We can never have single payer till we get corporate money out of politics. The big and corrupt donors will not let us. We all want it, except for the millionaires making money from our cobbled together plan. It is a joke to have endless discussions when we are not free to have the best option. How did the other 11 countries get single payer which spends far less per patient than we do, how did they manage it? Do our representatives in Congress have the guts to throw off corruption? You can tell this by who is really fighting for single payer and who says we are not quite ready for it yet! HA!
6
It sounds so admirable, the bipartisanship. Both sides get sizable contributions from insurance lobbyists. No mention of crazy drug prices, the outrageous prices hospitals charge for occupying a bed overnight, how the ER sends you out with crutches and a knee brace for eight hundred dollars when you could order them on Amazon for a quarter of that price. How X-rays cost hundreds of dollars and CT scans thousands when the real cost is roughly one tenth of that, including the radiologist's interpretation. Why an intravenous infusion of normal saline solution, basically sterile water, costs a hundred dollars when the materials and labor don't run more than twenty. How getting five stitches in the ER results in a bill of a thousand dollars when the doctor gets paid a hundred bucks for their time and then they bill you again to have them removed! How 650 mg of Tylenol costs less than a dollar if you buy it yourself over the counter but because a RN gave it to you with a cup of water in a Dixie cup, the hospital bills you fifty dollars.
Once again an Op-Ed in the NYT about health care reform that lacks the guts to mention what every other Western democratic country figured out decades ago- socialized (that word that's a synonym for filthy parasitic unpatriotic for half the population in this country) single payer health care.
Once again an Op-Ed in the NYT about health care reform that lacks the guts to mention what every other Western democratic country figured out decades ago- socialized (that word that's a synonym for filthy parasitic unpatriotic for half the population in this country) single payer health care.
10
I'm taking you at your word and so commend you for forming this coalition with the aim of treating cooperation and compromise as respectful ways to serve our country. We've had, and still have too much focus on serving the party. I'm wishing you great success and hope you'll also please focus in on pharmaceutical costs, and a clear standard menu of patient costs as most important ways to help lower costs and provide wider care.
2
There is a best way to cut health insurance costs - A not for profit, single payer, national health insurer.
No, not Medicare for All! Medicare has been hopelessly compromised over decades. Medicare is more efficient at providing profits to 3rd party claims managers and Medicare Advantage Plans than providing benefits.
Medicare uses mechanisms that transfer health insurance risks to caregivers: Physicians, Hospitals, Nursing Homes, and Home Health Agencies. These providers become their patients' small, inefficient health insurers. Forget the ethics. The math doesn't work. The math doesn't justify more than 1,000 health insurers either (See "Standard Errors: Our Failing Health Care (Finance) Systems and How to Fix Them" www.standarderrors.org).
Small insurers are inherently inefficient. Large health insurers are inherently efficient. Small insurers tend to have very extreme results: Very high or very low loss ratios. This leads to excessive profits or crippling losses far more often than for large insurers.
This is wasteful. Excessive profits line the pockets of executives or stockholders rather than buying health care services. Excessive losses can't be paid, so these insurers fail, socializing their lossses to policyholders through higher premiums.
A not for profit, single payer, national health insurer would have loss ratios very close to expected every year. and can offer far higher benefits, at far lower cost than any collection of 2, or more, health insurers
No, not Medicare for All! Medicare has been hopelessly compromised over decades. Medicare is more efficient at providing profits to 3rd party claims managers and Medicare Advantage Plans than providing benefits.
Medicare uses mechanisms that transfer health insurance risks to caregivers: Physicians, Hospitals, Nursing Homes, and Home Health Agencies. These providers become their patients' small, inefficient health insurers. Forget the ethics. The math doesn't work. The math doesn't justify more than 1,000 health insurers either (See "Standard Errors: Our Failing Health Care (Finance) Systems and How to Fix Them" www.standarderrors.org).
Small insurers are inherently inefficient. Large health insurers are inherently efficient. Small insurers tend to have very extreme results: Very high or very low loss ratios. This leads to excessive profits or crippling losses far more often than for large insurers.
This is wasteful. Excessive profits line the pockets of executives or stockholders rather than buying health care services. Excessive losses can't be paid, so these insurers fail, socializing their lossses to policyholders through higher premiums.
A not for profit, single payer, national health insurer would have loss ratios very close to expected every year. and can offer far higher benefits, at far lower cost than any collection of 2, or more, health insurers
3
Your concern isn't with medical coverage for the people but with bipartisan reelection.
4
Republicans want to repeal it, Democrats want to preserve it - so we can figure something in between - we'll just damage it and confuse the situation somewhat - enough damage and confusion to satisfy the Republicans, but not enough to destroy the system altogether - so the Republicans can take credit for the fact that something is still working, sort of. And blame everything on the Democrats.
Well, they will act to prevent Trump from destroying the system altogether in one swoop, by refusing to pay for it. But they will apparently allow him to undermine it by refusing to advertise and facilitate participation - and he can probably think of other weak points to attack.
Other than that, they will permit unregulated low-budget insurance scams, I mean "plans" being marketed from state to state - and they will relieve the medical equipment industry of some taxes.
And a few other adjustments. Maybe we can survive this and reconstruct a better system later, but I'm afraid that one benefit to the Republicans will be that - with their enforcer Trump holding a gun on us - they will be able to look like they are working in a nice bipartisan manner. Nice healthcare plan you have here. Wouldn't want anything to happen to it.
Well, they will act to prevent Trump from destroying the system altogether in one swoop, by refusing to pay for it. But they will apparently allow him to undermine it by refusing to advertise and facilitate participation - and he can probably think of other weak points to attack.
Other than that, they will permit unregulated low-budget insurance scams, I mean "plans" being marketed from state to state - and they will relieve the medical equipment industry of some taxes.
And a few other adjustments. Maybe we can survive this and reconstruct a better system later, but I'm afraid that one benefit to the Republicans will be that - with their enforcer Trump holding a gun on us - they will be able to look like they are working in a nice bipartisan manner. Nice healthcare plan you have here. Wouldn't want anything to happen to it.
1
Democrats should demand that GOP leadership begin Trump removal and impeachment proceedings before negotiating anything. In all seriousness, any negotiation should be a non-starter without Trump being removed first. The Democrats would be misplaying their hand with anything less.
No, unfortunately, Repubs CAN'T agree.
A sensible place to start fixing our health care system.
Working together....now there's a concept!!
More duct tape and bailing wire.
Just to keep the money spigot open to the Insur./Pharma/Medi. industries.
Scrap this multi trillion dollar miscarriage and give us the working models that all other 1st world nations have. Single Payer/Medicare for all.
Until that model goes into effect, we are just kicking the can. The people of America are getting ripped off.
Thanks I suppose for working hard to negotiate for us, how much care to allow the citizens of the most wealthy nation the world has ever known. I'm sure it would be worse under TrumpCare.
Question, do you guys use Direct Deposit or is it brown paper bags and junkets to vacation spots around the globe? Do the lobbyist sit in on your discussions?
Hope the Dem.'s are aware to begin all negotiations from the left, rather than being the "so called" adult and meet them right of center, as seems to be the accepted manner for the last...30+years.
Will be an eye-opener for sure what is birthed this time around. Sad when their are perfectly good plans ready and waiting for adoption.
Just to keep the money spigot open to the Insur./Pharma/Medi. industries.
Scrap this multi trillion dollar miscarriage and give us the working models that all other 1st world nations have. Single Payer/Medicare for all.
Until that model goes into effect, we are just kicking the can. The people of America are getting ripped off.
Thanks I suppose for working hard to negotiate for us, how much care to allow the citizens of the most wealthy nation the world has ever known. I'm sure it would be worse under TrumpCare.
Question, do you guys use Direct Deposit or is it brown paper bags and junkets to vacation spots around the globe? Do the lobbyist sit in on your discussions?
Hope the Dem.'s are aware to begin all negotiations from the left, rather than being the "so called" adult and meet them right of center, as seems to be the accepted manner for the last...30+years.
Will be an eye-opener for sure what is birthed this time around. Sad when their are perfectly good plans ready and waiting for adoption.
1
Recalling that 8 years ago Sen Mitch McConnell joined the "gang of eight" that was to bring a bipartisan effort to draft what became the ACA, and then boasted that he participated only for the purpose of sabotaging the effort, one can't help but look for a Trojan horse in any proposal or gesture from a member of the GOP that has a veneer of reasonableness. Not having the expertise to parse every nuance, I am still concerned about any move to allow health insurance companies to conduct business across state lines. Doesn't this really mean that they will not be subject to state regulation, which includes capitalization requirements? And, if there are no federal regulations to replace state requirements, then what? Sounds to me like one more GOP dream of "free market" principles (that Democrats have too often embraced) that will slip through, only to see the market become consolidated and shrink in numbers, just as happened with the deregulation of banking and the airline industry, to name two examples. So, just like "reform" of Medicaid being a now exposed tax cut for the wealthy, the supposedly innocent "reform" of removing health insurance from state regulation may well be a subterfuge to create another segment of the insurance industry, and with it the financial sector, that will become concentrated, consolidated, uncompetitive, and, ultimately, consist of several entities that are "too big to fail" when the next financial crisis hits.
4
aren't you still talking about insurance and not actual healthcare? the overwhelming importance of money, compared to actual health care and outcomes, dooms this effort from the start.
healthcare is not a profit making business, like underwear manufacturing. it isn't supposed to make a very few very rich. it is supposed to result in a healthier, more secure population.
healthcare is not a profit making business, like underwear manufacturing. it isn't supposed to make a very few very rich. it is supposed to result in a healthier, more secure population.
2
a health care marketplace...
There's your problem.
You write about health insurance not health care. You're making plans to subsidize a useless industry rather than provide care to people who need it.
Healthcare/health insurance is not a marketplace.
There's no way to compare prices or quality of service. You passed legislation that makes it impossible.
In most areas of the country there is no choice. Any other business would call it a monopoly.
You argue, out of both sides of your mouth, that large companies will continue to offer health insurance while also arguing that any regulation on company health insurance is a mortal sin against the market.
You moan about the burden of health care, a drag on the economy, and ignore that every other advanced nation has freed their corporations from those costs.
You plead for support saying that somebody has to do something. You couldn't be more wrong. As you know, if anyone does anything there will be no chance for decades to examine our health care system. You'll throw up your hands and say "We handled that".
If you are as responsible as you pretend, you have no choice but to consider and debate and accept comments about the benefits and costs of a legitimate single payer system.
It'll be a partisan issue, with name-calling and insinuations of socialism or communist leanings. You need the courage to go through it.
Otherwise you have no chance of accomplishing anything meaningful. Another can kicked down the road.
There's your problem.
You write about health insurance not health care. You're making plans to subsidize a useless industry rather than provide care to people who need it.
Healthcare/health insurance is not a marketplace.
There's no way to compare prices or quality of service. You passed legislation that makes it impossible.
In most areas of the country there is no choice. Any other business would call it a monopoly.
You argue, out of both sides of your mouth, that large companies will continue to offer health insurance while also arguing that any regulation on company health insurance is a mortal sin against the market.
You moan about the burden of health care, a drag on the economy, and ignore that every other advanced nation has freed their corporations from those costs.
You plead for support saying that somebody has to do something. You couldn't be more wrong. As you know, if anyone does anything there will be no chance for decades to examine our health care system. You'll throw up your hands and say "We handled that".
If you are as responsible as you pretend, you have no choice but to consider and debate and accept comments about the benefits and costs of a legitimate single payer system.
It'll be a partisan issue, with name-calling and insinuations of socialism or communist leanings. You need the courage to go through it.
Otherwise you have no chance of accomplishing anything meaningful. Another can kicked down the road.
2
Cooperation is a blessing and can only come out well. Keep it up!
Yes, just do it! Then let's move to Medicare for all as quickly as possible. It is not just unconscionable to refuse to fix the problems with the ACA--it is cruel.
2
Thank you for making the effort. If you can actually be successful in convincing your colleagues to adopt, I will fall down in a dead faint.
This is a wrong solution for the problem. We need to move our country from relying on business as a source of healthcare. That ends up creating one pool from better off healthy people and another will less well off, sicker or older people. We need to directly address costs through price controls.
I find the debate over medical care to be just hot air. More a debate between loyal party members then problem solution. For me the answer to the problem is realliy very simple. AE SPEND BILLIONS ON EVERYTHING BUT HEALTHCARE. All we would have to do is pay the medical bills of the folks in
the USA and subtract the dollars from a number of other areas. Foolhardy you say. Since when is building a bridge to nowhere more important than health.
Let's get our priorities straight and live better.
the USA and subtract the dollars from a number of other areas. Foolhardy you say. Since when is building a bridge to nowhere more important than health.
Let's get our priorities straight and live better.
why aren't the writers considering the LOOMING obvious :
so many big & small industrial countries have SUCCESSFULY SOLVED their heath care issues. WHY doesn't anyone ( including the writers) even mentioning that ?!
so many big & small industrial countries have SUCCESSFULY SOLVED their heath care issues. WHY doesn't anyone ( including the writers) even mentioning that ?!
3
I would also start to review hospital practices in large metropolitan areas.
In the hospital where i work every patient over the age of 40 admitted with "syncope" (fainting) goes to medical ICU, gets CT head, echo, holter, carotid doppler (in spite of the fact that the carotid artery has nothing to do with loss of consciousness), cardiology and neurology consult. If over the age of 70 and "frail" a palliative care and geriatric consult is added.
Patients get in for "stroke": the stroke machine starts, same as above, plus CTA. MRA, MRI. Whether patient had a stroke or not is irrelevant, physical exam is obsolete, diagnostic skills gone.
Patients in persistent vegetative state are treated aggressively (fancy antibiotics, scans , hemodialysis etc, in spite of the fact that they have no prognosis for waking up). The rationale (excuse) is "family wants everything to be done"
Not to talk about "heroic" treatments at end of life.
"Coders" massage the diagnoses, revenues increase.
The hospital CEOs, CFOs, CIOs, CTOs are all physicians
That is what we have become
Shame on us
In the hospital where i work every patient over the age of 40 admitted with "syncope" (fainting) goes to medical ICU, gets CT head, echo, holter, carotid doppler (in spite of the fact that the carotid artery has nothing to do with loss of consciousness), cardiology and neurology consult. If over the age of 70 and "frail" a palliative care and geriatric consult is added.
Patients get in for "stroke": the stroke machine starts, same as above, plus CTA. MRA, MRI. Whether patient had a stroke or not is irrelevant, physical exam is obsolete, diagnostic skills gone.
Patients in persistent vegetative state are treated aggressively (fancy antibiotics, scans , hemodialysis etc, in spite of the fact that they have no prognosis for waking up). The rationale (excuse) is "family wants everything to be done"
Not to talk about "heroic" treatments at end of life.
"Coders" massage the diagnoses, revenues increase.
The hospital CEOs, CFOs, CIOs, CTOs are all physicians
That is what we have become
Shame on us
2
It is so unbelievably refreshing to read something calm and realistic on this issue. There's been nothing but hype and fear-mongering for literally years. I hope this group is able to pass some legislation if only to prove that our system of government is not actually a complete failure. It's a small step but a step in the right direction.
My only quibble with the article is where it describes the stalemate in DC as "Republicans trying to repeal the current health care law, Democrats trying to preserve it and neither side willing to discuss anything in between." I get that this is a bipartisan approach and you have to say things that make everyone feel good. But Democrats haven't refused to discuss anything in between, they have been trying to talk about fixing Obamacare for years; it's just been inaudible beneath the repeal and replace hoopla. I'll overlook that, though, and congratulate everyone on the Problem Solvers Caucus for starting from the nowadays-novel position that compromise is how we move forward.
My only quibble with the article is where it describes the stalemate in DC as "Republicans trying to repeal the current health care law, Democrats trying to preserve it and neither side willing to discuss anything in between." I get that this is a bipartisan approach and you have to say things that make everyone feel good. But Democrats haven't refused to discuss anything in between, they have been trying to talk about fixing Obamacare for years; it's just been inaudible beneath the repeal and replace hoopla. I'll overlook that, though, and congratulate everyone on the Problem Solvers Caucus for starting from the nowadays-novel position that compromise is how we move forward.
3
Look, I fully agree with the comments recommending single payer, Medicare for all, public option - it's what any rational, thinking person would want. 34 of the 35 OECD countries provide some form of universal healthcare; 58 countries provide some form of universal healthcare. We spend almost 18% of our GDP (the world's largest in nominal value) on healthcare - generally double or triple the % of GDP most countries spend for universal healthcare. We spend more per capita GDP, in total dollars per person, more on just public healthcare (Medicare, Medicaid, VA) than most countries spend on their entire universal healthcare and then spend almost an additional equal amount on private healthcare, and get worse public health outcomes than most countries: it's insane. While Medicare for all would be better, it would also have an affordablity issue. There are many variations of universal healthcare to choose from. But we didn't have the votes in 2008 with a Democratic President, House and Senate to get universal healthcare. How are we going to get there with a Republican/insane/incompetent President, House and Senate? For now, we need to focus on and support a bipartisan fix like the one proposed in this op-ed. It's an ugly solution, but it's the best we can do for now - and an immediate and interim solution is indeed needed. We have to change the political reality in 2018, 2020 and beyond.
3
Firstly, we do not have a 'system,' we have a 'situation.' Employer based health insurance is an accident of history in the 1950's; expensive technology and drugs did not exist and a single employer for life was the norm. Now, instead of insurance, we need a healthcare delivery 'system.' There is no future in having doctor and patient make expensive decisions based on personal preference with no regard or knowledge of the cost incurred, or the positive or negative benefit on the health of the patient. Having practiced since the late 1970's, I can say confidently that patients tend to want more, not less. Because doctors get paid for doing more, there is a strong tendency to provide what the patient wants, provided the potential for harm is perceived as relatively low. We need a 'system,' based on objective knowledge of outcomes, and which conforms to guidelines based on knowledge of outcomes. We cannot get there with the current situation, with 10's of millions of patient's are seeing a million doctors daily, making isolated healthcare management decisions without regard to cost or benefit. There are healthcare models that do work, but they are 'systems,' e.g., Kaiser Permanente, and they do involve adherence to clinical guidelines. Sixty years ago, the diagnostic and treatment choices were limited, cheap and frequently ineffective. Today the armamentarium is extensive, expensive and potent. We need to use it selectively, only achievable with a system.
6
Single payer is an admirable goal, but you still have to actually get to the point where that's actually a viable outcome, you can't just expect the government to wave a magic wand and instantly go from a for profit insurance driven model to a government run single payer model. Think of Single Payer as being like the final boss in a video game, you want to get to it eventually but before that there are a lot of other goals you have to achieve, like you have to beat the other dungeon bosses (various things that drive up health care costs), do side quests (get doctors and other groups on board with the idea of reducing their income for the common good) and tackle the optional boss of out of control med school prices that are only compensated for by the fact that doctors in the US charge a lot more than they'd be able to under single payer.
1
And the pharmaceutical industry, the big hospitals, and so on. Maybe if we had a big central agency that was making all the payments, we'd be in a better position to negotiate and deal with those other issues. But as you say, how do we get there? Maybe with popular backing, it could be a step by step expansion of medicare - together with step by step adjustments of med school rates, and so on. A long row to hoe.
one sure thing the politicians will not do is to take all the money that goes to the health insurance companies and their highly paid CEO's. the reason is because some of that money ends up in the pockets of the politicians(legally of course). i doubt that the end user cares whether they have a dispute with the government or an insurance company about coverage for specific care. i am on medicare myself and have never had a problem. this is because regular medicare is single payer.
I applaud the efforts and forward thinking of the 43-member House Problem Solvers Caucus. And I cry over the comments, dare I say mindless comments, of readers who greet this rare good news with their own extreme prescriptions to cure the ailing American body. That's not point of this excellent essay. Healthcare in America is the rampaging herd of elephants in our backyard and it won't be readily or soon reigned in. Rational, measured, bipartisan agreement is vital to finding a cure and this is potentially the beginnings of a new era. Welcome it, nature it, campaign for it. Don't stifle and crush it with your own personal wishes, however practical they may seem.
Parenthetically, single-payer is my first choice. This American citizen enjoys that system here in New Zealand, bolstered as many locals do by affordable supplementary private insurance. And yet I have news for single-payer advocates. Rare diseases, expensive new drugs and other advanced technology are often beyond the grasp of single-payer and consequently some sufferers are left with few, if any choices. That, unfortunately, is life.
Parenthetically, single-payer is my first choice. This American citizen enjoys that system here in New Zealand, bolstered as many locals do by affordable supplementary private insurance. And yet I have news for single-payer advocates. Rare diseases, expensive new drugs and other advanced technology are often beyond the grasp of single-payer and consequently some sufferers are left with few, if any choices. That, unfortunately, is life.
4
Please!
Single payer universal coverage. Medicaid for all.
Reduce the military budget, increase taxes on teh weatlhy (even Steve Bannon is promoting that) and pay for comprehensive coverage for everyone. You will be shocked at the reduction in the level of anxiety and fear in this country if you do that.
Single payer universal coverage. Medicaid for all.
Reduce the military budget, increase taxes on teh weatlhy (even Steve Bannon is promoting that) and pay for comprehensive coverage for everyone. You will be shocked at the reduction in the level of anxiety and fear in this country if you do that.
1
A couple of problems:
(1) " It ... defines “full time” as a 40-hour workweek to discourage businesses from manipulating employees’ weekly hours to skirt the mandate. " This actually makes it easier to skirt the mandate. Before ERISA, "full time" was defined as 40 hours for determining pension plan eligibility; I saw several companies whose standard work week for low-paid salaried staff was 37 1/2 hours per week so that they would be ineligible for the pension plan.. ERISA changed the requirement to 1000 hours per year (roughly 20 hours/wk); no one was going to make a significant portion of their staff half-time just to avoid a mandate. However, reducing a work day from 8 hours to 7 1/2 (perhaps without reducing the pay) is too easy.
(2) "our plan eliminates the Medical Device Tax, an excise charge of 2.3 percent that is often passed onto consumers and reduces funds for research and development." If it is passed on to consumers, the funds are still available for R&D.
(3) "we provide states with additional flexibility to enter into agreements — such as enabling the sale of insurance across state lines — that would provide more choice and lower costs." For individual policies, there are only three ways to lower costs:
> reduce the charges for the specific services covered
> increase the portion of the cost paid by the insured
> reduce the services that the policy will cover
The first is not happening; the second and third are both bad for the policyholder.
(1) " It ... defines “full time” as a 40-hour workweek to discourage businesses from manipulating employees’ weekly hours to skirt the mandate. " This actually makes it easier to skirt the mandate. Before ERISA, "full time" was defined as 40 hours for determining pension plan eligibility; I saw several companies whose standard work week for low-paid salaried staff was 37 1/2 hours per week so that they would be ineligible for the pension plan.. ERISA changed the requirement to 1000 hours per year (roughly 20 hours/wk); no one was going to make a significant portion of their staff half-time just to avoid a mandate. However, reducing a work day from 8 hours to 7 1/2 (perhaps without reducing the pay) is too easy.
(2) "our plan eliminates the Medical Device Tax, an excise charge of 2.3 percent that is often passed onto consumers and reduces funds for research and development." If it is passed on to consumers, the funds are still available for R&D.
(3) "we provide states with additional flexibility to enter into agreements — such as enabling the sale of insurance across state lines — that would provide more choice and lower costs." For individual policies, there are only three ways to lower costs:
> reduce the charges for the specific services covered
> increase the portion of the cost paid by the insured
> reduce the services that the policy will cover
The first is not happening; the second and third are both bad for the policyholder.
3
Good opinions in this article and in the comments section. But we never really reach the point where the solution "wraps it all up - closes all the loose ends."
There does not seem to be a clear objective. I suggest two: PROFIT or PEOPLE.
All the solutions up to this time have focused on PROFIT. If the focus was on PEOPLE then the people's needs would come first and all other aspects, including the money side, would be added in to complete the program.
People would pay their share; doctors would adjust to new realities; insurance would compete to meet new requirements - but the PEOPLE'S NEED would be driving the program - not PROFIT!
There does not seem to be a clear objective. I suggest two: PROFIT or PEOPLE.
All the solutions up to this time have focused on PROFIT. If the focus was on PEOPLE then the people's needs would come first and all other aspects, including the money side, would be added in to complete the program.
People would pay their share; doctors would adjust to new realities; insurance would compete to meet new requirements - but the PEOPLE'S NEED would be driving the program - not PROFIT!
2
The two are not necessarily mutually exclusive. Without profit of some kind, those with the capital to invest have only philanthropy as a motive. Profit is only useless as a motive if you subscribe to the idea that economics is a zero-sum game.
Certainly the pursuit of profit without the counterbalance of informed consumer choice and industry competition is as dangerous and destructive as we believe it is. But when balanced by market forces that are upheld and enforced by smart application of government, we can restore Capitalism in our country into the productive force for good that it used to be.
Certainly the pursuit of profit without the counterbalance of informed consumer choice and industry competition is as dangerous and destructive as we believe it is. But when balanced by market forces that are upheld and enforced by smart application of government, we can restore Capitalism in our country into the productive force for good that it used to be.
It is always about cutting taxes.
The citizens of this country can have everything they want- but only if it isn't paid for.
The citizens of this country can have everything they want- but only if it isn't paid for.
I am glad that there is a part of Congress that is working together to bring solutions to problems rather than winning through pain of voting public. Although I have insurance from my workplace, and I might pay more, I am glad that Obamacare made insurance available to the most needy amongst us. I never want to push these people off the health insurance they have now. I read Mr. Trump's childish sulking comments about killing ACA with dread. So any reasonable solution that you collaboratively produce to stabilize exchanges is very wise. Again I am glad that the Congress is acting in this case as it was designed to act. My full support for your efforts and best of luck.
4
At bottom, this problem comes down to the astronomical costs of medical care. These are out of control, and I would hope that a single payer system could deal with this issue. We all hate insurance companies, but they are in business to make money. They are not here to help us. This is a basic flaw in the system.
These high costs demand that the insurance companies raise their rates, and all of these elaborate plans to make this system work will always be flawed because of these costs and the fact that it is costing the insurance companies more to pay for our care.
Going to a single payer program would eliminate many of these issues. Health care providers, from hospitals to physicians to device manufacturers, would have to focus on actual health care, not the bottom line.
Here is an example of the problem: a few weeks ago I spent 6 hours in the ER, had a few tests, some medication and 2 bags of IV fluids. The bill was over $15,000. That we have to fix along with the insurance.
These high costs demand that the insurance companies raise their rates, and all of these elaborate plans to make this system work will always be flawed because of these costs and the fact that it is costing the insurance companies more to pay for our care.
Going to a single payer program would eliminate many of these issues. Health care providers, from hospitals to physicians to device manufacturers, would have to focus on actual health care, not the bottom line.
Here is an example of the problem: a few weeks ago I spent 6 hours in the ER, had a few tests, some medication and 2 bags of IV fluids. The bill was over $15,000. That we have to fix along with the insurance.
5
The fundamental flaw is not that insursnce companies want to make money. When government implements a system, it is subject to just as much loss through inefficiency, fraud, waste and abuse as a capitalist system loses to corporate profits.
The flaw in our current system is that the pillars of market economics, being informed consumer choice and industry competition, are not being protected and enforced by the government under its designated role in a Capitalist system. Few individual consumers actually choose their own provider for insurance, and the companies are only competing for the business of the employers buying packages for their workers.
We ignore those dynamics today because they are so ubiquitous, but those are genuine corruptions of market economic principles that form the heart of the problems we see in today's healthcare marketplace. Government's role in the solution is to put the decision back into our hands.
If you want to improve access for the poor, you should implement those programs locally, where they are both easier to hold accountable, and more nimble to respond to the needs of citizens on an individual basis. "Small government" does not mean "no government"; it means using government at all levels for what government at each level does best.
The flaw in our current system is that the pillars of market economics, being informed consumer choice and industry competition, are not being protected and enforced by the government under its designated role in a Capitalist system. Few individual consumers actually choose their own provider for insurance, and the companies are only competing for the business of the employers buying packages for their workers.
We ignore those dynamics today because they are so ubiquitous, but those are genuine corruptions of market economic principles that form the heart of the problems we see in today's healthcare marketplace. Government's role in the solution is to put the decision back into our hands.
If you want to improve access for the poor, you should implement those programs locally, where they are both easier to hold accountable, and more nimble to respond to the needs of citizens on an individual basis. "Small government" does not mean "no government"; it means using government at all levels for what government at each level does best.
2
Single-payer is what the VA system is. Bureaucracy so deep that people die waiting to see a doctor and hospitals with mold growing on interior walls.
Single-payer is the International Red Cross reporting dangerous conditions in the British National Health Service known for letting the sick just starve blissfully to death because there aren't enough doctors.
Has anyone heard back from Sean Penn from his varied experiences in the Cuban medical system? Oh, that's right, he just said nice things then never trusted it. OK.
Single-payer is the International Red Cross reporting dangerous conditions in the British National Health Service known for letting the sick just starve blissfully to death because there aren't enough doctors.
Has anyone heard back from Sean Penn from his varied experiences in the Cuban medical system? Oh, that's right, he just said nice things then never trusted it. OK.
Oh come on, there health care does not exist in the magical "marketplace".
Congressmen,
God bless you all for understanding the truth that solving problems is not a team sport. Please allow this Texan to throw in his two cents to help solve the problems we face.
The one thing we should all agree on is that the market economic pillars of informed consumer choice and industry competition are the most effective tools to use, and that government's role should be to promote and protect informed consumer choice while enforcing that competition. The biggest source of our current problems is that government has either been trying to provide these services directly, or has forgotten it's role as referee and let the players run the game.
The long term solution is to out the ultimate choice for insurance back into the hands of the individual consumer. We all love our employer plans, but we should realize that having our employers make that choice is part of what is corrupting our free market, by taking ourselves out of the cycle of decision-making. This solution is little better than having the government choose, but we are scared of changing it.
The other problem was brushed on in the article. There is no such thing as "choice" paying for the thing that prevents your imminent death. Government does have a more vested role in helping to stabilize the market for catastrophic care, because elasticity of demand is nonexistent.
God bless you all for understanding the truth that solving problems is not a team sport. Please allow this Texan to throw in his two cents to help solve the problems we face.
The one thing we should all agree on is that the market economic pillars of informed consumer choice and industry competition are the most effective tools to use, and that government's role should be to promote and protect informed consumer choice while enforcing that competition. The biggest source of our current problems is that government has either been trying to provide these services directly, or has forgotten it's role as referee and let the players run the game.
The long term solution is to out the ultimate choice for insurance back into the hands of the individual consumer. We all love our employer plans, but we should realize that having our employers make that choice is part of what is corrupting our free market, by taking ourselves out of the cycle of decision-making. This solution is little better than having the government choose, but we are scared of changing it.
The other problem was brushed on in the article. There is no such thing as "choice" paying for the thing that prevents your imminent death. Government does have a more vested role in helping to stabilize the market for catastrophic care, because elasticity of demand is nonexistent.
3
The problem with individual choice in a free marketplace is that nobody has time to read 60 pages of small font policy from each of 5 insurance companies such that they can make a truly informed consumer choice. Instead most of us will be forced to decide based on a nice glossy 2 page (large font) brochure with pictures of beautiful nurses and smiling doctors. Markets do not work when the knowledge of sellers and buyers is hugely disproportionate – as it is in health care. If we want to continue to waste huge sums on sustaining a predatory for-profit health care system we need government to be closely regulating the predators and protect their prey.
3
Ivan,
Your point about the complexity of choice is very valid. That's why government rules that impose certain standards (such as coverage for pre-existing conditions) are valuable and useful mandates at the federal level are valuable. They prevent companies from diminishing informed choice by barring them from establishing overcomplicated terms and conditions for the exchange.
I'm a conservative, but that is one good point I believe the liberal side of the discussion brings to the table. It's those kinds of ideas that we should all be open-minded towards.
One thing my liberal friends should consider from the conservative side, is having state and local governments create subsidies to serve low income families instead of implementing it at the federal level. Not only are city and state governments easier for the individual citizen to hold accountable than federal programs, but they are more nimble and capable of responding to issues on an individual basis while operating on a balanced budget.
Thanks for contributing. I believe that both sides hold a piece of the solution here; we will need all of our ideas to solve the problems we face.
Your point about the complexity of choice is very valid. That's why government rules that impose certain standards (such as coverage for pre-existing conditions) are valuable and useful mandates at the federal level are valuable. They prevent companies from diminishing informed choice by barring them from establishing overcomplicated terms and conditions for the exchange.
I'm a conservative, but that is one good point I believe the liberal side of the discussion brings to the table. It's those kinds of ideas that we should all be open-minded towards.
One thing my liberal friends should consider from the conservative side, is having state and local governments create subsidies to serve low income families instead of implementing it at the federal level. Not only are city and state governments easier for the individual citizen to hold accountable than federal programs, but they are more nimble and capable of responding to issues on an individual basis while operating on a balanced budget.
Thanks for contributing. I believe that both sides hold a piece of the solution here; we will need all of our ideas to solve the problems we face.
Your solutions are the wrong ones, because they are not expanded Medicare/Medicaid or single payer.
But let's say we take you seriously: how can you justify your "unburdening of small business", which raises the threshold for a requirement to provide employer based insurance from 50 employees to 500, and redefines a "full time employee" up from 35 to 40 hours?
This is nothing but different bus to throw our citizens under, and a congressional endorsement for sizeable corporations (50 employees is big, brother) to continue to cheat and abuse their employees.
You didn't fix any problem, you just chose to throw a different few million people out of the health care system.
But let's say we take you seriously: how can you justify your "unburdening of small business", which raises the threshold for a requirement to provide employer based insurance from 50 employees to 500, and redefines a "full time employee" up from 35 to 40 hours?
This is nothing but different bus to throw our citizens under, and a congressional endorsement for sizeable corporations (50 employees is big, brother) to continue to cheat and abuse their employees.
You didn't fix any problem, you just chose to throw a different few million people out of the health care system.
6
Government's role is not to provide people with health care. It is to protect the informed choice of the consumer and enforce genuine competition between providers for that consumer choice.
If you want to provide money for the people who cannot afford it in your community, city or state, then you should go to your respective government officials at those levels and have them pass laws to take your tax dollars to do so.
Doing that at the federal level is harder for the individual taxpayer to hold accountable once authorized, as well as being less effective at making decisions on an individual basis, which is exactly what's needed for a charity-based system to be effective. Use the federal government for what it's good at, and use state and local governments for they do best. "Small government" does not mean government has no role.
Being generous with other peoples' money is no more virtuous than being selfish with your own, and creates as many problems as it hopes to solve.
If you want to provide money for the people who cannot afford it in your community, city or state, then you should go to your respective government officials at those levels and have them pass laws to take your tax dollars to do so.
Doing that at the federal level is harder for the individual taxpayer to hold accountable once authorized, as well as being less effective at making decisions on an individual basis, which is exactly what's needed for a charity-based system to be effective. Use the federal government for what it's good at, and use state and local governments for they do best. "Small government" does not mean government has no role.
Being generous with other peoples' money is no more virtuous than being selfish with your own, and creates as many problems as it hopes to solve.
1
where did you get this premise of government responsibility?
1
Suzanne Barlow, the original understanding came from a very informative and engaging political science course I took during my undergrad for my electrical engineering degree. It was based on the fundamental principle that the role of government, at its core, is to provide a peaceful means of resolving conflicts of interest between individuals and interest groups.
From there, my perspective was formed by a combination of my formal education in the areas of micro and macroeconomics and control systems engineering, my personal studies of history reading American history and the writings of our nation's founders, and my personal experience both as an employee of various countries, and in my adventures working for myself in various endeavors.
I would never assume that my perspective is perfect, and I always welcome the perspectives of my fellow citizens. If you have something to contribute to my understanding, I would love to hear it.
Thanks for asking.
From there, my perspective was formed by a combination of my formal education in the areas of micro and macroeconomics and control systems engineering, my personal studies of history reading American history and the writings of our nation's founders, and my personal experience both as an employee of various countries, and in my adventures working for myself in various endeavors.
I would never assume that my perspective is perfect, and I always welcome the perspectives of my fellow citizens. If you have something to contribute to my understanding, I would love to hear it.
Thanks for asking.
This is a terrific and timely proposal. I hope it passes quickly and puts this to rest until Trump is no longer President because for Mitchell McConnell and Donald Trump I believe their main objection really, is the name "Obamacare". The thought of Obama having a legacy equal to President Johnson for Medicare is as untenable to them as the whole idea of having an African-American in the White House was and the evidence is they used every dirty trick and lie they could to discredit the man.
4
Sounds to me like the Democrats are officially declaring the Bern and single payer totally extinguished and they are responsible for putting it out. Congratulations on selling out to corporate medical and turning your back on everyone else who's sick. Democrats and Wall Street . . . Like hand in glove.
5
I want a list of who is on this committee. Then I can respond by contacting my reps and senators.
2
In 1950 the USA spent less than 1/2% of the GDP for medical care.
Now US medical care costs are over 18% of the GDP, growing rapidly, and is predicted to be 20% in the next few years.
How much can this nation afford to spend on Medical Care before this nation becomes bankrupt?
I am a fiscal conservative, but I am now in favor of National Socialized healthcare, like the European “Nanny States,” rather than rely on local taxpayers to pay for healthcare for US citizens and illegal immigrants who are without health insurance.
US taxpayers are already paying for most of the nation’s healthcare right now. Local taxes create and support local free hospitals (ala our Harris County Hospital District taxes here in Houston, Texas) providing free medical care for the poor that cannot otherwise afford medical care or do not have insurance.
Free Medical Care seems to now be considered to be a government taxpayer provided right, like Freedom of Speech and the right to life, liberty and the pursuit of happiness!
Now US medical care costs are over 18% of the GDP, growing rapidly, and is predicted to be 20% in the next few years.
How much can this nation afford to spend on Medical Care before this nation becomes bankrupt?
I am a fiscal conservative, but I am now in favor of National Socialized healthcare, like the European “Nanny States,” rather than rely on local taxpayers to pay for healthcare for US citizens and illegal immigrants who are without health insurance.
US taxpayers are already paying for most of the nation’s healthcare right now. Local taxes create and support local free hospitals (ala our Harris County Hospital District taxes here in Houston, Texas) providing free medical care for the poor that cannot otherwise afford medical care or do not have insurance.
Free Medical Care seems to now be considered to be a government taxpayer provided right, like Freedom of Speech and the right to life, liberty and the pursuit of happiness!
8
Except only one of those rights imposes on others to provide it.
This is a small start but at least it is a start. I would add extra provisions that subsidies must continue to insurance companies for at least this year and a commitment going forward that bipartisan efforts to improve the ACA will continue.
Good luck getting the GOP to vote for this, especially in the House.
Good luck getting the GOP to vote for this, especially in the House.
1
It's easy:
single payer
High deductible (10,000)
Make overweight and obese pay 2x and 3x premiums
single payer
High deductible (10,000)
Make overweight and obese pay 2x and 3x premiums
1
Medicaid should provide basic benefits, palliative and preventive health care benefits. Private insurance can provide supplemental benefits, e.g., high deductible specialty coverage and additional coverage outside of what medicaid/medicare can cover. Maybe a travel option so that a patient might be able to choose to go to a different medical market to improve his chances of survival. This would be the step I would like to see.
Single payer for all. Funny those who make the suggestions need to get a better grip on what is out there and what isn't before they throw out their blanket. IE. access from state to state. Maybe it would be a good idea to listen to the users who use all of the types of health care out there and get a better opinion.
6
Again: just look at : GERMANY; FRANCE; ITALY; DENMARK; SWEDEN; SPAIN;
ISRAEL, THE UK - and many, many other countries.
get the basics of their solutions - apply it here.
ISRAEL, THE UK - and many, many other countries.
get the basics of their solutions - apply it here.
Single payer is the answer to our problems. It's disgraceful that we are the only developed country that doesn't have it. I'm with an HMO through which, so far, has suited me well, but before that, a high deductible plan with HSA - what a joke. Cigna is the worst! And before that, I was on COBRA plans and a plan with my partner through his work. Why must we suffer at the hands of the nincompoops in Washington? Give us what the elites in Washington have - thank you very much!
7
For goodness sake. Most of the comments seem to be unhappy that the problem solvers' caucus cannot right this minute fix the entire health care system. Think this through. The reason the healthcare system can't be changed right now is because of extremists. (If you are a D, you think the extremists are Rs; if you are an R, you think the extremists are Ds. But we all agree entrenched prejudices are the issue.)
These guys have come together to try to strengthen the middle, to make Congress a place where discussion and compromise is possible. If you want to rage at Congress, fair enough, but raging at the Problem Solvers' caucus is seriously misdirected anger. These guys are trying to reduce extremism - let's not vent our anger at extremists at those who are seriously trying to strengthen the middle.
And for the record, NO, OF COURSE NOT, no perfect solution can emerge immediately from a divided country. You may think the Rs or the Ds are idiots, selfish, dishonest, or agents of Darth Vader, but it doesn't matter - both Rs and Ds make up >45% of the country. Whether you are R or D, your perfect solution cannot be put in place as long as the country is relatively equally divided. Complaining that the problem solver's caucus isn't proposing single payer is silly. They are trying to deal with the FACT (like it or not) that the country is divided and trying to find ways to work with that division. Let's support them!
These guys have come together to try to strengthen the middle, to make Congress a place where discussion and compromise is possible. If you want to rage at Congress, fair enough, but raging at the Problem Solvers' caucus is seriously misdirected anger. These guys are trying to reduce extremism - let's not vent our anger at extremists at those who are seriously trying to strengthen the middle.
And for the record, NO, OF COURSE NOT, no perfect solution can emerge immediately from a divided country. You may think the Rs or the Ds are idiots, selfish, dishonest, or agents of Darth Vader, but it doesn't matter - both Rs and Ds make up >45% of the country. Whether you are R or D, your perfect solution cannot be put in place as long as the country is relatively equally divided. Complaining that the problem solver's caucus isn't proposing single payer is silly. They are trying to deal with the FACT (like it or not) that the country is divided and trying to find ways to work with that division. Let's support them!
6
“Incrementally” is a good word.
Reed? He's now jumping on the "why can't we all get along" bandwagon after years of egregious and smug obstructionism and the worst sort of tea party fanaticism?! Oh, please. Opportunism, thy name is Tom Reed.
I could show you all the inane boilerplate messages we have all received from him when calling on him to do the job he was ostensibly elected for rather than be just another GOP zombie. They're insulting and one can just see the smirk behind the meaningless words. And, yes, he has been among the mindless so-called congresspersons who have blindly toed the party line, including, of course, voting against the ACA--and everything else the Obama administration tried to do for the US.
Unfortunately for those of us who have had to stomach him, he is the beneficiary of one of the most blatant examples of gerrymandering that the GOP has wrought on this nation. He is, distressingly, a microcosm of what multiple congressional districts around the country look like. This is what passes for government in our times.
Obscene!
I could show you all the inane boilerplate messages we have all received from him when calling on him to do the job he was ostensibly elected for rather than be just another GOP zombie. They're insulting and one can just see the smirk behind the meaningless words. And, yes, he has been among the mindless so-called congresspersons who have blindly toed the party line, including, of course, voting against the ACA--and everything else the Obama administration tried to do for the US.
Unfortunately for those of us who have had to stomach him, he is the beneficiary of one of the most blatant examples of gerrymandering that the GOP has wrought on this nation. He is, distressingly, a microcosm of what multiple congressional districts around the country look like. This is what passes for government in our times.
Obscene!
3
This republic was not formed to or intended to manage health care to think Congress can is wishful thinking. The free market is the only place it can work but Congress can make laws to better protect the insured and disadvantaged. anything more than that will be a mess.
ECT,
Of course.
America is too good to adopt models of Care that are cheaper and provide better outcomes.
Bankruptcy, dying for lack of preventative care, and being thrown off our Health Plans, or priced out of, at the whim of the (so called) free market. That worked soo well previously, we should go back to it.
