high deductible plans coupled with health savings accounts, which is probably the most economically sensible approach.
Heritage proposed a Bismarck-type approach 25 years ago. I don't know why republicans didn't pass it when they controlled both houses. Bill Clinton would have signed it just so e could have his name on health care reform, and we would have avoided the whole Obamacare debacle.

What's the mechanism that keeps the supplemental private options? I'd imagine in a single payer program you would have the same options available if companies wanted to offer those options.

The mechanism that keeps the supplemental private options is demand in the marketplace.

No, you would not have the same options available in single-payer because you don't have companies to offer them. Single-payer means one payer. That's why it's called single-payer.

See bold above.

That's what led to my question. I was wondering how something like single payer differed from single payer and allowed for the private options. Would a Bismark-payer (let's just call it that to not be confusing) offer plans that would offer lower levels of coverage from a single payer program? That would drive the demand for supplemental insurance.

Lad, Owl#s has posted a volume of good information on this subject over the years. You might also review the following NY Times op-ed: A Better Path: Germany

(08-02-2019 04:24 PM)RiceLad15 Wrote:  Are there not cases where a doctor prescribes a specific treatment and someone's insurance doesn't cover that treatment?

In a similar vein, there are in/out of network mixups that can create a headache, and it would be nice to find a way to deal with these more effectively. I know that there are situations where people either misunderstand themselves, or are misinformed about who is in/out of network, leading to massive bills that they have to either fight or negotiate down.

OO answered this correctly... the insurance company decided (and you contracted with them) that such things wouldn't be covered ahead of time. If you know you need that, then buy a different policy. If you don't know you need it and ultimately find out you do, how is that any different than a drug company coming up with a new drug that costs $1mm per dose, but cures cancer... and you didn't pay a premium based on some percentage of people needing $1mm... how are they supposed to pay for it?

Insurance is math, not magic. If the standard of care for varicose veins in the legs is to inject saline and close them off, relying on ancillary circulation to manage... and your doctor decides to go outside that standard of care and individually repair all of them... it is likely that they won't be covered, because that is not the currently accepted standard of care.

As to in/out of network, that's not the insurers fault. They have a very clear list and you can always call them to verify. If you don't, or your doctor doesn't, how is that THEIR fault?

Doctors offices generally require that you pre-register to make sure of this.
Urgent care or Emergency rooms have systems that do this as well, though they aren't foolproof. I deal with this every day

This isn't in any way the same thing though as insurance denying a claim which was the topic. This is insurance doing exactly what they said they would do. I agree that this can be confusing... so choose an HMO instead where you get no coverage at all out of network... you can only go to a network provider...

I don't really see how that is actually better for you in terms of care, but it certainly solves the issue you have.

The reason for in and out of network providers is that network providers have signed contracts with the insurers to accept a) a fixed amount of money (a stipend) for your care, whether or not you use it and usually also b) pre-set amounts for specific services. Out of network providers haven't been paid the stipend, nor have they agreed to the pre-set amount. Maybe they're the best in the world at what they do and rightfully charge a premium for their services, or have an exceptionally convenient location or hours that costs them more than average, maybe they use more or better staff or offer extra amenities while the insurer pays for an 'average' provider at an 'average' location with 'average' staff and amenities? Or maybe they're just in one area and your policy expects you to be in another.

Insurance is both complex and simple. It's complex in that there are thousands of possibilities for any population, but simple in that all it does is take a list of illnesses and injuries... and the standard of care for each... and the probability that a population will need those services. They calculate the cost to deliver that care and administer the policies, plus a reasonable profit, and then they divide that total by the population size, which determines everyone's premium. It's math.

They do not (generally) accept the risk of new or experimental or 'outside the standard of care' treatments... and if they did, they would charge a higher premium for assuming that risk. Similarly, some don't let you go out of network at all (so they are cheaper)... some let you go out, but pay less when you do... because they've already paid someone to provide at least some of your care, and you decided to use someone else... and SOME (very few these days, almost none) are fee for service... where they pay no stipends... and just 'pay as you go' for your services. These policies are extremely expensive and very rare these days as a result.

The real topic here is medicare for all... and Medicare has networks, and also 80/20 copays etc etc... and they don't cover everything either.