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Post 08 Mar 2016, 2:48 pm

Sassenach wrote:
Any one can go on Medicaid (their choice). Doctors can refuse Medicaid (their choice). People can pay whatever insurance they can choose to afford (their choice). Insurance can sell in any state they are licensed in (their choice).

A great many choices there.


Not so many if you have an existing condition.


I don't know of anyone who is proposing permitting insurers to refuse based on existing condition, which is one clear reason why insurance rates will continue to soar. If you can buy it after discovering you're sick, that substantially tilts the table against insurers.
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Post 08 Mar 2016, 3:15 pm

Sassenach wrote:
Any one can go on Medicaid (their choice). Doctors can refuse Medicaid (their choice). People can pay whatever insurance they can choose to afford (their choice). Insurance can sell in any state they are licensed in (their choice).

A great many choices there.


Not so many if you have an existing condition.


Medicaid refuses if a pre-existing condition? Oh, the nerve of our Government...
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Post 08 Mar 2016, 3:19 pm

Well, insurance companies want to get rid of those who can't pay enough for their service ( the poor) and those that are bad risks (those with pre-existing conditions). So if you mandate that they cover for pre-existing conditions they make up for that by substantially raising rates for everyone. Under the ACA the hope is that those increases will be off-set by getting low- risk young people into the pool by mandating insurance. I am open to a plan keeping private insurance available as long as the government covers ALL people who cannot afford health insurance and is an insurer of last resort to cover high- risk patients that cannot get affordable insurance. The problem is solvable if people are willing to try to solve it.
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Post 08 Mar 2016, 4:20 pm

So Freeman, you would be OK with those who choose to be on Medicaid having that choice and those who do not want to be on Medicaid having that choice? With Medicaid delays and lower standards of treatment, people can make the choice to have that level of treatment. With Medicaid, no all doctors have to accept that insurance. I feel that the disparity between treatment qualities would not be satisfactory to many on the left.

It is a cost/quality issue. You get what you pay for.
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Post 09 Mar 2016, 1:11 am

Brad, I think that treatment should be roughly the same for emergency treatment, access to essential drugs, treatment of life- threatening illnesses. I am not as concerned about different tiers of treatment with regard to elective treatment, orthopedic treatment, convenience ,wait time, getting quicker MRIs for non life- threatening issues, even access to top level doctors as opposed to just competent doctors. There should be a core of necessary treatment available to everyone; if some people want to pay extra for VIP care that is not really related to mortality I don't care .
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Post 09 Mar 2016, 6:48 am

freeman3 wrote:Brad, I think that treatment should be roughly the same for emergency treatment, access to essential drugs, treatment of life- threatening illnesses. I am not as concerned about different tiers of treatment with regard to elective treatment, orthopedic treatment, convenience ,wait time, getting quicker MRIs for non life- threatening issues, even access to top level doctors as opposed to just competent doctors. There should be a core of necessary treatment available to everyone; if some people want to pay extra for VIP care that is not really related to mortality I don't care .


That's where I am ... note that there's a lot of cost -- forced on private individuals or forced on the taxpayer -- which is not for ERs, essential drugs, and life threatening illnesses. In other words, the huge U.S. cost overhang is a function of bad legislation, including ACA.
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Post 09 Mar 2016, 7:05 am

bbauska
It is a cost/quality issue. You get what you pay for
.
Actually you don't always. At least not in the US.
From Commonwealth study on health care:
It’s fairly well accepted that the U.S. is the most expensive healthcare system in the world, but many continue to falsely assume that we pay more for healthcare because we get better health (or better health outcomes). The evidence, however, clearly doesn’t support that view.


http://www.forbes.com/sites/danmunro/20 ... 80ecb91b96

bbauska
Why did the government mandate what insurance coverage I get to choose between


Because there were all kinds of nearly worthless insurance offerings available before the ACA. And people, being lousy at evaluating both risk and the complicated offerings of insurance often found themselves buying crappy policies that offered little when needed.
Its the same reason there are laws against predatory lending, and consumer protections in some financial services.
Its why standards are brought in to protect consumers of all kinds of products. Like automobile safety.... There is a terribly uneven relationship between the sellers and the buyers .

I think you assume that if people had a choice between Medicaid and private insurance that you would end up with two tier healthcare.
That really depends upon the actual offerings.
If Medicaid was offered for all medical services that were necessary and available at the same tax rate as without ... then you'd probably find well over 90% of people would move to Medicaid. If they save $1400 monthly or more, why wouldn't they?
You assume that Doctors would not move to serve Medicaid because they could make more money from private insurers. That may not be entirely true since private insurers deny insurance claims at a very high rate and are difficult to deal with ...(it costs practices a lot of money to collect).
And if the market of privately insured people shrinks quickly to under 10% of the total ...practices will be competing for a much smaller pool of patients.