Wouldn't want to get messy. Dying broke is easier.
Of course.
America is too good to adopt models of Care that are cheaper and provide better outcomes.
Bankruptcy, dying for lack of preventative care, and being thrown off our Health Plans, or priced out of, at the whim of the (so called) free market. That worked soo well previously, we should go back to it.
Wouldn't want to get messy. Dying broke is easier.
1
The Constitution does not give the federal government the authority to establish a national health plan. Obamacare advocates, not wanting to expend the effort to pass amendments giving the federal government authority to establish social insurance and social welfare programs, wanted to do so on the cheap. What Obamacare does is to practice redistributive health care economics (of dubious Constitutionality) and attempt to integrate medicaid into the larger medical "system." Those people who would lose their insurance with repeal really would be losing their subsidy. Meanwhile, middle class Americans are paying higher costs. A post Obamacare remedy, with a Constitutional social welfare amendment, would be to federalize medicaid and to dispense it through government clinics. The federal government, under the commerce clause, does have the authority to set up a rate regulating agency, if medical insurance companies could operate nationally.
1
first, USA is leader in major medical.e., catastrophic. We need better primary/preventive care, especially in rural areas and all care must be accessible and affordable. Everyone should have the same medical and healthcare I did. Major medical for the 25 years I was in workforce and care at our leading hospitals during and after catastrophic medical event.
1
Gawd, did the Dems cave into this?
1
Of course, its great opportunity to avoid the growing pressure for single-payer. Have you seen the fear in Pelosi's eyes if someone mentions single-payer?
I'm sorry, but to call the arguments that have been raging over Republicans' efforts to repeal the Affordable Care Act "bickering" completely misses the significance of the issues being debated, and completely ignores the dramatic consequences had the Republicans prevailed (namely, the loss of health insurance for more than 20 million Americans). This is hardly a trivial debate, and that two members of Congress can confuse it as such may be part of the problem.
5
The changes proposed would do nothing except further entrench Obamacare. They would in fact increase the deficit because nothing in these proposals does anything to create any market forces choice or competition into the insurance markets. The lack of choice, the mandates, the community health rating, the standard minimum benefit are driving premium increases. Perhaps the GOP would agree to some level of stability payments (read bailout due to pathetic democrat and CBO lies about the original cost of Obamacare) in exchange for significant market reforms. Cruz amendment or something like it. Buying insurance across state lines. Different ways to create group plans. And block grants of medicaid funding rather than the current insanity of a blank check of federal matching funds.
1
Indeed, universal, single payer healthcare for all. Medicare for all. Medicare now covers the sickest part of the U.S. population - those 65 and older. Imagine how much the cost per person would be reduced if Medicare also covered the healthiest portion of the population, i.e., those under 65. All these contorted work-arounds are ridiculous. Every other sane country in the rest of the world provides better health care at half the cost. And no one spends any time submitting insurance claims, or wondering how much of a particular procedure will be covered, or calling an insurance company about why or how much of something should be covered. You don't have medical personnel in doctors' offices whose job it is to interface with multiple insurance companies. You don't have entire industries devoted to "medical billing." What a colossal societal waste. And why should employers have anything to do with providing healthcare? A car manufacturer is in the car manufacturing business, not the health care business. Let them focus on what they and every other employer do best.
10
the administrtative costs to institute universal single payer need addressed. Also the levels of Medicare appeals and the 20% coinsurance. Also, I'm from UK where you can opt for private pay.
rats. one side wants universal health care at reduced cost and the other side wants continued profit-taking from the unfortunate sick.
if there can be a compromise -- if we must, for the sake of the polity -- then provide a public option to compete with insurers and let's see what works better.
if there can be a compromise -- if we must, for the sake of the polity -- then provide a public option to compete with insurers and let's see what works better.
4
A seemingly unlimited supply of other people's money ALWAYS works better than a product whose quality is tied directly to income, right up to the point that it collapses and bankrupt the institution that created it. That's the result we are trying to avoid right now.
A sure thing solution- give members of Congress whatever health care legislation they pass.
7
As long as insurance companies have to show increasing profits every year the premiums will continue to rise because the population sure as heck isn't getting any healthier. As long as the profit motive is there for the middle-men (insurance companies) they'll keep pushing the envelope with increasing premiums and more denials of needed care. The only way to fix this mess is the public option. It's absence should've been a deal-breaker when drafting the ACA. The mess we're in now was inevitable without it and republicans knew that the fear-mongering (death panels!) that led the democrats to scuttle it would ultimately doom the legislation.
6
Tom Reed is my congressman. I have spent the past 6+ months calling his office and speaking to his extremely polite interns to protest the Republican insanity of tax cuts for people who do not need them and eliminating health insurance for between 15-32 million citizens, depending on the plan in discussion. He favored the House plan.
My hope is that he is serious about fixing this very broken system. His group could start by talking to people who actually work in healthcare and care for patients. They have great ideas!
My hope is that he is serious about fixing this very broken system. His group could start by talking to people who actually work in healthcare and care for patients. They have great ideas!
7
The words used to describe a problem, influence the selected solution.
The problem is not the health care system.
Rather it is the medical care system.
Personal lifestyle dominates health outcomes.
The problem is not the health care system.
Rather it is the medical care system.
Personal lifestyle dominates health outcomes.
1
Great to have both sides talking to each other, but how does any of this address the spiraling costs of pharmaceuticals, hospital care and nursing home care - the main drivers of increasing health care costs? Premium subsidies only make sure that insurers make the 20% profit promised under the ACA.
2
It's great to see some rational thinking, even if just to address short term fixes. One small correction, though. Democrats have been willing to talk about fixing Obamacare for a while. Republicans have refused to talk about anything but repeal. I realize that bipartisan efforts need to seem balanced in accepting blame, but let's not forget the reality.
4
Your ideas are like covering gun shot wounds with gauze. Your "plan" does nothing to help most Americans, like me, who pay significant premiums for employee sponsored plans to get the privilege of paying astronomical deductibles for health care. Between premiums and out of pocket limits, I would pay almost $14K to get Blue Cross Blue Shield to cover 100% for my family. I am a single working parent with two children, and focus solely on preventative care, which thankfully is covered 100% (thanks Obama!).
Get back to the American people when you have real solutions. I would prefer the money I pay in premiums and deductibles go toward a single payer system, not insurance companies.
Get back to the American people when you have real solutions. I would prefer the money I pay in premiums and deductibles go toward a single payer system, not insurance companies.
9
The only fix is a single payer system for all.
Take the outrageous price gouging out of the BUSINESS of health care.
The only losers in a single payer system are the PHARMA companies, hospitals and doctors who reap outrageous profits from everyday people. All those mentioned above should be allowed to profit but not at the level that is seen today.
They would find efficiencies in care if they were held to a standard that demanded it.
Take the outrageous price gouging out of the BUSINESS of health care.
The only losers in a single payer system are the PHARMA companies, hospitals and doctors who reap outrageous profits from everyday people. All those mentioned above should be allowed to profit but not at the level that is seen today.
They would find efficiencies in care if they were held to a standard that demanded it.
10
Let's stop bickering and make insurance cost $0.00. Universal Medicare for all.
7
It is time for a universal, single-payer healthcare system. Now.
10
I do not trust the Trump Administration to either accept or enforce anything that smacks of a fundamental right to basic healthcare. When Trump is gone ... this may be do-able.
6
Imagine a society that believes the market is the best means of balancing supply and demand for healthcare...for your children, your mother, your... Imagine the cost you must pay and the profit the healthcare providers can grab.
Now imagine a society where everybody chips in to fund hospitals, train healthcare providers and believes providing such life support should not be a calling for those seeking McMansions and Ferraris. You have now imagined what most other rich countries have decided to do where going to the hospital is not going to bankrupt you.
Providing healthcare through a market system is like placing your children's lives on a scale. That is not what decent people do.
Now imagine a society where everybody chips in to fund hospitals, train healthcare providers and believes providing such life support should not be a calling for those seeking McMansions and Ferraris. You have now imagined what most other rich countries have decided to do where going to the hospital is not going to bankrupt you.
Providing healthcare through a market system is like placing your children's lives on a scale. That is not what decent people do.
12
Problem solvers Caucus: here's a little FREE advice. Stop attempting to reinvent the wheel. That is a exercise in futility, and a great waste of time and money. Want real, effective change: Medicare for ALL.
Take most of the " profit motive" i.e. Extreme, unfettered greed out of healthcare. Provide basic coverage for everyone. Tell the parasitic insurance companies, device manufacturers and Drug companies to play fairly, or drop dead. Or perhaps you want to keep taking their " campaign contributions ". Fine, you choose. But eventually, you'll be voted OUT.
Go back home, permanently. Sell used cars, it's more honorable.
Take most of the " profit motive" i.e. Extreme, unfettered greed out of healthcare. Provide basic coverage for everyone. Tell the parasitic insurance companies, device manufacturers and Drug companies to play fairly, or drop dead. Or perhaps you want to keep taking their " campaign contributions ". Fine, you choose. But eventually, you'll be voted OUT.
Go back home, permanently. Sell used cars, it's more honorable.
12
"Our proposal isn’t perfect, but......"
......... maybe single payer is.
......... maybe single payer is.
16
I am sick of hearing about "improving access to care". I don't want "access", I want health care! Universal healthcare. Period.
13
That would be within the definition of unacceptable partisanship, as well as a quick way to increase the deficit. "Universal health care" is also unacceptable on policy grounds, and immoral in its side effects because of the way in which our government works. It is unacceptable on policy grounds because it means the government is able to choose who lives and who dies based on resources on the highest scale, there are many examples of this in places like Great Britain where a child with a devastating disease was not allowed to have his parents take him, on their own funds even, to the U.S. for an experimental treatment because the government preferred the hedonistic arguments of the child's doctors that he wouldn't be happy enough. It is unacceptable in terms of how our government works because, while in Europe there are stricter controls on how businesses influence the government, businesses in the United States have no limit, and this can be clearly seen with the opioid epidemic caused by the FDA being in the pocket of companies creating the gateway painkiller drugs.
1
Evan
You are very wrong about increasing the deficit, as any number of other nations, nations with medical care far superior to ours, demonstrate every day.
I suspect if you boys drank less of the Kool-Aid, our medical costs would decrease significantly.
You are very wrong about increasing the deficit, as any number of other nations, nations with medical care far superior to ours, demonstrate every day.
I suspect if you boys drank less of the Kool-Aid, our medical costs would decrease significantly.
Here is a quote from the Aetna press release yesterday Aug. 3, 2017: Mark T. Bertolini, Aetna chairman and CEO: “Based on our continued outperformance, we are once again increasing our full-year 2017 earnings projections.”
http://www.aetna.com/investors-aetna/assets/documents/2Q17-earnings-call...
Here are some quotes from our corporatist politicians in todays op-ed:
“Democrats and Republicans — released a carefully drafted compromise to shore up the struggling insurance exchanges”
“insurers have said premiums could rise by 15 percent or more”
“our proposal provides relief to certain businesses”
“our plan eliminates the Medical Device Tax (a business tax)”
So the solution according to our corporatist politicians is to subsidize health insurance companies that are presently making record profits……and the other part of the solution is to provide relief for certain businesses and lower their taxes.
This is absurd. Demand Medicare for all NOW.
http://www.aetna.com/investors-aetna/assets/documents/2Q17-earnings-call...
Here are some quotes from our corporatist politicians in todays op-ed:
“Democrats and Republicans — released a carefully drafted compromise to shore up the struggling insurance exchanges”
“insurers have said premiums could rise by 15 percent or more”
“our proposal provides relief to certain businesses”
“our plan eliminates the Medical Device Tax (a business tax)”
So the solution according to our corporatist politicians is to subsidize health insurance companies that are presently making record profits……and the other part of the solution is to provide relief for certain businesses and lower their taxes.
This is absurd. Demand Medicare for all NOW.
8
Of course, you're aware that the reason Bertolini increased his earnings projections is because Aetna is GETTING OUT of the ACA exchanges, right? Oops.
1
Right. Evidently, "outperforming" isn't good enough.
I choose "healthcare for all" over greed.
I choose "healthcare for all" over greed.
1
Yankee
You missed the part about "continued outperformance", and "once again increasing earnings projections".
This goes on with or without Obamacare. And this is the biggest problem with our so-called health care system.
Double Oops.
You missed the part about "continued outperformance", and "once again increasing earnings projections".
This goes on with or without Obamacare. And this is the biggest problem with our so-called health care system.
Double Oops.
It really isn't rocket science, just simple math mastered by at least 30 developed countries with better health stats than ours, and some developing ones as well.
10
Negotiate drug prices. Get the profit out of the "Your Money or Your Life" scheme.
Change Medicare to 100% coverage, include eye, hearing and dental.
"Universal Health care., Single payer" What a concept !
Countries that enjoy it, pay only 1/3 to 1/2 of what we pay.
Get rid of the middlemen, get rid of the gougers, get rid of the citizens united payoffs that keep health expenses at an all time high and going higher.
Change Medicare to 100% coverage, include eye, hearing and dental.
"Universal Health care., Single payer" What a concept !
Countries that enjoy it, pay only 1/3 to 1/2 of what we pay.
Get rid of the middlemen, get rid of the gougers, get rid of the citizens united payoffs that keep health expenses at an all time high and going higher.
9
At their core, the generic proposals are a good start. One major core element is missing: Changing the health insurance structure from for profit to not for profit. Germany and Switzerland have done so. Keep the companies in business but end the fiduciary responsibility the companies' Boards of Directors and Executive management have to shareholders. Given the nature of health insurance, we cannot afford to have the overriding pressure to increase the equity value of insurance companies to be the driving force of a successful company. Give the industry three years to fully convert to not for profit status; reward those which do so with minimum livable profit and make those who do not convert to not for profit status leave the field. Lower the eligibility for Medicare to 55 with premium support for those younger than 65; and raise the eligibility for Medicaid to 400% of federal poverty levels and then allow private insurance to support insurance for those not eligible for Medicare or Medicaid. About the only functional alternative is a single payor system, which unfortunately has no viable political support at this time.
7
Where, exactly, are the Republicans "compromising" here - at preventing Trump from cutting the insurance markets off at the knees? How "bipartisan" of them! The rest of this "compromise" sounds like mostly a laundry list of GOP amendments proffered during the debate. Selling insurance across state lines is useless and makes no sense - this GOP idea isn't something the insurance industry is clammering after, but whatever. Using high-risk "reinsurance" pools for the sickest sounds to me as if you are planning on stripping the ACA rule against charging people with pre-existing conditions more for their insurance. If there isn't expected to be any change in the number of businesses who provide insurance to their full time employees, what's the point of changing the law? And if you do change the law, and more people end up on the exchanges as a result, are there going to be problems accommodating them? The medical device tax is 2.3%. That's not breaking anybody's bank, and really has no effect on R&D. The amount of money is trivial, but it does help subsidize premiums. What, if anything, will replace it? If nothing, where will the money come from to maintain the premium supports?
If you can explain to me why these "compromises" actually help the ACA remain in place, in spite of no attempt at cost control, I will consider asking my rep to support it.
If you can explain to me why these "compromises" actually help the ACA remain in place, in spite of no attempt at cost control, I will consider asking my rep to support it.
4
Notice how the authors describe "relief to businesses" aka the employer mandate. Their plan calls for the adjustment of the ACA's current threshold of 50 employees that would require the business to offer health insurance to a whopping 500 employees.
That's a 300% percent increase in "relief" to "small" businesses.
If you have 499 employees and you can't afford to offer insurance to them then you shouldn't be in business.
My Congressman John Faso R-NY19 is a member of the "Problem Solvers Caucus" yet he has no credibility on Health Care.
He repeatedly lied and parroted the Republican talking points for months leading up to his vote on the House bill.
He's refused to explain or defend his vote to his constituents in a public forum.
So why would we trust him?
Or anyone who hides the details in PC PR like this?
That's a 300% percent increase in "relief" to "small" businesses.
If you have 499 employees and you can't afford to offer insurance to them then you shouldn't be in business.
My Congressman John Faso R-NY19 is a member of the "Problem Solvers Caucus" yet he has no credibility on Health Care.
He repeatedly lied and parroted the Republican talking points for months leading up to his vote on the House bill.
He's refused to explain or defend his vote to his constituents in a public forum.
So why would we trust him?
Or anyone who hides the details in PC PR like this?
7
Every other advanced country has found the best answer to providing cradle-to-grave healthcare to every single citizen, It's call Universal Single-Payer Insurance. It cost the average person a tad over half what Americans must pay in monthly rates, high deductibles, co-pays, 80/20 coverage, limits, lack of coverage or inadequate coverage for many conditions (mental health leading the list).
Why does America have a dramatically higher percentage of women dying in child birth than the rest of the first world? Why is the life span of Americans 3 to 5 years less than in most advanced countries. We pay twice as much as the countries that have tax-payer-funded univeral coverage. They call the payments by a dozen names and couch them in a dozen forms in America, but they still come out of our wallets. And, they're still twice as much as, say, the French, pay from their taxes per capita.
Why does America have a dramatically higher percentage of women dying in child birth than the rest of the first world? Why is the life span of Americans 3 to 5 years less than in most advanced countries. We pay twice as much as the countries that have tax-payer-funded univeral coverage. They call the payments by a dozen names and couch them in a dozen forms in America, but they still come out of our wallets. And, they're still twice as much as, say, the French, pay from their taxes per capita.
7
The real problem is treating this as a technical problem when it's a philosophical one. The GOP in its current thrall does not "believe" in government intervention in the so-called market, even if it produces rainbows and puppy dogs for all - because "freedom." Since most Americans do not subscribe to the theories of Ayn Rand, they had to lie to their constituents that they could come up with something better. Many states outlaw price gouging on essential goods when there's a natural disaster. The same moral and ethical principles should apply to health care legislation, whether or not the government is a payer.
5
This is a reasonable start at replacing the ill-conceived ACA. Let's hope this common sense concept transcends politics.
Obviously, as all the negative comments here shows, the entire Problem solvers caucus are RINO's and DINO's. The purists will quash them, and then try to purify them out at their next primaries, replacing them with Real Republicans and Democrats, who can continue to do nothing and win elections.
1
The correct way to fix the healthcare system is follow any of the the single payer or hybrid model adopted in other advanced nations, all of which deliver health care for a fraction of what it costs in the US.
This caucus plan is not perfect, but it is necessary to keep our profiteering system from a total collapse for those who can least afford it.
This caucus plan is not perfect, but it is necessary to keep our profiteering system from a total collapse for those who can least afford it.
5
The spirit that this piece conveys is admirable and should gladden the hearts of all Americans, save for some hard-hearted souls in the GOP leadership and the Administration. But this proposal simply twirls the knobs, keeps us running in place, and won't fix what is not working permanently.
What would make a difference is to not revoke the employer mandate but instead alter how employers provide and employees receive work place insurance coverage. Employer tax deductions for health insurance and the employee tax free benefits are an artifact of many decades ago when this was seen as a way to get around a freeze on wage increases. It simply widens the gaps on lower wage earners and higher paid ones, and it makes it easier for companies to squirm out of providing insurance.
Why not make all companies provide employees access to health insurance through the exchanges? Keep the employer tax benefit and tax free employee benefit for now but start decreasing the former and increasing the latter. During the transition, employers would change their contributions to subsidize employee costs.
Insurance pools would grow dramatically, reducing the risk built in to premiums. During the transition and certainly beyond, tax revenues would swell and be targeted to reducing premium costs. The reduction should make up the loss of tax free income to employees, and maybe more.
Who, one wonders, are the beneficiaries of the current way of doing things?
Why are they resisting change?
What would make a difference is to not revoke the employer mandate but instead alter how employers provide and employees receive work place insurance coverage. Employer tax deductions for health insurance and the employee tax free benefits are an artifact of many decades ago when this was seen as a way to get around a freeze on wage increases. It simply widens the gaps on lower wage earners and higher paid ones, and it makes it easier for companies to squirm out of providing insurance.
Why not make all companies provide employees access to health insurance through the exchanges? Keep the employer tax benefit and tax free employee benefit for now but start decreasing the former and increasing the latter. During the transition, employers would change their contributions to subsidize employee costs.
Insurance pools would grow dramatically, reducing the risk built in to premiums. During the transition and certainly beyond, tax revenues would swell and be targeted to reducing premium costs. The reduction should make up the loss of tax free income to employees, and maybe more.
Who, one wonders, are the beneficiaries of the current way of doing things?
Why are they resisting change?
2
This is a weak plan at best. All it does is shore up the ACA and prolong the agony without making fundamental changes in the delivery and cost of health care. Employers should not have to foot the cost of health care. It makes them less competitive with companies throughout the world that do not have to bear this expense.
And what about putting caps on Big Pharma? They charge outrageous amounts for even generic drugs that have been on the market for many years (remember the Epi-Pen fiasco?).
We need a comprehensive single payer plan that covers all medical, dental, and vision care with an emphasis on prevention and drug addiction treatment. People who want to whiten their teeth or reduce their wrinkles can pay out of pocket for this.
And what about putting caps on Big Pharma? They charge outrageous amounts for even generic drugs that have been on the market for many years (remember the Epi-Pen fiasco?).
We need a comprehensive single payer plan that covers all medical, dental, and vision care with an emphasis on prevention and drug addiction treatment. People who want to whiten their teeth or reduce their wrinkles can pay out of pocket for this.
6
It is very interesting to me how people that know very little about the delivery of healthcare always try to fix it from a "political" standpoint.
The solution is really quite simple, but the implementation is near to impossible because of special interest groups. The PATIENT has been totally left out of the discussion and pushed to the sidelines.
ANY NEW SYSTEM MUST BE PATIENT-CENTRIC. None of the present proposals are.
The solution is really quite simple, but the implementation is near to impossible because of special interest groups. The PATIENT has been totally left out of the discussion and pushed to the sidelines.
ANY NEW SYSTEM MUST BE PATIENT-CENTRIC. None of the present proposals are.
7
And what does that mean from a legislative and funding viewpoint, Dr. Paulos? Are you a health care economist?
This effort is a breath of fresh air. Cooperation. Seeking solutions for the people. Compromise. What a concept!
Congratulations! First priority should be to stabilize the markets and tweak the glaring problems that have developed in our health care system: you've got a good plan to do that. Then, please continue the bipartisan effort and craft amendments that will enact a strategy for the future.
1
Funding for Obamacare and interstate junk insurance. What a compromise.
Wonderful. But you guys know of course that there is no equivalency between Republicans trying to destroy Obama for 8 years and the Democratic efforts that went into 2 years of open discussions of the make up of Obamacare. Good to know one NJ Republican DARES to forge something sensible but this is NOT bipartisanship. Just a beginning. Maybe.
1
Gottheimer is a Democrat from NJ.
Congratulations on being able and willing to work together. Now you/we need to convince “repeal and replace” Ryan to bring the bill to the floor.
"If that does happen, people will be justifiably livid that Republicans and Democrats in Congress did nothing to stop a train wreck we all saw coming." No, we would see this as the GOP further destroying what healthcare 20 million people had with the ACA.
1
A distant relative of my family had a stroke...in Japan...a month of rehab will be $302. Need I say more?
5
"Let's stop bickering" - when I hear those words come from a republican house or senate member, I just want to say "why didn't you say that last year, or the year before, or the year before that going back to 2009???".
Reed wasn't around to not vote for the ACA, but I presume that he voted to repeal it in congress' waste of time votes (Obama could veto it's repeal) over 50 times because that is what GOP house members do: political theater. He was recently to vote FOR the pathetic GOP healthcare bill, and happily defended his vote with typical misinformation about the ACA imploding (neglecting to say that much of the ACA's problems on the insurance side are deliberate sabotage by the GOP going back to 2009 and continuing with this administration), not particularly different from the misinformation about the ACA since 2009. Now he's part of, "aw shucks, let's all work together for the common good". Sorry, but I don't buy it, that someone who had no shame - or is it no clue??? - since 2010 now has found their conscience (and clue), cares about the people.
What do I want? I want the GOP to 'fess up to their lies about the ACA, 'fess up that GOP members had supported mandated universal coverage and insurance premium subsidies in bills as recent as 2008 and 2009 (Wyden bills), and as far back at least as 1996 (Nickle bill), apologize for the last 8 years in particular. But, people who are capable of remorse would never have given us the last 8.5 years - won't happen.
Reed wasn't around to not vote for the ACA, but I presume that he voted to repeal it in congress' waste of time votes (Obama could veto it's repeal) over 50 times because that is what GOP house members do: political theater. He was recently to vote FOR the pathetic GOP healthcare bill, and happily defended his vote with typical misinformation about the ACA imploding (neglecting to say that much of the ACA's problems on the insurance side are deliberate sabotage by the GOP going back to 2009 and continuing with this administration), not particularly different from the misinformation about the ACA since 2009. Now he's part of, "aw shucks, let's all work together for the common good". Sorry, but I don't buy it, that someone who had no shame - or is it no clue??? - since 2010 now has found their conscience (and clue), cares about the people.
What do I want? I want the GOP to 'fess up to their lies about the ACA, 'fess up that GOP members had supported mandated universal coverage and insurance premium subsidies in bills as recent as 2008 and 2009 (Wyden bills), and as far back at least as 1996 (Nickle bill), apologize for the last 8 years in particular. But, people who are capable of remorse would never have given us the last 8.5 years - won't happen.
4
A good first step towards renewing rational behavior on the Hill. The R's, though need to take steps to reduce the ability of the so-called Freedom Caucus to hold hostage those moderates, non-purists, who are willing to work with the Democrats.
Be careful what NYT tells you. NY times is anti-universal healthcare; it opposes a single payer system. What NY Times wants is a win-win solution for insurance companies. That is why it marginalizes Bernie Sanders' campaign at every turn. Whenever Bernie is making a push on Universal Healthcare, it won't be on NY Times' front page.
4
maximize the health insurance pool to decrease costs. SINGLE PAYER, MEDICARE FOR ALL
6
Thanks for trying at least.
Of course these two Congressman want to protect their Medical Device Manufacturers from the Medical Device Tax. So do I sitting here in Minnesota. But, the fact remains, we need to hammer the Medtronic's and Johnson & Johnson's of the world and make sure the Cadillac Tax of 40% on heavy insurance plans (sorry union members) remain intact, or the economics of ObamaCare doesn't work out.
Look, you can't give free insurance to 40 million new people and not pay for it. The fact these two Congressman want to give the Aetna's and Humana's their $100 Billion of corporate welfare is all we need to know about what doesn't work in Healthcare; which is the Congress of the United States.
Let the States decide. Democrats love the birth father of ObamaCare (RomneyCare), so let's get 50 versions of RomneyCare out there among the states and let each state decide what's best for their own residents. If they want high risk pools, set them up. If they want to throw people in jail for not buying insurance or not buying broccoli, let them. Letting the states decide is the most democratic form of reform you can imagine. I can't believe for a second the Democrats would be opposed to this approach.
Look, you can't give free insurance to 40 million new people and not pay for it. The fact these two Congressman want to give the Aetna's and Humana's their $100 Billion of corporate welfare is all we need to know about what doesn't work in Healthcare; which is the Congress of the United States.
Let the States decide. Democrats love the birth father of ObamaCare (RomneyCare), so let's get 50 versions of RomneyCare out there among the states and let each state decide what's best for their own residents. If they want high risk pools, set them up. If they want to throw people in jail for not buying insurance or not buying broccoli, let them. Letting the states decide is the most democratic form of reform you can imagine. I can't believe for a second the Democrats would be opposed to this approach.
In theory a nice idea, but what happens when people move from a state that has low requirements to a state that has high? Healthcare, or at least some basic form of it needs to be the same in Maine as it is in California and all points in between. Otherwise instead of one government bureaucracy to deal with, we'd have fifty of them. Ugh. i feel sick from that ideal already.
2
Nonsense. If I go from NY to PA and buy car insurance, the regulations are different. If I go from MN to CA, my property and casualty insurance is different. Look...I get the utopian dream of farting rainbows, but the states can truly experiment with what works and do so at a micro-level. RomneyCare was half-baked when they decided to serve it, and now we all have eColi from it. Come on..you're from NY...certainly you guys know what's best for NY'ers. Nothing good comes out of DC. NOTHING. If you want evidence of a great national health care plan, head to the UK where now if you're 6'3" and weigh just 200 pounds, they'll deny you hip or knee surgery. They've decided fat people don't deserve healthcare, and the economics are driving the healthcare decisions. I know we don't think it could ever happen here, but do you really think it's economically wise for someone on welfare to be having children, let alone surgery to amputate a leg when they're 200 pounds overweight and the diabetes-induced infection is spreading? We have better things to invest in. Call me cynical, but it is what it is. If you don't think a government can kill it's own citizens by denying medical treatment, you haven't traveled much.
The first thing that must be admitted by the Republicans in Congress is that both the House and Senate bills to "Fix" the healthcare system were really thinly disguised attempts to free up a ton of money for tax breaks for the wealthiest taxpayers who don't need a tax cut. Once that line of thinking is abandoned by the Senate Majority Leader and the Speaker of the House it should be possible to have a serious discussion about health care options.
Frankly, I'm a clear advocate of the single-payer model of health care if the program that is offered is a fully comprehensive insurance system that will save taxpayers billions of dollars every year as we would no longer have to subsidize the insurance companies. I agree that this is a fight that has little support in Congress or at the state level. After all, the insurance industry is one of the largest campaign contributors out there.
It will take true patriots in Washington to sacrifice their campaign contributions for the good of the people (Isn't THAT a horrible thing to have to say?). Heck, if they really are able to fix our disaster of a health care system, they may never need another dime of campaign contributions to stay in office.
Frankly, I'm a clear advocate of the single-payer model of health care if the program that is offered is a fully comprehensive insurance system that will save taxpayers billions of dollars every year as we would no longer have to subsidize the insurance companies. I agree that this is a fight that has little support in Congress or at the state level. After all, the insurance industry is one of the largest campaign contributors out there.
It will take true patriots in Washington to sacrifice their campaign contributions for the good of the people (Isn't THAT a horrible thing to have to say?). Heck, if they really are able to fix our disaster of a health care system, they may never need another dime of campaign contributions to stay in office.
3
Representatives Gottheimer and Reed are trying to solve a short-term problem that, without solution, can bring healthcare insurance crashing down for about 7% the US population.
Employer-provided plans cover 49% of Americans. The VA and active duty military programs cover 2% of Americans, Medicaid covers 20%, Medicare covers 14%, individual (non-group) plans cover 7% and the number of uninsured is about 9% (and yes, there is a rounding error here).
In total, public plans cover 36% of Americans. Employer-provided plans receive a tax waiver on the employed-paid portion of coverage that amounts to an uncollected $250 billion per year in Federal income and payroll taxes. That means 85% of Americans are already on the Federal dole when it comes to healthcare insurance. We are arguing about say, 15-16% of the population that apparently does not deserve to have some form of government subsidized health insurance.
With Medicaid expansion, some of the 9% uninsured population may get coverage but not all in the current uneven adoption of Medicaid expansion. The 7% of us currently with ACA or other private insurance who are paying huge premiums with huge deductibles are hanging in there hoping that the President and Congressional leadership do not push insurers to drop coverage or simply price us out of the market.
Let's continue the goofy, subsidized ACA program, with improvements, until the collective wisdom of our elected legislators comes up with a better solution.
Employer-provided plans cover 49% of Americans. The VA and active duty military programs cover 2% of Americans, Medicaid covers 20%, Medicare covers 14%, individual (non-group) plans cover 7% and the number of uninsured is about 9% (and yes, there is a rounding error here).
In total, public plans cover 36% of Americans. Employer-provided plans receive a tax waiver on the employed-paid portion of coverage that amounts to an uncollected $250 billion per year in Federal income and payroll taxes. That means 85% of Americans are already on the Federal dole when it comes to healthcare insurance. We are arguing about say, 15-16% of the population that apparently does not deserve to have some form of government subsidized health insurance.
With Medicaid expansion, some of the 9% uninsured population may get coverage but not all in the current uneven adoption of Medicaid expansion. The 7% of us currently with ACA or other private insurance who are paying huge premiums with huge deductibles are hanging in there hoping that the President and Congressional leadership do not push insurers to drop coverage or simply price us out of the market.
Let's continue the goofy, subsidized ACA program, with improvements, until the collective wisdom of our elected legislators comes up with a better solution.
3
Possibly collective wisdom, if indeed any of that still exists, could create a system whereby there is a basic floor of heath insurance below which none can fall, but all are protected against the stunningly high medical costs that appear to impact a small percent of the population. Employers then could still offer their employees supplemental insurance, either fully or partially paid for, not unlike what is available now for those over 65 on Medicare. The major economic nation in the world should be able see the wisdom of this while also meeting the directive in our constitution for Congress to "provide for the general welfare".
1
Universal health care like all the other civilized countries in the World. What are we waiting for?
8
Well....I kind of like the approach the UK is taking. They're telling their fat people that they can't get knee or hip replacement surgery unless they have a BMI that requires a 6'3" man to be 195 pounds or less. Otherwise it's tough tata's.
I could see that working here. Force all our smokers, drinkers, drug users and fat people to shape up or move to Canada.
Thanks for sharing. It's an Iowegian kind of idea, and I love it.
I could see that working here. Force all our smokers, drinkers, drug users and fat people to shape up or move to Canada.
Thanks for sharing. It's an Iowegian kind of idea, and I love it.
3
As the good ship Bipartisan sets sail with all on board basking in a newfound spirit of amity and fellowship I can't help but recognize some unease on my part. The ACA is not perfect despite being a vast improvement over the past. It was immediately attacked and weakened by those who shall remain nameless (that spirit of amity -- don't wan't to spoil it). In order to protect the core of the existing ACA bipartisanly, Republicans will request some bipartisan changes which will weaken or remove some aspect of the ACA. In place of a grand assassination of the ACA I foresee a prolonged crippling from a procession of Democratic (bipartisan) concessions.
4
There are plenty of health care plans around the world. Why doesn't the USA simply take a look at how they successfully work, and select one to model after.
Sadly, America turns everything into making a profit. Insurance companies, HMO's, hospitals, and doctors are the ones responsible. I'm sure it would be impossible to challenge the status quo and the Medical Industry lobbyists to come up with a universal plan for the PEOPLE!
Sadly, America turns everything into making a profit. Insurance companies, HMO's, hospitals, and doctors are the ones responsible. I'm sure it would be impossible to challenge the status quo and the Medical Industry lobbyists to come up with a universal plan for the PEOPLE!
11
It's because our society is built on paying for volume/production instead of outcomes.
If we take your point of view and extend it into...let's say..public education, we would pay teachers a $20,000 a year base salary and then comp them when they get their kids' test scores up to an acceptable level.
Or Apple. Instead of paying $800 for an Iphone, how about I pay them $200...and the rest only if I"m really happy with the phone 6 months from now.
Or our DMV. How about we pay the employees at the DMV $8/hour and another $20/hour if they actually smile while they make you wait in line for 3 hours during the middle of the day since they can't work at night..which would actually be the government serving us instead of us serving the government.
If we take your point of view and extend it into...let's say..public education, we would pay teachers a $20,000 a year base salary and then comp them when they get their kids' test scores up to an acceptable level.
Or Apple. Instead of paying $800 for an Iphone, how about I pay them $200...and the rest only if I"m really happy with the phone 6 months from now.
Or our DMV. How about we pay the employees at the DMV $8/hour and another $20/hour if they actually smile while they make you wait in line for 3 hours during the middle of the day since they can't work at night..which would actually be the government serving us instead of us serving the government.
1
Thank you PSC for proposing reasonable, even if short-term, changes that will resolve some of the more urgent ACA problems, and will bring more stability to the insurance market. A good start.
If the reinsurance program is adequately funded then the Federal Government will effectively take over 50% of health spending. High deductibles will leave patients or the Federal Government responsible for another large chunk of spending.
So tell me why we need private Insurers in this situation?
So tell me why we need private Insurers in this situation?
8
I think the reality is that insurers provide many good paying jobs and community benefits in the areas where they do business, and, I think the likelihood of our congress cutting them out of the picture completely would face significant protest. Why not negotiate with the insurers to give them stability in exchange for requiring them to be non-profits with regulated maximum reserves and basic plans that everyone can afford covering most needed services (like Medicare). We could also allow them to sell insurance plans to provide extra services (on the model of Medicare Advantage). France has been rated by the World Health Org. as providing the best care in the developed world at a much lower cost than the US and this is essentially the French model.
When I got my MPH in 1988, the Federal Government was the payor of 50% of all medical costs. That represented Medicare and Medicaid spending. It has to be much more than 50% currently. The Feds cover the most expensive segment of the population.
your plan is in the right direction, but you have to understand some vital things about the aca. it is imperative that everyone have health insurance and will be fined for not doing. republicans have to think of this in the same manner that they think of driver's insurance which probably all states have; meaning that every driver has to have driver's insurance. but most importantly, the congress has to put massive fines that are yearly on insurers who, for whatever financial reason, choose not to be part of the aca. that, like driver's insurance, is a must and for some reason is not being paid attention to. second, you have to understand what a pre-existing condition is from the various insurers' point of view. to them it's a quick ticket not to give insurance for even the must ridiculous reasons. they have used very simple means of not providing insurance because of acne, allergies etc. you have to put a clamp down on the insurers themselves. their costs going up was based on how many people, especially younger people, were going to get health insurance and that didn't work out. therefor the fines have to be substantial enough to get everyone aboard. these two major issues would, i am sure, be approved by most if not all democrats. the problem is with the pro-business republicans that is the main hurdle. finally, the subsidies are essential. this is not a republican or democratic health care plan. all people deserve and are entitled to having good health care.
2
"Third, our proposal provides relief to certain businesses from the mandate that they provide insurance to full-time employees. It also defines “full time” as a 40-hour workweek to discourage businesses from manipulating employees’ weekly hours to skirt the mandate. More than 90 percent of large businesses offered health care before the Affordable Care Act, and studies show that they would continue to do so under this change;"
So, let me get this straight: large businesses that provided insurance for full-time employees BEFORE the ACA will do so if they are relieved of a mandate to do so??? Not clear.
So, let me get this straight: large businesses that provided insurance for full-time employees BEFORE the ACA will do so if they are relieved of a mandate to do so??? Not clear.
Buying insurance across state lines? Are you kidding? Every state has its own set of regulations, which is why health insurance is more expensive in NY than Alabama- where it's less expensive but also provides much less.
One day we'll get to a single-payer system. When and how is the question.
One day we'll get to a single-payer system. When and how is the question.
8
I love the idea of a "House Problem Solvers Caucus" composed of Republicans and Democrats. What an idea -- problem solving together to benefit all Americans! Maybe they could also fix the immigration-refugee system? Develop an infrastructure bill? Fix the tax system? It's the way our government is supposed to work, and health care bipartisanship might even set a powerful precedent for the future. Let's hope the Senate and White House also gets on board with this idea...
4
The issues here are greater than attributing problems in the malfunctioning expensive health care system to insurance companies who treat their customers like cash cows.
The problem with health care in the US is that the US is the only country in the civilized world that still uses the insurance company based system for health care which is REGRESSIVE to the insured. In contrast, Canada, Japan and Western Europe use the single-payer health care system which is PROGRESSIVE to the insured.
Notwithstanding the positive developments of more affordable health care being offered to Americans under the ACA, the central issue on explaining the high costs for health care that has NOT been debated is that the U.S. insurance system of health coverage is REGRESSIVE. It is regressive in that a given policy with identified benefits will have a set price and this price is to be paid by all persons whether they are rich or poor. As a result, the rich buy the Cadillac versions and the poor the Skateboard versions.
In contrast the public single payer system of payments through taxes is PROGRESSIVE. In Canada, the government established that everyone has the right to have free access to health care. But the fact is that all health care expenses are paid by taxes and these payments of income taxes are progressive in that the more one makes in income the more one pays in taxes.
The universal health care system in Canada is not perfect, but it works. Also administration costs are much lower.
The problem with health care in the US is that the US is the only country in the civilized world that still uses the insurance company based system for health care which is REGRESSIVE to the insured. In contrast, Canada, Japan and Western Europe use the single-payer health care system which is PROGRESSIVE to the insured.
Notwithstanding the positive developments of more affordable health care being offered to Americans under the ACA, the central issue on explaining the high costs for health care that has NOT been debated is that the U.S. insurance system of health coverage is REGRESSIVE. It is regressive in that a given policy with identified benefits will have a set price and this price is to be paid by all persons whether they are rich or poor. As a result, the rich buy the Cadillac versions and the poor the Skateboard versions.
In contrast the public single payer system of payments through taxes is PROGRESSIVE. In Canada, the government established that everyone has the right to have free access to health care. But the fact is that all health care expenses are paid by taxes and these payments of income taxes are progressive in that the more one makes in income the more one pays in taxes.
The universal health care system in Canada is not perfect, but it works. Also administration costs are much lower.
6
You're wrong. Our healthcare system is the most expensive in the world because we are the fattest nation on earth...by far.
We eat too much, drink too much, smoke too much..and we don't exercise.
Our health care system is also the best in the world, which is why you have people from around the world flocking to Mayo, Cleveland Clinic, Anderson Medical Center and Johns Hopkins when they have serious medical issues.
It ain't free. Can we improve it? Sure...lose 30 pounds...all of you.
We eat too much, drink too much, smoke too much..and we don't exercise.
Our health care system is also the best in the world, which is why you have people from around the world flocking to Mayo, Cleveland Clinic, Anderson Medical Center and Johns Hopkins when they have serious medical issues.
It ain't free. Can we improve it? Sure...lose 30 pounds...all of you.
2
So if everybody meets your high standards of healthy living and theoretically (only) never needs a doctor, a hospital or a pharmacy, medical care will be practically free? I doubt if it works that way.
I'm sure obesity (diabetes etc.) is a contributor, but by itself it's not the biggest cost driver. Elizabeth Rosenthal just wrote a very good book on this, "An American Sickness". I haven't read the book yet but I highly recommend her interview on "Fresh Air" on April 10th.
What she seems to be saying is that the whole system (esp. providers such as docs, hospitals and so on) doesn't have enough controls around costs/pricing.
http://www.npr.org/programs/fresh-air/2017/04/10/523279708/fresh-air-for...
What she seems to be saying is that the whole system (esp. providers such as docs, hospitals and so on) doesn't have enough controls around costs/pricing.
http://www.npr.org/programs/fresh-air/2017/04/10/523279708/fresh-air-for...
1
This does sound like a start. We'd need to see the detail, of course, but that's always the case. A couple of red flags for me:
First, "Flexibility for states" has frequently in the past meant permission to discriminate or enforce onerous requirements regarding women and minorities. Flexibility in principle is fine. But any plans should be required to have a realistic and reasonable basic package of coverage. The Ted Cruz plan of allowing companies to sell insurance that is not really insurance should not be permitted.
Second, when you say "a seven-year stalemate in Washington that has featured Republicans trying to repeal the current health care law, Democrats trying to preserve it and neither side willing to discuss anything in between" it really stuck in my craw. That's simply not true. Democrats have been willing all along to discuss revising the ACA. It is purely 100% unalloyed Republican intransigence that has prevented needed amendments to the law. For Republicans it's been "repeal and replace" all along, though as we knew all along and have had demonstrated over the last few weeks, the "replace" part of that equation was "fake news."
Yes, discussion and compromise are the only path to fixing American health care and both sides will have to give up something that will be painful. But there must be honesty in the process and in the outcome. Give the awful experience of the last 8 years, I'm afraid I'm not confident this beginning will lead anywhere.
First, "Flexibility for states" has frequently in the past meant permission to discriminate or enforce onerous requirements regarding women and minorities. Flexibility in principle is fine. But any plans should be required to have a realistic and reasonable basic package of coverage. The Ted Cruz plan of allowing companies to sell insurance that is not really insurance should not be permitted.
