The Wall Street Journal has a good quote on what Americans say they want for healthcare and what has to happen for that to happen:
Cheap insurance means either very little gets covered or the people who need a lot of coverage can’t get insured. Covering sick people means either massive subsidies (public or private) from the healthy to the sick and restricting the size of those subsidies means limiting choices. Democrats got hammered for choosing to cover sick people via either Medicaid expansion or through subsidized private sector insurance with a coercive participation mechanism. Republicans will get hammered for telling people to go die quietly in the corner and here’s a tax deduction that only matters if you’re healthy and wealthy.
This is the core problem of health policy. There are no pure win-win solutions for the healthy and the sick at the same time.
I think there are possible solutions but only if we can get our politicians to think in terms of medical care rather than medical insurance. I wish I knew how to do that.
between trump’s little digits on the nuclear codes and Mother Nature’s last laugh, we may not need no stinkin’ health care coverage.
This is going to get dicey for Republicans. I’ve observed here and elsewhere that if you listen to Trump’s stump speeches during the campaign, he ragged all over Obamacare — which got a big applause — but then always promised that he was going to fix it and do it right and everyone would have so much cheap health care, you’d get sick of all the affordable, high-quality health insurance you’d be getting, And this got a big roar of approval as well.
Trump voters think he’s going to replace Obamacare with Trumpcare, which is like Obamacare, but premiums never rise, networks are broad and generous, and you can eat all you want and still lose weight. Trump thinks his epic deal-making skillz will just make this happen somehow. Ryan, McConnell and the Republicans in Congress have other plans, namely the die quickly plan. So what will win out, the Shitgibbon’s massive ego and need for fawning approval from his base, or the Shitgibbon’s short attention span and utter ignorance of policy details?
Either way you look at it, it has to be paid for.
Sadly, we don’t seem to be able to convince the healthy that eventually they will get sick and die and potentially impoverish their entire family. It’s like people haven’t been taught how insurance is supposed to work.
so Americans are children who want everything and don’t want to pay much for any of it.
This is no different from any other democracy in the world, so I guess we shouldn’t feel too bad about it…
Villago Delenda Est
@Pogonip: At gunpoint.
@jonas: in the worst case (and most likely scenario for a cynic like me), they kill O’Care, replace it with Go-Die-Quietly-In-A-CornerCare, and Trumpanzees harmed by this scheme will blame the Great Black Satan for screwing everything up with ACA so badly that even their Piss Christ messiah couldn’t fix it.
We already know they will conveniently forget whatever promises Piss Christ made in the campaign.
tell the truth, Mayhew.
In the midnight hour…
I sort of disagree, because there’s a third route, which was one of the longterm goals of the ACA: lower the outrageous and ever-exploding costs of medical care in the United States. That makes it easier to expand the bases of both who’s covered and for what simultaneously.
Obviously, instead of having customers upset with how little coverage they’re actually getting for their premiums, or a large segment of the population upset because they get nothing, you have an industry or two that’s pissed off. I’m of the mind of screw those industries that have gotten us to the point where our per capita spend on all things medical is whateverx the rest of the first world spends, but unfortunately the politics are impossible to overcome, because both of the parties are overly captured by the insurance and medical lobbies. Not to mention a substantial portion of the population are so reflexively “single payer means death panels and waiting 5 months to see your doctor and no one with the means to pay for it can even get cutting edge treatments and I heard of a guy who had a problem with his spleen on vacation in France and died there because of bureaucrats” that they simply can’t deal with the obvious: we may be a nation that believes in the power of the free market, but the free market done fucked it all up when it comes to medical care here, and the free market ‘aint gonna fix it. For every story about how the American medical system is the greatest in the world because some rich Russian came here to get the latest cancer drug (which 99.999% of the American population can’t access), or every story about wait times and rationing in Canada, there are 5 stories about people getting screwed by the insurance process, denied coverage they’re due, or spending months or even years bogged down in coding disputes, which leads to the same end results they’re so terrified of when they hear the term “socialized medicine.” On top of the outrageous premiums they’re paying and the millions of people getting their primary care at the ER.
@r€nato: The election was razor close. It’s not the hardcore Trumpanzees who will matter in 2020. They are beyond being reached by reality, but swingier voters- and we don’t need that many- may not be.
While we’re at it, I’d like extremely low taxes and extremely excellent public services. I’m pretty sure this can be achieved through “deals.”
резидент американской области Российской Федерации
This is why health care is so amenable to scaling – the need is universal (and particularly so in the last 5 years of anyone’s life).
Think about what costs looked like when facilities were not-for-profit, health insurance offerings were mutuals, when every doc didn’t need a large investment portfolio of poorly run real estate ventures, and when pharma did not advertise the newest useless allergy or mood med on TV. When Hillary was propounding reform in 1993, I remember Jabba the Limbaugh snorting up commentary on how “she is proposing to nationalizing one-seventh of the national economy”. By the time the ACA was passed, we’d blown through one-sixth and were approaching one-fifth.
