The Terrifying Stakes Of Repealing Obamacare Without A Clear Replacement

[drakensoul]

I welcome a single payer system with universal access which grants everyone in the country rights to basic healthcare. It's the right thing to do.

[Bumkin]

Trump will make a new great healthcare plan, it will be amazing

[Zan15]

I welcome a single payer system with universal access which grants everyone in the country rights to basic healthcare. It's the right thing to do.

then i don't understand?
are you saying under a single payer system you should or should not have pay cuts?

if they move to a true single payer system it will not be a gradual system change that will cut your salaries, it will be a drastic cut in salaries forced by govt regulations and forced rate acceptances.


i too am all for single payer even though it will most likely mean i am out of my current job and will have to find another

[drakensoul]

then i don't understand?
are you saying under a single payer system you should or should not have pay cuts?

if they move to a true single payer system it will not be a gradual system change that will cut your salaries, it will be a drastic cut in salaries forced by govt regulations and forced rate acceptances.


i too am all for single payer even though it will most likely mean i am out of my current job and will have to find another

I'm for a single payer system and understand that means pay cuts for doctors. All you have to do is look at any other socialized healthcare system. I just don't think saying "pay cuts for doctors will fix the majority of the problem" is anywhere near correct, because it won't and isn't. 15%. I think people immediately going there as the first-stop for fixing the system don't really understand how it works.

I think it will be a gradual change because the adoption of anything resembling a Germany, Switzerland, or other mandate access, semi-single payer setup is going to be slow and painful here. People are vomiting at the idea of the ACA which is only a 15% step toward it. I think it's going to take a lot of step-wise, systematic legislation to get there. Clearly it's not happening under Trump/Price/Ryan.

Ultimately I can see 20-40% reductions depending on specialty. I think it's a difficult thing to balance considering there's already a physician shortage in most fields and areas.

[hakujinbakasama]

Doesn't the US vastly outspend every other country in the world in medicinal services despite NOT having universal healthcare?

Probably but I'd wager it's a "we've dug so deep" issue. The biggest problem is that preventative care drastically reduces the overall costs. However, we've let things bloat and be put on the books for so long I'm not sure what could really be done to dramatically reduce the costs quickly enough. Additionally, I don't know what the insurance rates and coverage really look like in the comparison countries. Additionally too, we have a population which dwarfs the shit out of all those countries.

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then i don't understand?
are you saying under a single payer system you should or should not have pay cuts?

if they move to a true single payer system it will not be a gradual system change that will cut your salaries, it will be a drastic cut in salaries forced by govt regulations and forced rate acceptances.


i too am all for single payer even though it will most likely mean i am out of my current job and will have to find another

It would seem reasonable that the biggest push back to single-payer is exactly this. It would close a shit ton of jobs in the US with nothing to replace them and it requires a huge leap of faith that the fuckwits in office wouldn't ruin the entire industry putting actual care back to 1909.

[Zan15]

Probably but I'd wager it's a "we've dug so deep" issue. The biggest problem is that preventative care drastically reduces the overall costs. However, we've let things bloat and be put on the books for so long I'm not sure what could really be done to dramatically reduce the costs quickly enough. Additionally, I don't know what the insurance rates and coverage really look like in the comparison countries. Additionally too, we have a population which dwarfs the shit out of all those countries.

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It would seem reasonable that the biggest push back to single-payer is exactly this. It would close a shit ton of jobs in the US with nothing to replace them and it requires a huge leap of faith that the fuckwits in office wouldn't ruin the entire industry putting actual care back to 1909.

relative population size is not that big of an impact since the rest of the system is just as big and ratio's of both systems are about the same.



it will be a huge impact to the economy but the money spent on healthcare would quickly shift to other area's of the economy because no one in this country ever saves anything :P

[alexw]

Posting a bunch of big-sounding numbers is meaningless when you're talking about a sector trading in the trillions. Equivalent to posting graphs which are horribly under-scaled to make things look impressive.