Second, when you say "a seven-year stalemate in Washington that has featured Republicans trying to repeal the current health care law, Democrats trying to preserve it and neither side willing to discuss anything in between" it really stuck in my craw. That's simply not true. Democrats have been willing all along to discuss revising the ACA. It is purely 100% unalloyed Republican intransigence that has prevented needed amendments to the law. For Republicans it's been "repeal and replace" all along, though as we knew all along and have had demonstrated over the last few weeks, the "replace" part of that equation was "fake news."
Yes, discussion and compromise are the only path to fixing American health care and both sides will have to give up something that will be painful. But there must be honesty in the process and in the outcome. Give the awful experience of the last 8 years, I'm afraid I'm not confident this beginning will lead anywhere.
3
"Let's stop bickering" - sure, as soon as the GOP stops lyiing.
What SHOULD happen is that ideology is put aside and people put together a healthcare system based on what we have in place and altered based on what we know works better from observing other countries' systems; the shortcomings on the insurance side of the ACA should be addressed - some were known before passage and others have become apparent since; good things that were shouted out of the original bill should be put back in (e.g., insurance paying for patients to have a periodic end of life discussion with their doctor, where end of life specs can say when to pull the plug or never pull the plug, resuscitate or do not resuscitate etc.); what has worked in other countries on the insurance side is either single payer or non-profit - we COULD go in the non-profit direction; finally, address the cost and quality side of healthcare delivery, mostly unaddressed by the ACA and the recent GOP bills - bringing these costs down will bring down premiums, deductibles, out of pocket.
I am not optimistic, especially about the GOP being able to get there and get us there, considering the nature of the recent bills. I'd love to be proved wrong because that would be good for the country.
What SHOULD happen is that ideology is put aside and people put together a healthcare system based on what we have in place and altered based on what we know works better from observing other countries' systems; the shortcomings on the insurance side of the ACA should be addressed - some were known before passage and others have become apparent since; good things that were shouted out of the original bill should be put back in (e.g., insurance paying for patients to have a periodic end of life discussion with their doctor, where end of life specs can say when to pull the plug or never pull the plug, resuscitate or do not resuscitate etc.); what has worked in other countries on the insurance side is either single payer or non-profit - we COULD go in the non-profit direction; finally, address the cost and quality side of healthcare delivery, mostly unaddressed by the ACA and the recent GOP bills - bringing these costs down will bring down premiums, deductibles, out of pocket.
I am not optimistic, especially about the GOP being able to get there and get us there, considering the nature of the recent bills. I'd love to be proved wrong because that would be good for the country.
3
Even if Einstein tried to figure out our convoluted so-called he would be pulling his hair out and screaming expletives. The more they try and make it better it becomes more complicated and completely lacking in any kind of common sense. Our Congress must come up with a single-payer plan that includes every American from cradle to grave. People say it would make their taxes go up too high. Even if the tax is as much as 5%, a family of four with an income of $100,000 a year would pay $5.000 a year in extra taxes. I'm willing to bet that they pay more than that now in premiums. co-pays and deductibles. I used 5% as an example of the raise in taxes, but I don't think it even be that high. Europeans pay more in taxes than we do, but they get a lot more bang for their buck, and I'm not talking about healthcare alone.
6
What may be the ideal, if not immediately practical to implement is a form of universal basic coverage, aka "single payer," with the option to buy additional insurance, much as the "medigap" plans do now. Add an emphasis on encouraging healthy living and prevention, and it might become a win-win-win for the people, health care in general and the insurance companies. Does this have more than the proverbial "snowball's chance in Hell" of becoming reality? Only if we really want it badly enough, and Democrats and Republicans alike can get off their respective high horses and walk again amongst the ordinary people.
4
Glad to see no mention of Obamacare in the discussion, specifically claims that it's working well and just needs "tweaking". However, this proposal fails as it tries to operate in the Obamacare structure. You either subsidize the rates or you subsidize the health care carriers - you don't do both.
THANK YOU for working for the people instead of just your party.
The Problem Solvers Caucus includes only about ten percent of House members. How's that for symbolism?
2
you guys rock
You are preaching to the choir here. Go on Fox and tell it to that crowd.
4
The partisan bickering, aided by the media, has resulted in the Trump phenomenon. He promised to shake up establishment. He promised his voters he will fulfill his campaign promises swiftly and effectively by draining the swamp.
As a citizen my simple question to you two is why did you forget us? You got elected to represent us we the people. Instead you are directly answerable to your donors, your campaign funders and to big money that rules everything in this country. Our founding fathers never imagined that we the people will be forgotten in the din and chaos generated by partisan bickering enhanced by special interests, identity politics and big money.
As a citizen my simple question to you two is why did you forget us? You got elected to represent us we the people. Instead you are directly answerable to your donors, your campaign funders and to big money that rules everything in this country. Our founding fathers never imagined that we the people will be forgotten in the din and chaos generated by partisan bickering enhanced by special interests, identity politics and big money.
2
A Problem Solvers Caucus?
Egads. What, then, should we call the rest of Congress?
Egads. What, then, should we call the rest of Congress?
3
Like several of the commentors here, I have no strong opinions on the details of the plan. What I want to commend is the process used to come up with a plan.
It is probably good that, as a nonexpert on health care, that I have no instant opinion. If nothing else that suggests that in a very technical area they thought about what might work rather than which partisan buzzwords apply. That is a better focus than whether it "repeals Obamacare", has a "tax cut for the rich", or other mantras of the left and right.
Ultimately I blame the voters for rewarding politicians who obstruct more than they do those who legislate.
It is probably good that, as a nonexpert on health care, that I have no instant opinion. If nothing else that suggests that in a very technical area they thought about what might work rather than which partisan buzzwords apply. That is a better focus than whether it "repeals Obamacare", has a "tax cut for the rich", or other mantras of the left and right.
Ultimately I blame the voters for rewarding politicians who obstruct more than they do those who legislate.
1
Thanks to Gottheimer and Reed for their initial efforts, however the ONLY solution is universal single payer healthcare.
3
Josh Gottheimer wants to play nice with the Republicans who want to destroy the ACA so the can give Tax breaks to multi millionaires like Josh Gottheimer.
It's really time for a new Party.
It's really time for a new Party.
3
So Republicans reject all reason, spending 8 years stoking bile, hate, and lies with their base to achieve political victory, steal the supreme court, and now there is call from both parties to "work together"? Our elected democrats will - quite rationally - decide that they of course DO need to work with them because the Rep plan is so heinous and cruel, and something must be done.
The bottom line? Democrats seem to always willing to reach across the aisle to protect the very same ignorant fools who elected these despots. Four years from now, these same Reps will be taking the credit, and again demonizing any progressive legislation that managed to squeak through. This is simply not working for the Dems, and I think they are going to need to get much more cutthroat if they expect to survive in this new era.
I'm sorry our country has come to this, but I believe that we should give the voters of red-state america exactly what they voted for, and let the GOP pass it's health care legislation. How will our electorate ever learn what liberal democracy truly means in their lives if the Dems keep rescuing the most ignorant among us? They won't understand any of this until grandma is forced from the nursing home and they have to go back to changing her diapers themselves. Perhaps that is what it will take to inject truth and facts back into the conservative mind
The bottom line? Democrats seem to always willing to reach across the aisle to protect the very same ignorant fools who elected these despots. Four years from now, these same Reps will be taking the credit, and again demonizing any progressive legislation that managed to squeak through. This is simply not working for the Dems, and I think they are going to need to get much more cutthroat if they expect to survive in this new era.
I'm sorry our country has come to this, but I believe that we should give the voters of red-state america exactly what they voted for, and let the GOP pass it's health care legislation. How will our electorate ever learn what liberal democracy truly means in their lives if the Dems keep rescuing the most ignorant among us? They won't understand any of this until grandma is forced from the nursing home and they have to go back to changing her diapers themselves. Perhaps that is what it will take to inject truth and facts back into the conservative mind
4
Thank you. I could not agree more.
Is it not apparent that politicians do not understand, do not care about, and will never propose solutions to American health care?
Let's commission a small task force of American economists and European health care management experts to study American health care problems and propose a comprehensive, hassle-free, and cost-efficient health care system for Americans. Let's make their findings and proposals available to the government and the public.
Let members of Congress debate and legislate the recommendations in good faith, or ignore the proposals at their political peril.
Medical procedures are complicated, and medical equipment is technically complex. But the management and administration of a health care system is a routine, business process. A dozen or more modern nations do it with better results at half the cost. Why can't Americans?
It's politics and politicians that make us stupid!
Let's commission a small task force of American economists and European health care management experts to study American health care problems and propose a comprehensive, hassle-free, and cost-efficient health care system for Americans. Let's make their findings and proposals available to the government and the public.
Let members of Congress debate and legislate the recommendations in good faith, or ignore the proposals at their political peril.
Medical procedures are complicated, and medical equipment is technically complex. But the management and administration of a health care system is a routine, business process. A dozen or more modern nations do it with better results at half the cost. Why can't Americans?
It's politics and politicians that make us stupid!
3
But politicians are paid not to understand by their donors..
I bet if Trump cancelled the golden health care that Congress gets, and they had to go on the exchange, it would be solved pronto.
2
Wrong, legislators and their staff have to get insurance through the exchanges.
http://www.npr.org/sections/health-shots/2017/04/12/523335954/what-happe...
http://www.npr.org/sections/health-shots/2017/04/12/523335954/what-happe...
I love it when the NY Times goes chumming for Single-Payer, usually with a topic title including the required buzzwords: "For All", "Experts", "Lower Costs" and "Simple." The commenting-frenzy that follows invariably can be Cliff-Noted in the form:
"The solution is Easy - give everyone free stuff, paid for by ___________", where the answer-choices are 1) Greedy Insurance Companies, 2) Greedy Any Companies, 3) Greedy Capitalists, 4) Greedy Rich People, 5) Greedy Everybody Except Me.
The amazing thing is, this approach ACTUALLY WORKS - buoyed by Altruism, I feel so much better. And it cost ME NOTHING!
"The solution is Easy - give everyone free stuff, paid for by ___________", where the answer-choices are 1) Greedy Insurance Companies, 2) Greedy Any Companies, 3) Greedy Capitalists, 4) Greedy Rich People, 5) Greedy Everybody Except Me.
The amazing thing is, this approach ACTUALLY WORKS - buoyed by Altruism, I feel so much better. And it cost ME NOTHING!
1
Glad you have stopped the bickering, but I see that neither party has any intention of fixing the healthcare system. No need for bickering since both parties are owned by the special interest lobbyists. If you really wanted to fix the healthcare system, you would have to take on the insurance industry, the drug industry, the trial lawyers, the nursing home industry and the tormenting the dying for profit industry. Whoops, forgot the medical device price gougers. In short, neither party has any intention of dealing with the real drivers of health care costs, the pigs feeding at the trough of our bloated healthcare system. Pigs who use their ill gotten profits to pay off the frauds in our Congress.
5
How about the hospitals and outpatient practices that send "reasonable & customary" charges for service that are usually 3-4 x their actual cost, if any layperson was ever able to discern what it should cost. How come Hip replacements cost 5X more than in Canada? It's not just the drugs and devices; 90% of the system cost is in care delivery and there is more than enough waste and overhead there to find reasonable savings.
Hospitals and outpatient practices are encumbered by over-regulation. That jacks up the price. Also, prices are set high so to collect the maximum that the insurance company allows. The theoretical list price is rarely paid, a fantasy price. In the real world there is a lot of negotiation. But, you are not wrong. The hospitals and medical organizations have lobbyists too.
Every time Republicans talk about "stabilizing the market" or giving consumers of insurance more "choices" or "freedom," they're really talking about maintaining or increasing insurance company profits. Every bill they write should be called "The Insurance Industry Profits Protection Act." They are either using taxpayer dollars to subsidize insurance companies so low-income or very sick people can buy their policies, or letting them sell less coverage or higher deductibles to healthy people. Time to tell it like it is. We don't need health insurance companies and their stockholders sucking billions of dollars from the paychecks of workers and the pockets of employers to perform the simple service of paying providers for necessary medical services rendered. If Republicans (and quite a few Democrats) cannot be honest about this Ponzi scheme and their complicity in it, voters need to let them know in the midterms that we are not fooled.
2
If one begins with the premise that, in a civilized society, essential healthcare is a right and not an economic privilege, then only a federal approach to ensure access is necessary, not a state-driven program. Why should care depend on one's zip code when genetic predisposition is agnostic to geography?
Beyond the poor, elderly and disabled, the federal committment to all may be in the form of health care re-insurance to backstop standard issuers as proposed, but the quid pro quo for the Feds to act like Fannie Mae did for banks, is that all private insurers will then need to be managed as utilities and not private enterprises driving for maximized profit.
Defaulting to "Medicare for All" as the only insurance solution would disable one of the key economic and societal drivers for innovation in medical and pharmaceutical technology, which is one of the areas in which the US remains far ahead of any other western society.
The disparities in our health care outcomes against those societies are due to lack of access to standard, basic care, and that is a result of our conservative anathema towards a social benefit. Everyone will have to give a little for all to get.
Beyond the poor, elderly and disabled, the federal committment to all may be in the form of health care re-insurance to backstop standard issuers as proposed, but the quid pro quo for the Feds to act like Fannie Mae did for banks, is that all private insurers will then need to be managed as utilities and not private enterprises driving for maximized profit.
Defaulting to "Medicare for All" as the only insurance solution would disable one of the key economic and societal drivers for innovation in medical and pharmaceutical technology, which is one of the areas in which the US remains far ahead of any other western society.
The disparities in our health care outcomes against those societies are due to lack of access to standard, basic care, and that is a result of our conservative anathema towards a social benefit. Everyone will have to give a little for all to get.
3
Drug costs are the number one driver of increases in medical costs in this country.
What happened to any attempt to address that issue?
What happened to any attempt to address that issue?
2
The key point here is the 5%-50% factor, which is surprising at first glance but may not be that much different than other forms of insurance, fire for example wherein most people have it on their homes but very few ever use it. Some attempt to blame the 5% for their lifestyles resulting in everyone else picking up the tab, but a closer look will remind us that you never can be sure you won't be part of the 5% and will only hope your huge medical costs will be covered so you can live a little longer.
3
How about this? Let the government invest in health care by buying up all public shares in health providing and insuring companies. Let the government collect those dividends to help pay the cost of healthcare for all. I think it is time for private investors to stop earning passive income on other people's ill health.
5
Perhaps if we stopped wasting money on pointless wars, bloated Pentagon budgets, tax cuts for billionaires, gratuitous write offs, subsidies for profitable industries, and mortgage deductions for second homes, there might be some money left over for health care.
Of course there's a better chance of spotting a dancing green unicorn at the Lincoln Memorial.
Of course there's a better chance of spotting a dancing green unicorn at the Lincoln Memorial.
5
Definitely this is a great start. Hope the group will grow ten fold for the people. Politicians are supposed to work for the people, not for the parties.
2
The reason this effort is doomed to failure is that Gottheimer and Reed fail to recognize the biggest problem with healthcare because all aspects of healthcare in the U.S. are for profit, placing a return on shareholder investments ahead of access to care and even patient health. The for profit, market driven approach has been in place for nearly 70 years and it has failed by every metric when compared with single payer not for profit models that other Western democracies use. With such a record, merely continuing to try and prop up a failed system is to guarantee further failure - and worsen access to healthcare, quality of care, and to needlessly increase cost of healthcare. The model in Australia clearly indicates that for profit market driven systems - put in place in some regions as an alternative to single payer - increased wait times for access to healthcare and in fact didn't perform better than single payer at all. The ACA is a deeply flawed set of temporary solutions to an even more deeply flawed system that has no merits at all, except as a means of maximizing investor profits. The ONLY viable alternative to the ACA that will actually lower infant mortality rates, cover the entire population, lower costs, and increase longevity is to remove the profit structure from the entirety of the healthcare system and go all in for single payer. If our allies can do it, surely so can we.
9
Isn't it insane to pay 20% of your healthcare spending to administrative costs?
(That's the low end of the estimates of what the U.S. diverts to that purpose.)
Yet we fiddle around the edges of single payer while our maternal death rates rise - the only developed country's to do so at this point in time.
Free marketers like Paul Ryan have real blood on their hands.
(That's the low end of the estimates of what the U.S. diverts to that purpose.)
Yet we fiddle around the edges of single payer while our maternal death rates rise - the only developed country's to do so at this point in time.
Free marketers like Paul Ryan have real blood on their hands.
1
Is it comforting for you to know that a significant percent of the cost of your health care go to insure your insurer has the latest and most stylish Gulfstream G-650 parked at West Palm Beach to flaunt our so called "Free Market" extortion health care system?
7
Wow. There is a "problem solver's caucus" in the House? Nifty idea though it sounds like just the thing to take the other 390-some reps off the hook.
But let's pry up the rock and look underneath. This is the second best idea that might come out of the House. The first best is the one that a strong majority of Americans (by a huge margin) would prefer: single payer, Medicare for all coverage.
My hunch is that all you problem solvers are getting mobilized to solve the main problem Congress prefers to address: how to keep the big corporate health industry happy. And the money flowing into your reelection coffers.
But let's pry up the rock and look underneath. This is the second best idea that might come out of the House. The first best is the one that a strong majority of Americans (by a huge margin) would prefer: single payer, Medicare for all coverage.
My hunch is that all you problem solvers are getting mobilized to solve the main problem Congress prefers to address: how to keep the big corporate health industry happy. And the money flowing into your reelection coffers.
5
We have the best medical care - for those who can get it. We pay the most per capita - all the costs go only to those who can get the care. Equity should be the goal: collect taxes instead of insurance premiums, cut out insurance executives, fund medical education and employ physicians, fund hospitals and cut out the ridiculous billing for bandaids, give adults freedom to choose employment and not lose insurance. We have to do it in one of the several ways others have done it before us, with good results (France, England, the Nordic countries, Canada, Australia, Germany, and so on)
6
Ron Cohen, poster a few minutes ago is correct-Pelosi HAS TO GO. As does Schumer. All this talk about a better deal- what we want is something like a continuation of the NEW DEAL. The deal is healthcare for all. Liquidate the insurance companies if we have to. The neoliberal solution does not work and the country is sic.
3
There are two things obvious to me:
1) Obamacare = Romneycare = Heritagecare. Obamacare IS the conservative market-based plan. The only one that works, which is why repeal and replace was doomed from the start.
2) There is no possibility that single payer can be passed at this time. There are too many right-wing ideologues in power. So why don't we just put a pin in that, and forget it for now.
Kudos to you guys for trying to do something that helps people, rather than sticking to partisanship. I hope you succeed.
1) Obamacare = Romneycare = Heritagecare. Obamacare IS the conservative market-based plan. The only one that works, which is why repeal and replace was doomed from the start.
2) There is no possibility that single payer can be passed at this time. There are too many right-wing ideologues in power. So why don't we just put a pin in that, and forget it for now.
Kudos to you guys for trying to do something that helps people, rather than sticking to partisanship. I hope you succeed.
2
This includes a tax cut and unidentified offsets. Democrats, I know you are hungry but don't eat the rotten meat.
2
no, let's keep bickering.
Nice to see Democrats and Republicans actually working together to come up with a plan that most people could live with. How novel! Hopefully, this proposal can actually get written up as a law that both houses can debate and eventually vote on. Doing nothing is not an option.
Remember the inchoate cry of the Tea Party mobs? "Kill the Bill, Kill the Bill", and they didn't mean the movie or President Clinton. It was an orchestrated assault on President Obama and the Democrats who dared to improve people's access to god health care.
1
Tom Reed?
He's our representative, New York, 23rd district. He championed the repeal of the ACA and defended the nasty and mean healthcare bill passed in the House. In public statements, he has repeatedly tagged voters in our county (Tompkins County, which includes Ithaca, home of Cornell and Ithaca College ... and yes, it is bursting with organic farmers, potters, researchers, and professors) as "extreme." Extreme liberals. They don't like fracking. Darn those pesky hippie complainers!
These attacks and insults of liberal Democrats earn Mr. Reed support from his predominantly rural base.
Ithaca, NY, is one of the three largest cities in the 23rd district, along with Elmira and Jamestown. Tom Reed held no townhall meetings here for over a year. When he did appear, on a frigid morning, early, his timing was planned to inconvenience anyone inclined to protest against his very conservative policies. Lots of us stood outside in 4 degree weather nevertheless. (It hurt ... literally.)
Apparently he goes where the wind blows. He has been a staunch defender of Donald Trump, but now he senses a shift in the breeze. So he changes hats, adjusts his sails, and pretends to become a champion of compromise and nonpartisan cooperation.
Baloney.
He's our representative, New York, 23rd district. He championed the repeal of the ACA and defended the nasty and mean healthcare bill passed in the House. In public statements, he has repeatedly tagged voters in our county (Tompkins County, which includes Ithaca, home of Cornell and Ithaca College ... and yes, it is bursting with organic farmers, potters, researchers, and professors) as "extreme." Extreme liberals. They don't like fracking. Darn those pesky hippie complainers!
These attacks and insults of liberal Democrats earn Mr. Reed support from his predominantly rural base.
Ithaca, NY, is one of the three largest cities in the 23rd district, along with Elmira and Jamestown. Tom Reed held no townhall meetings here for over a year. When he did appear, on a frigid morning, early, his timing was planned to inconvenience anyone inclined to protest against his very conservative policies. Lots of us stood outside in 4 degree weather nevertheless. (It hurt ... literally.)
Apparently he goes where the wind blows. He has been a staunch defender of Donald Trump, but now he senses a shift in the breeze. So he changes hats, adjusts his sails, and pretends to become a champion of compromise and nonpartisan cooperation.
Baloney.
7
An opportunistic streak of some proportion is a prerequisite for life as a politician.
Three hearty cheers for this bipartisan effort! Though the wheels are sticky and rusty, and partisan flame-throwing still abounds, I feel a glimmer of hope that our system of legislation is beginning to work again.
The only way to fix the health care system is to get the people who've broken it and out of the way: All the politicians (who are only good at winning popularity contests) and government bureaucrats (who are only good at licking politicians' boots and evading responsibility).
Your essay is another "let's just tweak it a bit" - which sounds like a teenager playing with a computer program. You are the reason the healthcare system is "broken". You broke it, with every law and rule and regulation you imposed on Americans. Here's a hint: Never in the history of Forever has MORE regulation made anything cost LESS. But since you're politicians that knowledge escapes you.
Your essay is another "let's just tweak it a bit" - which sounds like a teenager playing with a computer program. You are the reason the healthcare system is "broken". You broke it, with every law and rule and regulation you imposed on Americans. Here's a hint: Never in the history of Forever has MORE regulation made anything cost LESS. But since you're politicians that knowledge escapes you.
1
wow...an anarchist.
Nope. But,
Wow, a three-year old.
Wow, a three-year old.
1
Wow, there is hope that Congress isn't totally corrupt. Should we credit Trump's bad behavior for encouraging Republicans and Democrats to work together in spite of McConnell and Ryan? Considering that a single payer plan for everyone is a very dim hope, this proposal from the Problem Solvers Caucus is a great solution. I hope that this new caucus will grow in size and keep working.
Why don't you Republicans start fixing healthcare by not sabotaging the healthcare system, that should stabilize things. Next, Republican governors should start accepting Medicaid expansion. It works, is cost effective and proven. I know 'freedom, blah, blah, blah'. Let it go and expand Medicaid.
Next, forget about selling across state lines, another Republican race to the bottom idea. I don't want the corrupt, paid for by the insurance lobby, insurance commissioner of Mississippi to have any influence on healthcare in my state. Which is what will have if we approve of selling across state lines. Do those simple things, and allow Medicare and Medicaid to bargain with big pharma. It will save us billions.
Next, forget about selling across state lines, another Republican race to the bottom idea. I don't want the corrupt, paid for by the insurance lobby, insurance commissioner of Mississippi to have any influence on healthcare in my state. Which is what will have if we approve of selling across state lines. Do those simple things, and allow Medicare and Medicaid to bargain with big pharma. It will save us billions.
1
Although I agree that a bipartisan approach is need to fix things in the short term, this is only a band aid. What is really needed is a fundamental reworking of the entire system.
1) Get medical costs under control. It is disgusting how the we are overcharged for medical services and drugs as compared to the rest of the world.
2) A reworking or elimination of the current insurance system. The concept of a company taking 25% of my medical dollars for pushing paper is infuriating.
3) Eliminate the price fixing between insurance companies and medical service providers. A service should have a fixed price to all patients.
4) Long term wellness of the county should be a priority. Too much of our medical dollars go to servicing diseases that are preventable. Just by reducing obesity in this country would go a long way to reducing medical costs to everyone.
1) Get medical costs under control. It is disgusting how the we are overcharged for medical services and drugs as compared to the rest of the world.
2) A reworking or elimination of the current insurance system. The concept of a company taking 25% of my medical dollars for pushing paper is infuriating.
3) Eliminate the price fixing between insurance companies and medical service providers. A service should have a fixed price to all patients.
4) Long term wellness of the county should be a priority. Too much of our medical dollars go to servicing diseases that are preventable. Just by reducing obesity in this country would go a long way to reducing medical costs to everyone.
1
Why should the Democrats agree to work with the GOP on healthcare right now? It would be a huge political mistake to let the GOP off the hook right now. There is a broader fight going on for the soul of America, and providing the GOP a life line would be a strategic blunder in that wider "war". Remember that were it not for three GOP Senators, the slimmest of margins, Obamacare would have been repealed. In the main, the GOP is the party of destruction and should not be given any leeway.
1
Despite all good intentions, the ACA or Obamacare is imperfect and in danger of imploding (with the nasty help of the Donald). Gottheimer/Reed's work needs to be applauded to turn away imminent danger to have ACA collapse.
Single care, of course, would be great, but in this badly divided country it seems an unreachable goal.
What most of reps, particularly the donor-bidding ones fear is another very costly entitlement where the rich have to bail out the poor/sick.
What needs to be talked about and addressed massively: prevention, prevention, prevention! including a fight against sickening, toxic industrialized food. To help people live with illnesses, rather than help them prevent them to get sick, is much more cost-effective!
Another fight is to stop the use and abuse of drugs by addressing and doing something about the social ills that produce the massive abuse problem. Interesting, the opioid epidemic is particularly rampant among those who elected Trump. What is the Donald doing about that?
Single care, of course, would be great, but in this badly divided country it seems an unreachable goal.
What most of reps, particularly the donor-bidding ones fear is another very costly entitlement where the rich have to bail out the poor/sick.
What needs to be talked about and addressed massively: prevention, prevention, prevention! including a fight against sickening, toxic industrialized food. To help people live with illnesses, rather than help them prevent them to get sick, is much more cost-effective!
Another fight is to stop the use and abuse of drugs by addressing and doing something about the social ills that produce the massive abuse problem. Interesting, the opioid epidemic is particularly rampant among those who elected Trump. What is the Donald doing about that?
1
Just another example of our corrupt Congress of both parties trying desperately to save the greedy, useless, cost-increasing, service preventing private insurance companies and keep those legalized bribes coming.
Any plan that includes private insurance companies in the US is doomed to failure. They are not in the health care business; they are in the investment business using other people's money any way they can get their hands on it. The more costs go up , the more premiums go up and the more money to invest( gamble) and the greater the profits for the owners and the compensation for top managers.
Single payer is the only workable system. Everyone would save, service would be better and health care results would be much better. It is obscene that the US has the worst health care results in the advanced world and pays twice as much as anyone else.
Don't let the "moderates" sell us out again to the insurance companies and big pharma.
Any plan that includes private insurance companies in the US is doomed to failure. They are not in the health care business; they are in the investment business using other people's money any way they can get their hands on it. The more costs go up , the more premiums go up and the more money to invest( gamble) and the greater the profits for the owners and the compensation for top managers.
Single payer is the only workable system. Everyone would save, service would be better and health care results would be much better. It is obscene that the US has the worst health care results in the advanced world and pays twice as much as anyone else.
Don't let the "moderates" sell us out again to the insurance companies and big pharma.
2
Bury the hatchet and govern by compromise! Well done!
Thank you!
>
I'm filing this under: I want a pony.
Sweden is a country; Germany is a country; France is a country, but the United States of America is a business, and Lucre is its Godhead. Once one understands this, one becomes enlightened. Now some people prefer illusion over enlightenment, e.g., Gottheimer and Reed.
“Why are groups so blind and stupid?—men have always asked. Because they demand illusions, answered Freud, they “constantly give what is unreal precedence over what is real.” And we know why. The real world is simply too terrible to admit; it tells man that he is a small, trembling animal who will decay and die. Illusion changes all this, makes man seem important, vital to the universe, immortal in some way.”
Ernest Becker
I'm filing this under: I want a pony.
Sweden is a country; Germany is a country; France is a country, but the United States of America is a business, and Lucre is its Godhead. Once one understands this, one becomes enlightened. Now some people prefer illusion over enlightenment, e.g., Gottheimer and Reed.
“Why are groups so blind and stupid?—men have always asked. Because they demand illusions, answered Freud, they “constantly give what is unreal precedence over what is real.” And we know why. The real world is simply too terrible to admit; it tells man that he is a small, trembling animal who will decay and die. Illusion changes all this, makes man seem important, vital to the universe, immortal in some way.”
Ernest Becker
3
BRAVO Josh Gottheimer and Tom Reed!! Thank you for pulling together the adults in the House of Representatives. Now if the Governor of Ohio John Kasich would create the Governors Problem Solvers Caucus, a bi-partisan group of governors that he alluded to that "stands ready to help," there might be a major league team in the game.
"...neither side willing to discuss anything in between." No, it is the Republicans who have refused to compromise, on anything, from the day that Barack Obama was inaugurated. Then when Trump was inaugurated, they thought they would be able to pass through anything they wanted. What is frightening is that stopping Trumpcare came down to one vote, and that from a man who is face to face with mortality.
Americans don't just DESERVE health care insurance, they DEMAND it.
Americans don't just DESERVE health care insurance, they DEMAND it.
2
As long as your "fix" to the health care system requires taking cash from one group and giving it to another, you are not fixing the system - you're merely propagating what's wrong into the future. You're just thieves, pretending to save some people by punishing everyone else.
1
"We have contrasting ideas — one of us is a Democrat, the other a Republican — about what ails the system and how to reshape it".
The one thing the two parties will always agree on: public opinion which overwhelmingly supports a Medicare-for-ll system must be ignored, and the lecherous private insurers must be kept in the game, propped up by huge subsidies if need be.
The one thing the two parties will always agree on: public opinion which overwhelmingly supports a Medicare-for-ll system must be ignored, and the lecherous private insurers must be kept in the game, propped up by huge subsidies if need be.
1
While the symbolic value of expending bipartisan energy toward a healthcare solution is encouraging, it all just amounts to various and sundry ways to placate insurance companies. Manipulating policy to conform to a specific industry profit model amounts to hitting a constantly moving target. The fact is, healthcare hasn't always been a marketplace and it shouldn't be now.
Removing insurers from the equation is the only way to permanently stabilize the healthcare system. While politically implausible on the federal level, for now, there are grassroots efforts in states like California with SB 562, which has hit a bump in the road but isn't dead. Nurses, doctors, professionals and citizens may very well have come up with a viable, and possibly exportable and scalable alternative that removes the insurance companies as the middle man—which is the only sane, sustainable solution to a health care system run by private companies that will always treat patients as a commodity.
That said, I applaud the sentiment—the "stop bickering" part especially. Unfortunately, big picture-wise, the actual fixes amount to not much more than lipstick + pig.
Removing insurers from the equation is the only way to permanently stabilize the healthcare system. While politically implausible on the federal level, for now, there are grassroots efforts in states like California with SB 562, which has hit a bump in the road but isn't dead. Nurses, doctors, professionals and citizens may very well have come up with a viable, and possibly exportable and scalable alternative that removes the insurance companies as the middle man—which is the only sane, sustainable solution to a health care system run by private companies that will always treat patients as a commodity.
That said, I applaud the sentiment—the "stop bickering" part especially. Unfortunately, big picture-wise, the actual fixes amount to not much more than lipstick + pig.
30
The health care system is irretrievably broken. There are too many hands in the cookie jar, too many high expectations and too little evidence that the health care system has anything to do with societies health. It is just another business that doesn't perform very well and does not add much to the productivity of society as a whole. After its collapse, it may be easier to construct a system that is beneficial to society.
1
You are confusing the collapse of Obamacare with the collapse of the healthcare system. These are totally unrelated. Healthcare will not collapse, on the contrary, it will continue to become ever more costly.
Cost containment is what is sorely needed. And that is not even discussed, because nobody wants to touch that hot potato.
Cost containment is what is sorely needed. And that is not even discussed, because nobody wants to touch that hot potato.
1
Let's stop talking about "tweets" and health care and get the real news.
West Virginia's "democratic" governor just switched parties. He pledged his allegiance to The Con Don and his International Mafia Top 1% Global Financial Elite Robber Baron/Radical religions Good Old Boys Party.
There are now 32 "republican" governors. The Koch brothers, Dictator Grover Norquist, Dick Cheney, Don Rumsfeld, Karl Rove and their Robber Baron buddies/bosses plan to call a "Constitutional Convention" to permanently alter OUR U.S. Constitution and turn The United States of America into a dictatorship - just as they are trying to do in Turkey and other International Mafia controlled countries around the world.
Here is what Wikipedia says about calling a Constitutional Convention:"A Convention to propose amendments to the United States Constitution, also called an Article V Convention, or Amendments Convention, called for by two-thirds (currently 34) of the state legislatures, is one of two processes authorized by Article Five of the United States Constitution whereby the Constitution, the nation's frame of government, may be altered. Amendments may also be proposed by the Congress with a two-thirds vote in both the House of Representatives and the Senate.[1]"
This is a SERIOUS DANGER TO THE UNITED STATES FROM WITHIN.
Good People of the media with a social conscience PLEASE GET THE WORD OUT. NOW!! This must not stand in America - not now not ever.
West Virginia's "democratic" governor just switched parties. He pledged his allegiance to The Con Don and his International Mafia Top 1% Global Financial Elite Robber Baron/Radical religions Good Old Boys Party.
There are now 32 "republican" governors. The Koch brothers, Dictator Grover Norquist, Dick Cheney, Don Rumsfeld, Karl Rove and their Robber Baron buddies/bosses plan to call a "Constitutional Convention" to permanently alter OUR U.S. Constitution and turn The United States of America into a dictatorship - just as they are trying to do in Turkey and other International Mafia controlled countries around the world.
Here is what Wikipedia says about calling a Constitutional Convention:"A Convention to propose amendments to the United States Constitution, also called an Article V Convention, or Amendments Convention, called for by two-thirds (currently 34) of the state legislatures, is one of two processes authorized by Article Five of the United States Constitution whereby the Constitution, the nation's frame of government, may be altered. Amendments may also be proposed by the Congress with a two-thirds vote in both the House of Representatives and the Senate.[1]"
This is a SERIOUS DANGER TO THE UNITED STATES FROM WITHIN.
Good People of the media with a social conscience PLEASE GET THE WORD OUT. NOW!! This must not stand in America - not now not ever.
1
This article is a breath of fresh air. But why has this kind of adult conversation become such a rare commodity?
1
People want entertainment. Politics has become a spectacle.
None of the proposals or comments I have seen here will "fix" the problem. The reason being that we are flawed biochemical "machines" with a finite expiration date and ever increasing repair costs as we age. As long as we are not honestly facing this fact, there can be no solution to the urgently needed cost containment. At the current rate, health care will devour 100% of our GDP in a few decades. Obviously that's not feasible.
Fact is that 95% of the medical care required to keep us productive and reasonably healthy can be achieved with 1/4 of current health care expenses. That's what we should focus our efforts on: Establish a single payer insurance system that maintains this 95% threshold. The remaining 5%, which makes up 3/4 of all medical costs today can still be covered by supplemental insurance, out of pocket payments or catastrophic insurance coverage.
The current system is so expensive, because everything is lumped together: Basic medical care is so expensive, because it has to pay for the exorbitantly high cost of heroic, but often futile, interventions of extending a life in pain bye a few months or even more pain. By further removing the bells and whistles and focusing on the essentials of medical care as such a 2 tier system allows, we can achieve 98% satisfaction. We will never be able to reach 100% and that's what we have to accept and live with.
Fact is that 95% of the medical care required to keep us productive and reasonably healthy can be achieved with 1/4 of current health care expenses. That's what we should focus our efforts on: Establish a single payer insurance system that maintains this 95% threshold. The remaining 5%, which makes up 3/4 of all medical costs today can still be covered by supplemental insurance, out of pocket payments or catastrophic insurance coverage.
The current system is so expensive, because everything is lumped together: Basic medical care is so expensive, because it has to pay for the exorbitantly high cost of heroic, but often futile, interventions of extending a life in pain bye a few months or even more pain. By further removing the bells and whistles and focusing on the essentials of medical care as such a 2 tier system allows, we can achieve 98% satisfaction. We will never be able to reach 100% and that's what we have to accept and live with.
1
Although I wholeheartedly agree with most commenters here that universal public health care is far and away the most rational course to take for almost everyone, such a dramatic shift would wreak havoc in the health insurance industry, essentially rendering it obsolete. But for the good of the *total* economy, is that such a bad thing?
Almost any economist will tell you that inefficiency in any major part of an economy is detrimental to the whole economy, and our health care system is terribly inefficient. "Medical care for profit" is at the heart of that problem. It's been determined time after time that Medicare operates with about a 3% overhead burden, as opposed to at least a 20% overhead burden common to private insurance companies. Most of that is waste in the form of duplication of services - every private insurer has its own analytics staff, claims processing staff, advertising burden, sales staff, management staff and board of directors.
A single, huge insurer would eliminate that duplication of effort and commensurate duplicate costing, which is one of the primary reasons companies merge. As a matter of economics, the best candidate to act as that "single, huge insurer" would be the central government.
Despite the rising costs of Medicare - due to extended life expectancies, amazing (but costly) improvements in geriatric diagnostics and care - Medicare remains the most efficient medical payments mechanism in the country, by FAR.
Almost any economist will tell you that inefficiency in any major part of an economy is detrimental to the whole economy, and our health care system is terribly inefficient. "Medical care for profit" is at the heart of that problem. It's been determined time after time that Medicare operates with about a 3% overhead burden, as opposed to at least a 20% overhead burden common to private insurance companies. Most of that is waste in the form of duplication of services - every private insurer has its own analytics staff, claims processing staff, advertising burden, sales staff, management staff and board of directors.
A single, huge insurer would eliminate that duplication of effort and commensurate duplicate costing, which is one of the primary reasons companies merge. As a matter of economics, the best candidate to act as that "single, huge insurer" would be the central government.
Despite the rising costs of Medicare - due to extended life expectancies, amazing (but costly) improvements in geriatric diagnostics and care - Medicare remains the most efficient medical payments mechanism in the country, by FAR.
7
Thank you for working together! Something so unheard of today.
As a small business person for most of my career, health care is a critical part of making life work for myself and for the people who work for me.
As someone who also manages or has managed the affairs of three seniors, it is so important to get this right and get off the grandstand. I challenge anyone that needs major medical to get a written quote on what it will cost. There is no other part of the US economy where you can't do price comparison.
As a small business person for most of my career, health care is a critical part of making life work for myself and for the people who work for me.
As someone who also manages or has managed the affairs of three seniors, it is so important to get this right and get off the grandstand. I challenge anyone that needs major medical to get a written quote on what it will cost. There is no other part of the US economy where you can't do price comparison.
4
Where's the incentives for healthier lifestyles and not using much health care resources?All I see is overpricing for those who take personal responsibility for their health,seldom needing or using health care resources and massive bail outs for those who don't.What nonsense.
2
The incentive for a healthier lifestyle is better health. What your comment really says is that you want to punish people who get sick, by suggesting that anyone who gets cancer, for instance, must have brought it on themselves by living an "unhealthy" lifestyle. Your self-centered, self-righteous attitude would probably evaporate the moment you or a loved one suffered a catastrophic illness or injury. If you enjoy good health, congratulate yourself on healthy living, but also thank your ancestors for bestowing good genes on you, and thank those lucky stars no one involved you on a disabling accident .
1
If, God forbid, your luck runs out and you are diagnosed with ALS or pancreatic cancer next year despite your healthy lifestyle, all the fat people who don't have a genetically-based disease will pitch in to pay for your care if they have the same insurer. That's how insurance works.
1
They still are ignoring the whole medical care problem - the charge master rate. The charge master rate is like the MSRP of medical goods and services, except it is completely unreasonable. All pricing and costs associated with healthcare start with the charge master rate regardless of how ridiculous. Then, insurance and governmental adjustments apply and reduce the charge to a more reasonable rate. Sometimes there is no adjustment, yet Hospitals still pursue the collection of the unreasonable rate. In setting these prices, hospital admins and insurers collude and determine values that will increase their revenue, help artificial inflate their nonprofit services, and deliver the appearance that insurance is saving you so much. Candidly, there are RICO and conspiracy criminal violations that have occurred that do not even approach the evilness of the charge master. Society tacitly accepts that if a hospital says it costs that much, it must be so. A real fix without succumbing to single payor or further stifling research and development must address the chargemaster. Establish a MED similar to the FED. Then set reasonable pricing ranges for all IDOC codes. Anyone opting in can take subsidies and accept governmental payments. Anyone opting out, can pricing as the market will bare. Interestingly, those medical providers that have left insurance markets have pricing far below even insurance adjusted rates. Get the evil chargemaster out of medical care.
6
I wish that I could recommend this comment a thousand times. No one, and I mean no one, in Congress nor in the White House, has ever addressed this insane charge master rate issue. In addition to challenging and abolishing the charge master rate, we need to know the average cost of medical procedures, and the rate of successful outcomes, at every medical facility in order to make informed decisions concerning our health care. The reasons for not doing any of this would appear to be, as you stated, worthy of a RICO investigation.
1
This article and all the NYT Picks should be required reading for everyone in Congress (and Trump if he reads). There are enough ideas in these comments to give our representatives, some who apparently have had none for the past seven years, ways to begin to fix our health care problems. Congress, listen to your citizens. They are knowledgeable and have good ideas. It's time to work together. Let's get it started now!
1
My 90-year-old mother has just been notified that her Medigap insurer is proposing a premium increase of 5.6% "due to a change in the anticipated benefit costs expected with the plan." The CEO of this insurance company earned over $15 million last year. Meanwhile, Social Security payments haven't changed since January 2015. How could any intelligent person think that tinkering with the insurance system is the answer to anything?
4
I think it is a very good start that some Democrats and Republicans are starting to work together on behalf of all of the citizens of the US, but this op-ed article does not address drug price gouging. I have personally priced some prescription drugs at pharmacies in the US, Canada, UK and Italy. For years, commonly prescribed medications, made by the same manufacturers, have routinely cost 300% or more in the US than in those other countries. When me-too drugs come on the market (for example another asthma medication or blood pressure medication in the same class as offered by rival companies), you would expect that "the marketplace" would result in a price drop by the competitors. Instead, they all charge the same high prices. Why? Because it not truly a free market and there is no price control. I write the prescription with NO idea of how much it will cost, the patient pays a co-pay (copays have been increasing exponentially this year), and the insurance company pays the rest. Each party has no idea what the other is paying in the black box of prescribing.
8
Thank you for your proactive collaboration.
I would just ask that at your level you look at the bigger picture of health care..... not insurance. The real way to reduce premiums is to reduce the astronomic costs built into the "system". We all know we have the most expensive health care delivery in the world. That is the root cause of the cost of insurance. Suggestions of how to go about it abound, including in other responses to this article.
Secondly, you should be working to take the burden of insurance off the shoulders of the employer. This would permit small companies to prosper and entrepreneurs to be born. It would permit job mobility by untying employees from their employers for fear of losing insurance.
I would just ask that at your level you look at the bigger picture of health care..... not insurance. The real way to reduce premiums is to reduce the astronomic costs built into the "system". We all know we have the most expensive health care delivery in the world. That is the root cause of the cost of insurance. Suggestions of how to go about it abound, including in other responses to this article.
Secondly, you should be working to take the burden of insurance off the shoulders of the employer. This would permit small companies to prosper and entrepreneurs to be born. It would permit job mobility by untying employees from their employers for fear of losing insurance.