Each and every 401k, public pension, private pension and mutual fund contains a large percentage of shares related to health care – some in insurance, some in facility networks, some in pharma. Fully 30% of the companies listed on the S&P 500 are medical related. At least 1,000,000 people are employed in medical offices, facilities, and medical insurance companies.
This is what the purity ponies who were squealing for single payer never understood – the extent to which medical investments had burrowed into the wider economy and how there would have to be long phase-ins to prevent the decimation of public, private and retirement investment, including that of current retirees. No foresight at all.
And yet this whole industry everyone hates used Harry and Louise to kill Bill Clinton’s health reform plan 20+ years ago. So I don’t think this rhetorical war produces quite the winners we’d expect.
Well, it goes back to the ideology that has been propagandize for the last 50 years, and which Ben Shapiro and Philiip Klein are at least hones enough to articulate, of radical individualism and risk shifting from society as whole to the individual, no matter how buried behind the 8-ball they may find themselves due to birth and circumstances. We all eventually get old and get sick. Some are born very sick. Some are born with little time bombs in their genes that go off at 20 or 30 or 40 or 50. Some are in the wrong place at the wrong time when a truck crashes through your bedroom. If we all pay a little bit extra now, we will be covered for that risk. If not, then it is just “the Devil take the hindmost.”
Universal coverage basically transfers wealth from the young, healthy, wealthy, and lucky to the old, sick, poor, and unlucky. You’re either OK with that or you’re not.
“This is the core problem of health policy.”
A problem solved in every other developed country for less money.
@Steve LaBonne: The big problem is that Republicans have such an advantage when it comes to control of Congress and state governments.
That means that when Republicans have the Presidency, they can do tremendous damage, and even when Democrats do, their power to fix the damage is extremely limited, a constant uphill struggle. We get Congress for just a couple of years every so often, and it’s always this marginal, conditional control that is like herding cats, against united, disciplined opposition. And the states just keep trickling away, to the point where Republicans are nearly able to call a convention and arbitrarily rewrite the Constitution. This despite the fact that Democrats usually have majority support in the abstract.
A really disastrous Trump administration might turn it around, but the Republicans’ powers of mystification and control of the information sphere, and their willingness to use every procedural trick to retain power even when they have a minority, are so great that I’m not sure even that can.
If they have any dying to do, let them do it now and decrease the surplus population.
Most other developed countries spend less money per capita but have better outcomes. That’s because the way we do things is the most expensive possible way to do it: for tens of millions of Americans, even many who have (crappy high-deductible) insurance, they can’t afford, or feel that they can’t afford, to go to the doctor, so they put it off until their condition becomes desperate and expensive. Add to that the fact that Americans, and American insurance companies, are forced to pay much more for drugs than everyone else, and the result is that we pay much more and get much less.
The previous commenter is right, but I would phrase it a different way: health care is wildly profitable for many players, so yes, a lot of money is invested in it to reap those returns and millions of people are employed in positions that pit “fight the insurance companies so doctors will be paid” people vs “fight the doctors so insurance companies don’t have to pay” people; any doctor’s office is filled with them. We could save some of their jobs by using a hybrid system like France’s: the public plan covers everyone, but the well-off have private insurance as well. If we can survive the next four years, then after that we can try to create something that will work better. It can be phased in: let people over a certain age buy into Medicare, and lower that age over time.
I completely disagree with this strategy. I’m sending thank you messages to every single Democrat who voted no to making the ACA part of budget reconciliation. Last night they all held–even Manchin. I do not think it makes sense now to risk any fissures in our solid Dem support by picking at prescription drug prices. I do support negotiating drug prices but it is not even a remote possibility right now. This is a triage situation. We have a patient (the ACA) in critical condition and now is not the time to do elective procedures.
Cory was so good yesterday. He testified against Sessions, went to his committee’s hearing and asked Tillerson tough questions, and then defended the people who need access to health care until 1:30 a.m. Asking him to do more than he did yesterday is insulting. I think a thank you is in order.
@Pogonip: It’s always seemed to me that medical insurance is propping up the medical industry’s high prices. We all take for granted that medical costs are super-expensive, but why? They’re generally more expensive here than anywhere else, yet we always attack the problem as either the insurance industry doesn’t negotiate enough (kind of funny when you look at list prices vs negotiated prices on a bill) or there are too many sick people, so everyone going to doctors should make everyone healthier and medical costs cheaper. But it doesn’t work that way.
Question is: how much padding are the medical equipment and drug companies adding on top of their operating costs? Are there savings to be had there if that area reformed (not likely, as it’s got money to burn)?
Actually, there’s a pretty obvious solution: tax the absolute living shit out of the top .1% like it’s 1952 and use the money to subsidize the crap out of health insurance premiums–through the general fund, not a dedicated tax– and then let everyone else feel like they’re paying for something that’s theirs by charging everyone above FPL+x the same low rate. (And maybe charging those below that some kind of low co-pay that we don’t try very hard to collect, just so those who need some kind of pride investment can have it).