If you correct the underlying systems (with a single-payer system with universal access), salaries will equalize accordingly. Making even a 40% cut to something comprising 22% of healthcare costs is, as I've already shown twice, a relatively low number.

3,200,000,000,000 - 422,000,000,000 (cutting salaries by 40%) = $2,780,000,000,000

So again, if you want to spend your time cutting salaries like it's going to make a big impact in health expenditures, you're going to be disappointed. A 15% reduction by cutting salaries by 40%. And since they're not going to get cut by anywhere near 40%, the reduction by a realistic cut would be even less impressive.

I'm actually fine with salaries going down because I think that will happen organically once the healthcare system itself is corrected, but saying that directly targeting salaries and reducing them will fix anything is bogus.

And yes, those are the three most overspent areas of healthcare. Personal health lifestyles is preventable diseases, by the way. Unless you've got data proving otherwise?

There is plenty of data out there. For example admin makes up 25% of all US healthcare spending. In other nations its between 10-15%.

https://economix.blogs.nytimes.com/2...ve-costs/?_r=0

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of course, if we go to single payer type system or a medicare system you will see major cuts in doctors salaries down to the level of medicare/Medicaid reimbursements. Those are not pretty numbers for most specialties in most states.


Bigger impact as far as job loss and salary % cut, i make no where near a doctors salary.....that was not what i was going for.
i am not a doctor or an high paid employee by most standards.

It would be too big to do in one go. The problem is so massive that its going to take a couple decades of slicing and dicing the system with a bit off here and a bit off there.

Unfortunately republicans are taking us in the wrong direction.

[hakujinbakasama]

relative population size is not that big of an impact since the rest of the system is just as big and ratio's of both systems are about the same.



it will be a huge impact to the economy but the money spent on healthcare would quickly shift to other area's of the economy because no one in this country ever saves anything :P

Yeah.... no.... I've never seen a quantitative study which actually supports that claim. That's the funny thing. People love to use "per capita" expect so many of the topics have been disproved when looking though deeper studies.

[alexw]

Trump will make a new great healthcare plan, it will be amazing

Tell me, did you say your evening prayers towards Trump tower yet?

Honestly you Trumpists and your cultish devotion to him. It's really saddening.

[Haegr]

There is plenty of data out there. For example admin makes up 25% of all US healthcare spending. In other nations its between 10-15%.

https://economix.blogs.nytimes.com/2...ve-costs/?_r=0

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It would be too big to do in one go. The problem is so massive that its going to take a couple decades of slicing and dicing the system with a bit off here and a bit off there.

Unfortunately republicans are taking us in the wrong direction.

Wouldn't it stand to reason that having many healthcare providers where there are many redundant version of the same system (One for each company) is a large contributing factor for admin costs being higher? And that it also stand to reason that allowing those redundant/duplicate systems to be consolidated reduce overall spending/

[Zan15]

Yeah.... no.... I've never seen a quantitative study which actually supports that claim. That's the funny thing. People love to use "per capita" expect so many of the topics have been disproved when looking though deeper studies.

i would love to see studies that show population as being a big impact as to why we cannot move to a single payer. having 300m vs canada's 40 million is not a huge reason why we could not move to their system.

[alexw]

Wouldn't it stand to reason that having many healthcare providers where there are many redundant version of the same system (One for each company) is a large contributing factor for admin costs being higher? And that it also stand to reason that allowing those redundant/duplicate systems to be consolidated reduce overall spending/

That is exactly the reason. You have multiple insurers each with multiple plans. Those have to be managed and negotiated over (in terms of how much is actually paid vs list price and whether payments are even made at all) by the insurance company, by the hospital/clinic, by the patient, and some involvement by the employer who provides it in the first place. It adds up to masses of wasteful overhead that doesn't improve care one bit.

Just going to a single payer system alone, would cut the cost of healthcare by ~10%, by getting rid of all this excessive bureaucracy.

[Polarthief]

I recent read this analysis from the Tax Policy Center. It basically states that, "in general, repealing the health reform law would, on average, cut taxes for the rich and raise them for low-income households."