3
It's time we recognized that health care is as much national defense as the Army, navy, Marine Corps, Air Force and Coast Guard. Conservatives, don't take it from me--take it from Margaret Thatcher, who privatized everything that moved in then socialist Great Britain, but left National Health alone.
8
Way back when I was an hourly worker, my pay stub said I worked 37.5 hours per week. My shift was 8.5 hours, and I got a 30 minute lunch and 2 15 minute breaks. I worked 5 days a week. Normal people call this a 40 hour work week. I will guess many service jobs are still counted this way.
Under this proposal, would I count as full time? If not, the numbers need some jiggering.
Under this proposal, would I count as full time? If not, the numbers need some jiggering.
5
The fatal flaw here is thinking that politicians can ever "build systems" or "fix" markets.
All they can do is meddle on the fringes of industries that exist because people need stuff, and market participants try and meet those needs. The best thing they can do is get out of the way. Instead, they spend their time (and your money) pretending to "fix" problems that they and their predecessors created by meddling in the first place.
All they can do is meddle on the fringes of industries that exist because people need stuff, and market participants try and meet those needs. The best thing they can do is get out of the way. Instead, they spend their time (and your money) pretending to "fix" problems that they and their predecessors created by meddling in the first place.
couldn't disagree more. First healthcare is one of the most non market systems that exist. first because for the most part doctors, not the consumer make the purchase. 2nd , because the need for healthcare is often deemed to be the "most "important issue, that there is no ability for a consumer to walk away because the price is too high (in the desert, if someone owned the oasis,there is no free market regulating prices charged). finally, because of corporate lobbying, the consumer (ie the us government for medicare) is not ALLOWED to negotiate drug prices. What kind of market is that?
market systems work very well for many commodities, but clearly not so well for police and fire care, nor military, nor healthcare.It would be a wonderful world if free market was the answer to every question, but life is to complex to have one answer for every question.
market systems work very well for many commodities, but clearly not so well for police and fire care, nor military, nor healthcare.It would be a wonderful world if free market was the answer to every question, but life is to complex to have one answer for every question.
8
Alan,
What you are describing are the distortions in the health care market caused by government intrusions upon the market, not a distinctive trait of the market itself. If you arrive at an emergency room in an unconscious state, then you have no ability to evaluate your purchase of medical care, but, barring that, you could shop for the best price from the best hospitals or doctors if only that information was available to patients. We need transparency in medical pricing and need to be able to evaluate the outcomes of procedures at competing health care facilities. Government, instead of assisting in seeing to it that such information is made available to consumers has, instead, permitted, and in some instances, encouraged, the hiding of this vital information.
What you are describing are the distortions in the health care market caused by government intrusions upon the market, not a distinctive trait of the market itself. If you arrive at an emergency room in an unconscious state, then you have no ability to evaluate your purchase of medical care, but, barring that, you could shop for the best price from the best hospitals or doctors if only that information was available to patients. We need transparency in medical pricing and need to be able to evaluate the outcomes of procedures at competing health care facilities. Government, instead of assisting in seeing to it that such information is made available to consumers has, instead, permitted, and in some instances, encouraged, the hiding of this vital information.
1
I am so tired of this meme both sides have been engaged in partisan politics and that the ACA represents a partisan proposal. The crafting of Obamacare was largely done on the basis of proposals for reform preferred by conservatives, and eschewed liberal preferences such as single payer, or a public option.
Paul Krugman pointed out that Republicans were the ones playing politics when they "fought against the idea of universal coverage, then denounced the ACA for failing to cover enough people; they made “skin in the game,” i.e., high out-of-pocket costs, the centerpiece of their health care ideology, then denounced the... high deductibles".
Compromise can be a good thing, but not if it is strictly in the service of bad ideas such as the one positing that Americans need more choice of insurers. Americans want and need to have a choice of doctors and providers, not insurers. Smaller insurers with less market share have less leverage over providers, and to compensate end up restricting to their customers to smaller networks of providers. There is no reason to believe more insurers will lower costs http://healthaffairs.org/blog/2010/07/09/will-more-insurers-control-heal....
Rather, their purpose is to allow healthy people to opt out of insuring sicker ones. The dedicated stability fund is apparently proposed to address that, but the million dollar question is who funds it, and how much. The devil is in the details, and there are none here.
Paul Krugman pointed out that Republicans were the ones playing politics when they "fought against the idea of universal coverage, then denounced the ACA for failing to cover enough people; they made “skin in the game,” i.e., high out-of-pocket costs, the centerpiece of their health care ideology, then denounced the... high deductibles".
Compromise can be a good thing, but not if it is strictly in the service of bad ideas such as the one positing that Americans need more choice of insurers. Americans want and need to have a choice of doctors and providers, not insurers. Smaller insurers with less market share have less leverage over providers, and to compensate end up restricting to their customers to smaller networks of providers. There is no reason to believe more insurers will lower costs http://healthaffairs.org/blog/2010/07/09/will-more-insurers-control-heal....
Rather, their purpose is to allow healthy people to opt out of insuring sicker ones. The dedicated stability fund is apparently proposed to address that, but the million dollar question is who funds it, and how much. The devil is in the details, and there are none here.
9
Before 1973, "for profit" health insurance was illegal. In 2017, the industry is greed driven with actual "healthcare" less than a primary concern. The road to profits is denial of service.
I wonder what went wrong.
I wonder what went wrong.
12
The only difference between "for profit" and "not for profit" is that the non-profits pay out 100% of their earnings in salary and benefits. You're a fool if you think there's no self-interest or "greed" in the self-sustaining operation of any business, 'for profit' or not.
Some good ideas in this proposal but "it also defines 'full-time' as a 40-hour workweek to discourage employers from manipulating employees' weekly hours to skirt the mandate"?: it seems to me that doing this will have precisely the opposite effect. What's to prevent those employers from just cutting everyone's work-week to, say, 39 hours and simply increasing their salaries by a slight amount to make up the difference? In any case, good luck getting this through the House and Senate; your colleagues may not be quite as open to compromise as you appear to be. (And please don't try this approach with the funding of Planned Parenthood or with women's reproductive rights in general. For us progressives, no such compromise on this issue is at all palatable.)
5
The other problem is the constant upcoding of illnesses and treatments to get higher payments. The codes we see on our medical bills are supposed to be accurate descriptions of what was wrong with us, what was done, and how severe the problems were. But if you ever look at some of the software out there to help with diagnosing or coding you'll see that it gives hints on how "high" one can code to get the most money for the work done. This is an outgrowth of our fee for service, for profit wealth care system. No doubt it also skews the statistics as well.
8
As a small business owner who has provided health insurance for my employees for over 20 years, I've never understood why I have to be involved in the health care system at all. It puts me in a difficult position. I can save lots of money by hiring part-time people and not providing health coverage. I can save by hiring young people who cost a lot less. Bronze health plans are much less expensive, but aren't as good for people with existing health problems. Health Savings Plans are good for my higher paid employees but useless for those with less income. Plus if I need to lay off or fire staff, I have to also worry about how it will affect their health care. And since health plans change and rates go up every year, every year I have to rethink options. Managing health plans is a significant burden on our company. Since I (and all employers) already pay into the Medicare insurance pool, and since I already pay close to 20% of my employee's salaries into our health plan, why not simplify things by offering Medicare for All, increase my company's contribution to Medicare, and give everyone in the country stable access to health care, whether they working or not. It would be much simpler for businesses and individuals and you wouldn't need so many rules and regulations about who has to provide coverage, and what happens to people who lose their jobs. And I could go back to full time focus on managing my business.
27
Steve,
As an American who emigrated to Canada (married a Canadian), I and thousands of other Americans living in Canada now know what you say is true, sane, and inevitable: It's startling that so many US voters cannot see it, i.e. the economic and social sanity of Medicare for All - as you called it. We know it simply as Universal coverage with a single payer system. To pay for it Canada Taxes here are a bit higher....,but: 1) employers don't suffer your constant dilemma, 2) overall health is better, thus better for industry and the economy, 3) total healthcare costs are nearly 50% less than US. Q: Why is it still confusing? A: Blame Fox News --sponsored by big Pharma who loathes single payer, of course.
As an American who emigrated to Canada (married a Canadian), I and thousands of other Americans living in Canada now know what you say is true, sane, and inevitable: It's startling that so many US voters cannot see it, i.e. the economic and social sanity of Medicare for All - as you called it. We know it simply as Universal coverage with a single payer system. To pay for it Canada Taxes here are a bit higher....,but: 1) employers don't suffer your constant dilemma, 2) overall health is better, thus better for industry and the economy, 3) total healthcare costs are nearly 50% less than US. Q: Why is it still confusing? A: Blame Fox News --sponsored by big Pharma who loathes single payer, of course.
3
Amen. All businesses get a level playing field and all employees get privacy and the freedom to follow entrepreneurial dreams.
Small business. Single Payer.
Small business. Single Payer.
Small business. Single Payer.
Small business. Single Payer.
Small business. Single Payer.
1
Mr. Gottheimer and Mr. Reed seem to be well-intentioned, and some bipartisanship on Capitol Hill is refreshing. The clock, however, is ticking. There is a framework which exists – Obamacare – which will work if Republicans stop trying to sabotage it and if a few adjustments are made to soften the effect on premiums of bringing younger, healthier individuals into the risk pool and protecting small businesses.
Coupled with aggressively attacking unjustified increases in the costs of care rendered by hospitals and physicians, stopping pharmaceutical companies from forcing Americans to foot the bill for providing low-cost drugs to other countries and allowing insurance companies and executives to demand high profits, the relatively minor changes to Obamacare can be achieved quickly.
For a long-run solution, the goal should be universal health care, and Republicans need to ask themselves why on earth they oppose it. There is no ideological reason in the history of conservatism for such opposition.
The best approach is a single-payer system, and a future change to that system ought to be the subject of bipartisan discussion. For now, however, to save millions of Americans from unnecessary family crises, let’s fix Obamacare quickly and move on.
Coupled with aggressively attacking unjustified increases in the costs of care rendered by hospitals and physicians, stopping pharmaceutical companies from forcing Americans to foot the bill for providing low-cost drugs to other countries and allowing insurance companies and executives to demand high profits, the relatively minor changes to Obamacare can be achieved quickly.
For a long-run solution, the goal should be universal health care, and Republicans need to ask themselves why on earth they oppose it. There is no ideological reason in the history of conservatism for such opposition.
The best approach is a single-payer system, and a future change to that system ought to be the subject of bipartisan discussion. For now, however, to save millions of Americans from unnecessary family crises, let’s fix Obamacare quickly and move on.
6
We have a universal health care plan. It's for senior citizens but it could be extended to all Americans. The name of that plan is Medicare. It would need some tweaks but since it's already nationwide it shouldn't be too difficult to enroll younger people in it, ramp up the existing network to accommodate the increase in covered people, and most important of all, end the fragmentation of records, care, etc., that seem to be a constant thread in every person's medical history.
Other things would have to change as well. Medical schools would have to charge a lot less or medical education would need to take less time than it does or both. But we could have national mandates like better nurse to patient ratios in hospitals, interchangeable platforms for EMRs, no searching for an approved provider and no drop or loss in continuity of care during critical illnesses. The only thing stopping this is a lack of political will on both sides to tell the "health" care industry that patients are not consumers, to check to see that all the research pharmaceutical companies claim they do is pharmaceutical instead of market, and to stop acting like our health care system is the best in the world. Just because foreigners come here doesn't mean we're the best. It means that they can afford it.
Other things would have to change as well. Medical schools would have to charge a lot less or medical education would need to take less time than it does or both. But we could have national mandates like better nurse to patient ratios in hospitals, interchangeable platforms for EMRs, no searching for an approved provider and no drop or loss in continuity of care during critical illnesses. The only thing stopping this is a lack of political will on both sides to tell the "health" care industry that patients are not consumers, to check to see that all the research pharmaceutical companies claim they do is pharmaceutical instead of market, and to stop acting like our health care system is the best in the world. Just because foreigners come here doesn't mean we're the best. It means that they can afford it.
8
Eliminate the Medical Device tax. That's the ticket to success not requiring Pharma, the Medical Industries, Hospitals, etc to do anything about the prices they charge. My guess it that the Federal Government is paying for most of those 'Medical Devices' already so let's just give them more money.
And this 'reduces funds for research and development' is a bogus argument. Eliminating the tax goes to the bottom line not to R&D and companies make the decision on what to spend on R&D based on what they want to do in the future. And I believe that R&D expenses are probably tax deductible as well.
And this 'reduces funds for research and development' is a bogus argument. Eliminating the tax goes to the bottom line not to R&D and companies make the decision on what to spend on R&D based on what they want to do in the future. And I believe that R&D expenses are probably tax deductible as well.
1
Here is a thought to take back you the Committee. Health Care is not a service that is compatible with the classical business model, which consists of investment in capital to produce a maximal return on investment given the market. Demand for medical service is inelastic. Since medical service is available only by the privilege of licensing you may be assured that the providers will limit competition which means the consumer pays monopoly prices.
The only rational context in which to place medical services is the utility. We have utilities that provide water, gas, electricity. MedicaL care and its associated insurance should be provided in the form of a utility. If the very well off want to construct a concierge medical service they should be able to do so once they pay their share for operating the medical utility.;
Utilities are or should be guided by cost considerations associated with the technology and distribution. Getting a profit on capital invested should not be the driver.
The only rational context in which to place medical services is the utility. We have utilities that provide water, gas, electricity. MedicaL care and its associated insurance should be provided in the form of a utility. If the very well off want to construct a concierge medical service they should be able to do so once they pay their share for operating the medical utility.;
Utilities are or should be guided by cost considerations associated with the technology and distribution. Getting a profit on capital invested should not be the driver.
6
I think that in order to fix the health care system in a bipartisan way, the first step is to state an ultimate bipartisan objective of the health care system, independent of the fiscal and programmatic ways of reaching that objective.
If the objective is universal, necessity based, care for all regardless of income, wealth, state of residence, and medical history, then the best minds and the peoples representative can embark on the task to meet this objective.
On the other hand if the objective is to have a triage system based, not on the urgency of medical need, but on a particular individual's employer, wealth, income, age, location, health history, etc, then partisanship we've had to date will flourish. And the recent Republican repeal effort has surely demonstrated that there are powerful political forces that are content to write off healthcare for tens of millions in our community.
If the objective is universal, necessity based, care for all regardless of income, wealth, state of residence, and medical history, then the best minds and the peoples representative can embark on the task to meet this objective.
On the other hand if the objective is to have a triage system based, not on the urgency of medical need, but on a particular individual's employer, wealth, income, age, location, health history, etc, then partisanship we've had to date will flourish. And the recent Republican repeal effort has surely demonstrated that there are powerful political forces that are content to write off healthcare for tens of millions in our community.
4
Sometimes in life it is better to scrap a system than try to patch it. Such is the case with Obamacare. "Fixing" Obamacare by increasing taxpayer subsidies to match the increasing premiums or expanding the budget-busting program called Medicaid is not "fixing". It's digging a hole that America cannot fill. This transfer of wealth from hard-working families who cannot go to Doctors because of high deductibles to people dependent on Government handouts and have no skin in the game has to stop. America needs to get back to the idea of personal responsibility when it comes to healthcare.
2
This hole you say cannot be filled is being filled very successfully in many other countries. It is often pointed out that people have healthier lifestyles in these countries, but nobody every concludes that having access to healthcare, and other social services in fact facilitates these healthier lifestyles.
2
Such extraordinary facile reasoning, John Smith. Your analysis is based on the stereotype that the "hard working" are somehow superior to those who have less income. That is a sad way to think about society.
Congratulations to the members of the problem-solving caucus. You appear to have worked well together in your seminal attempt to define your mission, establish a reasonable, effective, and efficient set of guidelines to achieve that mission, and implement these guidelines to improve our country's health care. Thank you for your courage and wisdom. Hopefully, you have taken the first step toward returning to the role of government in reaching the goals set out in our Declaration of Independence.
6
The problem is the "for profit" system currently in place. Protecting profit margins will always come before paying premiums, always! You could calculate it while waiting in the ER for treatment, so many claims will be automatically denied simply to cover the margin.....or at least it appears lite
Big Pharma is another issue, pricing has gone crazy, as if they all expect a government crackdown and are trying to grab as much as possible beforehand.
These are the issues........and a solution may no be possible in the current market....
Big Pharma is another issue, pricing has gone crazy, as if they all expect a government crackdown and are trying to grab as much as possible beforehand.
These are the issues........and a solution may no be possible in the current market....
4
Yes, the for profit hospital and clinic system is a gigantic problem.
But at least they are making a start on some very real problems.
But at least they are making a start on some very real problems.
1
A start in the right direction.
Market forces can substantially decrease the costs of medical care if and when the individual patient once again controls their healthcare dollars and pays providers directly. Republicans and Democrats take note. This has nothing to do with pseudo competition between large "blue" monopolies. A tiered "deductible", based on income and/or wealth, would limit the out of pocked liability of patients who have extremely complex problems and/or very limited means. A universal national medical back up insurance could provide $$ to those who have exceeded their deductibles, and would likely be much cheaper than anything currently envisioned.
Again Democrats and Republicans take note:
Individual choice
Individual responsibility for health care decisions
Progressive and universal coverage
Protection against financial catastrophe related to medical costs
Decreased costs overall
Market forces can substantially decrease the costs of medical care if and when the individual patient once again controls their healthcare dollars and pays providers directly. Republicans and Democrats take note. This has nothing to do with pseudo competition between large "blue" monopolies. A tiered "deductible", based on income and/or wealth, would limit the out of pocked liability of patients who have extremely complex problems and/or very limited means. A universal national medical back up insurance could provide $$ to those who have exceeded their deductibles, and would likely be much cheaper than anything currently envisioned.
Again Democrats and Republicans take note:
Individual choice
Individual responsibility for health care decisions
Progressive and universal coverage
Protection against financial catastrophe related to medical costs
Decreased costs overall
1
The current system is not about "health care"; it is about insurance companies making profits. Until we as a country agree to cut out the middlemen and have single payer for all (Medicare, or the federal employees' plan), no amount of bipartisan rearranging of deck chairs will make a meaningful difference.
14
Single payer replaces one middleman with another: insurance companies out, government in. Why do we believe that would solve the problems of our health care system?
I appreciate the sentiment. I really do.
But this plan illustrates the woeful inadequacy of anything approximating the status quo. The Gottheimer and Reed plan would slow—but not reverse—the growth of premiums. About high copays and outrageous deductibles, it would do nothing. About the 28 million Americans who still have no coverage at all, it would do nothing.
Gottheimer and Reed deserve our sincere thanks. They've taken an honest, thoughtful, practical approach to tweaking the status quo—and they've come up far short of a result that's at all reasonable. They've given incrementalism its best shot. They've proven Bernie Sanders has been right all along—we need deep, deep reform.
But this plan illustrates the woeful inadequacy of anything approximating the status quo. The Gottheimer and Reed plan would slow—but not reverse—the growth of premiums. About high copays and outrageous deductibles, it would do nothing. About the 28 million Americans who still have no coverage at all, it would do nothing.
Gottheimer and Reed deserve our sincere thanks. They've taken an honest, thoughtful, practical approach to tweaking the status quo—and they've come up far short of a result that's at all reasonable. They've given incrementalism its best shot. They've proven Bernie Sanders has been right all along—we need deep, deep reform.
7
What they've realized is that deep reform isn't going to happen in our bipartisan political system...at least not quickly. You are talking about what should happen, and they are talking about what might have a chance to pass and give us a start. A genuine concern is accepting nothing short of revolutionizing the healthcare system at once. That's just not going to happen, and even if it did you'd have 40% of the country hoping it fails. Imagine implementing this in a couple of years and seeing the issues the VA is having. The right would play it up, make it worse and convince people the government is killing them.
Do not define the compromise position as between Democrats who want to protect ACA and Republicans who want to repeal it. The right approach is to protect the good parts of ACA and IMPROVE the parts that don't work well. Step one is to publicly all out efforts at sabotage. After that every problem (high premiums, high deductibles, limited provider networks, and overall medical costs) can be dealt with. But, contrary to the authors' claims, all the improvements are not in the middle, but will be more liberal than the ACA. There are no significant improvements to be had through conservative means. Studies have shown that buying policies across state lines, or tort reform will not make much difference.
But first STOP THE SABOTAGE!
But first STOP THE SABOTAGE!
2
Sogh. It is currently perfectly legal to sell insurance across state lines, and Obamacare actually encourages multi-state Exchanges.
2
Many liberal Democrats seem to believe the 2018 elections are in the bag for the Democrats. Having read analyses by Nate Cohn of The Times, and others, I harbor no such illusions. There seems to be a sense of entitlement among liberals. They are on the side of the angels, and that is enough to assure them electoral success. They have apparently learned nothing from 2016.
Almost certainly, it was Nancy Pelosi who kept single-payer off the Dems’ agenda. Despite the defection to Trump by millions of former Obama voters in 2016, Hillary would still have won if so many erstwhile Democrats had not stayed home or voted for Johnson or Stein. (I blame Bernie for that, for his incessant character assassination of Hillary during the primaries.)
Pelosi symbolizes the so-called neoliberalism that so many of these voters profess to detest (although, truth be known, most of them are anti-working-class at heart). Unless Pelosi can be persuaded to step aside, I fear once again, the Dems will snatch defeat from the jaws of victory in 2018.
• "Democrats’ Best Chance to Retake the House? 8 Types of G.O.P. Districts to Watch," Nate Cohn, NYTimes, June 26, 2017, http://tinyurl.com/y922qf45
• "The Democratic Party’s Billion-Dollar Mistake," Steve Philips, NYTimes, July 20, 2017, http://tinyurl.com/y9wcleng
Almost certainly, it was Nancy Pelosi who kept single-payer off the Dems’ agenda. Despite the defection to Trump by millions of former Obama voters in 2016, Hillary would still have won if so many erstwhile Democrats had not stayed home or voted for Johnson or Stein. (I blame Bernie for that, for his incessant character assassination of Hillary during the primaries.)
Pelosi symbolizes the so-called neoliberalism that so many of these voters profess to detest (although, truth be known, most of them are anti-working-class at heart). Unless Pelosi can be persuaded to step aside, I fear once again, the Dems will snatch defeat from the jaws of victory in 2018.
• "Democrats’ Best Chance to Retake the House? 8 Types of G.O.P. Districts to Watch," Nate Cohn, NYTimes, June 26, 2017, http://tinyurl.com/y922qf45
• "The Democratic Party’s Billion-Dollar Mistake," Steve Philips, NYTimes, July 20, 2017, http://tinyurl.com/y9wcleng
7
Bingo. Pelosi was worth 196 million just recently. She has to go. She has done nothing. And no doubt, single payer was not in her Marin royal interest.
3
Democrats need to get back to standing up first and foremost for the American middle class. They need to stop being apologists for illegal immigration and champions of illegal immigrants. They need to stop shoving divisive identity politics down the country's throat.
This is the antidote to Trumpism.
This is the antidote to Trumpism.
2
I applaud the writers of this article and their caucus for "trying to get things done." At the very least, their plan will stabilize the ACA for the next few years.
But if we're honest with each other, some form of Medicaid for all should be the long-term goal of healthcare reform. One of the issues that needs to be addressed is that Congress-persons have a poor grasp of what Medicaid does and what models in the rest of the world "work." For those on Medicaid, to have "good" health insurance, requires the purchase of supplemental insurance. Half of all MD's do not accept Medicare or Medicaid patients.
Compared to other nations, e.g. the UK, Medicaid is very generous. Medicaid will pay for someone to get a motorized wheelchair; in the UK the NHS does not. Medicaid will pay for expensive drugs such as Nexavar that the NHS will not. To make Medicaid for all financially possible will require that the benefits available to each person are more comparable to those on the UK's NHS, and that expensive new drugs and other procedures will be available only to those who purchase supplemental insurance. Whether the Govt. wishes to then provide that insurance or still permit for-profit health insurance would then become the ideological question.
But if we're honest with each other, some form of Medicaid for all should be the long-term goal of healthcare reform. One of the issues that needs to be addressed is that Congress-persons have a poor grasp of what Medicaid does and what models in the rest of the world "work." For those on Medicaid, to have "good" health insurance, requires the purchase of supplemental insurance. Half of all MD's do not accept Medicare or Medicaid patients.
Compared to other nations, e.g. the UK, Medicaid is very generous. Medicaid will pay for someone to get a motorized wheelchair; in the UK the NHS does not. Medicaid will pay for expensive drugs such as Nexavar that the NHS will not. To make Medicaid for all financially possible will require that the benefits available to each person are more comparable to those on the UK's NHS, and that expensive new drugs and other procedures will be available only to those who purchase supplemental insurance. Whether the Govt. wishes to then provide that insurance or still permit for-profit health insurance would then become the ideological question.
2
That would be Medicare for all, not Medicaid. Medicare pays for the essentials, and one can get supplemental through the private market electively.
2
It isn't the a Medicare supplemental pays for fancy tests. It just picks up the part of the payment that regular Medicare will not pay.
Regular Medicare has deductible/co-pays and doesn't pay 100%.
Regular Medicare has deductible/co-pays and doesn't pay 100%.
Pres. Obama had on his healthcare team one of the most qualified medical professional in the country his CDC Director Tom Frieden, MD, MPH who prior to the CDC post was Mike Bloomberg's NYC Health Commissioner for 8 years. Yet, Frieden was not invited to architect Obamacare. Economist and MDs who had never run a healthcare system and who did not have a public health background were the chosen architects.
Following Dr. Frieden's interventions in NYC nationally is the way to fix health care. Efforts were put into public health interventions such implementing the MPOWER tobacco cessation program, efforts to tax Coke, cleaning the air pollution, and shoring up primary care interventions with electronic health record systems.
Improving healthcare and lowering healthcare costs are from changes in policy and spending for public health and primary care and following the work of Dr. Frieden in NYC and at CDC nationwide.
While tobacco use is declining (but not among those at the poverty level and below), in the past 15 years, the rates of diabetes has risen dramatically. In 2000, not a single state had 9 per 100 adults with diabetes, and only one state had the next lower rate. Today, about 3/4 of states are at 9 per 100 or more. Until these numbers are addressed, healthcare costs will rise.
Following Dr. Frieden's interventions in NYC nationally is the way to fix health care. Efforts were put into public health interventions such implementing the MPOWER tobacco cessation program, efforts to tax Coke, cleaning the air pollution, and shoring up primary care interventions with electronic health record systems.
Improving healthcare and lowering healthcare costs are from changes in policy and spending for public health and primary care and following the work of Dr. Frieden in NYC and at CDC nationwide.
While tobacco use is declining (but not among those at the poverty level and below), in the past 15 years, the rates of diabetes has risen dramatically. In 2000, not a single state had 9 per 100 adults with diabetes, and only one state had the next lower rate. Today, about 3/4 of states are at 9 per 100 or more. Until these numbers are addressed, healthcare costs will rise.
2
These are two completely different things. Health insurance is one; public health is another. The initiatives from Dr. Frieden, and later Dr. Farley, in New York are valiant efforts to improve the general public health. But people are still going to get sick or injured and when they do they need health insurance.
To provide care one must be of service, to be of service one must abrogate power, abrogating power is to disable achievement of gain, disabled from achieving gain means one is unable to profit. Care and Profit are diametrically opposed - Full Stop.
3
Now that Repeal and Replace died, or at least is in a dormant state, we need a bipartisan bill to rescue Obamacare’s most vulnerable element—the exchanges. Here’s a proposal:
For the conservatives,
Allow insurance companies to sell policy across state lines. The Obamacare requirement that all policies cover “essential benefits” limits insurance companies’ race to the bottom searching for lax state regulators.
For the insurance companies
Change the pool for the state exchanges from the county to the state. This broadens the pool—which is good for insurance—and mixes more expensive to serve rural policyholders with less expensive urban policyholders. If a company offers policies in a state they must sell to all the residents of the state.
Interstate competition potentially will make the markets stronger.
To protect Obamacare from sabotage
Codify the subsidies to low income buyers, the enforcement of mandate to buy insurance, and any other ways to administratively sabotage Obamacare.
For the conservatives,
Allow insurance companies to sell policy across state lines. The Obamacare requirement that all policies cover “essential benefits” limits insurance companies’ race to the bottom searching for lax state regulators.
For the insurance companies
Change the pool for the state exchanges from the county to the state. This broadens the pool—which is good for insurance—and mixes more expensive to serve rural policyholders with less expensive urban policyholders. If a company offers policies in a state they must sell to all the residents of the state.
Interstate competition potentially will make the markets stronger.
To protect Obamacare from sabotage
Codify the subsidies to low income buyers, the enforcement of mandate to buy insurance, and any other ways to administratively sabotage Obamacare.
6
Another answer for affordable dependable care for families and individuals are the fast-growing healthcare sharing ministry programs like Christian-based Liberty HealthShare, and Catholic-based Solidary HealthShare. Certified ministry programs like these are recognized by the ACA and classified as a 501(c)(3) organizations. Since not classified as health insurance, they are exempt from State Insurance regulations and the Individual Mandate. They are health care programs where participating responsible Christians or organized denominations holding common ethical or religious beliefs pay low monthly premiums & deductibles and share in medical costs through a formalized well-coordinated online electronic payment process. You go to any hospital or doctor you choose and much more affordable than Insurance Exchange Marketplace rates!
Interesting. Can Humanists, other religious denominations, and other community-based programs (of any or no denomination) do the same?
This isn't true; these orgs are okay only for routine stuff. Something really expensive happens, and you have to beg for help.
Moreover, these orgs all require to belong to certain churches.
Moreover, these orgs all require to belong to certain churches.
Instead of mindlessly taking components of each side's proposal, why not start with listening tho those who actually understand how health markets work? Bring in the health economists, the actuaries, the patient advocates, the providers, and the benefits managers from large employers. Work to implement what has widespread agreement within that group and ignore anything that they don't talk about.
2
Single payer yesterday. Single payer today. Single payer tomorrow.
13
Amen. Respect.
As one commenter said, "Here in my part of NC, an individual plan without subsidies has premiums of $900-$1400/month, plus a $6000-$7500 deductible, plus a $7500 out of pocket on top of that. In the case of serious illness, the individual could have to shell out up to $25,000 out of pocket before insurance pays one single dime. So how is that insurance?" If you're a welder, at a large 1200 employee company, you most likely have a good affordable insurance plan. If you're a welder (same skill and quality level) in a 4 man shop, you may have a serious problem as described above. I'm a retired lower middle-class federal employee out of a particular risk pool that approaches 100K. My low health insurance costs reflected the economies of scale that a 100K risk pool provides. Prior to retirement and Medicare, I had an expensive operation and hospital stay that cost me a total of about $1600. That I could do......$25,000 would have been a big problem. We can't have a healthcare system where the same person, doing the same job, is financially covered in one case, and financially destroyed in another.
7
While other commenters write about Single Payer, the only solution and one that works well all over the world, I want to chime in with something specific. Single Payer needs to include all forms of women's health care, including all that Planned Parenthood does, while making it easier for women to control their own bodies. Does a woman want an abortion? She should go to her doctor and get one. Does a woman want a form of birth control? She should get it. Single Payer is about protecting life, much more than anyone proclaiming to be pro-life. As such, the Hyde Amendment needs to go away so that women have as much control of their bodies as we men do.
2
No public option? Add it. It's essential to universal health care, which should be the ultimate goal. Further, try to keep something fairly radical in mind: health insurance is not the same as health care. That is a subliminal myth (lie?) gradually established in the public and congressional minds that is keeping us from achieving our loftiest and most virtuous goals. If they are incapable of competing in a market characterized by affordable premiums, tough. Good riddance.
3
Medicare for all.
5
Single payer, Medicare for all. This country can afford it plenty. Anyone wants to pay extra insurance, let them. Everyone should have what the Congressmen and women are receiving.
5
if you really want to make healthcare affordable - get the insurance companies out of system and negotiate drug prices down to those paid by india.
9
"Who knew heath care could be so complicated?" It does start with the insurance companies. Doctors are so overloaded with numbers of patients in order to carry insurance for their practice, that the wait to be seen [including for serious illnesses] can be 3-5 weeks. This of course is the other side of the coin, but one that has not been brought to light. The lucky insured patient can die because the Dr. books 2x the amt of patients in order to cover his [her] premiums. Whoda thunk it?
Your idea is great, but it will never happen. THe HMO's, Big Pharma, doctors, and insurance companies would NEVER let this happen!
It's not irresponsible to act tactically to address emergencies. I'll buy that insurance markets are so unstable that emergency action is necessary to shore them up and preserve health insurance for millions. And it's great news that at least some in Congress are committed to working together across party lines to govern effectively through compromise.
What IS irresponsible is forever patching up a program that offers NO promise that despite the patches funding needs will continue to rise until this one priority COMPLETELY strangles our states and now the federal government forever, foreclosing attention to other important priorities such as education and infrastructure ... WITHOUT forging a real solution to American healthcare that is both effective and strategically sustainable.
If all we can congratulate ourselves over is kinda-sorta sticking our collective fingers in the dike THIS year, then next year likely will see us inundated with new leaks -- and with fingers and toes completely occupied plugging old ones.
We need to completely re-imagine and re-launch the ship of American healthcare, not keep plugging a badly leaking dinghy. BOTH Republicans AND Democrats will be held to this charge by voters, since both of you dared to touch our third-rail of politics. By all means, keep talking, compromising and moving us forward incrementally with your ACA patch jobs. But ALSO get busy re-building that ship from the ground-up.
What IS irresponsible is forever patching up a program that offers NO promise that despite the patches funding needs will continue to rise until this one priority COMPLETELY strangles our states and now the federal government forever, foreclosing attention to other important priorities such as education and infrastructure ... WITHOUT forging a real solution to American healthcare that is both effective and strategically sustainable.
If all we can congratulate ourselves over is kinda-sorta sticking our collective fingers in the dike THIS year, then next year likely will see us inundated with new leaks -- and with fingers and toes completely occupied plugging old ones.
We need to completely re-imagine and re-launch the ship of American healthcare, not keep plugging a badly leaking dinghy. BOTH Republicans AND Democrats will be held to this charge by voters, since both of you dared to touch our third-rail of politics. By all means, keep talking, compromising and moving us forward incrementally with your ACA patch jobs. But ALSO get busy re-building that ship from the ground-up.
4
Yes, look at what works in other developed countries that are often less affluent than the US for lower costs and better outcomes, study it and adopt something similar here!
1
Anna:
For years those other countries have avoided any serious responsibility for defending the West and even themselves against existential adversaries, depending on us to do it alone; and only now are beginning to think how thoroughly in trouble they really are in the wake of Trump's cautionaries about NATO. As frustrating as it is to realize that there really ARE pirates and strongmen and tyrants out there who would enslave or otherwise harm them, they're only now beginning to wonder how they afford those social safety networks that they built while eviscerating their militaries and depending on us.
It will be interesting to see what they do. Adopting Russian and Arabic as cradle languages is an option.
For years those other countries have avoided any serious responsibility for defending the West and even themselves against existential adversaries, depending on us to do it alone; and only now are beginning to think how thoroughly in trouble they really are in the wake of Trump's cautionaries about NATO. As frustrating as it is to realize that there really ARE pirates and strongmen and tyrants out there who would enslave or otherwise harm them, they're only now beginning to wonder how they afford those social safety networks that they built while eviscerating their militaries and depending on us.
It will be interesting to see what they do. Adopting Russian and Arabic as cradle languages is an option.
Wow. You really have to applaud the common sense and pragmatism of this bi-partisan approach to finally work across the isle to improve the ACA and thus the lives of millions of Americans. It really doesn't take rocket scientists to figure this one out.
2
Can you please stop using the "Health Care System" and "Health Insurance" and the "Affordable Care Act" interchangeably? Fixing the ACA or getting insurance to more people DOES NOT MEAN FIXING HEALTH CARE!
Our health system is broken: Prices for simple procedures, like an MRI, vary 1000% (or more), we have to pay out-of-pocket for out-of-network care at in-network facilities, drug companies/PBM's/Pharmacies jack up cash prices for drugs in order to negotiate higher insurance reimbursements and then the Rx plans exclude those same drugs as "non-formulary" for no reason other than they don't want to pay for them (meaning I have to pay a jacked-up price out of my own pocket), hospital conglomerates are buying up small practices and immediately increasing the prices they charge by 100-500%.
I can have "great" insurance coverage and still go bankrupt because some billing person screwed up a code or because some claims payer at UHC or Cigna or Aetna decides the care MY DOCTOR ORDERED wasn't necessary.
Getting a few million more people insurance under that system doesn't change a thing. If put more people into a broken system. Stop talking about fixing health care... you haven't proposed a single thing that would help!
Our health system is broken: Prices for simple procedures, like an MRI, vary 1000% (or more), we have to pay out-of-pocket for out-of-network care at in-network facilities, drug companies/PBM's/Pharmacies jack up cash prices for drugs in order to negotiate higher insurance reimbursements and then the Rx plans exclude those same drugs as "non-formulary" for no reason other than they don't want to pay for them (meaning I have to pay a jacked-up price out of my own pocket), hospital conglomerates are buying up small practices and immediately increasing the prices they charge by 100-500%.
I can have "great" insurance coverage and still go bankrupt because some billing person screwed up a code or because some claims payer at UHC or Cigna or Aetna decides the care MY DOCTOR ORDERED wasn't necessary.
Getting a few million more people insurance under that system doesn't change a thing. If put more people into a broken system. Stop talking about fixing health care... you haven't proposed a single thing that would help!
3
There is no acceptable compromise, just do what is in the freaking ACA legislation. And stop doing things that undermine it -- stop Trump from doing harm to the ACA.
At this point, Congress has no ability to truly improve the so-called system we have, as the overwhelming of Americans now want, so we'll wait for a Democratic Congressional majority to take the next step.
At this point, Congress has no ability to truly improve the so-called system we have, as the overwhelming of Americans now want, so we'll wait for a Democratic Congressional majority to take the next step.
1
Am a retired RN who pre-dates Medicare and am disgusted with what the " money changers" have done to Health Care and am for Universal Coverage. However after reading "An American Sickness" , have decided that is an impossible dream. To maney hands in the till.
2
Tom Reed voted to shut down the government a few years ago. He's not to be trusted.
1
Yeah, sure. You guys work together to put out the house fire. I'll bet neither one of you will want to fix it up to sell it though. It's going to be a drag on the neighborhood until one party has the guts to go single payer.
3
Single payer is mentioned a lot in these posts. I want to address two BIG reasons why healthcare costs so much more in this country compared to European countries that have "universal health insurance" paid for by the government.
1) We are the #1 fattest nation on the planet; along with this comes much higher rates of diabetes, heart disease, joint failure, certain types of cancer. Other countries don't have as high of disease rates as the US. That costs $$
2) No other country has the medical tort system, where doctors are sued not just for a potential mistake, but ANY bad outcome, even if there was no fault by the physician. Malpractice costs many physician specialties 6 figures a year. The democratic party's #1 PAC contributor are the trial attorneys-they'll never allow malpractice/tort reform. That costs $$
1) We are the #1 fattest nation on the planet; along with this comes much higher rates of diabetes, heart disease, joint failure, certain types of cancer. Other countries don't have as high of disease rates as the US. That costs $$
2) No other country has the medical tort system, where doctors are sued not just for a potential mistake, but ANY bad outcome, even if there was no fault by the physician. Malpractice costs many physician specialties 6 figures a year. The democratic party's #1 PAC contributor are the trial attorneys-they'll never allow malpractice/tort reform. That costs $$
4
cant believe my tea party inspired congressperson is leading such a great concept. well done,mr reed
1
To fix the health care system we have to fix the entire country first!
As with any iceberg, the problem is not in what is clearly visible but in those parts hidden under the surface…
The ACA is not the cause of our problems but just a symptom of them!
As with any iceberg, the problem is not in what is clearly visible but in those parts hidden under the surface…
The ACA is not the cause of our problems but just a symptom of them!
to repair we need to remove ALLSTATE STATE FARM FARMERS BLUE CROSS these are all profit companies. non profit aka Medicare for Americans is the way to go
1
How about the TV special across channels hosted by these writers presenting and debating the plan (and other possibilities).
One small (?) addition to Vivien's idea. Please have the program done by Public Radio and Public Television--get as unbiased a program as possible!
Can someone please explain to me why expanding Medicare to cover everyone is a bad idea? It works for seniors so why won't it work for the rest of us? It would need some technical tweaks I'm sure but otherwise what's the hang-up?
3
The cost, maybe? California just voted down a statewide plan for single single payer because the cost was too great and there was no plan to fund it.
1
Seniors have paid into it for their entire working lives before receiving any benefit. How would one pay into Medicare to join? Put up thousands of dollars to join the 'club' and then keep paying because Medicare after retirement is not free.
more blather...still an insucanced market care plan, read it: "marketplace," "shore up struggling insurance exchanges," "stabilize markets," etc.
cost are important but they are not health care and until we nail that down.
try this guys: think of your own families (whom we have already taken quite good care of, thank you very much) and make a list of all the services, treatments, regular maintenance and preventive check ups, tests, supplies, devices, mefications, that are, or should be, available and plesae,conslt with constituents, what you get is the bill, a health care plan that serves everyone, without favor.
then let's see what it takes, what protections against fraud, (billions there!) which processes for contracting services, etc., etc...instead of going to the market as if it were a patient and worrying about its need, let the market come to us and trust that, as markets do, they will find a way toward gains, however regulated, for contracted services, ...past that health care should not be a for-profit enterprise.
so, gents, "provide a relief valve," i.e. health care, for people in need of health care, then help states and corporations (ok they're "citizens" too, yada, yada...no shame there, right?")
cost are important but they are not health care and until we nail that down.
try this guys: think of your own families (whom we have already taken quite good care of, thank you very much) and make a list of all the services, treatments, regular maintenance and preventive check ups, tests, supplies, devices, mefications, that are, or should be, available and plesae,conslt with constituents, what you get is the bill, a health care plan that serves everyone, without favor.
then let's see what it takes, what protections against fraud, (billions there!) which processes for contracting services, etc., etc...instead of going to the market as if it were a patient and worrying about its need, let the market come to us and trust that, as markets do, they will find a way toward gains, however regulated, for contracted services, ...past that health care should not be a for-profit enterprise.
so, gents, "provide a relief valve," i.e. health care, for people in need of health care, then help states and corporations (ok they're "citizens" too, yada, yada...no shame there, right?")
Subsidizing the insurers simply has them laughing all the way to the bank! Why not cut out the "middle-man" entirely and have Medicare for all. Oh, I know....the lobbyists for the industry are not going to let that happen.
2
Let's stop protecting the parasites and institute Medicare for all. We don't have time to permit healthcare be a "profit center" for corporations that exploit Americans while the rest of the world buys pharmaceuticals, medical equipment, and coverage at half the price that we pay. No Americans are not idiots who would rather pay inflating insurance premiums to corporations than pay less for more from Medicare for all. We are not idiots who believe that pharmaceuticals must cost more to encourage drug companies to invent new drugs while the same drugs cost 50% less in Canada even when they are manufactured in NJ. We are not idiots who think that government is the problem not the solution. We know that corporations want to privatize water and have profits in mind and not Americans. We know that democracy in government protects us from predators.
Let's stop bickering about how failed government protects predators and empowers exploiters of the ill, the hungry, the poor, the elderly, women....Let's re-institute government of, by and for the people. PS: not the rich people.
Let's stop bickering about how failed government protects predators and empowers exploiters of the ill, the hungry, the poor, the elderly, women....Let's re-institute government of, by and for the people. PS: not the rich people.
most good but a big prob is redefining "full time" as 40 hours. That guarantees a ton of people will be dropped from 40 hours to 39, so their employers don't contribute to their health insurance, leaving the employees to pay for it themselves with *after tax* dollars.
The advantage of the current 30-hour rule is, hardly anyone works 30 hours, usually part-timers are around 20.
A smarter way to get out of this trap is have employer contributions pro-rated for fewer hours than 40... avoids all the artificial cliffs having to do with hours.