Won’t be popular with everyone, of course. There are a fair number of people who make a decent, often modest, living out of extracting money out of rich people. People who do custom stone masonry or supply copper gutters and roofing, people who do fancy millwork, hot rod builders, subcontractors for yacht builders, (Not counting trappers, furriers and mink breeders. Fuck those fucking motherfuckers.) They hate high taxes on the rich as much, or more, than the rich people do. And, of course the Galtian Ubermensch will bitch every time they use their benefits. But I guarantee you it would be popular as hell with 85% of the population. Because hey, they’re paying for it so it’s theirs, right.
Don’t much care if the insurance is single payer or private. I don’t have the True Progressive’s loathing of the very idea of someone making a profit and we’re going to need allies, just like we did when we coopted them to support the ACA. But I won’t cry if we can do it without them and make them vanish, though the loss of all those jobs would make a big hole.
The oligarchs will scream and lie and predict doom and mass emigration to Switzerland and warn of death panels and long lines and doctors forced to leave practice, but surely to god we know how to deal with that by now, don’t we?
@father pussbucket: it’s not a wealth transfer program. It’s an insurance program. Young people fall ill too, sometimes at great expense. It’s just less likely for that to happen to them than it is for older people.
To view it as some sort of wealth transfer (or, “welfare”, or, “giving my goldurn hard-earned tax money to lazy shiftless blah people”) program is to buy into the Randian notion that we are all islands unto ourselves.
@Keith P.: VAST savings to be had. But try to recoup them and you’ll get “Big Gummint wants to deprive you of leading-edge treatments (for too-short eyelashes)!” and “Big Gummint wants to grab your scooter!” I’d LOVE to see something smaller bore as a start: a ban on direct-to-consumer advertising for drúgs and devices. Those ads for medical devices are all over the damn place, and hella fishy.
@Matt McIrvin: Not expecting Nirvana, but I like our chances of dumping Trump in 4 years. I agree that this will have limited benefits, but it’s still better than another 4 years of him.
I think Democrats need to be more accepting of their flawed political champions. My impression is that Booker is corrupted by Wall Street ties and other ethical baggage. He still had the balls to testify against Sessions. While that may not seem like much, I think it is more risk and political courage than we have seen from many.
Villago Delenda Est
@Joe Buck: Health care needs to be removed from the realm of rapacious profit seeking. If this takes the deaths of private hospital CEOs, Pharma CEOs, Health Insurance CEOs, the AMA, it’s a price worth paying.
Employer based coverage was a helluva a lot more generous 20-25 years ago than it is today. What was standard back then – $10/co-pays, little or no deductibles, low monthly employee contributions, if there were any – would qualify as a Cadillac plan today.
From an insured person’s perspective, back then, there was something substantial to lose.
But all that changed in a hurry during the Bush years, when premiums kept increasing and employers started scaling back benefits to try and control costs and shift more costs to employees.
No offense, but Republicans are not going to tell people to die quietly in the corner.
They will say, as they have been saying all along, that Obamacare is the worst law ever passed in human history. It has been destroying the economy. We had to repeal it, in order to save America. Because the law was so horrible and damaging to the country, there will be terrible consequences as a better law is crafted.
Over half the country will believe them and keep voting Republican.
@FlipYrWhig: That’s been my hobbyhorse for years now. Always shocked and appalled when I catch sight of day-time (or prime-time) commercial TV and see those ads. That’s something progressives could start rallying round – like banning cigarette and liquor ads on TV.
OT but not really since this post was titled “Dreaming Impossible Dreams…”
Mature Trump Tweets!
I’m going to offer a theoretical disagreement here. The state does have the capacity to shift costs in other ways to achieve the goal. The UK nationalized the health delivery system and took money from care providers rather than simply treating policy holders and insurers as a closed system. There are opportunities for cost benefits from subsidizing capital intensive care solutions to replace recurring cost ones. There are opportunities to lower the overall cost of care in certain scenarios by minimizing conditions through policy or through shifting where you spend for care. Vaccines are cheaper than polio. Not smoking is cheaper than smoking.
There are, in theory, a lot of levers that can be pulled to achieve the goal. Now, Europe pulled many more of those levers when they were effectively razed due to war and were pushed to a point that overturning longstanding social conventions was tolerable. The US has not seen that condition since the great depression, therefore we are unwilling to attempt an experiment as bold as nationalizing doctors or upending certain markets or putting down hard health policies like banning smoking. So, in practice, we can never realistically get there without wishing for something sufficiently catastrophic to strike us, but the toolbox is a lot larger than we tend to recognize.
Single payer is a tough sell for precisely this reason – it eliminates, in full or in part, the insurance market layer, and creates a monopsony (dominant buyer in a market, as opposed to a monopoly which is a dominant seller) which would unquestionably impact market pricing. But it returns part of the value chain to consumers if executed properly, and that is an unalloyed financial cost benefit for consumers. What consumers lose is market choice – something which barely even exists now in most states anyway.