There is no question but that opening up medicare to all would put a strain on the system. Demand would increase as those who previously suffered without seeking care, now could. The solution is better managed and organized system learning from the best practices in the UK, Sweden and Switzerland... And the health outcomes would improve....
When the profit motive is taken out of the insurance equation, and when the high cost of managing relationships with dozens of insurance companies is eliminated, there's more money to provide quality. and when people seek health care early on, instead of trying to avoid the costs, outcomes improve...
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Post 09 Mar 2016, 7:20 am

Rayjay
In other words, the huge U.S. cost overhang is a function of bad legislation, including ACA
.
What legislation are you talking about before the ACA?
The "market" prior to the ACA was not competitive. And so did not act as a market.
Because health care is not a truly elastic market. In almost every other market demand slackens when prices go too high. But this doesn't happen in health care. Never has. Never will. Except when it totally eliminates access for the very poor who were left to their fate.
The exceptions that prove this, are things that are entirely optional, like laser eye surgurey. This cost has plummeted because its entirely optional.
Appendicitis doesn't allow one to shop around...

Insurance you could shop for....but if the underlying costs of health care continue to rise without effective cost control, then insurance companies pass those costs along to protect their profit, or create ways to avoid paying claims...
There are things that are "forced" on patients by hospitals and doctors, in the for profit system. Doctors often own imaging clinics. Guess who send s their patients for imaging a lot?
We have much to learn from other health care systems about cost control, and effective outcomes.

The ACA is crappy.But it is still an improvement. Your WSJ story quoted a man as blaming the ACA for his high insurance costs. He stated that since 1999 his insurance had gone up 335%. I wonder how the ACA affected the inflation on that between 2000 and 2014?
Underlying costs of health care are really well addressed within the ACA because it was never designed to address them, in order to protect the provider industry.
If Sanders were elected would he actually be able to bring in Medicare for all?
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Post 09 Mar 2016, 7:42 am

Ricky
What legislation are you talking about before the ACA?


Tax deductibility of health insurance ... inability to cross state lines ... unable to negotiate drug prices ... sky high lawsuits ... extensive regulations that cause small providers to have to merge ... mandating life time extensive coverage for public sector union employees, etc.

All of these laws, among others, have caused the cost overhang.
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Post 09 Mar 2016, 10:52 am

I am all for laws against predatory lending and other illegal activity. However, I am not for all loans being the same. Are you? Should people have different loans and rates based upon the credit score they have?

Should insurance cost different amounts based upon the health/lifestyle choices of the insured? I would think so.

Did you say that you are NOT for people having the choice of going through Medicaid or private insurance?

Your comment "If Medicaid was offered for all medical services that were necessary and available at the same tax rate as without ... then you'd probably find well over 90% of people would move to Medicaid." is asinine and not applicable. If "ifs" and "buts" were candy and nuts, we'd all have a merry Christmas.

Medicaid availability is LESS than private insurance. Why do you think that is? US News has an idea or two...
http://health.usnews.com/health-news/health-insurance/articles/2015/05/26/youve-got-medicaid-why-cant-you-see-the-doctor

You want all health care to be the same. I get that. To make that happen, it means the quality level has to go down.
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Post 09 Mar 2016, 11:17 am

Maybe you're right Brad that treatment would not be as good if everyone was in a Medicare/Medicaid system. But then how are other Western countries able to do it at lower cost without affecting mortality rates? That's a very serious question--politics and ideology aside--we need an answer to.
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Post 09 Mar 2016, 11:47 am

freeman3 wrote:Maybe you're right Brad that treatment would not be as good if everyone was in a Medicare/Medicaid system. But then how are other Western countries able to do it at lower cost without affecting mortality rates? That's a very serious question--politics and ideology aside--we need an answer to.


Time delays
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Post 09 Mar 2016, 12:29 pm

freeman3 wrote:Maybe you're right Brad that treatment would not be as good if everyone was in a Medicare/Medicaid system. But then how are other Western countries able to do it at lower cost without affecting mortality rates? That's a very serious question--politics and ideology aside--we need an answer to.


There may be offsetting factors including obesity, gun violence, lifestyle, cultural differences, etc.
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Post 09 Mar 2016, 12:41 pm

Should people be allowed the CHOICE to not participate in Medicaid or not serve Medicaid patients w/o penalty.

That is the true question.
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Post 09 Mar 2016, 2:25 pm

bbauska
Your comment "If Medicaid was offered for all medical services that were necessary and available at the same tax rate as without ... then you'd probably find well over 90% of people would move to Medicaid." is asinine and not applicable. If "ifs" and "buts" were candy and nuts, we'd all have a merry Christmas

Really?
You didn't explain how you envision people getting Medicaid...
At the same tax level they now have?
For an additional taxation percentage?
How exactly do you envision Medicare for all being paid for?
Or did you not consider any of this?
If one doesn't want medicare do they get a tax break or not? Do they have to buy insurance? If they don't have it, do they get admitted to hospitals?

bbauska
Should people be allowed the CHOICE to not participate in Medicaid or not serve Medicaid patients w/o penalty


We have that choice in Canada. Strangely, everyone takes advantage of the public health insurance. Since they've paid for it in their taxes...Why would anyone not take advantage?
And doctors do have the choice of not taking Medicare. They can bill patients directly and the patients apply for reimbursement. The number who do? Close to zero.
There are a few who choose to travel to the States and pay directly for services they might have to wait for in Canada too. So the notion that a two level system might develop is probably supported by this.... Once demand begins to over whelm supply in the US, and it probably will if everyone has access to health care equally...
then maybe a system for the very wealthy would develop.
So the very wealthy could choose to pay luxury prices to jump the waiting line... and will.
(Although methinks it already does happen now)