The advantage of the current 30-hour rule is, hardly anyone works 30 hours, usually part-timers are around 20.
A smarter way to get out of this trap is have employer contributions pro-rated for fewer hours than 40... avoids all the artificial cliffs having to do with hours.
Better yet--require that medical care must be paid for anything over 15 hours! It has to be very unprofitable to try to run a company on workers coming in for 14.9 hours.
Oh pleeeeze...You guys can nitpick all you want but as long as your solutions are based on profit, it will mean Americans being short changed with worse health care outcomes. Insurance company profits, pharmaceutical company profits and keeping the doctors super wealthy are killing us. You know the answer is Medicare for all, so do it already and join the rest of the Western world.
1
Insurance across state lines
It is important to understand that this innocuous phrase is a Trojan Horse designed to destroy healthcare
Look at credit cards: rates are skyhigh cause way back when, theSCOTUS said banks cd offer cards across state lines
The good people of N Dakota have no qualms about usury, so your cards are from ND
It is important to understand that this innocuous phrase is a Trojan Horse designed to destroy healthcare
Look at credit cards: rates are skyhigh cause way back when, theSCOTUS said banks cd offer cards across state lines
The good people of N Dakota have no qualms about usury, so your cards are from ND
1
When Republicans are removed from the majorities in both Houses, and Hillary is inaugurated President, then we can begin to repair and revise ObamaCares, just like the Dems repaired and revised two of its most vaunted programs, Social Security and Medicare. Those two major pieces of legislation bear no resemblance to them in their infancy. They both went through enormous revisions over the course of the decades, courtesy of a willing Democratic Congress. Dealing with Republicans now after the scorn and contempt they threw at our beloved President Obama, sabotaging the ACA every chance they got, is to be avoided. I wouldn't trust a Republican as far as I could throw that bloated bag of hot gas Trump. No, if Republicans want to save ObamaCares for no other reason then they want to save their jobs, then let them fight among themselves looking for solutions. Republicans gave us Trump. They should hang their heads in shame. The Republican party of today is a sheer disgrace. Shame of them all.
DD
Manhattan
DD
Manhattan
Sounds like the beginning of adults working together. Next stop, the "public option."
Ladies and Gentlemen of the Congress, every single one of you is blinded by the "powerful" lobbyists who represent a "for-profit" model of health care which has failed this country for more than thirty years. These lobbyists are "powerful," of course, only because of the size of their cash-stuffed briefcases, and because of your collective willingness to accept the cash.
Not a single one of you, it would seem, has the VISION that the English or the Canadians do – the vision to realize that, in spite of the fact that the Hospital Corporation of America is Senator Frists' family business and that his brother is the CEO – it is, in fact, impossible to provide health care "for profit," or to pay for it "for profit." (If it were not so, we would have long ago successfully done it, and have become a model that the English and the Canadians would have copied.)
We continue to be willing to spend billions of dollars each week in the business of killing people in far-away places. Yet we refuse to spend a much smaller amount of money to allow every person whose foot is on American soil to go to the doctor or to the hospital and there to receive whatever medical care s/he needs.
And I would note that all of you, as Members of Congress, enjoy the privilege that you deny to hundreds of millions of people whom you claim to represent. Senator McCain will never see a bill for his surgeries. His family does not risk bankruptcy.
But: "Are there no prisons? Are there no workhouses?"
Not a single one of you, it would seem, has the VISION that the English or the Canadians do – the vision to realize that, in spite of the fact that the Hospital Corporation of America is Senator Frists' family business and that his brother is the CEO – it is, in fact, impossible to provide health care "for profit," or to pay for it "for profit." (If it were not so, we would have long ago successfully done it, and have become a model that the English and the Canadians would have copied.)
We continue to be willing to spend billions of dollars each week in the business of killing people in far-away places. Yet we refuse to spend a much smaller amount of money to allow every person whose foot is on American soil to go to the doctor or to the hospital and there to receive whatever medical care s/he needs.
And I would note that all of you, as Members of Congress, enjoy the privilege that you deny to hundreds of millions of people whom you claim to represent. Senator McCain will never see a bill for his surgeries. His family does not risk bankruptcy.
But: "Are there no prisons? Are there no workhouses?"
1
God bless you guys, a breath of fresh air in a ranker that's been unbreathable for years!! Now if we can get the indivisible group behind it and start showing up at the offices like they did against Trump care, you might stand a chance.
1
Check out just how expensive and bad US healthcare is here
https://ourworldindata.org/the-link-between-life-expectancy-and-health-s...
then weep at the pathetic incrementalism. American exceptionalism at its very worst.
https://ourworldindata.org/the-link-between-life-expectancy-and-health-s...
then weep at the pathetic incrementalism. American exceptionalism at its very worst.
As some posters say below, insurance can be sold across state lines.
http://www.insurancelibrary.com/health-insurance/can-health-insurance-be...
(You must follow that state's guidelines, though.)
http://www.insurancelibrary.com/health-insurance/can-health-insurance-be...
(You must follow that state's guidelines, though.)
1
This whole "let us compromise" thing is a wash and an excuse not to move on to a national single-payer plan. It is pathetic to see Dems going after this compromise plan which is essentially a Repub plan to loot Americans.
Still waiting for Gottheimer to explain why he signed on with only 5 other democrats for the money for the wall. Crickets chirping.
1
While I like this idea, I think calling the past 7 years "bickering" is a tad off. Its been more like a Hiroshima level "No Mercy" Apocalyptic Take no Prisoners fight to the death WWF Cage match
1
When you get serious and talk about repealing the Individual Mandate, I'll listen; till then ya'll enjoy your little kumbaya bipartisan thingy. It ain't going anywhere.
1
Little wonder that Mr. Gottheimer is pressing to prop up health insurance markets. His top contributors in the last election cycle were insurance companies.
Mr. Reed's top contributors include insurance companies, pharmaceuticals, and health professionals.
Each of these two industry stooges have taken over a million dollars from the industries who would benefit most from their "compromise" approach.
And thus, we're again blocked by special interest money from considering a single payer system that would deliver healthier Americans, vastly lower costs, and truly equitable healthcare for all.
How about some fair balance in the NYT Op-ed pages to expose this, and other Congressional payola schemes?
Mr. Reed's top contributors include insurance companies, pharmaceuticals, and health professionals.
Each of these two industry stooges have taken over a million dollars from the industries who would benefit most from their "compromise" approach.
And thus, we're again blocked by special interest money from considering a single payer system that would deliver healthier Americans, vastly lower costs, and truly equitable healthcare for all.
How about some fair balance in the NYT Op-ed pages to expose this, and other Congressional payola schemes?
5
It must be spring! There are signs of lif. Finally.
Another plan to keep insurance companies -- who make no diagnoses and clean no bedpans, who offer absolutely no medical benefit of any kind --- in business.
What about negotiating drug prices and and encouraging competition by allowing imports for those who want them ?
Or keep it simple : Medicare-For-All.
What about negotiating drug prices and and encouraging competition by allowing imports for those who want them ?
Or keep it simple : Medicare-For-All.
1
Republicans have spent seven years lying about healthcare and failed to even have a plan other than ways to weasel out of it to enrich the rich through taxcuts. Now Democrats have to work with them? How? Institute universal healthcare now and the Republicans then get to offer their input. In the meantime, get them out of office through he ballot box if that option is still available to Americans.
1
Gottheimer and Reed start off with an interesting idea,,,,,then proceed to sink right back in to the same old trite, superficial dagmatic useless mantra of "national health care" that hasnt worked once for five minutes in the past 70 years.
....
LAME.
We live in a new age....peer-to-peer instantaneous communications....NOT centralized authoritarian bureaucratic controls.
Everyone in power in government, in corporate america, in academia....insists on the New Deal Era system of hieracrchical centralized control systems of rules, regulations, fiscal carrots and sticks, etc, etc.
The worst mistake we are making is to confuse health insurance(non-essential) with health care(essential to everyone, health or sick).
As a consequence, in desparation, we have gift-wrapped a monopoly and handed it over to the old-time Insurance industry.....MANDATORY INSURANCE.....via a Tax Bill decieptfully labelled "Affordable Care Act".
Both SanFran and Massachusetts have demonstated via their LOCAL health Care programs......the Federal Support System is UNNECESSARY. RomneyCare works.....ObamaCare dont. Face Facts, people, face facts. Be American.....Pragmatic.
If it works.....keep it.
If it dont work.....drop it like a bad habit.
....
LAME.
We live in a new age....peer-to-peer instantaneous communications....NOT centralized authoritarian bureaucratic controls.
Everyone in power in government, in corporate america, in academia....insists on the New Deal Era system of hieracrchical centralized control systems of rules, regulations, fiscal carrots and sticks, etc, etc.
The worst mistake we are making is to confuse health insurance(non-essential) with health care(essential to everyone, health or sick).
As a consequence, in desparation, we have gift-wrapped a monopoly and handed it over to the old-time Insurance industry.....MANDATORY INSURANCE.....via a Tax Bill decieptfully labelled "Affordable Care Act".
Both SanFran and Massachusetts have demonstated via their LOCAL health Care programs......the Federal Support System is UNNECESSARY. RomneyCare works.....ObamaCare dont. Face Facts, people, face facts. Be American.....Pragmatic.
If it works.....keep it.
If it dont work.....drop it like a bad habit.
Not a single word about trying to control the incredible price of prescription medications. I own three pharmacies, I see what the wholesale cost of these medications are. They should be published for the public to see. You would hear a huge outcry. Example--5 rectal suppositories for treating hemorrhoid--$800! I could go on and on. Perhaps the pharmaceutical industry's 2500 Washington lobbyists have something to do with politicians' silence.
The only part of this article that isn't just watered-down Republican perpetual lies in making the subsidy mandatory.
Everyone wants to push this idea of high risk pools that have NEVER worked. We already have such pools, they are called Medicare and Medicaid.
Whenever you hear "give states flexibility", "encourage competition", "give relief for the small business mandate" or "Eliminate the Medical Devise tax...to encourage research", just think "same old Republican lies".
The only part of this article that isn't just watered-down Republican perpetual lies in making the subsidy mandatory.
Everyone wants to push this idea of high risk pools that have NEVER worked. We already have such pools, they are called Medicare and Medicaid.
Whenever you hear "give states flexibility", "encourage competition", "give relief for the small business mandate" or "Eliminate the Medical Devise tax...to encourage research", just think "same old Republican lies".
1
Let me get this straight, there's yet ANOTHER legislative bunch called the "House Problem Solvers Caucus"?
Isn't that what the entire bunch of you are supposed to do to begin with?
Two ideas for both of you and your chums in Congress:
a. Single Payer for healthcare and
b. Term limits so none of you get too "comfy" in your jobs.
Otherwise, have a nice August break!
Isn't that what the entire bunch of you are supposed to do to begin with?
Two ideas for both of you and your chums in Congress:
a. Single Payer for healthcare and
b. Term limits so none of you get too "comfy" in your jobs.
Otherwise, have a nice August break!
3
More garnish on a nothing-burger!
American healthcare is not a “system” worthy of incremental improvement; it is a free-for-all of con-artists, price extortionists, lobbyists, and politicians. We have patients needing care. We have good doctors, nurses, and medical technicians. We have excellent, even luxurious, medical offices, clinics, and hospitals. But, standing between patients and providers are money-sucking parasites, specifically insurance companies, lawyers, self-serving politicians, rip-off suppliers, and patent-protected drug-makers.
The result? Americans get restricted, rationed coverage with limited provider choice, and pay $2.4 trillion per year for the hassle and neglect. Other modern nations provide near-universal, near-comprehensive coverage at half, or less, the cost. And, their citizens have higher life expectancy, lower infant mortality, and healthier lives at every age.
Want to save $1.2 trillion per year, and give Americans near-universal, near-comprehensive, hassle-free health care? Toss the insurance companies and lawyers out of health care management; relegate them to support positions. Offer Medicare for all at age-adjusted premiums for those under the age of 65. Negotiate the price of patent drugs. Obtain medical equipment from low-cost, high-quality bidders instead of the open market. And, purge Congress of every member who voted to deprive 20+ millions of Americans of health care, and raise the insurance premiums for the middle-class.
American healthcare is not a “system” worthy of incremental improvement; it is a free-for-all of con-artists, price extortionists, lobbyists, and politicians. We have patients needing care. We have good doctors, nurses, and medical technicians. We have excellent, even luxurious, medical offices, clinics, and hospitals. But, standing between patients and providers are money-sucking parasites, specifically insurance companies, lawyers, self-serving politicians, rip-off suppliers, and patent-protected drug-makers.
The result? Americans get restricted, rationed coverage with limited provider choice, and pay $2.4 trillion per year for the hassle and neglect. Other modern nations provide near-universal, near-comprehensive coverage at half, or less, the cost. And, their citizens have higher life expectancy, lower infant mortality, and healthier lives at every age.
Want to save $1.2 trillion per year, and give Americans near-universal, near-comprehensive, hassle-free health care? Toss the insurance companies and lawyers out of health care management; relegate them to support positions. Offer Medicare for all at age-adjusted premiums for those under the age of 65. Negotiate the price of patent drugs. Obtain medical equipment from low-cost, high-quality bidders instead of the open market. And, purge Congress of every member who voted to deprive 20+ millions of Americans of health care, and raise the insurance premiums for the middle-class.
3
at last a start at managing a problem instead of a saloution.,there are no solutions .
What an idiot of a Democrat. We already "gave" to the Republicans to "get' the ACA from the Heritage Institute. THIS is the reason this junk drags out forever. Perhaps this plan is workable, but just how much thought and number work actually went into it from two politicians? We lifelong Democrats have had it with compromises that constantly end up working to the GOP's favor somehow. Gottheimer wants his job-WE WANT A SINGLE PAYER OPTION. How do we reconcile on that-finally and without career politicians subverting our will?
1
I am disappointed to see so many rabidly negative comments here. So lets set some obvious facts that are indisputable.
1- The health care system stinks, I think we can all agree on that one.
2- Partisanship stinks, and is now worse than ever. I think we can all agree on that one too.
3- Both party's have differing views on how to change things, I think we can also all agree on that one.
So......lets all now think like adults before we type. How do we resolve all three items that we all just agreed on? First and foremost, DONT KEEP DOING WHAT WE ARE NOW DOING. Stop with the rhetoric. Lets talk, and more important, lets listen.
To Republicans- not all Democrats are communists.
To Democrats- not all Republicans are morons.
BOTH sided have ideas worth listening to. I think Mr. Gottheimer and Mr. Reed are onto something here- not perfect, but considering where the country is right now, this bipartisan committee is a great start.
1- The health care system stinks, I think we can all agree on that one.
2- Partisanship stinks, and is now worse than ever. I think we can all agree on that one too.
3- Both party's have differing views on how to change things, I think we can also all agree on that one.
So......lets all now think like adults before we type. How do we resolve all three items that we all just agreed on? First and foremost, DONT KEEP DOING WHAT WE ARE NOW DOING. Stop with the rhetoric. Lets talk, and more important, lets listen.
To Republicans- not all Democrats are communists.
To Democrats- not all Republicans are morons.
BOTH sided have ideas worth listening to. I think Mr. Gottheimer and Mr. Reed are onto something here- not perfect, but considering where the country is right now, this bipartisan committee is a great start.
59
Most Democrats think the answer is more government intervention; many want a single payer system. Most Republicans think the government in general and the federal government in particular should not participate in health care and health insurance issues at all. the A.C.A. should be repealed and should be replaced by nothing. Medicaid should disappear or shrunk to the point that it becomes a non-factor in the health care market.
You can reach bipartisan agreement now on measures that would prevent the system from collapsing and control premium increases to some extent mostly by increasing federal subsidies. The problem is that even limited agreements are unlikely to be enacted because Republicans want repeal and short of that, they want the A.C.A. to fail miserably.
So what kind of compromise do you have in mind?
You can reach bipartisan agreement now on measures that would prevent the system from collapsing and control premium increases to some extent mostly by increasing federal subsidies. The problem is that even limited agreements are unlikely to be enacted because Republicans want repeal and short of that, they want the A.C.A. to fail miserably.
So what kind of compromise do you have in mind?
I laugh when you say "obvious facts that are indisputable" then proceed to give us your opinion.
1. You say the healthcare system stinks, when Americans now have a favorable view of the ACA. Americans on Medicare and Medicaid have overall favorable views on their health coverage as well. (https://www.realclearpolitics.com/epolls/other/obama_and_democrats_healt....
2. You say partisanship stinks and is worse than ever. I'd counter that it was probably worse leading up to the civil war, and what you call partisan, I call Democrats not rolling over and playing dead while Republicans take away the aforementioned healthcare.
3. Let one Republican argue for the ACHA or BCRA on the merits alone. They're not allowed to say how bad Obamacare is rail against Nancy Pelosi. Then I'd like to see how many ideas they can actually come up with.
1. You say the healthcare system stinks, when Americans now have a favorable view of the ACA. Americans on Medicare and Medicaid have overall favorable views on their health coverage as well. (https://www.realclearpolitics.com/epolls/other/obama_and_democrats_healt....
2. You say partisanship stinks and is worse than ever. I'd counter that it was probably worse leading up to the civil war, and what you call partisan, I call Democrats not rolling over and playing dead while Republicans take away the aforementioned healthcare.
3. Let one Republican argue for the ACHA or BCRA on the merits alone. They're not allowed to say how bad Obamacare is rail against Nancy Pelosi. Then I'd like to see how many ideas they can actually come up with.
First, let's clear the air and have the GOP admit they never intended to "fix" healthcare in the 7.5 years since implementation and further, also admit the last few attempts to repeal and replace were cynical attempts to pass a bill, any bill, contents be damned. The GOP cannot be trusted to craft a social program: it's not in their DNA.
70
This new plan, if legislated, will be called the ARGH (American's Rube Goldberg Healthplan).
Along with adding cost, it does nothing to reduce the mind-numbing complexity of the entire system.
Trump is partially correct. This is truly a bailout to insurance companies. It's also a bailout to medical providers. They will simply pass increasing costs on to taxpayers. It’s similar, yet even worse, than how subsidized student loans to students enabled colleges to raise tuition.
Yet, Trump has yet to propose the right solution – a single payer option for those who receive subsidies. Maybe just expand Medicaid? And perhaps offer a 55+ Medicare option, that allows those between 55 and 65 to buy into Medicare with reasonable monthly premium? I don’t claim to know the best solution, but just know that complexity adds cost.
Since the Republicans in Congress pushed Trump to focus on health insurance, and then failed to deliver the votes (or even a rational plan), Trump should feel free to go bigger and bolder.
I am a Trump supporter. I am a conservative. I support a single payer option.
Along with adding cost, it does nothing to reduce the mind-numbing complexity of the entire system.
Trump is partially correct. This is truly a bailout to insurance companies. It's also a bailout to medical providers. They will simply pass increasing costs on to taxpayers. It’s similar, yet even worse, than how subsidized student loans to students enabled colleges to raise tuition.
Yet, Trump has yet to propose the right solution – a single payer option for those who receive subsidies. Maybe just expand Medicaid? And perhaps offer a 55+ Medicare option, that allows those between 55 and 65 to buy into Medicare with reasonable monthly premium? I don’t claim to know the best solution, but just know that complexity adds cost.
Since the Republicans in Congress pushed Trump to focus on health insurance, and then failed to deliver the votes (or even a rational plan), Trump should feel free to go bigger and bolder.
I am a Trump supporter. I am a conservative. I support a single payer option.
5
A well crafted Single payer plan is probably the only rational solution. But you are the first conservative Trump supporter I have heard recommend it.
Bipartisanship is great. But please don't try to paint this as a middle ground. For one thing, Tom Reed is a Republican from upstate NY - quite moderate for the right. It's like asking the left to be happy with whatever tax reform Republicans come up with along side Joe Manchin and Heidi Heitkamp - two conservative Democrats.
"Fixing" Obamacare has become a euphemism for basically spending more money on top of the $170 bn/yr we already spend on Obamacare - $7 bn for the poor (Cost Sharing Reductions) and even more money for "the costliest 5 percent of patients [who] account for nearly half of all health care spending in the country".
Those two types of supplements show that Obamacare is really two problems that have little to do with each other. I can accept the money spent to make sure that no one dies due to lack of health insurance. We established this concept with EMTALA under Reagan. But anywhere from 76% to 96% of those who lack insurance are not sick. Rather, they are poor.
Even here, I can see the argument for giving health insurance to those who cannot work - children, elderly, disabled. On the other hand, able bodied adults do have a choice. 31% of the poor did not even finish high school. Only 2% work full time. For 30 years prior to Obama, we moved in the direction of helping people if they helped themselves - e.g. EITC and Welfare Reform required full time work. Why do we want to go back to rewarding people for having a heart beat ?
"Fixing" Obamacare has become a euphemism for basically spending more money on top of the $170 bn/yr we already spend on Obamacare - $7 bn for the poor (Cost Sharing Reductions) and even more money for "the costliest 5 percent of patients [who] account for nearly half of all health care spending in the country".
Those two types of supplements show that Obamacare is really two problems that have little to do with each other. I can accept the money spent to make sure that no one dies due to lack of health insurance. We established this concept with EMTALA under Reagan. But anywhere from 76% to 96% of those who lack insurance are not sick. Rather, they are poor.
Even here, I can see the argument for giving health insurance to those who cannot work - children, elderly, disabled. On the other hand, able bodied adults do have a choice. 31% of the poor did not even finish high school. Only 2% work full time. For 30 years prior to Obama, we moved in the direction of helping people if they helped themselves - e.g. EITC and Welfare Reform required full time work. Why do we want to go back to rewarding people for having a heart beat ?
Let's punish people for having a heart beat if they can't afford ,edical care or insurance premiums, Right?
2 things stand out here. First with a mid-August deadline, Congress has waited until the last minute to do anything. By anything, i mean anything constructive. Second, what stands out over this is a bully-in-chief determined to wreck anything accomplished by his predecessor. We have seen repeated attempts in a mean spirited way to deny coverage to millions of people.
A short term basis is assuring that the subsidies will be paid and taxes left in place to pay for them, and that the mandate, the core principle here, also remains in place.
Long term would be medicaid turned into single payer with a 2% tax added to withholding, which would be for basic coverage (100%) including a yearly physical, a Dr. visits and generics--preventive medicine, coverage for women, and a continuation of programs to bring costs down based on payment for outcomes. If like Medicare which pays 80%, private insurance could be offered to cover the difference for treatment beyond basic coverage.
The big change for Republicans is to think of how to deliver healthcare to the people by offering them health insurance, rather than to take it away from them. Needless to say, stipulating that prescription drugs cost no more than Europe or Veterans would be a major cost reduction for everybody.
A short term basis is assuring that the subsidies will be paid and taxes left in place to pay for them, and that the mandate, the core principle here, also remains in place.
Long term would be medicaid turned into single payer with a 2% tax added to withholding, which would be for basic coverage (100%) including a yearly physical, a Dr. visits and generics--preventive medicine, coverage for women, and a continuation of programs to bring costs down based on payment for outcomes. If like Medicare which pays 80%, private insurance could be offered to cover the difference for treatment beyond basic coverage.
The big change for Republicans is to think of how to deliver healthcare to the people by offering them health insurance, rather than to take it away from them. Needless to say, stipulating that prescription drugs cost no more than Europe or Veterans would be a major cost reduction for everybody.
1
The medical industrial complex is pillaging its patients and the American system of its wealth. For example, here is my billing for the annual exam paid for every Medicare eligible person. The physician billed $640 for the one hour appointment. That exam itself was $375. The $60 hearing screening took 3 minutes, was wrong (didn't pick up my hearing loss); the $45 cursory eye exam took 2 minutes (I wear glasses, shouldn't they ask when my last optometrist exam was done?); there was a $45 charge for a nutritional evaluation that never happened; and an advance care planning charge of $100 that consisted of advising me that the forms can be downloaded from the internet. The doctor's office had to write off $164 of it, but that left mostly Medicare, supplemental insurance ($22) and me ($118) to pay the balance. This does not include the lab charges. These wellness exams have identified thyroid and heart issues, so I wholly support the benefit. The bill, however, reflects overcharging for "services" that either were not provided or were minimal at best, misleading at worst. Multiply that by virtually every aspect of the medical industrial complex and it is clear why premiums continue to skyrocket.
6
In many parts of Europe, the entire thing would have cost 30 to 50 dollars.
1
Thank you for giving us hope.
We don't have a healthcare crisis. We have an insurance crisis- which could be easily remedied by removing insurance from the healthcare equation. people hold not need to buy a ticket (insurance) to access needed healthcare. It should be the right of every citizen. Look to Canada for a model. I bet we can do an even better job with Medicare for all.
13
The NYt could help us all running a series on some of the best healthcare systems in the world. Pick a few, say, Swiss, British, Canadian, German. And describe the basic features, costs to individuals, cost to the central/state governments, limitations. I am sure they all have pluses and minuses, but the public discourse here in America almost never mentions them. It is very complicated and the over simplification of our 10 second sound bites is not helping. We have brilliant creative minds in America, but we could still learn from others.
2
Amen! And God speed!
So, correct me if I'm wrong: you're proposing to enshrine in law business's practice of denying benefits to part-time workers? That will certainly be a favor to the Wal-Marts of this world, who assiduously keep the bulk of their workforce on part-time.
5
For the life of me I cannot understand how anyone in their right mind would advocate for anything other than something along the lines of, say Germany's Gesetzliche Krankenversicherung, which has above 90% citizen participation. Last I heard, the plan offers participants a choice of some 200 providers networks, and costs the nation about 6 percentage points GDP less than the idiotic US marketplace. I would add that Germany has a lower infant mortality rate than the US, greater average longevity, and 100% of its citizens have comprehensive health care coverage. Perhaps I should qualify my earlier assertion. For the life of me I cannot understand how anyone in their right mind, who is not cutting deals with hospitals, big pharma and medical device manufacturers (as is unfortunately, business as usual with both parties) advocating for anything other than a universal healthcare system modeled after the rest of the developed world.
10
The Government is heavily in debt.
all the comments are the usual Left wing solutions - get the Government to pay for more things! After all its free! No its not free, its our tax money.
Glad there are some adults in the room who are willing to work together.
Maybe thats an unspoken benefit of Trump - there is clearly no adult or leader at the White House in charge so you better do it yourself.
all the comments are the usual Left wing solutions - get the Government to pay for more things! After all its free! No its not free, its our tax money.
Glad there are some adults in the room who are willing to work together.
Maybe thats an unspoken benefit of Trump - there is clearly no adult or leader at the White House in charge so you better do it yourself.
1
We as a country need to decide if all Americans have a right to healthcare. If the answer to that is 'yes' than the proposals of this article are just band-aids on a system that is deeply flawed. We have a perfectly good system in place that ensures that all Americans over the age of 65 have healthcare, and that is Medicare. Expanding Medicare so that all people are eligible to use it is the most efficient and cost effective way to make good on the right to healthcare.
The proposals being discussed here, and the bill passed by the house are more interested in propping up private insurance with massive payouts and subsidies on premiums. Replace private primary health insurance with Medicare and pay for the whole thing with a bump in taxes. Bernie Sanders estimated that the tax increase would be about 2% for someone making $50k a year. That is far less than the cost of ACA premiums. Rather than using complicated subsidies to make private insurance more affordable, Medicare-for-all uses our progressive tax system to spread the cost out equitably. It would also solve the problem of individual mandates since everyone is de facto insured.
The proposals being discussed here, and the bill passed by the house are more interested in propping up private insurance with massive payouts and subsidies on premiums. Replace private primary health insurance with Medicare and pay for the whole thing with a bump in taxes. Bernie Sanders estimated that the tax increase would be about 2% for someone making $50k a year. That is far less than the cost of ACA premiums. Rather than using complicated subsidies to make private insurance more affordable, Medicare-for-all uses our progressive tax system to spread the cost out equitably. It would also solve the problem of individual mandates since everyone is de facto insured.
7
So, in this plan, the Democrats get one thing: The expansion of the ACA to all of the states, which is only a problem because of Republican intransigence. The Republicans get the rest: The elimination of the medical-device tax, the state high-risk insurance pool, and raising the weekly hourly cut-off for employer-provided healthcare to 40 hours from 30 hours.
I am really not seeing much of a compromise. C'mon Democrats, put on your big-boy pants and do a better job negotiating. At a certain point, you are going to have to consider letting go of the 50-states dream and focus on saving the rest of us who live in reasonable states. The device tax incentive is already bringing the rising cost of devices down ("bending the cost curve"), the state risk pools have been shown to be unworkable because they are always dollar-capped, and everyone will now be working 39 hours a week. The voters in the red states will have to wake themselves up and vote in better state leadership if they want affordable health care. Or move to a state that cares about them.
I am really not seeing much of a compromise. C'mon Democrats, put on your big-boy pants and do a better job negotiating. At a certain point, you are going to have to consider letting go of the 50-states dream and focus on saving the rest of us who live in reasonable states. The device tax incentive is already bringing the rising cost of devices down ("bending the cost curve"), the state risk pools have been shown to be unworkable because they are always dollar-capped, and everyone will now be working 39 hours a week. The voters in the red states will have to wake themselves up and vote in better state leadership if they want affordable health care. Or move to a state that cares about them.
4
No matter what little fixes you put in place, in a free-market system, Martin Shkreli is eventually going to figure out a way to bankrupt you. Or you can choose not to have health care.
The NYT continues to miss the salient point. Government has no business making laws that control an already imploding healthcare system. Healthcare is a disaster because of the government, not in spite of. We might as well have giving the 9/11 hijackers the building permits to rebuild the trade center. It s absurd trusting our government to fix their own mess. Just get rid of it all together.
1
The public option-allowing people to buy into Medicare-would have prevented much of this. Rural counties with limited private insurance options would have had an alternative. Unfortunately Pres Obama left it out in an unsuccessful attempt to appease the right (who were he'll bent on destroying him).
If Medicare is good enough for our parents, it is good enough for rest of us
If Medicare is good enough for our parents, it is good enough for rest of us
5
When you read the elements of our health insurance issues, you might uncover the real problem. Just a few of the first, as mentioned here: struggling exchanges, cost sharing payments, stability funds, re-insurance, mandates. There are many more.
The real problem: We refuse to join the rest of the world's advanced countries, as well as many of the not so wealthy, in implementing a uniform system of national insurance that focuses on healthcare for all their citizens rather than increasingly complex ways to pay, or avoid paying, for it. We'll likely get there someday, but it could be decades. Our health insurance industry is too powerful, and our democracy works in factions. The only constant in the world, though, is change. Let us remain optimistic.
The real problem: We refuse to join the rest of the world's advanced countries, as well as many of the not so wealthy, in implementing a uniform system of national insurance that focuses on healthcare for all their citizens rather than increasingly complex ways to pay, or avoid paying, for it. We'll likely get there someday, but it could be decades. Our health insurance industry is too powerful, and our democracy works in factions. The only constant in the world, though, is change. Let us remain optimistic.
2
I'm glad we are working together...if we can say that of 10% of congress doing that means that.
Now y'all get on one of these insurance plans in the congress where you will learn that your New York plan will not work in DC.
One payor system - Medicare for all now.
Drugs reduced-
Dentist programs
Eye care
Thank you
Now y'all get on one of these insurance plans in the congress where you will learn that your New York plan will not work in DC.
One payor system - Medicare for all now.
Drugs reduced-
Dentist programs
Eye care
Thank you
Just more mass confusion ... Forget it .. it won't work ... you want to get together, get together on medicare for all. Otherwise it's the same old thing.
Orange, NJ
Orange, NJ
2
Medicare for all, cradle to grave, is an even better idea.
2
All good immediate solutions...but they do not correct the absurd and complicated system that the US has (over time) morphed itself into.
Yes...we are the only "advanced" country in the world not to have universal health coverage....and why? because we are the only advanced country in the world to have an employer based system for most of the population ( other than Medicaid type citizens)....the result is that the consumer( the individual) who in a vast portion of our society gets his health insurance as part of his employment is not the purchaser....hence...customer satisfaction of an open market does not matter. Compare to auto insurance....to own a car you need to buy auto insurance....the markets are efficient and the consumer is the buyer...there is real competition....but not in health where the purchaser is NOT the consumer....SO...how did we get there? the ORIGINAL SIN was the granting tax deduct-ability to employers who paid for their employees health insurance (this occurred post WW2 )...so...we will never have a truly based market system until that loophole is removed....
My solution is to eliminate that loophole...have the employment market stabilize by employers paying more to employees and then have employees mandated to purchase insurance with minimum basic benefits like pre-existing conditions, etc ( with support from government if needed)....
Yes...we are the only "advanced" country in the world not to have universal health coverage....and why? because we are the only advanced country in the world to have an employer based system for most of the population ( other than Medicaid type citizens)....the result is that the consumer( the individual) who in a vast portion of our society gets his health insurance as part of his employment is not the purchaser....hence...customer satisfaction of an open market does not matter. Compare to auto insurance....to own a car you need to buy auto insurance....the markets are efficient and the consumer is the buyer...there is real competition....but not in health where the purchaser is NOT the consumer....SO...how did we get there? the ORIGINAL SIN was the granting tax deduct-ability to employers who paid for their employees health insurance (this occurred post WW2 )...so...we will never have a truly based market system until that loophole is removed....
My solution is to eliminate that loophole...have the employment market stabilize by employers paying more to employees and then have employees mandated to purchase insurance with minimum basic benefits like pre-existing conditions, etc ( with support from government if needed)....
Keep up this great work.
Thank you.
Thank you.
1
Like so many others, this article begins with the premise that both sides are to blame for partisan gridlock and dysfunction in Washington. But that meme is a big part of the problem. Obamacare WAS the compromise, based on a Heritage Foundation idea and enacted in Massachusetts by Mitt Romney. When they set out to reform health insurance, Democrats extended a hand to Republicans, in a big way, and had it slapped away, in a big way. Republicans then doubled down on their obstructionism, illogically and seemingly out of nothing more than spite, for the whole of the Obama administration. If Republicans are truly interested in making our government work again, they need to admit that, to themselves most of all. The "both sides do it" routine is just a way for Republicans to duck responsibility for the utter dysfunction and disgrace they have brought to the Capitol. Democrats, and newspapers, shouldn't let them get away with it.
2
Can't help it; I'm skeptical.
Please show us that you and the Problem Solvers are truly serious about fixing the Health Care System, and start an honest, candid and comprehensive discussion about a single payer system.
It is the elephant in the room; the 800 pound gorilla everyone knows is there. If there are good reasons we should move to this system, then why aren't we doing it? If there are reasons why it can't or shouldn't be done, then enumerate and explain them.
It's not enough to say it would cost too much. We don't believe that anymore. And we can mount an extremely credible argument for it.
We want to talk about it.
So much time and money has been wasted, and so many lives disrupted with medical bankruptcies and illness untreated and treated badly. Sorry Republicans, you are the ones who refused to cooperate 8 years ago with Barack Obama. Don't blame us for our skepticism. Prove to us that you are ready to solve the problem.
Please show us that you and the Problem Solvers are truly serious about fixing the Health Care System, and start an honest, candid and comprehensive discussion about a single payer system.
It is the elephant in the room; the 800 pound gorilla everyone knows is there. If there are good reasons we should move to this system, then why aren't we doing it? If there are reasons why it can't or shouldn't be done, then enumerate and explain them.
It's not enough to say it would cost too much. We don't believe that anymore. And we can mount an extremely credible argument for it.
We want to talk about it.
So much time and money has been wasted, and so many lives disrupted with medical bankruptcies and illness untreated and treated badly. Sorry Republicans, you are the ones who refused to cooperate 8 years ago with Barack Obama. Don't blame us for our skepticism. Prove to us that you are ready to solve the problem.
1
I'm a self employed art restorer and 58. I am so screwed. I have a bronze plan with a 5k deductible that I never use. I got a pneumonia this past winter. One script was $847!!! I told doctor that was insane and went to visit my daughter in Arizona instead for $247 plane ticket. Much cheaper and more pleasant. The fact that Medicare can't negotiate drug prices (thx GOP!) shows everything wrong with special interests in trying to "solve" this. Single payer makes most sense.
4
So basically Obamacare stays fundamentally the same with a few changes to make Republicans feel like they've repealed and replaced.
2
Nobody needs Health Insurance...Everybody needs access to Health Care...As a small business owner, I spend 40-80 hours a year dealing with my insurance agent to purchase high quality coverage for my employees...I would much rather see my company's Medicare tax rate increase and have universal coverage for all Americans...the health insurance industry is a scam...it is time for universal Medicare coverage.
4
With absolutely no leadership from the White House, Gottheimer and Reed have proposed a rational approach here. Trump, McConnell and Ryan have shamelessly grandstanded this issue, offering nothing but complaints about the present system but no solutions on how to repair it.
I would much prefer a single-payer, Medicare for all system, but these two congressmen are absolutely right: This is the way our government is supposed to work.
I would much prefer a single-payer, Medicare for all system, but these two congressmen are absolutely right: This is the way our government is supposed to work.
A question? How does one compromise with a group that:
1. Does not have to live with or abide by the decisions the impose on others?
2. Wants to institute complete control of it's "subjects"?
3. Insists that a nebulous concept "Climate Change" gives it the right to run every aspect of your, not their, life?
4. Is so disingenuous that it tolerates, even lionizes, inveterate corrupt office holders and cronies?
We are not debating healthcare, we are debating human rights vs elitist control and we all know it.
1. Does not have to live with or abide by the decisions the impose on others?
2. Wants to institute complete control of it's "subjects"?
3. Insists that a nebulous concept "Climate Change" gives it the right to run every aspect of your, not their, life?
4. Is so disingenuous that it tolerates, even lionizes, inveterate corrupt office holders and cronies?
We are not debating healthcare, we are debating human rights vs elitist control and we all know it.
You really are mysterious...
The idea of collaborating to enhance incremental change is a step backward. it promotes the false hope that we can eventually get to a good endpoint. The idea that incremental change will eventually lead to good health care for all is a total fraud. How many years of data do we need to accept the fact that we need a real shift.The marketplace does not and cannot work as a health care infrastructure. We need to remove the money lenders (insurers) and move to a single payer system. Not another incremental shift!!
1
This is either absurd or dishonest -- or both. How is "improving" the ACA a partisan issue on which there must be compromise?
You either improve it or you don't. "Improve" does not mean "satisfy ideological demands", "placate lobbyists" or "redeem free market platitudes".
What next? We vote that 2 plus 2 equals 4-1/2, because there's an argument over whether the answer is 4 or 5?
You either improve it or you don't. "Improve" does not mean "satisfy ideological demands", "placate lobbyists" or "redeem free market platitudes".
What next? We vote that 2 plus 2 equals 4-1/2, because there's an argument over whether the answer is 4 or 5?
Set agreed upon goals: health care for all the sick and injured when they require it is top priority. Let all policy details flow from that primary mission.
I fear Republicans will never agree to that mission since their top priorities are always returning money to the rich and removing government from all spheres of human life except military defense and women's uteruses.
I fear Republicans will never agree to that mission since their top priorities are always returning money to the rich and removing government from all spheres of human life except military defense and women's uteruses.
Selling health insurance policies across state lines.
Two things I've heard very credible people say:
1) The ACA, Obamacare as we all call it, allows for this already. Got that? Surprise!
OK.
2) The reason it's not done by insurance companies is that the local networks of doctors and hospitals in a given area - a city or a state - are already well established by the local insurance company -so, an out of state company doesn't want to bother to compete in an area with an already organized network.
It's not fertile ground for them.
It's ground that is already covered.
This is information I've heard repeatedly.
The whole concept is, apparently, just another Republican vacuous blah, blah. Like constantly harping that cutting taxes for a tiny fraction of wealthy people stimulates demand for goods and services enough to affect our economy.
LOL.
(they'll keep selling nonsense as long as there are buyers)
If you know different about state lines please weigh in.
Two things I've heard very credible people say:
1) The ACA, Obamacare as we all call it, allows for this already. Got that? Surprise!
OK.
2) The reason it's not done by insurance companies is that the local networks of doctors and hospitals in a given area - a city or a state - are already well established by the local insurance company -so, an out of state company doesn't want to bother to compete in an area with an already organized network.
It's not fertile ground for them.
It's ground that is already covered.
This is information I've heard repeatedly.
The whole concept is, apparently, just another Republican vacuous blah, blah. Like constantly harping that cutting taxes for a tiny fraction of wealthy people stimulates demand for goods and services enough to affect our economy.
LOL.
(they'll keep selling nonsense as long as there are buyers)
If you know different about state lines please weigh in.
The "bickering" will stop when the plutocrats quit attacking the aca - which is , gasp, working!
The system can't be fixed because Obama destroyed it. This was his plan from the start. It was intentional. He expected Hillary and the democrats to go to single payor. Now it will simply implode. Behold Obama's legacy.
And not one word about attacking and lowering the bloated, unsustainable costs of medical care, just talk of another bandage about who is going to foot the bill for out of control medical costs. The latter are due to many factors, including malpractice insurance, deeply indebted young physicians, tight control on the supply of physicians, for profit hospitals and clinics, exorbitant drug costs, and many more interest groups. And not a word about this
Just like we learned as children; money is the root of all evil, or at least most.
Actually, the quote is "love" of money.
Health Insurance stocks are at an all time high, nothing is "failing" and there is clearly plenty of room to give.
It's an understatement to label the 8-year concerted attempts to sabotage health care by the Ryan/McConnell machine as "bickering". If these "leaders" of the GOP remain, the only purpose of involving the Dems is to attach the blame for their tar baby to the Dems, who will be said to have made the GOP effort unworkable by their foul additions to the GOP's noble effort.
1
Hooray! Thank you. Perhaps the shock effect of the incompetent and dangerous administration of 45 will lead to more of this type of real legislating!
"Let’s Stop the Bickering and Fix the Health Care System"
But I thought Obama Care fixed the Health Care System!
But I thought Obama Care fixed the Health Care System!
Fix
Pour more government money in.
Pour more government money in.
Josh Gottheimer is a Democratic representative from New Jersey. Tom Reed is a Republican representative from New York. Both are clueless when it comes to fixing this problem. Get ready to be primaried
Hogwash. Give it up with the 'market' solutions. Single payer. Health is a right not a corporate business plan.
2
It is a constantly re-proven truth that everything the federal government does is far more expensive than if a state or local government does it. My personal rule of thumb is four to eight times as expensive.
Therefore, if the evident truth arises that this simply must be left to the states, will our fiefdom-builders in Washington, D.C. realize that and return this issue to the place the Constitution placed it?
We have seen the Democratic Party's answer to that question in giant letters since 2010. What will the Republicans say?
Therefore, if the evident truth arises that this simply must be left to the states, will our fiefdom-builders in Washington, D.C. realize that and return this issue to the place the Constitution placed it?
We have seen the Democratic Party's answer to that question in giant letters since 2010. What will the Republicans say?
Should medicare be outsourced to the states then? It seems to do OK now
This is a good start. To it I would add that Medicare/Medicaid have the ability to negotiate drug and device prices.
The other thing it needs to do is to gather good comprehensive data on health care expenditures, both public and private. We know that, for example, readmissions are costly and need to be reduced. We know that in hospital infections are costly and need to be reduced. Perhaps ways to encourage reducing these would be worth exploring.
The other thing it needs to do is to gather good comprehensive data on health care expenditures, both public and private. We know that, for example, readmissions are costly and need to be reduced. We know that in hospital infections are costly and need to be reduced. Perhaps ways to encourage reducing these would be worth exploring.
1
Stabilizing the market is important, and obviously preferable to sabotaging them. As many have said, though, the underlying issue is profit-driven healthcare delivery. The ACA has introduced a number of measures and experiments to link outcomes to spending. That work needs to continue.
Simultaneously putting a public option out there is the most straightforward thing to do to expand coverage and cost controls. Both Medicare and Medicaid have reimbursement formulae and low operating margins with no profit incentive. They're more efficient than private payers.