@Hitless: I see no reason not to do both. Plaudits for the good, brickbats for the bad. They need to know not just their big donors are watching.
Wall Street / Finance and Big Pharma are huge chunks of the NJ economy. He’d be derelict in his duties as a Senator for going against their interests.
I don’t think Booker would make a good Presidential candidate. He’s good as a Senator, but I do not think he can make the next step. He seems like he is trying too hard to craft an imagine, as opposed to being who he is.
@Miss Bianca: I think it was Atrios who said the best accomplishment of George W. Bush’s presidency was the creation of the Do Not Call List. Maybe this could be a transpartisan issue.
I understand the difference between income redistribution and insurance; maybe I oversold my point. Voluntary insurance only works if nobody knows who’s going to get sick, and the unlucky get money from what the lucky pay in premiums. But there are too many ways to anticipate who gets sick, and some will be too poor to afford even “fairly” priced insurance. So do we, as a society, believe the fortunate should help the unfortunate or not? Not that there aren’t a lot of other wonky issues involved as well.
I just think we need to choose our battles. I’m not going to pick the prescription drug battle when the entire law and all the protections it affords are in jeopardy. It doesn’t make any sense.
In terms of fighting for our interests, Booker was spectacular yesterday. Remember, the Republicans threw everything at us in one fucking day.
I will continue to say this: I have never, either here or in any other country, either in the public or private sector, encountered an industry that needs me to hold their hands, look over their shoulder, check and recheck and rerecheck each and every single little thing they do in the same way that the American health insurance industry does.
I’m talking about having a company, upon cancellation of my coverage, retroactively canceling it two months before I told them to simply so they wouldn’t have to cover a $150.00 doctor’s visit, and then failing to fix the problem despite months and months of phone calls telling them that I never told them to end coverage at that point.
I’m talking about having my in-network PCP refer me to an in-network specialist only to be told retroactively that the specialist wouldn’t be covered unless there was paper trail evidence of my referral (which I’d given to the specialist), and the specialist’s office matter-of-factly explaining to me that often these paper referrals which they now no longer had didn’t upload properly into the database.
I’m talking about telling the local care center repeatedly to send my blood work to this office and not that office because only one of them was covered, only to have them, sure enough, send it to the wrong office.
I’m talking about being assured repeatedly that, yes indeed, this hospital is in-network, and then being billed over seven thousand dollars retroactively when the hospital and insurance company then told me that, well, no, of course we’re not in-network, why would you ever have thought we were in network?
Etc, etc, etc.
The entire fucking industry is organized crime, full stop. It lies, cheats, steals, and swindles its clients at every possible step of the process, and the less you can afford it, the more they do it.
@MCA1: Agree. The UK spends 6% of their GDP on health care. Of course doctors there only make 60-100,000 pounds a year, not 200-300,000 dollars like they do in the US.
I found it laughable when during the run up to the ACA there were doctors saying they would leave the US because their income was threatened. I thought “where you’re going to go, the UAE only has a limited number of positions, and everywhere else pays less.”
Thus creating a classic real-life “lifeboat” type of dynamic – with an acrimonious discussion ongoing about who gets thrown overboard and who is strong enough to pull their weight with the oars and hence deserve staying aboard and getting a share of the rations. Those aboard most willing to throw people overboard are unfortunately the ones at the moment sitting closest to the weaponry aboard. And they’ve definitely got an IGMFY attitude about both their own health (and insurance) status and their patience with putting up with carrying anyone they consider “dead weight” in the boat.
The problem begins with the GOP philosophy of small government and rugged independence, small government with low taxes means we can’t afford things like a robust safety net and a bloated military industrial apparatus, but we want both of those things, and they are the biggest drivers of government spending. The two ideas of what it is to be an American are in direct contradiction. Rugged individuals want to be able to build the American dream and keep their money, but as soon as a hurricane, tornado, or bankruptcy strike, they are the first in line bleating for the Feds to come in and fix it. Where do they think the money is coming from? They want us to have the biggest, bestest military, but again where is the money coming from, farm subsidies, corporate tax giveaways, keeping churches tax exempt, all the things they love cost money, money they don’t want to pay. The myth of the rugged American who builds themselves up from nothing to one day having it all is just that a myth, no one does it alone, we are all in it together. Problem is they only ever remember this, when there is a crisis.
Someone needs to tell America that you can’t get something for nothing, never, so just grow the fuck up. Either you pay jack shit and get jack shit, or you pony up and pay for the overage you actually need.
This is not a fairy tale, here in the real world, you get what you pay for.
Do you really want to have to go against big pharma AND the Republicans and the health insurance industry all allied against us if we have to fight for some kind of ACA replacement? If so, that is a sure way to lose.
Agnes: And you, start over. I want everything in one bag.
Pimple Faced Kid: Yes, ma’am!
Agnes: But I don’t want the bag to be heavy.
