What would you change about the Health Care System
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  What would you change about the Health Care System
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Author Topic: What would you change about the Health Care System  (Read 4840 times)
Pragmatic Conservative
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« on: December 14, 2015, 09:52:20 PM »

Option 1-Reapeal of Obamacare, no government intervention in the Healthcare System

Option 2-Ammend Obamacare by (basically the main GOP Proposal) :Elimination of the Mandate,  allow Health insurance companies to compete across state lines, allow people to keep their current plan.

Option 3-Status Que-No Changes to the Healthcare system

Option 4- Hybrid System- part B is left non regulated, The government fully regulates part A Health Insurance. 

Option 5- Universal Health Care- Full Government intervention in the Health Care System for both Part A + B.

Option 6-Other 
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NeverAgain
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« Reply #1 on: December 14, 2015, 09:58:01 PM »

Option 5/6, I support a free public option, I support healthcare competition though.
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muon2
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« Reply #2 on: December 14, 2015, 11:36:09 PM »

Option 5/6, I support a free public option, I support healthcare competition though.

I'm curious as to how you would support healthcare competition while using a free public option. Is there a model out there you can point at?
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shua
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« Reply #3 on: December 15, 2015, 01:56:32 AM »

Option 1-Reapeal of Obamacare, no government intervention in the Healthcare System

Option 2-Ammend Obamacare by (basically the main GOP Proposal) :Elimination of the Mandate,  allow Health insurance companies to compete across state lines, allow people to keep their current plan.

Option 3-Status Que-No Changes to the Healthcare system

Option 4- Hybrid System- part B is left non regulated, The government fully regulates part A Health Insurance. 

Option 5- Universal Health Care- Full Government intervention in the Health Care System for both Part A + B.

Option 6-Other 

part A and B? you mean like in Medicare?   I don't get what you are trying to say here with option 4. 
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Intell
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« Reply #4 on: December 15, 2015, 01:59:00 AM »

Free Single-payer healthcare.
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Clark Kent
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« Reply #5 on: December 15, 2015, 08:21:41 AM »
« Edited: December 15, 2015, 06:37:55 PM by Lt. Governor and Senator-elect Kent »

Definitely Option 2
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« Reply #6 on: December 15, 2015, 08:40:47 AM »

Option 5/6, I support a free public option, I support healthcare competition though.

I'm curious as to how you would support healthcare competition while using a free public option. Is there a model out there you can point at?

presumably the free public option would be a bare bones package, while private insurance competes among the rich and middle-class for special deals that allow customers to stay in the swankiest of hospitals and get assurances of lower waiting times etc. Most UHC countries have significant private insurance niches, although it often ends with ghastly situations like South Africa, where apartheid lives on in the differences between the public and private healthcare systems.
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muon2
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« Reply #7 on: December 15, 2015, 11:31:01 AM »

Option 5/6, I support a free public option, I support healthcare competition though.

I'm curious as to how you would support healthcare competition while using a free public option. Is there a model out there you can point at?

presumably the free public option would be a bare bones package, while private insurance competes among the rich and middle-class for special deals that allow customers to stay in the swankiest of hospitals and get assurances of lower waiting times etc. Most UHC countries have significant private insurance niches, although it often ends with ghastly situations like South Africa, where apartheid lives on in the differences between the public and private healthcare systems.

That's what I was wondering about. Was NeverAgain suggesting automatic Medicaid enrollment for all with opt outs to better packages offered by private insurance? That would seem to enhance class differences for a UHC system.

If it is going to be a UHC with private insurers, I think the better way would be to have a payroll deduction like Medicare to fund a pool, but instead of a government payer (ie Medicaid) everyone gets to select a private insurance plan at something like the ACA bronze level. Individuals can optionally purchase added coverage from their insurance provider. There are still class differences but they aren't as dramatic as a Medicaid vs private system.
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Enduro
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« Reply #8 on: December 15, 2015, 11:57:57 AM »

Option 1 because if one health care law sucks, there are 49 others to choose from.
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DavidB.
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« Reply #9 on: December 19, 2015, 06:56:22 PM »

Option 5, because poor people should get good healthcare too.
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Goldwater
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« Reply #10 on: December 19, 2015, 07:11:06 PM »

I'm not quite sure where I stand on the issue at this point. I kind of like the idea Muon brought up.
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pho
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« Reply #11 on: December 23, 2015, 10:56:26 PM »

I would replace the entirety of the safety net with a cash grant of equal value for every citizen (to be phased out after certain income levels), part of which could be used to fund private health insurance if the recipient decides to do so—I would abolish the individual mandate.
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« Reply #12 on: December 24, 2015, 09:47:47 AM »

It's a privilege so keep it for the wealthy!  What do you Democrats have to say to that?