But Medicare and Medicaid pay less to providers than private payers, which is why providers continuously complain about reimbursement. I can agree with critics of bureaucratic burdens, and understand that physician burnout is an issue. But paperwork can be addressed, as can appropriate reimbursement rates.
Bottom line, perhaps it's time to see who really wants to practice medicine as a calling, and who's in it for the money and prestige.
Simultaneously putting a public option out there is the most straightforward thing to do to expand coverage and cost controls. Both Medicare and Medicaid have reimbursement formulae and low operating margins with no profit incentive. They're more efficient than private payers.
But Medicare and Medicaid pay less to providers than private payers, which is why providers continuously complain about reimbursement. I can agree with critics of bureaucratic burdens, and understand that physician burnout is an issue. But paperwork can be addressed, as can appropriate reimbursement rates.
Bottom line, perhaps it's time to see who really wants to practice medicine as a calling, and who's in it for the money and prestige.
Being a physician is a job like any other job. We all want to be paid for the work we do.
And you can get paid. I've got a number of friends who are extremely well-respected and successful physicians/surgeons. They're smart, they work hard, they save lives. They have my utmost respect.
But you can't address cost without looking at all cost centers. Compensation is one of them. Silly hospital charges are another (and I know charges are different than reimbursement). Consolidation among hospitals (and physician groups they purchase) to obtain leverage and with payers and geographic market dominance is another. FFS encourages more spending detached from outcomes. Private payer profit and overhead push up spending, as do pharmaceuticals. (Though, to be fair, we have to consider lifetime patient costs vs. the cost of a drug.)
Question regarding physicians, in particular, is whether they, say in exchange for taking on less debt in going to medical school, are willing to accept less pay, aka that akin to Medicare and Medicaid reimbursement rates.
For the care continuum overall, we can focus more on primary care, wellness, earlier intervention and better care coordination to minimize disease development/progression to help lower spending.
But you can't address cost without looking at all cost centers. Compensation is one of them. Silly hospital charges are another (and I know charges are different than reimbursement). Consolidation among hospitals (and physician groups they purchase) to obtain leverage and with payers and geographic market dominance is another. FFS encourages more spending detached from outcomes. Private payer profit and overhead push up spending, as do pharmaceuticals. (Though, to be fair, we have to consider lifetime patient costs vs. the cost of a drug.)
Question regarding physicians, in particular, is whether they, say in exchange for taking on less debt in going to medical school, are willing to accept less pay, aka that akin to Medicare and Medicaid reimbursement rates.
For the care continuum overall, we can focus more on primary care, wellness, earlier intervention and better care coordination to minimize disease development/progression to help lower spending.
Medical School loan forgiveness in part or full if a doc works after residency a certain number of years in certain facilities makes more sense. If a doc works for 5 years in certain State of Ohio hospitals, for example, they get that plus a very nice pension benefit.
I am one of Tom Reed's constituents and there are many non-profits in our District that can only survive by having a standard 35-hour work week. Also many, many employers have 30-hour weekly jobs (including our biggest employer, Cornell) as it fits the needs of both employer and staff to have this many hours. Tom Reed is advocating for his ideology not for his constituents. Which is also why he has voted to repeal ACA about 25 times! If only our District hadn't been gerrymandered by Republicans after the 2010 census!
2
I think those who want single payer need to start there own medical and nursing schools. Whoever enrolls you can own and dictate what they make in salary. I have a feeling the current batch of providers aren't all that interested in having there salaries dictated by you. Best to start all over and create your own healthcare workers.
2
Medical Residents in this country are all paid through Medicare. Ergo, all physicians have had this experience of having the federal government dictate their salary. My husband actually came through his medical residencies being MORE in favor of a single payer system than he had been previously. I get that lots of doctors have tons more debt that he does, however, and want to make more money out of the gate, so this is a problem for sure.
I would have to add that if you really want doctors that know our country and our systems, these doctors will have to be Americans, by and large. A generation of experience has taught us that foreign-born doctors help, but the language and cultural adaptations can take far too long.
Their salary is dictated by Medicare while a resident not as an attending physician. Really the salary as a resident is dictated by the hospital as they keep most of the training money for other things.
2
The devil is in the details. What does it mean, exactly, to give states 'flexibility'? Is it a backdoor way to achieve repeal without replace?
Here in Texas, I am not keen on a state government led by right-wing extremists having much by way of flexibility. The fewer options for them the better. The same is true in other states as well.
Here in Texas, I am not keen on a state government led by right-wing extremists having much by way of flexibility. The fewer options for them the better. The same is true in other states as well.
Fifty experiments are better than one system imposed by elite bureaucrats who are answerable to no one.
Government jobs have the highest percentage of healthcare coverage. Government jobs are paid for with taxes. We are paying for their health insurance plus paying for our own. The vote for single payer might put government workers on the same insurance plan as the average American. They just will not have that.
2
Gee, you sound just like Scott Walker. It's common (at least at our state level) for government employees to receive their health insurance coverage as part of their compensation package (read: pay). If that gets removed, then the pay levels need to be increased an equal amount so that government employees receive wages more comparable to/competitive with those in the private sector. So if you want to "put us" on "the same insurance plan", then put us on the same pay plan, too. Or will you "just not have that"?
I agree with the need to compromise and I think the authors offer a reasonable plan -- with one exception. I fear that allowing insurance to be sold across state lines will lead to a "race to the bottom" as states minimize their regulation of insurance company abuses. Couldn't that lead to a sparsely populated, low-regulation state (say, South Dakota) becoming the "home" of insurers who sell crummy policies into a well-regulated state (like California)? Why would "home" state regulators care about abusive behavior in another state, as long as the money keeps flowing into the coffers of the "home" state?
1
If the Canadian model is good enough for Trump for immigration, why not healthcare?
Single-payer is the only permanent solution.
Single-payer is the only permanent solution.
3
I am glad to see that the issue of the actual cost of healthcare has entered into the debate in these comments, rather than just deciding how the money will be shifted around to pay for an overpriced system.
The idea of a high risk/pre-existing conditions pool of government subsidized or paid for patients will be the first step toward a single payer system. It is a political win as the low risk, low cost folks will now have lower premiums and "Trump will have fixed it" as promised. This was never complicated in concept, just difficult politically in a system driven by special interests. Once the high cost patients are taken care of through a tax subsidized system, we might as well extend the process to the low risk patients - most of the work has been done by then.
What will actually bring down the cost of healthcare (rather than the premiums paid) will be the ability of the government to control the payments made for the high risk patients, as it does with Medicaid and (to a large extent) with Medicare. I suspect they will just get covered under Medicare. What's not to like about that?
The idea of a high risk/pre-existing conditions pool of government subsidized or paid for patients will be the first step toward a single payer system. It is a political win as the low risk, low cost folks will now have lower premiums and "Trump will have fixed it" as promised. This was never complicated in concept, just difficult politically in a system driven by special interests. Once the high cost patients are taken care of through a tax subsidized system, we might as well extend the process to the low risk patients - most of the work has been done by then.
What will actually bring down the cost of healthcare (rather than the premiums paid) will be the ability of the government to control the payments made for the high risk patients, as it does with Medicaid and (to a large extent) with Medicare. I suspect they will just get covered under Medicare. What's not to like about that?
3
This proposal is a small baby step forward. But it deals only with the cost of Health INSURANCE for some, not with the cost of HEATHCARE! If government can't have a comprehensive discussion, then healthcare advocacy groups and think tanks need to band together and hold public hearings on healthcare options, including the approaches other countries have taken. As citizens we need to demand a comprehensive discussion of options, so some real progress can be made.
4
We need a stopgap solution. We need symbolic gestures of cooperation. We need these if we are ever to get to health care for all at lower cost. As a step forward, I applaud this, if only for the symbolism - the proof that cooperation is possible.
2
These authors are making the same mistake President Obama made for eight years: they are assuming Republicans represent a loyal opposition who actually care about the welfare of the American people. That flies in the face of all objective facts. Even if individual Republicans in congress try to find to solutions to our healthcare problems, the leadership will crush their efforts.
2
The inconvenient truth regarding America's healthcare access and efficacy crisis cannot be "temporarily" solved by incrementalism any more than a sinking Titanic could be saved by incremental evacuations to life rafts. As in the example of the Titanic, a fraction of the passengers will be cast adrift in a cold dark uncertain sea of service costs, premium and prescription drug increases set by an inefficient cartel of for profit providers. The other "passengers" are doomed to the embrace of that same sea.
Exactly what segment of the American political spectrum maintains the depraved ideological indifference to the fact we waste an insane obscene percentage of the largest GDP in the world on a health care regime which by all applicable metrics is mediocre at best in terms of access and public health standards? Recent polls document broad majority support for a Medicare For All in the American electorate. The proposals of this bipartisan group of Congress rely on a series of "patches" to a broken inefficient healthcare regime until a more effective solution can be implemented. Well, the "patch" was the PPACA passed almost a decade ago.
If the 43-member House Problem Solvers Caucus truly wants to solve America's healthcare access/insurance crisis the "incremental" solution is simple; terminate ALL federal subsidies to members of Congress and their staffs to purchase healthcare. Then the stark grime necessity of Medicare For All will become inescapably and painfully evident.
Exactly what segment of the American political spectrum maintains the depraved ideological indifference to the fact we waste an insane obscene percentage of the largest GDP in the world on a health care regime which by all applicable metrics is mediocre at best in terms of access and public health standards? Recent polls document broad majority support for a Medicare For All in the American electorate. The proposals of this bipartisan group of Congress rely on a series of "patches" to a broken inefficient healthcare regime until a more effective solution can be implemented. Well, the "patch" was the PPACA passed almost a decade ago.
If the 43-member House Problem Solvers Caucus truly wants to solve America's healthcare access/insurance crisis the "incremental" solution is simple; terminate ALL federal subsidies to members of Congress and their staffs to purchase healthcare. Then the stark grime necessity of Medicare For All will become inescapably and painfully evident.
5
I still can't understand why congress people don't think that their constituents do not deserve the very same health benefits that they enjoy. Just goes to show what a cockeyed country this is and the republicans with Trump at the helm are determined to make it worse all the while shouting "make America great again".
If only people would wake up and throw the whole bunch out.
If only people would wake up and throw the whole bunch out.
While I agree with other comments that the answer lies with a single payer system, this is better than doing nothing. I also like the spirit of compromise in order to accomplish incremental improvements. Perhaps this could begin a trend of bipartisan compromise on other issues.
3
Argument against "single payer:" Who is going to be the payer? If it is the government, you should be aware that their reimbursement schedule to doctors is so pitifully low (Medicare and Medicaid) that it is often below overhead costs for the doctor's office. I see noting in this article nor the demanders of single payer that would address and fix this problem.
I am very aware of the rates of government reimbursement. Are you aware that providers of healthcare in the US in total earn twice the amount that they earn in other industrialized countries? Providers include doctors and hospitals. Our doctors and nurses for example earn twice what they earn elsewhere. Is that good policy? Are American doctors and nurses that much better? Maybe Americans are ok with the current state of affairs, but I'm not sure they realize it. Just like with pharmaceuticals, we need to drive harder bargains with our provider community. We're getting steamrolled.
Doctors in the US train for longer periods than in other countries.
Reimbursement to physicians is determined by the insurance companies...including Medicare and Medicaid...with their fee schedules. Some plastic surgeons and dermatologists work outside the system, as well as a few internal medicine doctors with concierge practices.
Hospitals have nothing to do with my statement. Neither do nurses.
So how much do you think a neurosurgeon should make per year, after being in intense competition and sleepless years with 4 years of college, 4 years of medical school, a year of internship, and 5 to 9 years of residency. That makes the beginning neurosurgeon 32 to 36. Further, an AMA study of about a dozen to fifteen years ago found that the average neurosurgeon works 75 to 80 hours a week for his/her income.
And would you please give me your "aware" of how much government reimbursement is for a few encounters and procedures?
Reimbursement to physicians is determined by the insurance companies...including Medicare and Medicaid...with their fee schedules. Some plastic surgeons and dermatologists work outside the system, as well as a few internal medicine doctors with concierge practices.
Hospitals have nothing to do with my statement. Neither do nurses.
So how much do you think a neurosurgeon should make per year, after being in intense competition and sleepless years with 4 years of college, 4 years of medical school, a year of internship, and 5 to 9 years of residency. That makes the beginning neurosurgeon 32 to 36. Further, an AMA study of about a dozen to fifteen years ago found that the average neurosurgeon works 75 to 80 hours a week for his/her income.
And would you please give me your "aware" of how much government reimbursement is for a few encounters and procedures?
This is very constructive article for the improvement of the ACA. I would like the authors to consider the following additions to their proposal.
First, the law must mandate that providers of healthcare services must accept payments based on the Medicare reimbursements system. This would reduce uncertainty of expected insurance loss cost, and it would enhance insurance affordability and availability. Congress could also consider a form of limited tax credit to providers of services.
Second, The Department of Health and Human Services would be authorized to establish a Reinsurance Department funded by Congress to reinsure a defined level of excess loss ratio that insurers would experience from paying "excess" losses due to "Preexisting conditions" and to "no dollar limit on annual covered heath care expenses".
Third, the law would require that drug prices must be subject to negotiation between insurers and drug manufacturers and suppliers.
First, the law must mandate that providers of healthcare services must accept payments based on the Medicare reimbursements system. This would reduce uncertainty of expected insurance loss cost, and it would enhance insurance affordability and availability. Congress could also consider a form of limited tax credit to providers of services.
Second, The Department of Health and Human Services would be authorized to establish a Reinsurance Department funded by Congress to reinsure a defined level of excess loss ratio that insurers would experience from paying "excess" losses due to "Preexisting conditions" and to "no dollar limit on annual covered heath care expenses".
Third, the law would require that drug prices must be subject to negotiation between insurers and drug manufacturers and suppliers.
3
Consumers and their employers are pouring billions into healthcare. Unfortunately, not all of it is received by the hospitals, doctors, or pharmaceutical companies providing the service. There is a huge gap created by the insurance companies. That's the biggest problem. Insurance companies have stockholders, stockholders want value for their investment, and the profit motive takes a huge chunk of cash out of the system.
That suggests a single-payee system. But how do you prevent it from being reduced to a DMV of healthcare, where the lowest service is provided for the most money? The funding could come from a tax of both employees and employers, like Social Security or unemployment. That hits the middle class hardest, while the rich (who generate more income from investments than salary) would escape, but surely there is a way to keep it fair.
The same actuaries computing profits for the insurance companies could surely figure out what services and costs would be reasonable for the system to remain solvent.
Eliminating malpractice insurance and lawsuits would greatly benefit doctors, and stop another big drain on the system. Opt into the system, waive the right to sue except in cases of gross negligence (surgeon was drunk).
It could be done. It would take a huge change in mindset. Right now people think something is better if you pay more for it. Middle Americans don't want to risk the so-so solution, fearing it might get worse.
That suggests a single-payee system. But how do you prevent it from being reduced to a DMV of healthcare, where the lowest service is provided for the most money? The funding could come from a tax of both employees and employers, like Social Security or unemployment. That hits the middle class hardest, while the rich (who generate more income from investments than salary) would escape, but surely there is a way to keep it fair.
The same actuaries computing profits for the insurance companies could surely figure out what services and costs would be reasonable for the system to remain solvent.
Eliminating malpractice insurance and lawsuits would greatly benefit doctors, and stop another big drain on the system. Opt into the system, waive the right to sue except in cases of gross negligence (surgeon was drunk).
It could be done. It would take a huge change in mindset. Right now people think something is better if you pay more for it. Middle Americans don't want to risk the so-so solution, fearing it might get worse.
2
The Republicans have been attempting to overturn the Affordable Care Act. However they have not put forth any comprehensive substitute. I have not heard any discussion of this. Do nothing Congress indeed
1
Thank you for something reasonable, even if imperfect. To know that some in Congress do reach across the aisle gives me hope for the future.
My husband and I recently spent several weeks in Europe, mainly in countries with low or no-cost governmental sponsored health care. Across the board they said, "yes, we do have access for basic needs BUT . . . if something elective is wanted, the wait time can be months or years." One told us that the wait for a simple dental filling might be six months. Forget the idea of implants or crowns. Cheaper and easier to pull all the teeth and offer dentures.
Many people supplement their government benefits with private insurance. That appears to be the most workable of long-term options. Make sure everyone gets the basics, especially for children and women of child-bearing years. The health of these two demographics are vital to our future as a nation. Then let those who want more buy the more extensive private insurance.
My husband and I recently spent several weeks in Europe, mainly in countries with low or no-cost governmental sponsored health care. Across the board they said, "yes, we do have access for basic needs BUT . . . if something elective is wanted, the wait time can be months or years." One told us that the wait for a simple dental filling might be six months. Forget the idea of implants or crowns. Cheaper and easier to pull all the teeth and offer dentures.
Many people supplement their government benefits with private insurance. That appears to be the most workable of long-term options. Make sure everyone gets the basics, especially for children and women of child-bearing years. The health of these two demographics are vital to our future as a nation. Then let those who want more buy the more extensive private insurance.
3
Notice that the authors wait until the sixth paragraph to present the actual plan. If it were that good, they would have put it up front.
Single payer.
Single payer.
They admit it isn't perfect. But incremental steps may be all that are possible at this time. We certainly have to commend those 43 problem solvers who are trying to do something in a bi-partisan way. The republican intransigence has made Congress pathetic.
Personally, I believe all this stumbling around is part of the process that will eventually lead to a Medicare for all type system. I hesitate to call it single payer because that is a misnomer. It also makes it sound as if government will bear all the costs, which, unfortunately, too many uniformed Trump supporters believe, and one of the reasons they fear it so much, thinking that it will be fearfully expensive and raise their taxes.
I wish the NYT would do an article on how Medicare for all would actually work. The Democrats don't seem able or ready to explain it in a way that the masses would understand.
Personally, I believe all this stumbling around is part of the process that will eventually lead to a Medicare for all type system. I hesitate to call it single payer because that is a misnomer. It also makes it sound as if government will bear all the costs, which, unfortunately, too many uniformed Trump supporters believe, and one of the reasons they fear it so much, thinking that it will be fearfully expensive and raise their taxes.
I wish the NYT would do an article on how Medicare for all would actually work. The Democrats don't seem able or ready to explain it in a way that the masses would understand.
This approach only addresses the Affordable Care Act as a solution to affordable health care, when it is merely supporting insurance purchasing. That said, I am glad to hear that some members of Congress are working together. Here are my concerns. The medical device tax on cardiac and orthopedic device manufacturers goes directly into the fund to provide funding for the ACA and should not be eliminated. Medical device manufacturers charge Americans much more for these devices than other countries in which they market their products, like Canada. These companies do not fund much medical research, the U.S. government does through the Health and Human Services Agency and the National Institutes of Health, for which Trump has proposed a 20% budget cutback. Both pharma and medical device manufacturers always whine they will have to cut back on medical research, when their research is funded through studies conducted at universities, with government grants. What they mean is, they will have to cut back on marketing. There is no way this sector deserves a pass on contributing to the insurance fund. Secondly, the federal government should not be providing reinsurance to the states, unless they will fully comply with all of the provisions of the ACA. Thirdly, since the government already provides insurance through the Centers for Medicare and Medicaid with administrative costs which are 6% compared to 20% for private insurance, why not also review the cost of Medicare for all.
7
We need to get the profit motive out of health care. Doctors in the OECD countries, specialists included, all make very comfortable amounts of money, and that could be done here, too. Call it socialized medicine, Medicare for all, single payer, whatever, just get these rapacious insurance companies away from health care!
5
Mmmm. So tell me that other industrialized nations who have single payer systems probably have some experience with those systems. Best practices, maybe? I am reasoning these countries have faced challenges in implementation and delivery and that these experiences are available for analysis. Combine these "histories" with good old fashion American know-how, and one wonders if we could develop a system that is the envy of the world. I also wonder, since healthcare accounts for a sixth of our economy,
If that huge amount of money could fund a well-designed and efficient single payer system for less. Bet ya. Keep up the pressure.
If that huge amount of money could fund a well-designed and efficient single payer system for less. Bet ya. Keep up the pressure.
3
Danger here for ACA proponents!
While this article purports to emphasize inter-party cooperation to fix acknowledged shortcomings of the ACA, that inevitably leads to those shortcomings being examined and discussed. Once that happens, it's an easy step to abandon cooperation and announce a one-party solution to those shortcomings.
While this article purports to emphasize inter-party cooperation to fix acknowledged shortcomings of the ACA, that inevitably leads to those shortcomings being examined and discussed. Once that happens, it's an easy step to abandon cooperation and announce a one-party solution to those shortcomings.
Single payer is the only way. There cannot be a market based system.
6
To the author,
I'll believe Congress is serious about fixing health care when it decides to at least analyze single payer as an option, with a cost-control mechanism for medical services. Until I see that, I will remain highly skeptical of all bipartisan health-care “reform” efforts.
I'll believe Congress is serious about fixing health care when it decides to at least analyze single payer as an option, with a cost-control mechanism for medical services. Until I see that, I will remain highly skeptical of all bipartisan health-care “reform” efforts.
5
Your model does not address the fundamental issue, we don't want health insurance we want health care. We do not want to be struggling with "shopping" for insurance. What happens when someone cannot afford the plan he or she needs, what if they choose the wrong plan relative to a health condition they experience down the rode. We do not need your convoluted plan. We need a single payer system that includes all Americans regardless of current or future health status. Medicare for all.
11
We need a system that substantially reduces our costs. Our peer nations use a variety of systems, including private insurance that accomplish this.
Medicare for all, without cost controls would achieve nothing.
Medicare for all, without cost controls would achieve nothing.
4
The biggest easily achievable reduction in cost is to eliminate the profit motive from all levels of healthcare. You could instantly reduce costs by 30% or more, and in the pharmaceutical industry even far more than that. Cite any instance where private insurance performs better than not for profit single care systems. Australia's model indicates the exact opposite of your claim. Profit is the greatest impediment to controlling the cost of healthcare, because it takes precedence over access to care, the health of patients, and even to longevity and infant mortality rates.
So a Democrat bends over backwards to prop up the Heritage-Foundation hatched end-run around single-payer. What else is new? The Democrats enacted this boondoggle in 2008 without a single Republican vote (meaning they had they votes to pass anything they wanted). That is why they "own" it, and why so many of their former base voters are fleeing for the exits.
2
Actually, their voters fled because of 7 years of GOP lies promising them "something better and cheaper" than Obamacare, even no one in the GOP could describe what it would actually be. Yet when called upon to actually produce the plan, they were exposed for the hollow liars they had always been. Voters actually realized this remarkably quickly after the GOP victory, which is why Obamacare replacement had a whopping 17% approval rating.
Rep. Gottheimer and Rep. Reed deserve large campaign contributions from the for-profit health insurance industry – and they know it.
If they wanted to reduce the cost of health care they would prevent medical providers from charging one group of patients (uninsured or out of network) more than another. This rule works well in France where insurers compete on service and reimbursement.
If the Congressman really wanted to reduce the cost of health insurance they would allow completion from non-profit health insurers that object to the elective mandates for abortion, contraceptives, transgender surgery, etc. Today, Catholic Universities and Hospitals may compete but the law prohibits the formation of a Catholic Health Insurance Company that is able to exclude coverage for elective procedures that fail to meet the Catholic medical standard of doing no harm.
If the Congressmen wanted to spend tax dollars for the most return they would provide free prescription medication to all. The would provide a minimum level of care for the insured and uninsured, reduce the cost of health insurance, greatly reduce the cost of medication, and enable the taxpayers to reap the benefit of pharmaceutical advances and cures.
If they wanted to reduce the cost of health care they would prevent medical providers from charging one group of patients (uninsured or out of network) more than another. This rule works well in France where insurers compete on service and reimbursement.
If the Congressman really wanted to reduce the cost of health insurance they would allow completion from non-profit health insurers that object to the elective mandates for abortion, contraceptives, transgender surgery, etc. Today, Catholic Universities and Hospitals may compete but the law prohibits the formation of a Catholic Health Insurance Company that is able to exclude coverage for elective procedures that fail to meet the Catholic medical standard of doing no harm.
If the Congressmen wanted to spend tax dollars for the most return they would provide free prescription medication to all. The would provide a minimum level of care for the insured and uninsured, reduce the cost of health insurance, greatly reduce the cost of medication, and enable the taxpayers to reap the benefit of pharmaceutical advances and cures.
3
The answer is Medicare for all. It gets large businesses out of paying for health insurance for the majority of Americans, a yuge windfall. The problem solvers can solve what portion of that windfall accrues to those businesses, and what is diverted to paying a portion of medicare premiums.
Since private insurers have made record profits in the Obamacare years while destabilizing the exchanges with Republicans happy about that. Therefore, we relegate them to offering Medigap policies only.
I expect the problem solvers to flesh out the necessary details.
Since private insurers have made record profits in the Obamacare years while destabilizing the exchanges with Republicans happy about that. Therefore, we relegate them to offering Medigap policies only.
I expect the problem solvers to flesh out the necessary details.
8
On a per person basis. US healthcare is twice as expensive as our peers, but with no better outcomes. The US spends $10,000 per person on healthcare, totaling $3.4 trillion annually and consuming 18% of GDP. The average healthcare premium for a family of 4 with both parents over age 55 is $20,000 with a $10,000 deductible. US healthcare is already not affordable to many, and impacting economic expansion for all of us. I don't oppose a quick fix to a small component of a very big problem - but it is similar to arranging deck chairs on the Titanic .
6
In many instances our outcomes as compared with nations using single payer models - in instances such as infant mortality, rate of coverage, cost, and longevity - are shamefully FAR worse.
Will your plan require carriers to provide the "essential benefits" as the ACA does now? If not, selling insurance across state lines will encourage a race to the bottom.
4
You have an ideal model to build from, Medicare. It is something you can simply replicate for the rest of us under the age of 65. The insurance companies can still sell supplemental coverage for gaps like they do now. So there will still be some free market choice.
You say premiums are the issue. As a healthcare worker, I would say this is not true. It is the out of pocket costs. After deductibles, which are thousands of dollars, you must meet out of pocket expenses, which I have seen as high as $15,000. And it renews itself each year. This is the problem. People cannot afford this. The insurance companies are still making a huge profit. Hospitals are doing okay as well. But the average citizen is avoiding going to the MD or ER because of the outrageous out of pocket expenses.
Get real and start looking at the true issues. You guys in government have a federal plan and you and your families have virtually no out of pocket expenses.
Single payer is the only answer and you know that. Get the insurance lobby out of your pockets and start doing what is right for the American people you "govern". I put that in quotes because you are not doing a good job at your job.
You say premiums are the issue. As a healthcare worker, I would say this is not true. It is the out of pocket costs. After deductibles, which are thousands of dollars, you must meet out of pocket expenses, which I have seen as high as $15,000. And it renews itself each year. This is the problem. People cannot afford this. The insurance companies are still making a huge profit. Hospitals are doing okay as well. But the average citizen is avoiding going to the MD or ER because of the outrageous out of pocket expenses.
Get real and start looking at the true issues. You guys in government have a federal plan and you and your families have virtually no out of pocket expenses.
Single payer is the only answer and you know that. Get the insurance lobby out of your pockets and start doing what is right for the American people you "govern". I put that in quotes because you are not doing a good job at your job.
22
@ Janice Nelson - Great to see you back at least in the settings where I might usually see a comment from you. In my comment a ways down I was cautious, letting Funky Irishman, you, and others speak directly for Universal Health Care. Your observation that UHC with private supplementary insurance can be nice for those who are able is on target. Here in Sweden I occasionally have visited a clinic or physician who is in effect both private and public. The public system pays part of his or her fee - always quite modest - and I pay the rest, almost always re-imbursed by the Aetna complementary that I maintain along with having Medicare, which only is usable in the US.
And yes, those out-of-pocket charges as reported here by many commenters are unbelievable for one who has Swedish UHC. There is a cap on total out-of-pocket expenses that I think is perhaps $1000 USD!
My best
Larry L
Only-NeverInSweden.blogspot.com
And yes, those out-of-pocket charges as reported here by many commenters are unbelievable for one who has Swedish UHC. There is a cap on total out-of-pocket expenses that I think is perhaps $1000 USD!
My best
Larry L
Only-NeverInSweden.blogspot.com
Mos of these measures are a watered-down version of the horrid bill that almost passed the Senate last week. Take, for example, your "accross state lines" proposal, which most states that have tried it have found totally unsuccessful. Here's an abstract from a recent Georgetown University study on this "stabilizing" measure you propose:
"We find that while across state lines proposals cite many important goals — such as enhancing consumer choice, increasing competition and making insurance more affordable — the across state lines proposals as currently enacted in six states do not address the true drivers of health insurance costs nor do they adequately take into account the complexity of how insurance products are sold and regulated. The proposals also underestimate the administrative hurdles necessary for full implementation. As a result, none of the across state lines laws resulted in a single insurer entering a new market or the sale of a single new insurance product." https://ssascholars.uchicago.edu/jhppl/content/selling-health-insurance-...
The best thing about your proposal is the permanence of the subsidy. But you should go farther, and make it a criminal offense for any public official to intentionally try to destabilize the market by threatening to withhold subsidies, for example.
"We find that while across state lines proposals cite many important goals — such as enhancing consumer choice, increasing competition and making insurance more affordable — the across state lines proposals as currently enacted in six states do not address the true drivers of health insurance costs nor do they adequately take into account the complexity of how insurance products are sold and regulated. The proposals also underestimate the administrative hurdles necessary for full implementation. As a result, none of the across state lines laws resulted in a single insurer entering a new market or the sale of a single new insurance product." https://ssascholars.uchicago.edu/jhppl/content/selling-health-insurance-...
The best thing about your proposal is the permanence of the subsidy. But you should go farther, and make it a criminal offense for any public official to intentionally try to destabilize the market by threatening to withhold subsidies, for example.
7
The "health care system" in the US works just fine. It's the health insurance system that is broken. Health care itself is fine. That's why people from Norway, England, Germany, Canada and all the other places that have universal, single payer insurance systems come here for treatment.
And the part of the healthcare insurance market that is broken here is the individual market. The vast majority of Americans are insured through their employer, though that market has been adversely affected by the individual market.
The thing that's really broken is our government. Our government officials - the gentlemen who penned this OpEd - are bound not to any moral/ethical ideology. They are influenced only by their Darwinian instinct to survive politically and, of course, financially.
Perhaps if their terms in office were limited they would seek policies that are good in themselves and not for the derivative benefits bestowed on the elected official.
Interesting how the article lead with "if we were going to fix the system from the ground up...". The fact that no one has proposed a complete overhaul - individual market, Medicare, employer sponsored, VA and, though it is not health insurance so much as welfare, Medicaid - tells us a lot about the swamp creature's problem solving skills.
And the part of the healthcare insurance market that is broken here is the individual market. The vast majority of Americans are insured through their employer, though that market has been adversely affected by the individual market.
The thing that's really broken is our government. Our government officials - the gentlemen who penned this OpEd - are bound not to any moral/ethical ideology. They are influenced only by their Darwinian instinct to survive politically and, of course, financially.
Perhaps if their terms in office were limited they would seek policies that are good in themselves and not for the derivative benefits bestowed on the elected official.
Interesting how the article lead with "if we were going to fix the system from the ground up...". The fact that no one has proposed a complete overhaul - individual market, Medicare, employer sponsored, VA and, though it is not health insurance so much as welfare, Medicaid - tells us a lot about the swamp creature's problem solving skills.
7
1) Make health care a human right in this country as it is in most developed countries.
2) Create a public option-- Medicaid for all! (Medicare is horribly designed from a cost-effective and evidence-based perspective.) Right now we have separate healthcare payment mechanisms for veterans, children, the elderly, the disabled, low-income people the employed, the unemployed. No wonder it's a bloated mess.
3) Take the profit out of the healthcare insurance arena-- except for policies issued to people who consider themselves too special for a Medicaid-for-all plan.
4) Make it illegal for healthcare to be a political volleyball with no one knowing how it's all going to work and whether they will have coverage from one year to the next.
Maybe it's not that complicated after all!
2) Create a public option-- Medicaid for all! (Medicare is horribly designed from a cost-effective and evidence-based perspective.) Right now we have separate healthcare payment mechanisms for veterans, children, the elderly, the disabled, low-income people the employed, the unemployed. No wonder it's a bloated mess.
3) Take the profit out of the healthcare insurance arena-- except for policies issued to people who consider themselves too special for a Medicaid-for-all plan.
4) Make it illegal for healthcare to be a political volleyball with no one knowing how it's all going to work and whether they will have coverage from one year to the next.
Maybe it's not that complicated after all!
7
I really have two points: 1. Any compromise that moves the health care issue forward is a good thing. I'd like to hear some detail on the "several options to offset new spending". 2. I can theoretically agree with the idea of a single payer system, but I'd like to hear some discussion about how to avoid the bureaucratic bloat and malaise that seems to infuse all government programs. In my opinion, it would not take long before the cost of the single-payer bureaucracy costs as much if not more than the insurance industry "middle man".
1
1. Medicare has been around for "long", and the bureaucracy costs are amazingly controlled; I have read that the cost of processing a single claim is $0.75.
2. Medicare is the only force acting to keep health care costs controlled. Any new procedure is doomed if it does not get a reimbursement code, and reimbursement rates are based on audited actual costs. For example, I had a "routine 12 lead EKG" which took a nurse's aide about 5 minutes to do. The hospital billed $111, Medicare approved rate is $18.29. And the hospital accepted it. If it weren't for Medicare, every bill would be impossibly high.
Your supposition is not supported by evidence, sir.
2. Medicare is the only force acting to keep health care costs controlled. Any new procedure is doomed if it does not get a reimbursement code, and reimbursement rates are based on audited actual costs. For example, I had a "routine 12 lead EKG" which took a nurse's aide about 5 minutes to do. The hospital billed $111, Medicare approved rate is $18.29. And the hospital accepted it. If it weren't for Medicare, every bill would be impossibly high.
Your supposition is not supported by evidence, sir.
4
Medicare isn't "bloated" really. It has lower administrative costs than for-profit companies, and a fairly small bureaucracy. Since it doesn't have marketing costs, or payment collection costs, it can concentrate on claims processing.
1
I'm among the many who've become convinced that single payer is the best, and maybe only, long-term solution to our health insurance problems. But with Republican majorities in both houses of Congress, that isn't going to happen in the foreseeable future. Meanwhile, we have to deal with a president who is determined to prove the ACA is in a death spiral, even if he has to kick it off a ledge to prove it.
Of course, I disagree with several points in the proposed bipartisan plan. I'd rather have a small business defined as one with up to 200 full-time employees, not 500. I'd rather have "full-time" defined to be at least 35 hours of work, not 40. And I share Democrats' skepticism that interstate insurance sales will reduce costs.
But still, I'm in favor of the package - first because it makes discretionary federal subsidies mandatory, and second because it restores re-insurance provisions to the ACA. Those two steps alone will ensure that the ACA survives assault by the president. If the 40-hour and 500-employee minimums prove to be problematic, they can be adjusted in the future. And if interstate insurance works, I'll be glad to be proven wrong; if not, then we can finally be rid of that argument.
Taking a step back from the specifics, I'm in favor of the package because it takes a second step (the first being Russia sanctions) to restoring functional bipartisan compromise to our legislative process.
politicsbyeccehomo.wordpress.com
Of course, I disagree with several points in the proposed bipartisan plan. I'd rather have a small business defined as one with up to 200 full-time employees, not 500. I'd rather have "full-time" defined to be at least 35 hours of work, not 40. And I share Democrats' skepticism that interstate insurance sales will reduce costs.
But still, I'm in favor of the package - first because it makes discretionary federal subsidies mandatory, and second because it restores re-insurance provisions to the ACA. Those two steps alone will ensure that the ACA survives assault by the president. If the 40-hour and 500-employee minimums prove to be problematic, they can be adjusted in the future. And if interstate insurance works, I'll be glad to be proven wrong; if not, then we can finally be rid of that argument.
Taking a step back from the specifics, I'm in favor of the package because it takes a second step (the first being Russia sanctions) to restoring functional bipartisan compromise to our legislative process.
politicsbyeccehomo.wordpress.com
7
A doctor's prescription to fix the HCS: 1) Empower patients with choice to select insurance plan offered in their area. 2) Decouple health insurance from employment. 3) Create one universal healthcare insurance system, consolidating Medicare, Medicaid, CHIP, employer-sponsored and non-group insurance, VA, TRICARE and worker’s compensation. 4) Finance system with a value-added tax (VAT) solely devoted to healthcare expenditures. Now everyone knows what healthcare costs and has “skin in the game.” This would not raise the marginal tax rate would be a good investment in human capital. Everyone pays into the VAT, eliminating other taxes and premiums currently funding our fragmented system. Government acts as the conduit for the VAT collected and disburses funds by means of a debit card to every citizen, which would pay for the low-priced insurance plan in each market area. 5) Consumers pay in full for excess in premiums over low-cost plan with out of net after-tax income to encourage cost consciousness. 6) Endorse prepaid Kaiser-like integrated delivery systems. 7) Let government support competition by setting guidelines for standard coverage contracts, adjusting risk premiums based on community rating and providing reinsurance to protect health plans. 8) Promote transparency through government-published consumer satisfaction data. 9) Encourage competition between health plans and providers based on value for money. 10) Initiate incentives for primary care.
9
More pertinent than your MD degree is probably you Master in Public Health degree.
I would shove your last recommendation way up to top portion of the list.
The VAT for healthcare idea needs more exploring. I am not convinced it is adequate to deal with the indigent care needs.
You are leaving untouched tech for profit hospital and clinic systems. That is a huge mistake.
There needs to be more control of the pricing of pharmaceuticals, also, as well as better funding for more development of more medications.
Lastly, we need free of charge, mandatory inoculations for children. Free distribution of condoms also would be great step forward.
Lastly, free water filters for low income families who live in old housing would be a great idea.
I would shove your last recommendation way up to top portion of the list.
The VAT for healthcare idea needs more exploring. I am not convinced it is adequate to deal with the indigent care needs.
You are leaving untouched tech for profit hospital and clinic systems. That is a huge mistake.
There needs to be more control of the pricing of pharmaceuticals, also, as well as better funding for more development of more medications.
Lastly, we need free of charge, mandatory inoculations for children. Free distribution of condoms also would be great step forward.
Lastly, free water filters for low income families who live in old housing would be a great idea.
Thanks Josh and Tom,
You are tackling a complex problem and issue, and should be commended for producing three good, common-sense suggestions for improving the current health care insurance system. Stabilizing the markets and helping states deal with the high cost of pre-existing and chronic conditions make a lot of sense. And, although it may be unpopular depending on the business you're in, it does make sense to provide relief, even if temporary, to certain businesses from the mandate that they provide insurance to full-time employees in order to keep our economy growing.
A key issue, unstated in your op-ed, is 'what should be the overriding goals for making any changes to our current health care system?' This seems to be the gorilla in the closet, one which seems to be radioactive and which elected members of Congress run away from as fast as possible when asked - but one which quite simply must be answered since it really is, or should be, difficult to move forward on a bill without knowing the true purpose of the bill.
As has been seen over the past 7 months, the American people have spoken on this question. The vast majority of Americans agree that the purpose for change to our current health care system should be to develop a plan that will actually increase the number of Americans who can get real - not fake - health care insurance.
Let us hope that members of Congress can agree on this purpose as it moves to make changes to our health care system.
You are tackling a complex problem and issue, and should be commended for producing three good, common-sense suggestions for improving the current health care insurance system. Stabilizing the markets and helping states deal with the high cost of pre-existing and chronic conditions make a lot of sense. And, although it may be unpopular depending on the business you're in, it does make sense to provide relief, even if temporary, to certain businesses from the mandate that they provide insurance to full-time employees in order to keep our economy growing.
A key issue, unstated in your op-ed, is 'what should be the overriding goals for making any changes to our current health care system?' This seems to be the gorilla in the closet, one which seems to be radioactive and which elected members of Congress run away from as fast as possible when asked - but one which quite simply must be answered since it really is, or should be, difficult to move forward on a bill without knowing the true purpose of the bill.
As has been seen over the past 7 months, the American people have spoken on this question. The vast majority of Americans agree that the purpose for change to our current health care system should be to develop a plan that will actually increase the number of Americans who can get real - not fake - health care insurance.
Let us hope that members of Congress can agree on this purpose as it moves to make changes to our health care system.
4
I suggest the biggest change necessary is reducing costs.
Without compromise, there is no democracy.
In other words, a GOP plan. Perhaps Mr. Gottheimer should change parties.
The problems with the insurance system is not just premiums. It is sky-high deductibles and sky-high out of pocket costs on top of that. Here in my part of NC, an individual plan without subsidies has premiums of $900-$1400/month, plus a $6000-$7500 deductible, plus a $7500 out of pocket on top of that. In the case of serious illness, the individual could have to shell out up to $25,000 out of pocket before insurance pays one single dime. So how is that insurance? Those who have the money for that might as well take that money and put it into some sort of HSA, except the HSA limits are so low. Those who don't have that money are still out of luck, only they are paying around $1000/month for the privilege of having to possibly spend $25,000/year on their own health care.
The problems with the insurance system is not just premiums. It is sky-high deductibles and sky-high out of pocket costs on top of that. Here in my part of NC, an individual plan without subsidies has premiums of $900-$1400/month, plus a $6000-$7500 deductible, plus a $7500 out of pocket on top of that. In the case of serious illness, the individual could have to shell out up to $25,000 out of pocket before insurance pays one single dime. So how is that insurance? Those who have the money for that might as well take that money and put it into some sort of HSA, except the HSA limits are so low. Those who don't have that money are still out of luck, only they are paying around $1000/month for the privilege of having to possibly spend $25,000/year on their own health care.
7
Great! Here's another idea you could work out:
Single Payer. Done.
Single Payer. Done.
7
Good for the two of you and you bipartisan Problem Solvers Caucus. We need such an approach to governing.
Your healthcare ideas sound like sensible starts to making the system function better.
We clearly we need several steps before the nation ultimately considers the best fix: single payer. Maybe eventually you will be willing to sponsor such legislation,
Your healthcare ideas sound like sensible starts to making the system function better.
We clearly we need several steps before the nation ultimately considers the best fix: single payer. Maybe eventually you will be willing to sponsor such legislation,
2
Well, this proposal certainly represents some degree of compromise, but it somehow overlooks some common sense ideas that would dramatically improve our factious, inefficient health care system.
One such initial step would be to repeal the insane law passed under Dubya that prohibits Medicare/Medicaid from negotiating drug prices.
For any kind of rational health care system to operate fairly and equitably, costs in the system must be controlled. And right now, the high costs of prescription drugs are seriously out of line. Yes, pharma needs research dollars for new products, but not on the backs of households and individuals by maintaining mandated high drug prices for government programs.
Incidentally, all western democracies (with the exception of us, of course) long ago took this step because it is essential in order to manage a single payer health care plan, which should be Congress' overriding goal.
One such initial step would be to repeal the insane law passed under Dubya that prohibits Medicare/Medicaid from negotiating drug prices.
For any kind of rational health care system to operate fairly and equitably, costs in the system must be controlled. And right now, the high costs of prescription drugs are seriously out of line. Yes, pharma needs research dollars for new products, but not on the backs of households and individuals by maintaining mandated high drug prices for government programs.
Incidentally, all western democracies (with the exception of us, of course) long ago took this step because it is essential in order to manage a single payer health care plan, which should be Congress' overriding goal.
3
While some of these ideas are O.K. like making the cost-sharing payments mandatory, others are just the same old vague nonsense.
What are the criteria that let businesses avoid the employer mandate? And do you have any ideas to have the business who are exempted make up the lack of coverage in wages?
Repealing the Medical Device Tax would just make some already rich people even richer. Medical device companies have seen their profits continue to increase, even after the new tax from the ACA. The GAO looked at 102 medical device companies and found a roughly 44 percent increase in profits from 2005 to 2014 — from $11.4 billion to $16.5 billion.