Pimple Faced Kid: I don’t think that’s possible!
Agnes: What are you, the possible police? Just do it!
I shall call my junior senator and voice my displeasure. Drug costs are huge driver of medical costs.
You have entirely failed to read between the lines of the Harrington quote. You have missed its tone and its subtext, which are not benign. Go back and read it again.
@gene108: But the thing that really changed was the degree of care that could be provided. I recognize that because I have a daughter which, had she been conceived 10 years earlier, would not have survived.
When republicans say ‘we have the best health care in the world’, they aren’t entirely wrong. We have the best health care capability in the world – whether or not you can afford to avail yourself of that is a different question entirely to them. People from around the world travel to the US to get procedures done that quite often can only be done here.
But that capability comes at tremendous cost – both in terms of overcharges on common treatments to subsidize their development (we pay more than the production cost of drugs so that drug companies have capital to invest in new drugs), and in terms of direct costs of treatment. It cost somewhere in the neighborhood of a million dollars to bring my daughter into this world, between the preparatory surgery, the constellation of medical equipment and 3x a week in-home nurse visits during my wifes pregnancy, the several weeks of hospitalization for her, and the several weeks of NICU for my daughter. Her OB knew this would be a challenging pregnancy, but it was way, way worse than anyone expected. But, through the massive application of cash, it was successful. But we paid nothing. Literally, $0. Arguably even less than that because they let me eat hospital pudding that I wasn’t entitled to as a non-patient.
But a decade before, or so our OB told me, there wasn’t enough money on earth to make that pregnancy possible because half of that equipment hadn’t yet been invented, nor had one of the drugs we relied on. So we went from a state of cheap but unsuccessful health care to one of expensive but successful. I (or my employer) will never pay a million dollars in premiums to pay for that situation, which means that you and everyone else helped pay for it through increased premiums (thank you everyone in California for doing that, I truly owe you all).
And that’s where the death panel smear gets complicated. There’s always a death panel of some form or another. It’s either the government denying payment for care, or the insurance company denying payment for care, or the doctor saying ‘don’t bother, it’s too late’, or the NIH denying the grant to develop the drug or procedure or equipment, etc. Someone has to pay for all of this at some level, and every day someone is saying ‘no, that’s too expensive for what we get’. Constantly. And we all participate in that. We all have our opinions on whether a double chin is a sufficiently esteem-damaging condition to cover or treat or not, or dry eye, or dysfunctioning penîs, and so on. But by and large, as a nation, we are generally sympathetic to all of these things (except abortion and contraception) in ways that other nations really aren’t. Because we’re sympathetic, we pay for it.
Gin & Tonic
@Steve LaBonne: There is no chance that tub of lard lives to be 78.
@FlipYrWhig: If nothing else, it sure would be interesting to see what happened when people started campaigning for this type of ad ban – in terms of who comes out against it, I mean.
I’m actually wondering how such a campaign would work. I mean, with the case of liquor and cigarettes, those are “sin” or “luxury” items, in addtion to being health hazards that are attractive to minors. You could defintely get the Puritans and moral scolds/worriers on board with arguments against them.
How would you do it with Big Pharma advertising of products directly to consumers?
There’s a reason why ‘mass murder by spreadsheet’ got popular before the ACA passed. Now it’s back with a vengeance, and I’m one of the first on the death list. I’ve been there before, but at least I had junk insurance then.
It’ll take a miracle (i.e. me getting a job that comes with insurance) to save me now. I’m working on that, though. Maybe the New Year will bring something better then the wretched 2016 did.
@Bubblegum Tate: Wow, didn’t know that one before, but it totally works here, doesn’t it?
I think he’s turning into a better senator than I thought he would be, but I still plan to keep pushing him on the drugs issue. I can thank him for yesterday, but also tell him that I want more. I’m a democrat, I can walk and chew gum at the same time. @Hitless: Jersey is populated with many, many people who either work on Wall Street or are connected to them. Wall Street is very important to our economy, so just like every other congresscritter who caters to or caters to the interests of a major constituency, he does. One thing that many may not know is that after 9/11 many companies moved their operation to Jersey, it was cheaper and safer. So anyone who thinks or expects that he will not cater to them when he can, is delusional. The question is can he balance this constituencies priorities with those of the nation as a whole, the jury is still out on that one.
@Miss Bianca: Some of them you could characterize as gross verging on indecent — I don’t really care for hearing about “black or bloody stools” over dinner — but more to the point, I think you could say they’re increasing costs (have to make make the price of the ad blitz), leading to overuse of drúgs, and making doctors’ lives needlessly complicated by giving their patients incomplete information. The counterargument would be that it’s all free speech as long as it’s not misleading, and misleading claims are already regulated. I don’t have a lot of faith that a Republican-majority Supreme Court would see it otherwise. :(
@father pussbucket: absolutely. the young will get old. health degrades to sickness. wealth is not guaranteed. luck is a fickle mistress.