Seriously I said expand Medicaid which was all we needed to do. Anything else is a scam.
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Frodo
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« Reply #13 on: December 24, 2015, 08:08:35 PM »

Federalize Medicaid, first and foremost.   
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« Reply #14 on: December 24, 2015, 10:37:19 PM »

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Hillary pays minimum wage
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« Reply #15 on: December 25, 2015, 03:02:25 AM »

Federalize Medicaid, first and foremost.   

details or is it something you heard from Bernie Sanders?
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Kingpoleon
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« Reply #16 on: December 29, 2015, 09:27:10 PM »

Other: Eliminate the mandate, eliminate the advisory board,nallow health insurance companies to compete across state lines, allow people to keep their current plan, and full government subsidies in the healthcare system for both Part A + B. Companies will be allowed to keep their plans, people will be provided a government agent who asks or advises them on a healthcare outline that they want, and the agent negotiates deals with the companies on the price of the various things the client wants. A HHS Department will be assigned a region of a state/state, a budget for agents, and a budget for deals with a rainy day fund. An Inspector General of HHS will make sure the Departments prioritize efficiency and fairness in spending.
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« Reply #17 on: December 30, 2015, 08:47:13 AM »

I haven't really heard a compelling argument for why sales of insurance across state lines wouldn't result in a regulatory race to the bottom as happened with credit cards.
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Kingpoleon
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« Reply #18 on: December 31, 2015, 02:26:50 PM »

I haven't really heard a compelling argument for why sales of insurance across state lines wouldn't result in a regulatory race to the bottom as happened with credit cards.
Usually the states will compete to have better healthcare rather than any regulation. Any undue regulation can easily be prevented by so called "corporate interests", and those that do pass would hopefully stabilize the healthcare financial sector. Besides which, it allows for national health insurance unions to be able to nationally cooperate workers's strike.
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Famous Mortimer
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« Reply #19 on: January 01, 2016, 03:52:07 PM »

I know Republicans usually love to point out that health care services and health insurance aren't the same thing. They would do well to remember that though when advocating for competition across state lines.

Interstate competition won't isn't going to result in better health care services, it's going to result in "better" (cheaper) health care insurance.

Under such a system, it won't really make a difference that 100% of the people have crappy coverage, if they still can't afford treatment because of super high co-pays and deductibles.
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Mr. Smith
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« Reply #20 on: January 01, 2016, 05:41:41 PM »

Opt. 5, something that should've happened as far back as Teddy for crying out loud!
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Marokai Backbeat
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« Reply #21 on: January 01, 2016, 05:56:36 PM »

Just to bring up a random hobby horse: The botched implementation of electronic medical records - which remain expensive, laborious to implement, difficult to use, and in many cases unable to communicate with each other - is one of the biggest domestic policy missteps of Obama's presidency, yet hardly anyone who works outside of health care talks about it.

My mother worked at a hospital for awhile and was in charge of this process for her particular office. She basically described the transition as a total nightmare. Incredibly time consuming, required far more training to navigate, almost completely pointless in the long run, and whenever there was any issue with the computer system, which was a fairly common occurrence, all records just got stuck in the ether. I never understood it.
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« Reply #22 on: January 01, 2016, 06:10:51 PM »

Well, at its heart, healthcare should be a basic human right, available to all persons on earth. From what I know there is no scientific or technological reason why that should not be the case already - it's merely a matter of logistics and political will.

WARNING UK SPECIFIC

I would reverse partial privatisation, agency staffing, consultants and managerial corporatisation (NHS Commissioning Board, Moniter etc.) that are essentially interesting (yet costly!) failed experiment at best. Create a well-funded non-profit pharma company under public (in a matter of speaking) hands, that will be (less) free of the shenanigans that go on under private care (obviously new public behemoths should be avoided, but ... ). That would free up funding for the many diseases that are chronically underinvested in, and allow private pharma companies to focus on the stuff they prefer to study for).