Providing states with additional flexibility to enter into agreements — such as enabling the sale of insurance across state lines would be an utter disaster. Suppose one state got a waiver to eliminate the requirement of maternity benefits. Then any company could offer nationally only plans that did the same. We would have a repeat of the credit card situation, in which Citibank bribed SD to eliminate crucial regulation (usury laws, etc.) & then moved their national CC operation there. They were followed by almost all of the other CC companies. The last thing we need is to only have plans available that satisfy the rules in TX or MS.
All this is just nibbling around the edges. HR676 would give an improved Medicare to everyone, get better results, and save $600 Billion its first year and $1.5 TRILLION after a few more.
What are the criteria that let businesses avoid the employer mandate? And do you have any ideas to have the business who are exempted make up the lack of coverage in wages?
Repealing the Medical Device Tax would just make some already rich people even richer. Medical device companies have seen their profits continue to increase, even after the new tax from the ACA. The GAO looked at 102 medical device companies and found a roughly 44 percent increase in profits from 2005 to 2014 — from $11.4 billion to $16.5 billion.
Providing states with additional flexibility to enter into agreements — such as enabling the sale of insurance across state lines would be an utter disaster. Suppose one state got a waiver to eliminate the requirement of maternity benefits. Then any company could offer nationally only plans that did the same. We would have a repeat of the credit card situation, in which Citibank bribed SD to eliminate crucial regulation (usury laws, etc.) & then moved their national CC operation there. They were followed by almost all of the other CC companies. The last thing we need is to only have plans available that satisfy the rules in TX or MS.
All this is just nibbling around the edges. HR676 would give an improved Medicare to everyone, get better results, and save $600 Billion its first year and $1.5 TRILLION after a few more.
3
Selling insurance across state lines sounds good on the surface when mentioned in the same breath with "freedom of choice," and "competition." But those are PR phrases used by the largest insurance carriers to invade states where other insurance carriers offer better rates and lower deductibles.
"Selling across state lines" also is a reminder of how banks invaded states where branch banking and out-of-state banks were illegal. They "merged," bought out, and in some cases, conducted hostile takeovers of other banks in those states and in communities with smaller, locally-owned banks. Having lived in Colorado and Connecticut, I have seen the damage done to local bank customers when the biggest banks move in and change the rules.
The upshot is, allowing the biggest insurance carriers to operate "across state lines" will be the likely deathnell for in-state insurers who have been doing a pretty good job so far.
But at least there is bipartisan effort to make the repairs to the ACA. Let's be clear, though. For seven years, the Republicans never invited Democrats to the table to discuss, negotiate or fine common ground from which to repair the ACA. The Dems were locked out for the sake of GOP power and their power mongers. We can thank Gingrich and the GOP strategy coach, Frank Luntz, for their efforts to demonize the Democrats as the enemy in the 1990s.
It will take several years to achieve a single-payer system but it will happen in a bipartisan manner. Someday ...
"Selling across state lines" also is a reminder of how banks invaded states where branch banking and out-of-state banks were illegal. They "merged," bought out, and in some cases, conducted hostile takeovers of other banks in those states and in communities with smaller, locally-owned banks. Having lived in Colorado and Connecticut, I have seen the damage done to local bank customers when the biggest banks move in and change the rules.
The upshot is, allowing the biggest insurance carriers to operate "across state lines" will be the likely deathnell for in-state insurers who have been doing a pretty good job so far.
But at least there is bipartisan effort to make the repairs to the ACA. Let's be clear, though. For seven years, the Republicans never invited Democrats to the table to discuss, negotiate or fine common ground from which to repair the ACA. The Dems were locked out for the sake of GOP power and their power mongers. We can thank Gingrich and the GOP strategy coach, Frank Luntz, for their efforts to demonize the Democrats as the enemy in the 1990s.
It will take several years to achieve a single-payer system but it will happen in a bipartisan manner. Someday ...
3
Proclaimed "freedom" disguising economic "servitude" has been a persistent theme of an American history dominated, not by democracy, but by an elite-supporting capitalism.
Companies can already sell policies across state lines. Nothing is stopping them.
1
This is a critical point, and it's well made. It's going to have to be made even more clearly, though. If people don't take to the streets over interstate insurance prohibitions, this will be the way that meaningful health-care reform dies.
Why is it that those who always shout that the private market is the most efficient mechanism for providing the best outcomes absolutely refuse to test that theory. Allow medicaid to provide policies on the exchanges through an umbrella vehicle that must be self sufficient--similar to the post office. If it fails, the Republicans have proven their point.
Private insurers all have formularies and bid pharmaceuticals all the time. They cut their costs often by 10 fold. Allow the insurers to bid just like private companies bid. Instead of paying $12 per pill, they would suddenly be paying fifty cents. This would really create competition. Then let every insurer publish what the costs of each formulary drug would be to their patients. A company offering my prescriptions at a substantial savings would certainly get my business. Competition!
Private insurers all have formularies and bid pharmaceuticals all the time. They cut their costs often by 10 fold. Allow the insurers to bid just like private companies bid. Instead of paying $12 per pill, they would suddenly be paying fifty cents. This would really create competition. Then let every insurer publish what the costs of each formulary drug would be to their patients. A company offering my prescriptions at a substantial savings would certainly get my business. Competition!
2
Mr. Reed, in your last town hall meeting in Ithaca on March 11, your constituents asked, with a single voice, for a single payer system. Please listen to them.
10
To imply that those attending a town hall meeting represent all the voters in a district is farcical. Mr. Reed should be applauded for reaching across party lines to solve a problem. What you are advocating can not be done in today's political climate. So don't let perfection be the enemy of good and learn to compromise yourself to push issues you care about forward.
1
Ah yes, nothing can gather bipartisan support better than multi-billion dollar corporate bailouts and corporate welfare paid for with borrowed and printed money.
If Congress does this, they should at least require that all insurance companies receiving this bailout money pay top executive no more than 1 million dollars per year.
If Congress does this, they should at least require that all insurance companies receiving this bailout money pay top executive no more than 1 million dollars per year.
8
Everyone has their own priorities. My favorite, Single Payer. It won't happen now or in the near future. ACA was a step forward to providing healthcare for all. Not perfect by any means, but better than where we were. Fixing the most glaring problems in the ACA is another step. Eventually we may reach the holy grail. Fixing the problems with insurance companies, hospitals, physicians paper work can come later. Each is a hornets nest of competing forces that will not be solved easily. Providing healthcare for all is the ultimate goal.
2
If Congress were subject to the healthcare morass that the rest of the country is subject to instead of their own Cadillac plan, we would have had a viable solution in place long ago.
It's like so-called "political reform." And that's because our political system won't be fixed because those in charge are benefiting from the current system.
Gottheimer and Reed say lots of nice things. But nothing will happen. Again.
It's like so-called "political reform." And that's because our political system won't be fixed because those in charge are benefiting from the current system.
Gottheimer and Reed say lots of nice things. But nothing will happen. Again.
4
Nothing about controlling out of control drug prices? Seemingly the lobbyists from Big Pharma are very good at what they do.
This whole plan sounds like minor tinkering to keep an antiquated structure ready to fall over from collapsing. While it may kick the can down the road it really is not addressing several big problems in the system.
Like the fact that even though American taxpayers will pay for the brunt of this insurance companies will still be making huge profits, profits that do not go towards improving patient care and outcomes. Or the outrageous salaries those running the current system are receiving.
If other countries around the world can fix healthcare the US should be also be able to do so. But as long as the US chooses to be followers and not leaders this country will never return to the prominence it once had around the world.
As long as Congress refuses to show true leadership the US will truly never fix the system. And as long as the as the system does not get fixed Congress will not be able to address other pressing matters affecting this once great country.
As long as some people are making a buck on the medical problems of others the system will never get fixed. As long as Congress receives huge bribes in the form of political contributions from those benefiting from the current the system will never get fixed.
True problem solvers think outside of the box, they don't engage in half-hearted measures simply because of political expedience.
This whole plan sounds like minor tinkering to keep an antiquated structure ready to fall over from collapsing. While it may kick the can down the road it really is not addressing several big problems in the system.
Like the fact that even though American taxpayers will pay for the brunt of this insurance companies will still be making huge profits, profits that do not go towards improving patient care and outcomes. Or the outrageous salaries those running the current system are receiving.
If other countries around the world can fix healthcare the US should be also be able to do so. But as long as the US chooses to be followers and not leaders this country will never return to the prominence it once had around the world.
As long as Congress refuses to show true leadership the US will truly never fix the system. And as long as the as the system does not get fixed Congress will not be able to address other pressing matters affecting this once great country.
As long as some people are making a buck on the medical problems of others the system will never get fixed. As long as Congress receives huge bribes in the form of political contributions from those benefiting from the current the system will never get fixed.
True problem solvers think outside of the box, they don't engage in half-hearted measures simply because of political expedience.
16
I was also struck by the lack of controlling drug prices. And, "death with dignity" laws need to expand along with more public education on palliative care. Not everyone wants to be kept alive when the mind and/or body has failed. We should have the option to end our own lives when death is near in a humane way. I have watched the medical system milk my loved ones for every possible test and "consulting physician" possible in order to gin up the bills. Now that I am the elder generation, I want more than ever to have options that allow nature to take its course without the medical system and elder care industry trying to grab my assets (and the taxpayers'). Death panels = no; Death with Dignity Options = hell yes!
A consequence of reducing employer mandates in Obamacare will be many employers not providing insurance. In addition to the obvious savings of not paying for employee insurance, there will be another competitive reason to drop health insurance coverage after both employer and individual mandates are gone. Consider two fast food firms trying to hire minimum wage workers. One employer offers the minimum wage plus some (probably meager) health insurance, that requires some partial payments from the employee. The other employer offers the minimum wage and can tell the prospective employee that since there is no health insurance the employee will not have any premium taken from their pay and that will significantly increase their take-home pay. In this way the employer not providing health insurance actually has an easier time attracting low wage workers.
Focusing attention on the insurance companies, which are simply intermediaries between the doctors and the patients, was a tragic error. It would like trying to solve a problem of high energy prices by focusing on gasoline stations. Only if the government sets prices can health care prices be controlled. Controlling prices does not automatically result in longer waiting times. Japan and Switzerland generally have shorter waiting times to see doctors than does the USA. Additionally, if prices were controlled there would be no such thing as "in-network" or "out-of-network" since all ...."
http://seekingalpha.com/article/1647632
Focusing attention on the insurance companies, which are simply intermediaries between the doctors and the patients, was a tragic error. It would like trying to solve a problem of high energy prices by focusing on gasoline stations. Only if the government sets prices can health care prices be controlled. Controlling prices does not automatically result in longer waiting times. Japan and Switzerland generally have shorter waiting times to see doctors than does the USA. Additionally, if prices were controlled there would be no such thing as "in-network" or "out-of-network" since all ...."
http://seekingalpha.com/article/1647632
6
When do you tackle the underlying costs that are healthcare instead of just trying to come up with ne ways to finance (meaning insure) those exorbitant costs?
If you do not reduce the out patient and in patient doctor and hospital fees (62% of healthcare costs), prescription drug cost (10%) and the rest, then healthcare will continue to consume our economy at the expense of the rest of the economy, which is already happening.
Putting the 5% of really sick people in a separate pool may make sense from an insurance standpoint, but I suspect there is no benefit on cost reduction of the actual healthcare provided. While this could result in more affordable insurance, greater percent insured and more dollars for healthcare providers this will also cause healthcare costs to rise.
Like college tuition, if we increase the size of Pell grants and student loans available per student we have found that college tuition increases likewise to consume those funds.
Healthcare currently consumes 18.6% and rising of our economy about 3.5 Trillion annually. In 1960, healthcare was 5%. If you want to know why we do not have enough money to rebuild our infrastructure and meet other vital public needs, we can start by looking at healthcare costs. This is why Warren Buffet calls healthcare costs the largest threat to our ability to function and compete in a global economy.
If you do not reduce the out patient and in patient doctor and hospital fees (62% of healthcare costs), prescription drug cost (10%) and the rest, then healthcare will continue to consume our economy at the expense of the rest of the economy, which is already happening.
Putting the 5% of really sick people in a separate pool may make sense from an insurance standpoint, but I suspect there is no benefit on cost reduction of the actual healthcare provided. While this could result in more affordable insurance, greater percent insured and more dollars for healthcare providers this will also cause healthcare costs to rise.
Like college tuition, if we increase the size of Pell grants and student loans available per student we have found that college tuition increases likewise to consume those funds.
Healthcare currently consumes 18.6% and rising of our economy about 3.5 Trillion annually. In 1960, healthcare was 5%. If you want to know why we do not have enough money to rebuild our infrastructure and meet other vital public needs, we can start by looking at healthcare costs. This is why Warren Buffet calls healthcare costs the largest threat to our ability to function and compete in a global economy.
6
A step in the right direction! Let's not let Perfect (unattainable in 2017-18) be the enemy of Good, or at least Adequate-for-the-moment. Let's move on from the scorched earth repeal notion, and the threats to yank funding for subsidies, etc. (Those are not making America great, btw.) I celebrate the inkling of bipartisanship consideration toward helping the individual market. Thank you.
2
Regarding employer sponsored health insurance guidelines everyone knows that the most common full time work totals today is 37,5 and not 40 hours a week. The present law defines full time work at 30 hours. Selling insurance across state lines is a favorite Republican bromide but would likely cause huge regulatory problems with substantively lowering the price of insurance.
3
Without substantively lowering the price of insurance.
3
Milliband says: "Regarding employer sponsored health insurance guidelines everyone knows that the most common full time work totals today is 37,5 and not 40 hours a week."
This jumped out at me too. And presenting it specifically as a way to "protect" employees from business manipulation shows that this whole "Fix" is a lie and a sham. A shameful sham. But what's new?
This jumped out at me too. And presenting it specifically as a way to "protect" employees from business manipulation shows that this whole "Fix" is a lie and a sham. A shameful sham. But what's new?
1
The roots of the stalemate in the house can be traced to Speaker of the House Haestert (who was also a child molester). He established the "Haestert rule". The rule said the house would not pass any legislation unless the could do it with all Republican votes. That essentially disenfranchised the Democrats who were the minority party and made bi-partisan compromise impossible.
We have been paying the price of dysfunctional government ever since (May Haestert rot in hell).
We have been paying the price of dysfunctional government ever since (May Haestert rot in hell).
7
Similar to the main problem I saw in this essay - that the so-called morass and dysfunction in D.C. is not because the two parties are butting heads and being obstinate. It's because the Republicans have been running rampant for the last 30+ years, and certainly during the Obama years. The whole country pays the price, and somehow the blame gets shifted to D.C. in general, with the Democrats sharing the blame (showing it's a great strategy). I'm hoping that the ascension of the mad-hatter in chief (a perfect Republican figure) will help to finally collapse their house of cards.
The concept of selling insurance across state lines is interesting but it is the states that prevent it. Each state wishes to have there own insurance regulators, etc. and set their own rules. Insurance companies would greatly prefer a national standard. It would reduce their costs which would enable them to reduce our costs. Unless Congress can get together and decide on national rules (the ACA tried) there will never be plans that are sold across state lines.
2
And it would allow insurance companies to act like credit card companies: they could set up shop in the state that had the fewest regulations and consumer protection requirements and sell policies all over the country that conformed to the requirements of that state.
Insurance contracts are contracts of adhesion. They contain provisions put in by the insurance companies that are designed to increase profits and decrease customer benefits. The other provisions, the ones that protect the insured, are the ones mandated by either state or federal governmental authority. If you allow the sale of insurance across state lines, you allow insurance companies to bypass state insurance regulations that prevent fraud and require insurance companies to provide policies that actually have benefits. That provision of the Problem Solver Caucus is the most dangerous of all.It takes regulating insurance companies out of the hands of state insurance commissioners and puts it into the hands of the insurance companies themselves.
Insurance contracts are contracts of adhesion. They contain provisions put in by the insurance companies that are designed to increase profits and decrease customer benefits. The other provisions, the ones that protect the insured, are the ones mandated by either state or federal governmental authority. If you allow the sale of insurance across state lines, you allow insurance companies to bypass state insurance regulations that prevent fraud and require insurance companies to provide policies that actually have benefits. That provision of the Problem Solver Caucus is the most dangerous of all.It takes regulating insurance companies out of the hands of state insurance commissioners and puts it into the hands of the insurance companies themselves.
1
Here's a national standard : Medicare For All.
1
This is a reasonable short term proposal that may get us through the next couple of years without a disaster for millions of Americans. I have been disappointed reading many of the comments that criticize this proposal because it does not go far enough. Haven't we learned that waiting until we can go all the way to single payer universal coverage (some liberals) or eliminate government from health care entirely (some conservatives) means that nothing ever gets done. The current ACA needs some changes to make it adequate for many people, and a proposal like this one will do that. It certainly beats the alternative of making Obamacare fail as the President has proposed.
3
There are three parts to this equation, and this proposal only addresses one. The parts are the consumer, the insurance companies, and the providers. The way this works is that the providers inject their fees and product prices into the system, the insurance companies then create a payment system to link the providers to the consumers, and the payment system is then used by the consumer.
The problem is twofold: 1) at the back end with the providers, who are running rampant in overpricing their fee and product sales structures; and 2) the insurance companies, who create risk pools as the way to define their premiums for coverage to the consumers, with the main objective of maintaining their profit margins.
The way to fix this is to put controls on the providers so that they don't get away with charging excessive fees and product prices (which includes prescription drugs). Then, the insurance companies need to be treated more like utilities so that they don't prioritize their profits over the good of the consumer.
It'd good to help the consumer afford the price of healthcare through subsidies. But it's better to do away with the need for subsidies by controlling costs injected into the system in the first place.
The problem is twofold: 1) at the back end with the providers, who are running rampant in overpricing their fee and product sales structures; and 2) the insurance companies, who create risk pools as the way to define their premiums for coverage to the consumers, with the main objective of maintaining their profit margins.
The way to fix this is to put controls on the providers so that they don't get away with charging excessive fees and product prices (which includes prescription drugs). Then, the insurance companies need to be treated more like utilities so that they don't prioritize their profits over the good of the consumer.
It'd good to help the consumer afford the price of healthcare through subsidies. But it's better to do away with the need for subsidies by controlling costs injected into the system in the first place.
4
Our healthcare system is too important NOT to fix. Republicans have lost my respect because they have played politics with this system for years while developing no coherent policy aimed at providing broad access to health care services and supporting and reforming our healthcare system. The "Better Care Act" Mitch McConnell proposed was a tax cut bill, not a health reform bill.
I'm begging our senators and congressmen to work together to figure out how to provide more people with dependable access to healthcare while shifting the costs of some optional services--some elective procedures, antibiotics for sinus infections, joint surgeries of negligible benefit--to individuals.
I'm begging our senators and congressmen to work together to figure out how to provide more people with dependable access to healthcare while shifting the costs of some optional services--some elective procedures, antibiotics for sinus infections, joint surgeries of negligible benefit--to individuals.
1
Should have said "supporting and reforming our health care payment system."
This bipartisan proposal is basically a very modest attempt to Trump and Republicans from destroying the ACA. For that reason alone it's welcome, although it falls far short of what America really needs.
What does this proposal do to help middle class families facing $25,000 in out of pocket health care expenses?
By all means, let's hope Republicans mean it when they say they (finally!) want to compromise. Then let's get to work and create affordable health insurance for all (i.e. single-payer).
What does this proposal do to help middle class families facing $25,000 in out of pocket health care expenses?
By all means, let's hope Republicans mean it when they say they (finally!) want to compromise. Then let's get to work and create affordable health insurance for all (i.e. single-payer).
4
Health care should be a public utility like police and fire protection, education, roads, bridges and transportation and even defense. Get the middleman(insurance) out of it completely.
10
The proposal raises more questions than it answers. Aside from the premium subsidy and the medical device tax, everything else is decidedly murky. What are "certain businesses" exactly? How does a 40-hour workweek prevent schedule manipulation? How does state reinsurance work in the context of interstate insurance markets? Why is interstate insurance a state option rather than the insurance company's prerogative? Why is there still no public option? I'm sure you could tease out the answers with a little research but they aren't clear from this document.
I won't split too many hairs with an Aug. 16th deadline. By all means, pass the thing. As mentioned, the train is moving and the bridge is out. All the same, our representatives could do a better job of acknowledging and supporting controversial points rather than talking around them.
I won't split too many hairs with an Aug. 16th deadline. By all means, pass the thing. As mentioned, the train is moving and the bridge is out. All the same, our representatives could do a better job of acknowledging and supporting controversial points rather than talking around them.
I just got back from India. On my way out, I stocked up on generic drugs for the next six months. I have excellent health insurance, but I still pay $80-$120 as a copay on basic steroid inhalers for chronic asthma. These cost $4 in India. (They are manufactured in Israel for those of you worried about the safety of generics). Its absurd that its cheaper for me to fly once in six months to India or Israel and pick up drugs, than it is to pay a copay.
The problem with healthcare is not just political, and its not all the fault of the insurance companies. Our health case system is based on whole sale robbery by the drug industry and hospitals, one aspect of which is a systematic arbitrage of drug prices. Many basic drugs (e.g. broad spectrum antibiotics, inhalers, painkillers) cost next to nothing to manufacture and go a long way in non-critical healthcare, yet all stakeholders have a vested interest in keeping prices inflated beyond any reasonable norms of profit. I'm all for market-based solutions, but it doesn't work in an oligopoly.
The problem with healthcare is not just political, and its not all the fault of the insurance companies. Our health case system is based on whole sale robbery by the drug industry and hospitals, one aspect of which is a systematic arbitrage of drug prices. Many basic drugs (e.g. broad spectrum antibiotics, inhalers, painkillers) cost next to nothing to manufacture and go a long way in non-critical healthcare, yet all stakeholders have a vested interest in keeping prices inflated beyond any reasonable norms of profit. I'm all for market-based solutions, but it doesn't work in an oligopoly.
9
This is not about fixing health care. As always, it's about fixing health insurance.
As long as for-profit insurers are in charge of my health, I will not get he care I need. Period. The time for incremental change has been squandered over seven years of bickering.
A Medicare option for everyone is the solution. And please don't call me a "purist" -- this is as real as it gets.
As long as for-profit insurers are in charge of my health, I will not get he care I need. Period. The time for incremental change has been squandered over seven years of bickering.
A Medicare option for everyone is the solution. And please don't call me a "purist" -- this is as real as it gets.
7
Two questions for Reps. Gottheimer and Reed:
1. Compared with doing nothing - maintaining the status quo - will more people or fewer people be insured if your proposal is adopted?
2. Compared with doing nothing, will insurance cost more or less if your proposal is adopted? (Apples-to-apples comparison of policies.)
1. Compared with doing nothing - maintaining the status quo - will more people or fewer people be insured if your proposal is adopted?
2. Compared with doing nothing, will insurance cost more or less if your proposal is adopted? (Apples-to-apples comparison of policies.)
5
I certainly agree with the premise of this plan: It is better to fix the current situation(s) than to insist on a comprehensive re-imagining of our country's health care system. This is especially true since the more comprehensive we try to make such legislation the less likely we are to agree.
However the plan proposed ignores some "low hanging" fruit available to reduce costs going forward such as prescription drug costs.
I think any short-term plan should include at least some effort to reduce costs and a mechanism which "forces" our legislators to address the broader issues of health care which makes up fully one-sixth of our economy. We need a long term properly researched and sustainable solution. We have learned a lot from our first pass and examples of working systems abound both domestically,(Cleveland Clinic), and Internationally.
Developing a health care system which is truly World-class is within our reach. We just need the will to proceed which I perceive to be nascent in the aftermath of the Trump Care debacle.
Enacting some short-term fixes would be good practice for developing a lasting health care system we can have justifiable pride in.
However the plan proposed ignores some "low hanging" fruit available to reduce costs going forward such as prescription drug costs.
I think any short-term plan should include at least some effort to reduce costs and a mechanism which "forces" our legislators to address the broader issues of health care which makes up fully one-sixth of our economy. We need a long term properly researched and sustainable solution. We have learned a lot from our first pass and examples of working systems abound both domestically,(Cleveland Clinic), and Internationally.
Developing a health care system which is truly World-class is within our reach. We just need the will to proceed which I perceive to be nascent in the aftermath of the Trump Care debacle.
Enacting some short-term fixes would be good practice for developing a lasting health care system we can have justifiable pride in.
1
The nondiscriminatory universal healthcare system though ideal yet not possible under the charged political environment. As such if the Congressional caucus working on bipartisan understanding to offer a short term solution of fixing the ACA rather allowing it to be dumped by seeking changes like making the individual insurance affordable and help stabilise such insurance marketplace, the initiative deserves full support.
1
Please research the constitutional convention outlines. in West Virginia, the governor announced his flip. Trump now has 39 governors. This affects the constitution. Please read the details. Trump doesn't care about the health system, education, infrastructure, the wall, anything. We know this. But read about the constitution convention requirements and details.
1
I, too, thank the congressmen for the proposal. But, as such, it's still part of the problem because it doesn't recognize the problem, call it what it is, and therefore, can't hope to end it. The model the health-care industrial complex has been operating with the last 70+ years can no longer function without annual funding increase of over $100 billion. Obviously, this is unsustainable. This is why we the people are screaming for politicians to stop this madness.
Perhaps congress needs to first address where they can make up the lost donor revenue the health industry bestows on the 535 members each year. That would be the first step. Then, create the exit strategy for dismantling the insurance industry (over 25 years, so the CEO's can get retrained ). Then phase in ( 7-10 year increments) a similar model for big pharma, etc. it'll be revolutionary and that's the idea.
Perhaps congress needs to first address where they can make up the lost donor revenue the health industry bestows on the 535 members each year. That would be the first step. Then, create the exit strategy for dismantling the insurance industry (over 25 years, so the CEO's can get retrained ). Then phase in ( 7-10 year increments) a similar model for big pharma, etc. it'll be revolutionary and that's the idea.
1
Working together is great, but this proposal is no more than bureaucratic Band-Aid. It does not address some of the fundamental failures of the US health system, such as:
1- The fleecing of US patients, employers, and insurance companies by international pharmaceutical companies who charge 10 times the cost of a drug in the US relative to prices overseas.
2- The tremendous cost of paper work. A doctor may need as many as 10 staffers to do paper work, billing, scheduling, and of course medical support.
3- Unrealistic predatory pricing by doctors and hospitals to any one without a negotiated insurance rate. How can it be legal for a doctor to bill $970 to a poor uninsured patient, but they would accept $80 from an insurance company + $40 co-pay as full payment?
4- Restricting supply of doctors by medical associations to keep price of service up
5- Ridiculous professional insurance costs rising to 50% of earning in some states/specialties due to out of control legal costs.
You cannot cure the symptoms without eradicating the underlying maladies.
1- The fleecing of US patients, employers, and insurance companies by international pharmaceutical companies who charge 10 times the cost of a drug in the US relative to prices overseas.
2- The tremendous cost of paper work. A doctor may need as many as 10 staffers to do paper work, billing, scheduling, and of course medical support.
3- Unrealistic predatory pricing by doctors and hospitals to any one without a negotiated insurance rate. How can it be legal for a doctor to bill $970 to a poor uninsured patient, but they would accept $80 from an insurance company + $40 co-pay as full payment?
4- Restricting supply of doctors by medical associations to keep price of service up
5- Ridiculous professional insurance costs rising to 50% of earning in some states/specialties due to out of control legal costs.
You cannot cure the symptoms without eradicating the underlying maladies.
11
" The fleecing of US patients, employers, and insurance companies by international pharmaceutical companies who charge 10 times the cost of a drug in the US relative to prices overseas."
The U.S. pharmaceutical are gigantic fleecers as well. Do you remember not so long ago, when busloads of elderly and sick patients were crossing into Canada. Medications were less expensive here in Canada, than in the USA.
What happened. Big Pharma caught wind of this, and with their lobbyists put an end to this cross-border plan!!!!
The U.S. pharmaceutical are gigantic fleecers as well. Do you remember not so long ago, when busloads of elderly and sick patients were crossing into Canada. Medications were less expensive here in Canada, than in the USA.
What happened. Big Pharma caught wind of this, and with their lobbyists put an end to this cross-border plan!!!!
Great! Now folks working for Walmart can work up to 39 hours without getting company-paid health insurance! Yay!
Okay - here's a way to force companies to pay without too much pain - have the companies pay into the FICA account of each employee the cost of providing a "bronze" plan, prorated for the amount of hours the employee works. Require, for contract workers, that the same is paid upfront as part of the contract costs.
Any excess monies (say for young workers covered by their parents) could be accumulated for future medical needs or transferred to a retirement account.
If the worker bee wants to upgrade to a "silver" plan, then they would pay the difference.
Using FICA has other advantages for the worker - the money is tax-free, the worker can work multiple jobs, and the "bite" of paying for health insurance (after taxes) would be gone - just direct the money to a provider automatically.
Okay - here's a way to force companies to pay without too much pain - have the companies pay into the FICA account of each employee the cost of providing a "bronze" plan, prorated for the amount of hours the employee works. Require, for contract workers, that the same is paid upfront as part of the contract costs.
Any excess monies (say for young workers covered by their parents) could be accumulated for future medical needs or transferred to a retirement account.
If the worker bee wants to upgrade to a "silver" plan, then they would pay the difference.
Using FICA has other advantages for the worker - the money is tax-free, the worker can work multiple jobs, and the "bite" of paying for health insurance (after taxes) would be gone - just direct the money to a provider automatically.
5
Make a constitutional amendment, let us vote on healthcare.
Majority rules, you know, like in a democracy.
Majority rules, you know, like in a democracy.
5
We don't have a democracy; we have a representative form of government.
Political Science 101. Take it.
Political Science 101. Take it.
1
Majority would vote for single payer.
1
When most affordable policies these days are strictly "in network," how are people from, say, Texas, supposed to benefit from a policy issued in New Hampshire, if the only network of physicians is located in New Hampshire? Our current "in network" policy already strictly limits our ability to see the doctors we want to see, or to find specialists. The only out-of-state coverage offered is solely for emergencies. How are insurance companies going to deal with the "in network" problem if they are selling policies across state lines?
Also, how does defining a full-time work week as forty hours prevent employers from manipulating their employees' hours to skirt the requirement that full-time employees be covered? What prevents an employer from simply scheduling every employee to work thirty-nine hours per week, thus allowing them to get around the insurance requirement? There are already plenty of companies that deliberately keep employees under-employed at 35 hours per week, precisely so they won't have to provide insurance. Separating health insurance from employment would go a long way toward solving these employer-related problems, help to cover part-time workers, freelancers, and independent contractors, and cut down on the need to regulate businesses. Aren't Repubs always championing fewer regulations?
Single-payer would solve all of these problems and more.
Also, how does defining a full-time work week as forty hours prevent employers from manipulating their employees' hours to skirt the requirement that full-time employees be covered? What prevents an employer from simply scheduling every employee to work thirty-nine hours per week, thus allowing them to get around the insurance requirement? There are already plenty of companies that deliberately keep employees under-employed at 35 hours per week, precisely so they won't have to provide insurance. Separating health insurance from employment would go a long way toward solving these employer-related problems, help to cover part-time workers, freelancers, and independent contractors, and cut down on the need to regulate businesses. Aren't Repubs always championing fewer regulations?
Single-payer would solve all of these problems and more.
6
How about this for starters: Make Medicare available to everyone from 0-7 years old for little to no buy in cost and lower Medicare start age to 55 with a buy in premium. Then, every year lower the Medicare eligibility age by one year and raise the child eligibility age by 2 years. When they finally meet in the middle there will be insurance for all.
2
The question Republicans should ask themselves is why do countries like Denmark, Germany, Sweden, Australia, Japan, etc. all have universal healthcare at about 60% of the cost the US pays.
9
The ACA has proven to be a successful prototype dealing with national healthcare. Every complex prototype presents opportunities for improvement. The ACA is not perfect, but considering its size and complexity, it is a marvelous first step. Starting over from scratch would set the process back years. Repealing the ACA is nothing more than an attempt to remove Obama’s name from this extraordinary achievement. A bipartisan approach to fixing the ACA could be help heal the toxic political rift in Congress.
5
For those of you with Employer coverage, you are probably fairly happy with Obamacare. I disagree that the ACA has been successful, and there are millions of people like me. I own a small business and have have to get insurance in the individual market. My premiums went from $137 to $296 from 2013 to 2016 and my deductible went from $2,500 to $6,500. As a single dad who pays child support and expenses for my kids, this became unaffordable - and I just think it is a ripoff. $300 a month for a catastrophic plan. I voted for Obama twice, but the ACA has not been successful. It is crony capitalism for the health insurance industry. There were never adequate cost controls put in place or requirements for price transparency. We don't need to keep tinkering with a system that is totally broken, we need to replace it altogether. We spend about $4,000 more for healthcare in this country for every man, woman and child vs. every other industrialized country and yet we don't cover everyone and we don't have the best outcomes. Please take time to research it.
Wrong Title. These are not proposals to Fix Healthcare, but a bandaid for Health Insurance.
7
To all of those chanting "single payer" like automatons: Those of us with good employer provided coverage, half the country, do not want to give it up for a system that inevitably will be worse for us. We will fight you. I will fight you. Your best bet is to patch this horrific Obamacare mess as these congressmen are proposing,
4
And why would it be "inevitably worse" for "us"? What evidence do you have?
Whether you call it "single payer" (which can be misleading) or national universal health insurance (which I prefer), the evidence provided by the experiences of other countries -- and there are a number of variations -- is enormously compelling. How foolish to simply dismiss or ignore them. I also reject your attempt to tar the current situation as "this Obamacare mess. The problems with the health insurance system in this country go far, far deeper than the ACA, which, by the way, has been relatively successful despite Republicans' continual efforts to sabotage it at every turn.
Whether you call it "single payer" (which can be misleading) or national universal health insurance (which I prefer), the evidence provided by the experiences of other countries -- and there are a number of variations -- is enormously compelling. How foolish to simply dismiss or ignore them. I also reject your attempt to tar the current situation as "this Obamacare mess. The problems with the health insurance system in this country go far, far deeper than the ACA, which, by the way, has been relatively successful despite Republicans' continual efforts to sabotage it at every turn.
We spend $4,000 more for healthcare for every man, woman and child in this country vs. every other modern industrialized country. Why do so many Americans accept a system that is so clearly a ripoff. There are many models to get to Universal coverage like the what the Swiss or New Zealand have done. The current system is going to bankrupt the country. I'd urge you to do more research on healthcare costs and outcomes around the world. The system we got is just a horrible one, even for those with Employer sponsored insurance.
Good for you. You got yours. That's all that is important, to you. Perhaps you could put all o the energy you put into your obstructionist mentality ago better use, that of creating a national health system that costs far less than the current one and which covers everyone for everything. In countries that have national health care, they still have private insurance. The money your employer saves could be used to reward employees with a supplemental private plan, for the "best and the brightest", a category into which no doubt you clearly feel you fit, given that you think you are more deserving of your fellow Americans.
Two thoughts. First, where are Trump and HEW Sec. Tom Price in working on solving the problem of health care in America? Sec. Price has said he won't let the ACA "implode"--Trump's favorite word when talking about Obamacare. But he needs to support a serious bipartisan solution.
Second, I do not know how the two parties can come to agreement on health care until they agree that basic health care is a fundamental right for all Americans. The proposal by these "problem-solving" members of Congress reflects a tacit agreement on this issue but falls far short of endorsing the right to health care.
Second, I do not know how the two parties can come to agreement on health care until they agree that basic health care is a fundamental right for all Americans. The proposal by these "problem-solving" members of Congress reflects a tacit agreement on this issue but falls far short of endorsing the right to health care.
4
You do not have a right to the education of others.
Do you have a right food? Do you have a right to shelter?
Do you have a right food? Do you have a right to shelter?
In the end, we are still shackled by an employer provided system and a for profit middle man. The compromise is the equivalent of packaging tainted food in smaller quantities so it takes longer to kill you.
3
Simple fix: SINGLE PAYER. Works in other countries...little bickering. If you have the money and want more, go wherever in the world you want for your Cadillac care. But we have a nation made up of many people who aren't rich, and they need to be alive and healthy as well. For those who are more focused on the economy, a healthy workforce is the key.
7
Why not throw in a line or two about meeting every two years to iron out any wrinkles that come to light? I mean, instead of saying, "There, problem solved," pushing it through Congress, and letting it sink or swim, while demagogues and sycophants use it for political advantage and you spin it this way and that. Call it ACA Flex.
Again this is ridiculous especially while the great majority in the United States want universal Medicare and Medicaid. Why do the authors want it to remain a profitable business instead of an American right? This would be the only way to morally "fix" health care as so many more enlightened countries have recognized.
7
Hurray! So in addition to reviving Saturday Night Live, the New York Times, and Town Hall attendance, Trump can also be credited for a new bipartisanship by the admirable Gottheimer and Reed! (Well, a REACTION to Trump can be credited for this, but let's not bicker about terminology.)
1
Look at the CEOO, etc pay at insurance companies, at the drug companies. Why should there be profit in health insurance? SINGLE PAYER is the only way to go.
3
"If Washington does not act to stabilize the insurance exchanges, many families we represent will lose coverage or be hit with premiums they can’t afford. This isn’t conjecture." That is absolutely true and it's heartening to see Republicans and Democrats working together for the benefit of all Americans. In this era of hyper politics Gottheimer and Reed know what it takes to serve in the House of Representatives. It's not about the party. It's about the country.
2
I can't help but be discouraged by a proposed solution that contains language like this: "people earning less than 250 percent of the poverty line." What does that even mean?
Incrementalism will NEVER provide coverage to all Americans. No system that fails to cover all Americans is acceptable, let alone moral.
Universal healthcare. It is the ONLY acceptable option, whatever the 'sensible centrists' might tell you.
Also, sick people are not 'consumers', like these two wealthy, powerful men have suggested.
Thank god for the NHS.
Universal healthcare. It is the ONLY acceptable option, whatever the 'sensible centrists' might tell you.
Also, sick people are not 'consumers', like these two wealthy, powerful men have suggested.
Thank god for the NHS.
6
One reason "health care" won't get "fixed"? You all keep talking only about health INSURANCE. This is only a small part of the big picture and is not the root of the problem. It's akin to complaining about the cost of war without asking why we're invading and bombing in the first place.
Morbidity and mortality statistics vary widely across this country, even across counties and within cities. Why is that? Until you are ready to address this sort of question, our health care problems will remain. But few in Congress are ready to address the real issues of health, because the questions and answers are so profound as to make health insurance seem like remedial arithmetic.
Finally, one of the great criticisms of "Hillarycare" oh so many years ago was that she and her allies crafted their plans without meaningful input from any doctors or other health care professionals. This most recent try by the Republicans (and even the gist of this above-noted bipartisan effort) doesn't seem much different. We have a nation full of highly educated physicians, public health experts, health economists, social workers, sociologists, educators and more. Many have direct experience with what ails us and/or have spent years researching solutions. Much of this work is paid for with public money. USE THEM. Substituting the vague blathering of a bunch of dilettante, charlatan congressman for actual expertise is a great disservice to the public.
Morbidity and mortality statistics vary widely across this country, even across counties and within cities. Why is that? Until you are ready to address this sort of question, our health care problems will remain. But few in Congress are ready to address the real issues of health, because the questions and answers are so profound as to make health insurance seem like remedial arithmetic.
Finally, one of the great criticisms of "Hillarycare" oh so many years ago was that she and her allies crafted their plans without meaningful input from any doctors or other health care professionals. This most recent try by the Republicans (and even the gist of this above-noted bipartisan effort) doesn't seem much different. We have a nation full of highly educated physicians, public health experts, health economists, social workers, sociologists, educators and more. Many have direct experience with what ails us and/or have spent years researching solutions. Much of this work is paid for with public money. USE THEM. Substituting the vague blathering of a bunch of dilettante, charlatan congressman for actual expertise is a great disservice to the public.
4
Define "flexibility." Does this include the obsession some Republican lawmakers have with making women's healthcare optional (and hence unaffordable) because they don't make use of it?
1
Until congress takes the first step to start bidding on the trillion $ drug give away, they are not serious about health care.
3
Sounds like we should think about keeping the 43-member House Problem Solvers Caucus and letting the remainder of congress go on a 12 month August recess.
3
It's great to see that you are acting like grown ups again. Maybe this will help the country move forward. Compromise is always the best way forward. We make unconscious compromises each day
1
The Very Serious People are speaking, so we must listen. And even ignore all the evidence.
Excuse me for being so blunt, but what rot.
In a democracy the representatives of the people supposedly decide where to allocate the taxes that the citizens pay.
In this case, we are given a head over heels explanation about the elements of American health care that need changing. Incredibly, the fixes ignore the most obvious, simple, efficient, and most effective choice there is. Every other single western civilized country uses this system. To not employ Universal Health Care is to ignore the longstanding evidence. For all to see. In broad daylight.
So, we want to spend our taxes on the military so they can go kill people on our behalf. Or, we want to redeploy a small amount of the Pentagon's budget on making the country healthy. They'll be less unnecessarily dead Americans both here at home and also abroad. Sounds like a win win to me.
The choice couldn't be simpler. The medicare system works well and the bureaucracy is already in place.
Any other supported option must obscure the facts as we know them so as to not be laughed out of the room.
And so why do the Very Serious People obscure the facts? Because they're pretty sure their constituents won't take to the streets if they do.
Why is that? Propaganda is a very powerful tool. Used effectively, as it has been, it can convince 300+ million people they can't afford Universal Health Care.
Wow!
Excuse me for being so blunt, but what rot.
In a democracy the representatives of the people supposedly decide where to allocate the taxes that the citizens pay.
In this case, we are given a head over heels explanation about the elements of American health care that need changing. Incredibly, the fixes ignore the most obvious, simple, efficient, and most effective choice there is. Every other single western civilized country uses this system. To not employ Universal Health Care is to ignore the longstanding evidence. For all to see. In broad daylight.
So, we want to spend our taxes on the military so they can go kill people on our behalf. Or, we want to redeploy a small amount of the Pentagon's budget on making the country healthy. They'll be less unnecessarily dead Americans both here at home and also abroad. Sounds like a win win to me.
The choice couldn't be simpler. The medicare system works well and the bureaucracy is already in place.
Any other supported option must obscure the facts as we know them so as to not be laughed out of the room.
And so why do the Very Serious People obscure the facts? Because they're pretty sure their constituents won't take to the streets if they do.
Why is that? Propaganda is a very powerful tool. Used effectively, as it has been, it can convince 300+ million people they can't afford Universal Health Care.
Wow!
4
I really do not care about the particulars of the bill but am pleased that the bill appears to be truly bipartisan and is moving the debate forward.
The stubborn, hidebound, doctrinaire "my way or the highway" attitude of Trump and the Republicans is certainly not democracy. It hearkens more to the authoritarian and despotic governance of Putin in Russia and is not fit for
true American values. Just as Trump is not fit to be President.
The stubborn, hidebound, doctrinaire "my way or the highway" attitude of Trump and the Republicans is certainly not democracy. It hearkens more to the authoritarian and despotic governance of Putin in Russia and is not fit for
true American values. Just as Trump is not fit to be President.
Having Democrats and Republicans start working together on ANYTHING seems a good thing. That said, a single payer system seems the best approach to getting all this under control. Do it, get it over with and let's move on to other issues the country needs fixed. It would be nice to see Washington governing again and really making America not Great, but America again!
1
For people who are very sick, health care policy is life or death. For the society as a whole, it's less clear. The Cubans spend pennies compared to the dollars we spend on health care, yet have the same life expectancy. Other factors seem to weigh more heavily, perhaps what we eat and how much we eat among others.
For more than 25 years, rampant partisanship has brought our Congress to a state of "us v. them" versus them tribalism and institutional gridlock. With this effort by the Problem Solvers Caucus, there is some hope that the pendulum is is swinging back toward sane, responsible governing. Thank you, Reps. Gottheimer and Reed. May your bipartisan efforts remain squarely focused on the need to solve the problems with health care, and may you pave the way for more clear-headed compromise and (much) less empty partisan sound-biting on other important issues Congress should address as well. May it be so.