@Chris: I did say it was obvious.
Enhanced Voting Techniques
Except everyone gets sick sooner or later. This is more like the logic of the boomers who were going to kill themselves when they turned 30 because they didn’t want to get old.
Here’s something to brighten up this thread.
<a href="https://www.youtube.com/watch?v=1aVDefOvPJI“>I give you Michelle Obama my hero :-) Enjoy.
My viewpoint is quite simple. One of my best friends has stage 4 prostate cancer that’s currently being held in check via $8,000/month in meds. If he loses his insurance, he dies. Fuck every motherfucking bigoted sellout shitbag Republican who votes to kill him.
Lots of people want it and want to make sure other people don’t get it. And they don’t understand why no one can make those two things work together.
@r€nato: that, and the fact that young healthy wealthy people turn into sick poor old people.
But just remember, in the US we spend twice as much for the same care, and our life expectancies are lower than those of people in other developed nations. Kind of a lose-lose situation.
Was there a Democratic Party before obnoxious phone drives that accomplish nothing? How did it work? Can we go back to that?
Holy Shit! MSNBC reporting the DoJ IG will investigate the FBI’s actions ahead of the election!
@Gin & Tonic: This. Trump is visibly showing a few signs of heart trouble (flushed face, huge neck waddle, pale hands). I bet he’s got cankles and deep elastic marks on his calves. I give him 2 years before he dies of a massive heart attack. I just hope it’s on TV, and he crashes through a podium ala Chris Farley.
Major Major Major Major
So I’m reading some reports that there aren’t votes for repeal because some Republicans secretly want to keep it and the teahadists don’t want to do anything without a replacement plan, but I’m also reading reports that Ryan is pressing full steam ahead to have something by EOB tomorrow. Which is right?
I want to bet on a slightly modified version of Obamacare, relabeled as “Trumpcare”, and if Trump really was what a substantial portion of his supporters thought he might be – a more conservative version of Teddy Roosevelt, minus the fondness for environmental conservation – then we likely would get something like that, albeit with more and different flaws. However, the realist in me thinks the McConnell / Ryan faction will prevail because they’ll wear down and power right through Trump’s short attention span and inattentiveness to policy details, plus they’ll make sure to stoke his adolescent temperament and ego into a fist-busting-holes-in-the-wall dominance-and-spite display over the dems and the ACA.
@p.a.: So what, if any, rationale was put forward by Dems for voting against it? (I just heard that Michael Bennett voted against it too).
Republican congresscritters I hear on my radio:
“Yeah, we should keep the no preexisting condition refusal part.”
Me, shouting at my radio:
“How does that remotely work without a mandate? Can I wait until I get in a wreck before buying car insurance, because that would be cool!”
Heh. Yes, indeed.
A blogger I used to like had this to say back in 2011 about the state of the American economy: “All across the country, states and localities are confronting the same problem. Like the federal government, they won’t do anything redistributive. In the absence of that, in particular in the absence of the necessary taxes on the people who can afford it to pay for the things society needs, what’s left is a zero-sum game pitting the good of society against the budget. Where the federal government wrecked the budget so as not to wreck society, local governments are wrecking society so as not to wreck the budget.”
It’s unfortunately going to get so, so much worse.
резидент американской области Российской Федерации
If things get too bad, would you mind paying a visit the the offices of Americans for Prosperity, Heritage, ALEC, the NRA and the Family Research Council?
@FlipYrWhig: The only way I could see it working would be to get the AMA on board with the notion that by advertising prescription drugs/devices directly to consumers, this was in some way interfering with the doctor-patient relationship, and doctors’ ability to make informed decisions for their patients’ care. I dunno if that really would work, tho’.
Yes there are.
If we implemented both single payor and single provider (a la Britain’s NHS), we could spend a lot less money for universal care that’s at least as good as we have now for people who already have insurance.
Sure, it might not be politically feasible, and it might make insurance companies, doctors, pharma, and other rent seekers cry, but it’s not like there’s no solution.
The realist in me thinks that Trump neither understands nor gives a shit about the complexities of health care policy, and that the simple realities of political tribalism plus sticking it to Obama’s legacy plus sticking it to all those obnoxious uppity blacks and poors who voted for Hillary plus the potential at an opportunity to make a profit out of it for himself (the only thing he cares about, and I’m sure congressional Republicans will phrase it in those terms) are more than enough for him to repeal.
You really think consumers want to see those stupid fucking ads?
I disagree. He understands, along the lines of “(SNIFF) Private sector good, public sector bad! (SNIFF)”
@резидент американской области Российской Федерации: LOL!
Locked and loaded, beyotch!
@liberal: I have no idea. Do they *not* want to see them enough to band together to lobby for banning them from the public airwaves? That would be the $6.4 billion question.
@ArchTeryx: Maybe we should start some kind of funding pool to ensure that actually good people like yourself keep breathing, while we wait for the Angel of Death to strike down the Trumptards. (Not snarking…would contribute to such if it were well-run.)