It is indeed mind-boggling that people voted the way they did.

What? You think our country's voters actually do research on their choices? You should have seen family members of mine who supported Hillary and had no idea she was so pro-war/violence (for the record, I'm blue and supported neither). By next year, you'll see middle/lower income idiots who supported Trump and start raging about taxes.

[Roxaos]

Trump hasn't exactly been one averse to flaunting the might of the US Military.

[Rotted]

No one is going to lose their lives over this, that's just a scare tactic used on ignorant people.

Requote me so I remember in the morning to post you the link.

My other half found a legit source just two days ago about a family that has a toddler who has some sort of terminally ill disease, its being managed by medication supplied by this care, if it goes, the toddler goes.

[Cthulhu 2020]

Tell me, did you say your evening prayers towards Trump tower yet?

Honestly you Trumpists and your cultish devotion to him. It's really saddening.

Let's be fair though, if he comes up with a great healthcare plan, we all win. If he comes up with an absolute failure monstrosity, many poor may get fucked, but that just kills their credit and their chances in 2020.

[Slant]

Hi, non-burger slinger here (nice one, though. Glad you don't view burger-slingers as people who deserve health insurance without going bankrupt?). Had to go in for a knee operation a while back. Had to pay $1,500 total for it due to my insurance, which was a chunk of change but something that I could afford with my savings.

If I hadn't been insured I would not have been able to afford the operation at all.

So how's that argument working out for you?

And now I butt in and tell you that I'd have to pay 10 bucks for the initial visit to the doctor and that's it. We're so confused by the healthcare debate in the US, you have no idea how puzzling it is for us.

[alexw]

Let's be fair though, if he comes up with a great healthcare plan, we all win. If he comes up with an absolute failure monstrosity, many poor may get fucked, but that just kills their credit and their chances in 2020.

Trump won't come up with anything. He's far too stupid to be able to do that. He'll spout meaningless drivel like he always does and someone else will do the work. Whether what those other people come up with will be any good is another thing entirely. Since there really isn't any viable alternative to the ACA except single payer I expect the republican replacement to be a total disaster.

[Tinykong]

Maybe I'm not posting in English? I thought saying "The fact that a family practice doc making $120,000 a year (on the high end) works 45 hours a week is meaningless" pretty obviously [i]included a reduced work schedule, since someone making $200,000 a year isn't working 45 hours a week.

Most doctor's aren't working the hours you said, in fact, hardly any are. You're posting incorrect information to make your argument, don't get snide when you get called out on it.

You can stop paying physicians entirely and reduce the healthcare expenditure from $3.2T to $2.6T.

This is a deliberate misrepresentation of my argument. Reducing physicians salaries, by lowering the reasons for why their salaries are high, will have further reaching impacts than just the cost of their salaries. Doctors aren't being paid $400k a year solely because they are worth $400k to their practice, but because of the cost of doing business as a doctor. You completely glossed over that point in your crusade to defend the tireless medical professionals who are working 45 hours a week.

[Fugus]

That is exactly the reason. You have multiple insurers each with multiple plans. Those have to be managed and negotiated over (in terms of how much is actually paid vs list price and whether payments are even made at all) by the insurance company, by the hospital/clinic, by the patient, and some involvement by the employer who provides it in the first place. It adds up to masses of wasteful overhead that doesn't improve care one bit.

Just going to a single payer system alone, would cut the cost of healthcare by ~10%, by getting rid of all this excessive bureaucracy.

More than that I would think. With Single Payer you would remove

Insurance companies, Medicare, Medicaid, Tricare and literally an entire wing of most major hospitals and all the redundant overhead to do with it.

That would be a minimum of a 20% reduction in costs from all that overhead gone, let alone the profit motive of the insurance companies. And that is before the idea of actually being able to better negotiate prices unlike now where Medicaid is banned from negotiating medicine prices due to Bush Jr, forcing them to pay upwards of 40% more than what the VA pays for the same stuff.