 There is a lot of legislation you also need around the regulation of medical studies - existing regulation from journals and university boards are weak and fail all the time.) Oh yeah and replace drug patents with a reward system, taking a huge wedge out of the cost of drug procurement, a rare interesting idea proposed by Bernie Sanders.

Smaller healthcare providers (dentists, clinics etc.) should be given incentives to form cooperatives. All essential medicine should be free at point of use (dentristry, social care, optics, prescriptions  and mental health included); I have largely soured on means-testing in any capacity in the health service.  Phase out PFI; and any debts incurred from that should be audited and centralised under the Treasury. Reintroduce elected Community Health councils to replace the trusts. They should be half elected by people, half by NHS employees.

Appropriate public and holistic measures should be taken to eliminate (or at least, reduce) preventable death (via action on pollution, crappy food, poor work conditions etc.), but not in manner that is overly punitive. (I'm sorry but 46397637% taxes on tobacco is just lazy and shortsighted garbage + people who propose "fat people taxes" know jack about anything.) People at the end of their lives should be allowed to depart in dignity (One of the few times I have been visually angry at someone for their political views is when somebody framed spending money on helping the elderly and dying as "inefficient" under utilitarian grounds. ugh.). Replace loans with grants for nursing degrees (it literally pays for itself, which is one of the reasons I rag on so-called fiscal conservatives so much) to increase nursestaff.

As for the individual model used by individual trusts? The "Southcentral Solution" ( http://www.kingsfund.org.uk/publications/commissioned/intentional-whole-health-system-redesign-nuka-southcentral ) has been recommended to me a couple of times, and seems like a good step. Obviously each region needs its own model - models successful in location X can fail drastically in Y. That's why, err, the staff need to be able to manage themselves rather than a mixture of shiny young finance shltheads and doddery bureaucrats from DH.

that's some basic thoughts, and I'm sorry it got very UK focused at parts.

@Averoes, bureaucracies (whether public or private, and especially when the two interact) are incapable of managing IT, for some reason.
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Potus
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« Reply #23 on: January 01, 2016, 07:10:06 PM »

There are two huge distortions in the US healthcare system: employer subsidies for health insurance and having a sizable chunk of the working age population insured by a disastrously managed, low quality health insurance program operated by a bureaucratic mess of state and federal agencies (Medicaid).

Medicaid in its current form creates a very vicious cycle. In West Virginia, medicaid reimburses at about 50 cents on the dollar and many hundreds of thousands of people are insured by it. The patient mix for a lot of these rural hospitals tends to be like 80% government payer, 15% commercial payer, 5% self payer. However, Medicaid accounts for something like 60-70% of the government payments. Taking the 50% reimbursement number, you're looking at 26% of all Medicaid bills going unpaid. That doesn't include the price controls put in place by PEIA and Medicare.

The public insurance programs pass off these exorbitant costs to the remaining 20% of hospital customers. That's why paying your own way in the healthcare system is untenable for a very large majority of the people. That also inflates the cost of private insurance very dramatically.  Government-insured patient costs are put on the private insurer, which is passed off in the form of higher deductibles and higher premiums.

This "passing off" effect costs the government more money when it comes to tax season. Higher premiums means that employers spend more on healthcare leading to a larger tax exemption. As spending on healthcare for employees increases, it crowds out wage increases for workers. I haven't done much research to back this up but a well-reasoned hunch says that healthcare inflation plays a dominant role in wage stagnation for most workers.

The means by which single payer is supposed to reduce healthcare spending is by setting prices, which advocates call "negotiating," lower than what existing insurers set them at. We already have a huge amount of price setting being done by, in my state, 80% of payers. I actually think public employee insurance is counted as employer insurance and therefore it's part of the 15%.

The price controls fail to constrain spending growth. This alone creates a pretty clear indictment of Sanderscare. The United States's incredible healthcare inflation problem is not the fault of private insurance, though something should be said about the over-utilization of healthcare that comes with a health insurance model of care.
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Famous Mortimer
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« Reply #24 on: January 02, 2016, 01:13:14 AM »

The problem with American healthcare is not that Medicaid pays $10 for a box of tissues when an insurance company pays $15. It's that a box of tissues at a hospital is $15 in the first place.
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