It’s one of my go-to quotes when people are demanding mutually exclusive things. Plus, I just love Edna’s, “What are you, the possible police?”
@Miss Bianca: Oh, of course not. But that’s a much more general problem with politics: one side is small with a very focal interest; the other is very broad with a very diffuse interest. Very hard for the latter to solve coordination/collective action problems.
@Keith P.: Also, Trump is a man with the hips of a mother of 5. You can see it in his profile (his poorly fitting suits mask this a bit)…the man is a walking
pearGrimace. If he were to start exercising today (not cart golfing!), his heart would give out that night.
Major Major Major Major
@Miss Bianca: It’s a perfectly legitimate argument, that nobody says out loud, to say that the American consumer subsidizes the whole world’s pharma R&D by being the only country to pay full price for drugs.
If he actually had something done about his suits it would not be so blatantly disgusting. This freaking schlumpert is going to symbolize the US of A. Drives me fucking insane!
@Major Major Major Major:
Nope. Pharma is such a gigantic rent-seeking clusterfuck that the American consumer is merely subsidizing waste.
@Major Major Major Major: Is it actually, tho’? I mean, I would be willing to accept and even make that argument, little tho’ I might agree with it, but are US pharmaceutical companies really doing the lion’s share of the world’s drug research?
@Corner Stone: The crazy thing is, when you typically buy a suit (at least where I’ve bought them), tailoring is included in the cost; it’s not a binary choice between custom-made suit and buying off the rack. It is inexcusable for someone with a clothing line in his name to wear such poorly-fitting clothes. And the fucking ties. Jeez, it does not lengthen his appearance at all…it just looks like the man doesn’t know how to tie a tie.
Major Major Major Major
@Miss Bianca: Yes, but it’s not necessarily the most valuable stuff due to the profit motive.
@liberal: I said it was legitimate, not 100% correct.
A good friend of mine is a nonprofit-type MPH who says that this is unfortunately trueish.
Yoda Dog Democrat
Right? Either you have a sense of human fucking decency or you don’t. Exactly.
@Miss Bianca: Thank you for what you said to Crackerjaxguy earlier, +1 for me too.
Jack the Second
@father pussbucket: That’s really the difference between insurance and investment. Insurance — of any sort — transfers money from the lucky to the unlucky; investment from the unlucky to the lucky.
@резидент американской области Российской Федерации: Disagree. All those med sub-industries, with the exception of insurance, will continue to thrive, whether single payer or other mechanism are in place.
The key to health insurance is to have two things:
1) a society of people who care enough for each other that they are willing to join together into large, stable groups that spread risk out (e.g. Alberta, where I live).
2) insurance companies that accept a standard, low-level rate of return on capital, and understand that part of their mission is to pay for health care and manage the actuarial fees for that in such a way that they make sense on both ends of the transaction.
Well, you know what *I* hate? Having to subsidize DEAD people with my life insurance! Why should *they* get a hundred grand just for dying? Hm? I’m still living and WORKING, the lazy moochers!
What? The point of insurance is, someone piles all the money together to consolidate risk into a statistically predictable pool, so when *I* die, the money of the living will be used to make sure my debts are settled and my family provided for? Don’t give me that LIEberal elitist crap!
And I don’t see why health insurance shouldn’t be the same way (cough) huh, blood, maybe I should have quit smoking? NO! No dumbass scientist is telling ME a lousy 3 packs of cigarettes a day could hurt me! And besides, MY health insurance has a… $100,000 lifetime limit? What’s the average cost for a year of lung cancer treatment? BOGGLE
(The above is, of course, ironic, intended to illustrate the utter stupidity of health insurance that doesn’t actually provide useful benefits)
@резидент американской области Российской Федерации: That’s silly. You’re failing to distinguish between real wealth and paper wealth.
@Nick: Yes, but the US isn’t a society where “a fair day’s wage for a fair day’s work” is accepted. On the low end, it’s “they laid me off, then the contracting firm hired me back at a lower salary with worse (or “no”) benefits” and on the high end, it’s “a fair day’s wage? That’s for CHUMPS!”
@Major Major Major Major: It shouldn’t be considered reasonable, especially given that the big drug companies spend more on marketing than research. I heard a *great* story of a drugmaker who couldn’t get the price they wanted in Europe (or maybe just “a European country”) because their BRAND NEW AND UNDER PATENT drug showed no benefit over the old, reliable drug. I had no sympathy for them.
It’s the first rule a person needs to learn in business: SUNK COSTS DON’T COUNT. You spent a billion dollars trying to make this drug? That’s a sunk cost. You don’t get to demand to recoup it. If GM drops a deuce with a new car that cost a billion dollars to produce, they don’t get to demand people buy the damn thing at a much higher price so they can recoup their losses. Drugs are no different. Either the drug is profitable to sell now, at the market price, or it isn’t. Manufacture it if it’s profitable, and stop whining about how you sunk costs, wisely or unwisely.
Maybe you can license your research. Or maybe you can spread the risk of your research, finding funding sources who will demand a share of the profits but recognize they might lose their investment; or maybe you can encourage *public* research and hope you can capitalize on a discovery faster or better than your competition.
Just because drug companies make bad business decisions is no reason for other folks to bear that cost – not until there’s a reasonable fear that drug research money for good and useful drugs is drying up.
@cmorenc: I think that’s a possibility. The one I’m toying with is that they basically leave Obamacare in place in some form — rebrand it in some way — but do manage to eliminate all the taxes that fund it, exploding the deficit and leading to a bunch of handwringing about how we have to voucherize Medicare or cancel food stamps for children or something to pay for it. Whatever they do, their priority will be making sure the superrich get a tax cut.
This is manifestly not true.
Britain’s NHS is expensive to maintain, and fails in some areas. And yes, citizens are glad they have it, but they are also used to its problems.
Republicans keep falsely asserting that universal health care is failed socialism, no matter what. But foolish liberals keep falsely asserting that “single payer” is one thing and an unalloyed success, no matter what. Universal health care and single payer are not synonymous. The challenge, once we get past the Trumpian nonsense, will be to come up with the best plan. And that will take some work.
That doesn’t really address the underlying issue. The problem with healthcare is that you can ALWAYS spend more for improved outcomes. Always. Which means that you can easily reach a point where you tax at 100% and still run out of money.
The real issue is where do you decide that an investment is worth making? At some point you need to say, no, we’re not going to extend this person’s life another month, or no, we’re not going to spend a million dollars to save this preemie, or no, we’re not going to give you a billion dollars to develop this drug. We are unwilling as a society to deal with that reality. We’ve offloaded it to people like Richard to do on our behalf and then complained about his decision. We tried to give it to government and then bitched about death panels. But we have to deal with it, and until we do this is going to be an out of control situation. Taxing will buy us time, but it won’t solve anything.
Other nations have public standards for these things that we broadly (but not entirely) lack. Can a 75 year old get a heart transplant? No. We cut off at about 70, and if you’re older than that, then sorry, death panel says you’re out of luck. We HATE the fact that’s necessary, but it is, and the truth is the survival statistics on a heart transplant can be aligned with those for almost every other medical condition which would allow us to say no to this medication and no to that treatment and no to other things.
Richard has said clearly that the way the VA gets their drug costs in line is by saying no to certain medications. There’s a downside to that, but it’s one that they’ve calculated balances out against not having enough of the other drugs because they lost their discount and can’t afford as many. If I give up eating bananas I could save enough money to buy 3x as many calories worth of apples, etc. Ultimately, we need to accept a societal contract that allows that kind of thing to happen at all levels equally – so that private insurers and Medicaid are doing the same thing, and therefore seeing the same cost/benefit outcomes. Then you attenuate the system to how much money you’re willing to dump into it. If the public demands better outcomes, then you tell them what it’ll cost. If the public is outraged by the cost, then you tell them what outcomes will worsen. Politics, of course, is ill suited to solving that problem.
These are extremes that have nothing to do with real health care reform.
But a 75 year old can get heart valves replaced, the surgery is not excessively expensive, and recovery is straightforward.
Dianne Feinstein, age 83, just got a pacemaker installed. Just not a big deal. But when pacemakers were first used, you couldn’t get one until you had had a second heart attack.
Your view of cost/benefit outcomes is too simplistic to be useful.
@Brachiator: 100% agree with you. Many countries have health care systems that have much lower costs than ours combined with universal access and good quality care (often better than ours based on outcomes). Few of these are single-payer. The single-payer fetish on the left is plain stupid.
yep. even if the guy believed in climate change, he’d just say he could fix it by renegotiating a better deal with the laws of physics.
Villago Delenda Est
@Miss Bianca: We know they’re doing the lion’s share of DRUG ADVERTISING.
Most people basically want magic health care. They want to be able to go to whatever doctor they want, pay maybe a $10 copay, get their medicine for about $10 a refill, and have really low premiums, perhaps $25/month for whole-family coverage. And they don’t want to pay any taxes for it, either.
@Original Lee: Yeah, they do. And in many countries, although they pay taxes for it, they get things like that.
I heard it said that France has better health insurance than us – basically, there are health insurance companies who are really competing on administrative overhead – they all have to cover the same sort of stuff, and you pick your provider, and they get paid (either by you or the government – I wasn’t clear on whether there was a split or not).
That’s how you know the Republicans are crazy. Remember when France was the anti-christ for thinking that there wasn’t any proof of WMDs in Iraq, so they wouldn’t support our invasion? In any rational world, “France is kicking our ass in (societal measure)” would be an impetus to prove we can do better than the French.
But the Republicans don’t live in a normally rational world. They *do* live in a rational world: they want to support, protect, and assist (and occasionally fluff) the wealthy. But they can’t *say* that, so they have to come up with completely irrational justifications for why we should be proud that our people can die, go broke, or both.