The first thing Republicans need to do is apologize to the American people for their behavior over the last 7 years. they need to apologize for their lying, their obstinacy, and their obstructionism that has gotten us into this place.
every one of the Republicans in the house voted dozens of times in lockstep to repeal the ACA Obamacare - never once did they propose or try to fix it.
Trump is a problem the GOP created - they must now deal with him - but please remember that Trump was the one who introduced the concept of Repeal and Replace with something much better. Without Trump - the GOP would have simply continued to march down the path of full repeal - without replacement. GOP - remember this please.
every one of the Republicans in the house voted dozens of times in lockstep to repeal the ACA Obamacare - never once did they propose or try to fix it.
Trump is a problem the GOP created - they must now deal with him - but please remember that Trump was the one who introduced the concept of Repeal and Replace with something much better. Without Trump - the GOP would have simply continued to march down the path of full repeal - without replacement. GOP - remember this please.
High time for Democrats and Republicans to start speaking to each other. What a novel idea to craft legislation with bipartisan input.
Wonderful to have a Problem Solvers Caucus. Now let's solve some problems:
1) making the CSR permanent is a good idea to protect it from becoming a perpetual political football.
2) It is well known that 1% of the population uses 20% of the healthcare dollar and that 20% consume 50%. The Republican answer is to segregate that population with a special funding stream (catastrophic fund, etc.) That is a terrible idea. The only viable solution is for everyone to be in the same lifeboat, with the (temporarily) healthy funding the currently ill. The healthy guy who only wants to have skinny coverage may soon find out how expensive motorcycle accidents and testicular cancer can become
3) why presume that putting 40 hours as full time work will prevent employers from gaming the system?
4) with the individual and corporate mandate off the table for Republicans, how will getting rid of the medical tax device sustain an already under-funded program?
C+ for effort
Wonderful to have a Problem Solvers Caucus. Now let's solve some problems:
1) making the CSR permanent is a good idea to protect it from becoming a perpetual political football.
2) It is well known that 1% of the population uses 20% of the healthcare dollar and that 20% consume 50%. The Republican answer is to segregate that population with a special funding stream (catastrophic fund, etc.) That is a terrible idea. The only viable solution is for everyone to be in the same lifeboat, with the (temporarily) healthy funding the currently ill. The healthy guy who only wants to have skinny coverage may soon find out how expensive motorcycle accidents and testicular cancer can become
3) why presume that putting 40 hours as full time work will prevent employers from gaming the system?
4) with the individual and corporate mandate off the table for Republicans, how will getting rid of the medical tax device sustain an already under-funded program?
C+ for effort
1
When will you folks quit dancing around the real issues, which are: 1. what benefits will be universal?; and 2. how will the money be collected to pay for them.
1
This proposal from the ridiculously named Problem Solvers Caucus is as lame as the name of the caucus.
All it shows is how irrelevant and useless the Democrats have become.
Let's not forget that it was Republicans, via their premiere think tank The Heritage Foundation who came up with the idea of the ACA in the first place (it is basically Romneycare, which is itself a direct descendant of John Chafee's 1993 HEART bill, which in turn derived from a 1989 Heritage Foundation publication (primarily authored by Stuart Butler)).
Obamacare isn't an accomplishment, it's a capitulation to right-wing corporatists by Democratic corporatists.
The only way forward is Single Payer and that's exactly what the American public wants according to all the polls.
Unfortunately the Democrats are too beholden to their donors to do what the electorate wants and are therefore trying to 'improve Obamacare', nothing but putting lipstick on a pig and kicking the can down the road.
The 'leadership' of the Democratic Party, including the new darling of of the donor class and presumed frontrunner to challenge Trump in 2020, Kamala Harris, have already taken Single Payer off the table.
Pathetic.
It's looking more and more like Trump 2020, not because of Trump's circus show but because of the abysmal failure of establishment Democrats to fight for Average Jane/Joe.
A collection of empty platitudes like "A Better Deal" is not gonna cut it, nor is their insistence on a continuation of illegal immigration.
All it shows is how irrelevant and useless the Democrats have become.
Let's not forget that it was Republicans, via their premiere think tank The Heritage Foundation who came up with the idea of the ACA in the first place (it is basically Romneycare, which is itself a direct descendant of John Chafee's 1993 HEART bill, which in turn derived from a 1989 Heritage Foundation publication (primarily authored by Stuart Butler)).
Obamacare isn't an accomplishment, it's a capitulation to right-wing corporatists by Democratic corporatists.
The only way forward is Single Payer and that's exactly what the American public wants according to all the polls.
Unfortunately the Democrats are too beholden to their donors to do what the electorate wants and are therefore trying to 'improve Obamacare', nothing but putting lipstick on a pig and kicking the can down the road.
The 'leadership' of the Democratic Party, including the new darling of of the donor class and presumed frontrunner to challenge Trump in 2020, Kamala Harris, have already taken Single Payer off the table.
Pathetic.
It's looking more and more like Trump 2020, not because of Trump's circus show but because of the abysmal failure of establishment Democrats to fight for Average Jane/Joe.
A collection of empty platitudes like "A Better Deal" is not gonna cut it, nor is their insistence on a continuation of illegal immigration.
1
A good place to start would be bringing down drug costs - remember Mylan's price hike for essential epi-pens and the CEO 19 million dollar bonus? The issues (and the money) run deep in healthcare...
Unless Congress fixes the ridiculous regulatory burden imposed by ObamaCare on physicians, and fixes the gross underpayment by government payers (Mcare and Mcaid), physicians will continue to either leave medicine (worsening the doctor shortage) or continue to drop out of Medicare and Medicaid. Either way, patient care will continue to suffer. Its not just all about insurance companies.
1
Gentlemen, you are to be commended for at least trying to move this blockage from the American digestive tract. Yes, the hard edges of identity politics must be softened if this thing is to move to a place where health care actually works for most people.
But can you imagine your Speaker, Paul Ryan, suddenly coming to his senses and having the courage to begin serious deliberations about making the ACA a lasting benefit for American citizens? And perhaps "benefit" is a poor choice of words for, as your Mr. Speaker is all to clear about, American's don't require "benefits;" what they need, in his mind (as well as in his serial public declarations) is to work harder, to save their money for the vouchers that would go towards privatizing the system even further. He's all about profits for Big Med, Big Pharma, Big Insurance. Their donors contribute to his campaigns to keep him in office. The same applies to Senate Leader Mitch McConnell in the. Senate. They both want to keep this issue politicized; they want Americans both angry and anxious about healthcare and it's why they keep it front and center, on the eternal boil. And the grossly-incompetent President Donald Trump cheers for the law's defeat on the sidelines, never taking the slightest interest in policy; he simply is desperate for any victory.
Your 51-51/75 has great merit. But won't the Tea Party and the Freedom Caucus work tirelessly to scuttle your ideas because they might work?
And because they fear Trump's base?
But can you imagine your Speaker, Paul Ryan, suddenly coming to his senses and having the courage to begin serious deliberations about making the ACA a lasting benefit for American citizens? And perhaps "benefit" is a poor choice of words for, as your Mr. Speaker is all to clear about, American's don't require "benefits;" what they need, in his mind (as well as in his serial public declarations) is to work harder, to save their money for the vouchers that would go towards privatizing the system even further. He's all about profits for Big Med, Big Pharma, Big Insurance. Their donors contribute to his campaigns to keep him in office. The same applies to Senate Leader Mitch McConnell in the. Senate. They both want to keep this issue politicized; they want Americans both angry and anxious about healthcare and it's why they keep it front and center, on the eternal boil. And the grossly-incompetent President Donald Trump cheers for the law's defeat on the sidelines, never taking the slightest interest in policy; he simply is desperate for any victory.
Your 51-51/75 has great merit. But won't the Tea Party and the Freedom Caucus work tirelessly to scuttle your ideas because they might work?
And because they fear Trump's base?
@Sox
Your IBS reference has indeed clogged up the health care debate. However, no amount of stool softener will allow passage of this Republican party blockage. Obamacare isn't perfect but the relief afforded to all Americans will be welcome, regardless of how the ACA is called.
Your IBS reference has indeed clogged up the health care debate. However, no amount of stool softener will allow passage of this Republican party blockage. Obamacare isn't perfect but the relief afforded to all Americans will be welcome, regardless of how the ACA is called.
Simply put, thank you for this injection of sanity into the healthcare debate.
I am still naive enough to believe that, as was the case in drafting our Constitution itself, the ability to compromise is a core value of our democracy.
I am still naive enough to believe that, as was the case in drafting our Constitution itself, the ability to compromise is a core value of our democracy.
In the first dozen or so comments I've read here, no one has bothered to thank Gottheimer and Reed for their work. I do thank you for your effort gentlemen . What you've proposed obviously won't please anyone completely. There are provisions that I don't like and some, like selling policies across state lines, probably won't be effective in lowering costs. But it is a start and represents how government should solve problems: cooperation and compromise. I just hope that if this or a similar proposal gains enough traction to be approved by the house and senate , that our spiteful president will not veto it. After all he promised to repeal Obamacare, and he must please his base.
More window dressing. We will never get cost under control without fundamental change.
First, we need to limit the amount of money individuals can receive from a malpractice award. We also need to hold plaintiffs accountable for the cost of defending a frivolous law suit.
Second, if we all agree that health care is a right, we need to regulate the return on equity of insurance companies that provide health insurance. They should be treated the same way as power companies, and need to get regulatory approval before raising rates.
Next, we need to limit the amount doctors can charge for services.
Finally, we must allow insurance companies to sell across state lines.
Just throwing money at the problem while allowing ambulance chasers to drive up costs and insurance companies to pad their bottom lines on the back of sick people wont work.
First, we need to limit the amount of money individuals can receive from a malpractice award. We also need to hold plaintiffs accountable for the cost of defending a frivolous law suit.
Second, if we all agree that health care is a right, we need to regulate the return on equity of insurance companies that provide health insurance. They should be treated the same way as power companies, and need to get regulatory approval before raising rates.
Next, we need to limit the amount doctors can charge for services.
Finally, we must allow insurance companies to sell across state lines.
Just throwing money at the problem while allowing ambulance chasers to drive up costs and insurance companies to pad their bottom lines on the back of sick people wont work.
While I applaud the efforts of the House Problem Solvers Caucus, we have to deal with the reality that most members of the House are not problem solvers, that the Senate is arguably even worse, and that we have a president who is a problem creator not a problem solver. So these folks have a real uphill climb. Good luck, guys, but don't quit your day jobs!
Given it's bipartisan nature, this proposal is a clear example of how out of touch with the world and their own constituents both major parties are. They just don't seem to get it. We don't want to any of this complex 'take this and give that' type of deals. We want universal health care.
1. Eliminate insurance companies
2. Drive costs down by closing all loopholes for all players including medical professionals, pharma and medical equipment manufacturers
3. Institute a healthcare tax similar to income tax which pays in it's entirety for health of the nation.
Once you eliminate insurance, you will take away premiums, deductibles, coinsurance and all these fancy offerings which are nothing but disguised methods to milk more out of patients. Why are we allowing this disgusting practice?
1. Eliminate insurance companies
2. Drive costs down by closing all loopholes for all players including medical professionals, pharma and medical equipment manufacturers
3. Institute a healthcare tax similar to income tax which pays in it's entirety for health of the nation.
Once you eliminate insurance, you will take away premiums, deductibles, coinsurance and all these fancy offerings which are nothing but disguised methods to milk more out of patients. Why are we allowing this disgusting practice?
1
Because those with money and good jobs do not want to pay for those who do not have these things. We want you to have skin in the game.
The only way to fix this mess that the Dems have created is to repeal Obamacare and get the Feds out of our healthcare. We already have Medicaid and the VA, so we already have government-run healthcare for our vets, and a welfare program for our poor.
Freee market capitalism, not crony-capitalism, is he only answer. Open up the healthcare insurance company markets, let people buy the product that suits their individual needs. That is the only answer.
Freee market capitalism, not crony-capitalism, is he only answer. Open up the healthcare insurance company markets, let people buy the product that suits their individual needs. That is the only answer.
1
Agreed
"We aim to solve an immediate problem and move past a seven-year stalemate in Washington that has featured Republicans trying to repeal the current health care law, Democrats trying to preserve it and neither side willing to discuss anything in between.
That approach has led us to our current moment, in which no one is happy with the status quo (...)."
Democrats have been offering ideas to improve Obamacare from the very beginning (adding the public option that Independent Lieberman destroyed but that was part of the bill the House under Pelosi passed has always been among those suggested improvements).
The ONLY thing that has caused a seven-year stalemate is obviously the fact that Republicans feared that if they wouldn't invest millions in lies about the ACA and make their base believe that this was "Armageddon" and HAD to be ENTIRELY repealed, then they might end up being an opposition party for quite some time.
Of course a "Problem Solving Caucus" is a good idea and this healthcare initiative should be applauded. But in real life, it only means one thing: after eight years of obstructionism, twenty Republican congressmen now finally accept to start doing their job again.
I'm sorry, but this is too little too late. You can't hurt the American people for seven years and lie until you control DC entirely, and only then start taking some responsibility. Democrats never do this, so it's ONLY the GOP approach to losing elections that is so immoral and despicable ... !
That approach has led us to our current moment, in which no one is happy with the status quo (...)."
Democrats have been offering ideas to improve Obamacare from the very beginning (adding the public option that Independent Lieberman destroyed but that was part of the bill the House under Pelosi passed has always been among those suggested improvements).
The ONLY thing that has caused a seven-year stalemate is obviously the fact that Republicans feared that if they wouldn't invest millions in lies about the ACA and make their base believe that this was "Armageddon" and HAD to be ENTIRELY repealed, then they might end up being an opposition party for quite some time.
Of course a "Problem Solving Caucus" is a good idea and this healthcare initiative should be applauded. But in real life, it only means one thing: after eight years of obstructionism, twenty Republican congressmen now finally accept to start doing their job again.
I'm sorry, but this is too little too late. You can't hurt the American people for seven years and lie until you control DC entirely, and only then start taking some responsibility. Democrats never do this, so it's ONLY the GOP approach to losing elections that is so immoral and despicable ... !
The solution to the bickering starts with overturning Citizens United which allows the Koch brothers to buy the loyalty of Republican congressmen (or threaten/coerce/extort those Republican congressmen who don't go along with them by threatening to withhold their obscene bribes.
Freeing the system of vast sums of payola would allow legislators to do the right thing instead of having to take the Grover Norquist loyalty pledge and adhere to crackpot oligarchs and rightwing evangelical ideology.
The right thing is Medicare for all. Eliminate health insurance companies and their profiteering, control the costs of pharmaceuticals and the cost of health care will come down to the levels other developed countries experience, which is to say less than half the costs of funding the health care extortion business in the US.
Freeing the system of vast sums of payola would allow legislators to do the right thing instead of having to take the Grover Norquist loyalty pledge and adhere to crackpot oligarchs and rightwing evangelical ideology.
The right thing is Medicare for all. Eliminate health insurance companies and their profiteering, control the costs of pharmaceuticals and the cost of health care will come down to the levels other developed countries experience, which is to say less than half the costs of funding the health care extortion business in the US.
Once again...........
What this and every other argument we keep hearing/reading about is NOT about health care costs.....We keep talking about INSURANCE COSTS. There is a big difference between the two.
If the powers to be were serious, they would be breaking up the major monopolies called "hospital networks" who basically set the prices on all elements of health care. Just one little item points out the problem. Ask yourselves, why is it the hospitals can get away with charging the government $5.50 for a BABY ASPIRIN? God forbid we look at something more complicated.
If we were serious about health care cost, look at the problem. Insurance is there to also make money off this legal scam run by the AMA.
What this and every other argument we keep hearing/reading about is NOT about health care costs.....We keep talking about INSURANCE COSTS. There is a big difference between the two.
If the powers to be were serious, they would be breaking up the major monopolies called "hospital networks" who basically set the prices on all elements of health care. Just one little item points out the problem. Ask yourselves, why is it the hospitals can get away with charging the government $5.50 for a BABY ASPIRIN? God forbid we look at something more complicated.
If we were serious about health care cost, look at the problem. Insurance is there to also make money off this legal scam run by the AMA.
Evidently, since the tag Obamacare is not used in this opinion piece, that intended pejorative for the program will also be quietly jettisoned?
As much as I would also like to reset America's health coverage (thebantameconomist.wordpress.com/2017/03/28/deadonarrival/), I believe this proposal will go far in stabilizing the individual marketplace. The uncertainty around the CSRs is probably doing the most harm. Shame on President Trump for his "I will make the ACA fails" attitude. He can take his personal vendetta for "anything Obama" and shove it. It's the Americans that are outside the mainstreams of employer-provided health coverage and Medicare / Medicaid that are most vulnerable should the marketplace actually fail. Most everyone else is comfy with their current coverage..
I'm not bright enough to grasp the difference between this scheme -- which removes the medical-devices excise tax, allows insurance to be sold across state lines, gets rid of the employer mandate, and throws people off health insurance -- and the scams that decent people rejected in the House and Senate.
Nice backbencher try for publicity -- the tired, old, let's-stop-the-bickering-and-do-it-my-way ploy.
Nice backbencher try for publicity -- the tired, old, let's-stop-the-bickering-and-do-it-my-way ploy.
The comments on this page are why it is so difficult to pass any bipartisan legislation in this country. What an enormous bunch of self-righteous idealogues, each making arguments that one side or the other is evil, or proposing huge changes that are politically impossible. In other words, offering absolutely nothing constructive. You're all as useless as Krugman.
I applaud the Problem Solvers Caucus and hope that their proposal will be put up for a vote. It won't happen because of NYTimes readers, who are happier to carp and lecture than to actually work to improve the country.
I applaud the Problem Solvers Caucus and hope that their proposal will be put up for a vote. It won't happen because of NYTimes readers, who are happier to carp and lecture than to actually work to improve the country.
What does 'stabilize insurance exchanges' mean in real world terms that voters can understand? How much compromise do you want? The ACA is a Gop plan from the Heritage think tank. It's 2nd rate, only made to look good compared to the previous non system, that was a human rights atrocity by international standards, with excess deaths, disabilities, and bankruptcies.
The big compromise on ACA is that its costs are too high because it must buttress corporate profits. Some of those profits go to campaign donations to finance Dems and Gop runs for office. This is not mentioned in our news media. Yet, the big news story is this comparison: In the dozens of nations with true universal h/c at lower cost, they use more public funds for elections and limits on private donations. How about some real news facts in our media on this cause/effect connection?
We are getting plenty of fake news rationalizations for the 2nd rate ACA, that leaves out millions, and burdens us with high costs. Our news media must start giving us some real news facts---how do other advanced democracies pay for and use their h/c systems. They are also capitalist, and have varied systems, but they don't put profits 1st over the health care of the citizens.
The Dems should have been vigorously campaigning for h/c that's up to mid 20th century international standards, to make that 'politically possible'. They could have been educating voters, putting pressure on the Gop.
The big compromise on ACA is that its costs are too high because it must buttress corporate profits. Some of those profits go to campaign donations to finance Dems and Gop runs for office. This is not mentioned in our news media. Yet, the big news story is this comparison: In the dozens of nations with true universal h/c at lower cost, they use more public funds for elections and limits on private donations. How about some real news facts in our media on this cause/effect connection?
We are getting plenty of fake news rationalizations for the 2nd rate ACA, that leaves out millions, and burdens us with high costs. Our news media must start giving us some real news facts---how do other advanced democracies pay for and use their h/c systems. They are also capitalist, and have varied systems, but they don't put profits 1st over the health care of the citizens.
The Dems should have been vigorously campaigning for h/c that's up to mid 20th century international standards, to make that 'politically possible'. They could have been educating voters, putting pressure on the Gop.
Who are the 43 members of the bipartisan committee? I sure hope my congressman is part of this group.
I laud your commitment to a bi-partisan process, but recommend you base it on accurate information.
You state "our proposal provides relief to certain businesses from the mandate that they provide insurance to full-time employees. It also defines “full time” as a 40-hour workweek to discourage businesses from manipulating employees’ weekly hours to skirt the mandate."
You are saying that Obamacare's definition of full-time as a 35-hour workweek was manipulated by employers. That has been disproved by the fact that part-time work has declined (not increased) since the marketplaces of Obamacare began operating in 2014.
Your also state "More than 90 percent of large businesses offered health care before the Affordable Care Act, and studies show that they would continue to do so under this change"
Another misleading statement implying employer coverage was lower after ACA. In fact, 94% of employers (employing 100+) offered health coverage in the year before the markets opened and 96%-97% have offered coverage since
The profits of 102 device companies were $16.5 billion in 2014, up from $11.4 before ACA was passed. Why? ACA gave them millions more insured customers, which was the rationale for making them contribute 2.3%. No need for tax relief there.
Letting insurers sell across state lines just drives coverage to the level of states with low coverage and few protections. It will violate the rights of the other states
Please start with a clean slate, not a biased view
You state "our proposal provides relief to certain businesses from the mandate that they provide insurance to full-time employees. It also defines “full time” as a 40-hour workweek to discourage businesses from manipulating employees’ weekly hours to skirt the mandate."
You are saying that Obamacare's definition of full-time as a 35-hour workweek was manipulated by employers. That has been disproved by the fact that part-time work has declined (not increased) since the marketplaces of Obamacare began operating in 2014.
Your also state "More than 90 percent of large businesses offered health care before the Affordable Care Act, and studies show that they would continue to do so under this change"
Another misleading statement implying employer coverage was lower after ACA. In fact, 94% of employers (employing 100+) offered health coverage in the year before the markets opened and 96%-97% have offered coverage since
The profits of 102 device companies were $16.5 billion in 2014, up from $11.4 before ACA was passed. Why? ACA gave them millions more insured customers, which was the rationale for making them contribute 2.3%. No need for tax relief there.
Letting insurers sell across state lines just drives coverage to the level of states with low coverage and few protections. It will violate the rights of the other states
Please start with a clean slate, not a biased view
4
First item. Currently there is no health care system in the United States. There is a hodge-=podge collection of cobbled together laws and practices that provide health care to some of our citizens. At ridiculous cost, both in lost time filling out forms and money. We spend more money and have a poorer outcome than many developed countries of the world. A true system would solve much of this.
Second item. The politicians have been standing in a circle and pointing fingers at each other, talking blather rather than sitting down together and trying to help the population of the country. There is plenty of blame to go around. What we need is real leadership; not partisan grandstanding.
Let's try that for a beginning. Mr's. Gottheimer and Reed have made a beginning. I hope it doesn't die aborning.
Second item. The politicians have been standing in a circle and pointing fingers at each other, talking blather rather than sitting down together and trying to help the population of the country. There is plenty of blame to go around. What we need is real leadership; not partisan grandstanding.
Let's try that for a beginning. Mr's. Gottheimer and Reed have made a beginning. I hope it doesn't die aborning.
76
We do have a health care system. As system thinkers know, every system is perfectly designed to get the results that it gets. As stated correctly by Mr. Kapper, we do spend more per capita with some of the worst outcomes in the developed world. That is our system. To get better outcomes we need to change the system and stop beating up on people.
Secondly, to change the system, we need a common compelling vision for the country in regards to healthcare. Agree on the questions, what are we trying to accomplish?, and what changes can we make that will result in an improvement?, and how will we know that those changes are an improvement? I would hope that the Problem Solvers Caucus would first lead us in creating an agreed upon vision of what we are trying to accomplish with healthcare.
Secondly, to change the system, we need a common compelling vision for the country in regards to healthcare. Agree on the questions, what are we trying to accomplish?, and what changes can we make that will result in an improvement?, and how will we know that those changes are an improvement? I would hope that the Problem Solvers Caucus would first lead us in creating an agreed upon vision of what we are trying to accomplish with healthcare.
Ok -- but where's the public option?
2
The only missing item is to offer to those who get their insurance through the marketplace and option to buy in to Medicare. This will increase competition and will also remove the threat of all insurers leaving a given market.
1
The so-called President promised us on TV that his 'plan' would cover everyone, would be better, and would cost less. Single-payer would meet those parameters, so why isn't he publicly calling for it? Instead, he says's he's got his pen ready to sign the dreadful 'plan' that fell 1 vote short of getting through the Senate last week; that was the plan that cut close to a trillion dollars from Medicaid, raised rates by 20%, undermined pre-existing conditions, and would cause 15 - 32 million to lose coverage due to them not being able to afford it.
So now we talk about the 40 hour week requirement as being a good deal? Under the current law I believe it's 30 hours.
So now we talk about the 40 hour week requirement as being a good deal? Under the current law I believe it's 30 hours.
72
Regarding the 40-hour work week: Indeed, these congressmen's call for a 40-hour work week rule shows how out of touch they are. In my college job in the mid-80s, employers regularly scheduled 38 to 39 hours to weasel out of paying health care. Being more than 3 decades out of date on important topics does not instill confidence in constituents!
Maybe the bill didn't pass, but your rates are going up anyways. Winning!!
MEDICARE FOR ALL.
It's the only civilized solution.
It's the only civilized solution.
6
This is so convoluted, requires more constant intervention and tweaking, and guarantees that the health care debate will continue to dominate the country. It would be so much simpler with single payer, then the only thing to argue about is the level of financing.
4
How refreshing! Politicians working together across the aisle to fix a problem rather than create one by uttering the taboo word "compromise." But will the "purists" who only want "repeal" or those who only want a single payer ever come around so that commonsense can once again walk the halls of Congress?
26
How is it common sense when there is overwhelming data that shows single payer is a vastly more efficient?
All other industrialized countries have some form of universal government run health care, mostly single payer. They get at least as good care as measured by all 16 of the bottom line public health statistics, and they do it at 40% of the cost per person. If our system were as efficient, we would save over $1.5 TRILLION each year.
http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequ...
Here are the per capita figures for health care costs in 2013 in PPP dollars from the OECD:
OECD average - 3463
US - 8713
UK - 3235
France - 4124
Australia (similar obesity) - 3966
Germany - 4919
Denmark - 4553
The Netherlands - 5131
Canada - 4361
Israel - 2128
Switzerland (Highly regulated private insurance) - 6325
)
Let's compare some bottom line statistics between the US and the UK which has real socialized medicine.
Life expectancy at birth:
UK - 81.1
US - 78.8
Infant Mortality (Deaths per 1,000):
UK - 3.8
US - 6.0
Maternal Mortality (WHO):
UK - 9
US - 14
The WHO using a formula developed by The Harvard School of Public Health ranks our system as 38th in the world. (France & Italy are 1 & 2). This formula doesn't include costs. Bloomberg ranked countries' systems on efficiency which does include costs. We came out as 50th out of 55.
As Einstein said,
"The difference between genius and stupidity is that genius has its limits."
All other industrialized countries have some form of universal government run health care, mostly single payer. They get at least as good care as measured by all 16 of the bottom line public health statistics, and they do it at 40% of the cost per person. If our system were as efficient, we would save over $1.5 TRILLION each year.
http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequ...
Here are the per capita figures for health care costs in 2013 in PPP dollars from the OECD:
OECD average - 3463
US - 8713
UK - 3235
France - 4124
Australia (similar obesity) - 3966
Germany - 4919
Denmark - 4553
The Netherlands - 5131
Canada - 4361
Israel - 2128
Switzerland (Highly regulated private insurance) - 6325
)
Let's compare some bottom line statistics between the US and the UK which has real socialized medicine.
Life expectancy at birth:
UK - 81.1
US - 78.8
Infant Mortality (Deaths per 1,000):
UK - 3.8
US - 6.0
Maternal Mortality (WHO):
UK - 9
US - 14
The WHO using a formula developed by The Harvard School of Public Health ranks our system as 38th in the world. (France & Italy are 1 & 2). This formula doesn't include costs. Bloomberg ranked countries' systems on efficiency which does include costs. We came out as 50th out of 55.
As Einstein said,
"The difference between genius and stupidity is that genius has its limits."
@Len Charlap While I agree with you, there is also the saying, "Don't let the perfect be the enemy of the good." Fixing Obamacare is "good" while "Medicare for All" is "perfect.
Paul, while the ACA is progress, calling it "good" is a bit of a stretch. One of its many flaws is its almost mind boggling complexity. This not only makes it extremely hard to administer, but, more importantly today, makes it easy to wreck. If the Republicans can eliminate any of its myriad of moving parts (various subsidies and mandates, plan requirements, counseling, etc., etc., etc.), the whole thing will tumble down like Humpty Dumpty. We are seeing that today. A simple plan like HR676 would be much easier to defend.
"The definition of insanity is doing the same thing over and over, but expecting different results."
The thing we are repeating is trying to devise an efficient healthcare plan based largely on private insurance companies.
"The definition of insanity is doing the same thing over and over, but expecting different results."
The thing we are repeating is trying to devise an efficient healthcare plan based largely on private insurance companies.
This is a good start, and it's encouraging that a bipartisan group has formed to actually work vs. the current dysfunctional state of affairs.
I have had a 32 year career in various parts of the insurance/health care world, in health plans, in consulting/brokerage and now head employee benefits at a large, global company. I sit on several boards related to health care, including an ACO, and am a frequent speaker on health subjects.
From this perspective, my thoughts on your 5 starting points:
1. Stabilize the markets - yes, absolutely, good place to start. Insurers need predictability
2. Reinsurance pool - a short term fix for high cost patients (BTW - it's not just people with chronic conditions, but just as much those with traumatic or sudden events: cancer, accidents, sudden disease. Ultimately, this leads to the issue of cost and quality for providers and changing the financial incentives. MACRA is a great start, but there should be more APM models supported.
3. Relief for small business and full time= 40 hours/week - you didn't mention the new limits, which currently sits at 50 FTE and 30 hours per week as full time. The first part, sure, go for it. The second part would not have much of an impact since most companies already moved to define full time as 30 hours. People would lose coverage.
4. Med Device Tax - Fine, small $
5. State flexibility - selling policies across state lines won't reduce costs. Underwriters consider local conditions in pricing policies.
I have had a 32 year career in various parts of the insurance/health care world, in health plans, in consulting/brokerage and now head employee benefits at a large, global company. I sit on several boards related to health care, including an ACO, and am a frequent speaker on health subjects.
From this perspective, my thoughts on your 5 starting points:
1. Stabilize the markets - yes, absolutely, good place to start. Insurers need predictability
2. Reinsurance pool - a short term fix for high cost patients (BTW - it's not just people with chronic conditions, but just as much those with traumatic or sudden events: cancer, accidents, sudden disease. Ultimately, this leads to the issue of cost and quality for providers and changing the financial incentives. MACRA is a great start, but there should be more APM models supported.
3. Relief for small business and full time= 40 hours/week - you didn't mention the new limits, which currently sits at 50 FTE and 30 hours per week as full time. The first part, sure, go for it. The second part would not have much of an impact since most companies already moved to define full time as 30 hours. People would lose coverage.
4. Med Device Tax - Fine, small $
5. State flexibility - selling policies across state lines won't reduce costs. Underwriters consider local conditions in pricing policies.
Good start, perhaps, although it's hard to see that you actually have backup for claims that the medical device tax is 'mostly passed on to consumers.' More likely, their lobbiests have some leverage.
But what about the 'medical insurance premiums by zipcode' problem? Having insurance available across state lines might work, but how about just making things uniform in a state? Sure, urban consumers face higher costs than rural ones perhaps, or maybe there are too few rural insureds in some counties to achieve scale ... but having some counties in a state dramatically facing higher premiums than other neighboring counties seems nutty. It's insurance, spreading the risk amoung the largest population seems like the basics of that entire idea. Let's not hammer some counties with enormous premium increases, or lack of competitive options compared to urban or more wealthy counties, or the reverse either where that might occur.
But what about the 'medical insurance premiums by zipcode' problem? Having insurance available across state lines might work, but how about just making things uniform in a state? Sure, urban consumers face higher costs than rural ones perhaps, or maybe there are too few rural insureds in some counties to achieve scale ... but having some counties in a state dramatically facing higher premiums than other neighboring counties seems nutty. It's insurance, spreading the risk amoung the largest population seems like the basics of that entire idea. Let's not hammer some counties with enormous premium increases, or lack of competitive options compared to urban or more wealthy counties, or the reverse either where that might occur.
I applaud these two Representatives from different sides of the aisles engaging in a compromise for the individual non-group health insurance market. I have been self-employed for 35 years and am frightened what will happen come 1/1/18 to the cost of my premium and OOP
Two issues not mentioned:
1) The individual mandate to require young, healthy not receiving benefits through their jobs to buy a health insurance policy. This is no different then these same young individuals paying a Medicare tax to help support those 65 and older enjoying the benefits of Medicare.
2)The 1:3 ratio currently charged youngest to oldest in the individual market. Insurance companies are clamoring to return to the pre ACA days of 1:5 ratio. If this happens it will be a catastrophic rise in premiums for all 50 and older!
Two issues not mentioned:
1) The individual mandate to require young, healthy not receiving benefits through their jobs to buy a health insurance policy. This is no different then these same young individuals paying a Medicare tax to help support those 65 and older enjoying the benefits of Medicare.
2)The 1:3 ratio currently charged youngest to oldest in the individual market. Insurance companies are clamoring to return to the pre ACA days of 1:5 ratio. If this happens it will be a catastrophic rise in premiums for all 50 and older!
Glad to see this effort. Members of Congress need to get beyond their ideology and take steps that will actually work in real life. One major problem has been that Democrats see healthcare as a human right, while many Republicans, and their Billionaire Bankrollers, see healthcare as a privilege for those with money. If they can't agree on a common goal, it's harder to reach a solution. The cuts to Medicaid in the 2017 Republican bills were not about providing medical care, they were about freeing up money to use for a tax cut for the wealthy.
The Problem Solvers Caucus is a project encouraged and endorsed by the non-partisan, non-profit organization called No Labels, whose mantra is "Fix, don't fight!" Understanding that it is the Times' policy not to print anything that is construed as an endorsement, we need to have more media light shed on the work of this organization and others like it that work to restore functionality to government in a positive and proactive way.
It's time to reward good behavior with positive press. This Op-Ed piece is such a refreshing change. More please?
It's time to reward good behavior with positive press. This Op-Ed piece is such a refreshing change. More please?
2
Single payer is the only way to go. Private insurance companies are middle men who take a large percentage of the national health care bill for their CEO's and investors. They do NOTHING but push papers and get in the way. If they were to disappear as a business, the only ones who would care would be those profiting off other's misery. But this in the USA, land of greed and coarse profiteering, best symbolized by our current president.
We need a massive attitude change, and weak tea incremental changes, so that the Dems and Repubs can keep their insurance company donations (bribes) are not at all the answer. Their may be a serious opioid addiction problem in the US, but the bigger addiction problem is our politicians greed for lobbyist money, and THAT, not the Russians, is destroying our Democracy. Everyone know it too.
We need a massive attitude change, and weak tea incremental changes, so that the Dems and Repubs can keep their insurance company donations (bribes) are not at all the answer. Their may be a serious opioid addiction problem in the US, but the bigger addiction problem is our politicians greed for lobbyist money, and THAT, not the Russians, is destroying our Democracy. Everyone know it too.
160
"If [health insurers] were to disappear as a business, the only ones who would care would be those profiting off other's misery."
You're right. Doctors, hospitals, and drug companies would love it. They could charge whatever they want with no need to negotiate with another powerful business.
You're right. Doctors, hospitals, and drug companies would love it. They could charge whatever they want with no need to negotiate with another powerful business.
"middle men who take a large percentage of the national health care bill for their CEO's and investors."
Let's see some proof of this claim. A&H net income in the numerator and "national health care bill" in the denominator.
Let's see some proof of this claim. A&H net income in the numerator and "national health care bill" in the denominator.
I hope that Rep's. Gottheimer and Reed and the Problem Solvers Caucus are better deal makers than Mr. Trump who couldn't even make a deal with his own party. These are the guys who are closest to their constituents and are in the best position to eschew ideology and concentrate on the needs of all of the people in their districts.
Representatives are the parish priests of the political world. They are responsible for the welfare of all of the souls in their districts, not just the ones who voted for them.
Representatives are the parish priests of the political world. They are responsible for the welfare of all of the souls in their districts, not just the ones who voted for them.
1
Having saddled the American people with a Trump presidency and a dysfunctional government, Republicans have to find a way to win in 2018. It's great that this latest move should help improve health care, but you can just bet the Republicans will be saturating the airwaves come election time about how they 'saved' the health care system from both Trump and Obamacare.
Yes!
Thank you for recognizing that you REPRESENT PEOPLE, and most definitely NOT YOUR PARTY. The people sent you, the people pay you and you are accountable to them (whether they voted for you or not), not a political organization that - in both cases - has been focused on doing more harm than good.
Thank you also for realizing that health care is not a cover for a tax break for rich people. In making that the ultimate aim rather than repairing the system, the GOP made an ugly, obvious and cynical mistake.
Your proposal is tentative and incomplete, however. It is mandatory that the pharma and insurance industries, which have posted record profits for years, take the hit here. Premium growth has been obscene and consumers have paid too much for too long. Open the American pharma market to global imports and put in place a national health insurance program that will compete with private insurance in a realistic, effective way.
These changes are massive, but they are obvious and inevitable. Get our markets moving in that direction so that we can achieve what the rest of the West already has - basic, affordable health care for everyone with market competition to keep prices in check.
Thank you for recognizing that you REPRESENT PEOPLE, and most definitely NOT YOUR PARTY. The people sent you, the people pay you and you are accountable to them (whether they voted for you or not), not a political organization that - in both cases - has been focused on doing more harm than good.
Thank you also for realizing that health care is not a cover for a tax break for rich people. In making that the ultimate aim rather than repairing the system, the GOP made an ugly, obvious and cynical mistake.
Your proposal is tentative and incomplete, however. It is mandatory that the pharma and insurance industries, which have posted record profits for years, take the hit here. Premium growth has been obscene and consumers have paid too much for too long. Open the American pharma market to global imports and put in place a national health insurance program that will compete with private insurance in a realistic, effective way.
These changes are massive, but they are obvious and inevitable. Get our markets moving in that direction so that we can achieve what the rest of the West already has - basic, affordable health care for everyone with market competition to keep prices in check.
4
Great start as it should have been in the first place. A bipartisan approach to FIXING the ACA and not repealing it or gutting it. Now let's return to regular order as Sen. McCain said, and hold hearings, take testimony and proposed changes and suggestions from all of the parties, including the providers of healthcare services, insurance companies, consumers and involved interest groups. Followed by real legislative debate on a final, bipartisan supported bill with plenty of time for the legislators to read it, the CBO to score it, and then vote on it after the full debate. If it passes, and it probably will, give it to the president to sign, which he will, and then prepare for him to take full credit for it so he can claim the big win. Even though he is totally ignorant, as always, of the details. In the end, that will definitely help the people who need a better health insurance plan the most.
It's about time. What's been most wrong with the ACA is the GOP fervor to kill it. What we've needed all along are bipartisan efforts to improve it.
99
Good start but acknowledging that no insurance is possible unless healthy & sick are paying in- with premiums or subsidies.
A public option would relieve all businesses, large or small, of the fixed cost of employee benefits- why isn't that part of a Trump job/growth strategy??
A public option would relieve all businesses, large or small, of the fixed cost of employee benefits- why isn't that part of a Trump job/growth strategy??
2
This is all very nice, but we all know perfectly well that for the majority in Congress, bickering and partisanship are the goal. All the futile, and knowingly futile votes to repeal Obamacare during his two terms had nothing to do with health care or the welfare of the American people, but only to humiliate and obstruct Obama's agenda. And as events has now proven, Republicans don't have a plan of their own and never did.
1
Band aids on bullet wounds. Your plan does nothing to contain the skyrocketing costs of medical care and that of prescriptions. People who have plans now can't use them because of of astronomical deductibles and out of pocket costs. The only way forward is it abolish the profit and make health care universal single payer. All others will fail.
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It was not clear whether or not this proposal address squarely the problem of deductibles and co-pays. It precisely mentions premiums, but that is just the head of the out of pocket problem.
Deductibles make using your coverage impossible, and many people find they have used up their deductible - paid for all of their health care themselves along with paying the premiums - just when a new year kicks in and a new deductible starts the clock all over again. Co-pays add insult to injury.
These two elements of the total package must also be addressed in any "reform" of our health care insurance if any meaningful coverage is to be extended to the struggling middle and lower middle classes of our country -
a large part of the working poor.
Deductibles make using your coverage impossible, and many people find they have used up their deductible - paid for all of their health care themselves along with paying the premiums - just when a new year kicks in and a new deductible starts the clock all over again. Co-pays add insult to injury.
These two elements of the total package must also be addressed in any "reform" of our health care insurance if any meaningful coverage is to be extended to the struggling middle and lower middle classes of our country -
a large part of the working poor.
I'm all for removing the middleman and his added costs, but the big problem is the prices of goods and services. We pay the highest prices in the world to hospitals, physicians, laboratories, other service providers and for drugs and durable goods. Insurance premiums are high because the price of actual care is so high. This proposal while well intended and providing some temporary relief for some only kicks the can down the road. We need to seize the moment and expand Medicare to all. It is the most efficient and only economically sustainable path.
9
The 3 Trillion dollar plus a year problem that America can not solve — and by no means the supposedly best healthcare system in the First World.
Heartily agree this is meager movement movement, but not even close to a solution. Under current political conditions, even with the best intentions, a comprehensive solution seems impossible.
I have looked again and again for evidence of credible, comprehensive proposals for a real fix to American healthcare, but find no prospects, but rather reams of discussion on the economic and organizational problems with the current lash up.
Have to wonder why?
Heartily agree this is meager movement movement, but not even close to a solution. Under current political conditions, even with the best intentions, a comprehensive solution seems impossible.
I have looked again and again for evidence of credible, comprehensive proposals for a real fix to American healthcare, but find no prospects, but rather reams of discussion on the economic and organizational problems with the current lash up.
Have to wonder why?
Seems like a reasonable stop gap.
Long term perhaps focus on why a 5 min follow up visit costs $850, a 10 minute ambulance ride costs $1500, 15 min airlift (in an urban area no less) costs $25,000 and why an hour and a half long surgery costs $80,000. Not to mention why we pay 6x what they do in Brazil for the same drug, let alone 16x what they pay in India.
Long term perhaps focus on why a 5 min follow up visit costs $850, a 10 minute ambulance ride costs $1500, 15 min airlift (in an urban area no less) costs $25,000 and why an hour and a half long surgery costs $80,000. Not to mention why we pay 6x what they do in Brazil for the same drug, let alone 16x what they pay in India.
14
Because our medical professionals and staff are paid well
The only fix is universal health care. Look at New Zealand and other countries that provide a single pay system. Note to congress: stop screwing around; vote in a single pay.
1
And because insurance businesses seek to maximize profits.
Thank you
Here's a plan: Medicare For ALL-2020- It's Time.
Enough of this " crap". Seriously.
Enough of this " crap". Seriously.
19
Yes. Single pay now.
1
Ditto!
So, it's agreed then. Obamacare is the trainwreck that everyone ( other than the collectivist progressive ideologues) claim it is.
Admitting that, is the first step.
Nice to see that the N Y Times made a content filter oversight and accidentally allowed this piece to be published.
2
Don't you have RomneyCare? And its working pretty well up there in Mass? So why cannot the rest of the country have the same program?
1
I don't think you'll find any liberal who thinks the ACA is perfect. However, it does a lot of good things. It's nice to see Republicans and Democrats growing up and being responsible by seeking compromise, rather than conflict, for a change.
Objectivist: so much for "stop the bickering"...
Medicare-for-All program is less complex and the best way to the provide affordable health care for all. It is based on a social compact where ALL pay medicare taxes for the benefit of ALL. If one no longer has to pay for a private health insurance plan (about $15K per year in most cases for a family plan), an increase in the Medicare taxes to cover the cost would result in a savings of about $5K per year per family.
A Medicare-for-All program would obviate the need for an employer sponsored health care system. This would be a welcome relief to businesses. This is what enables Japanese manufacturers to sell their cars cheaper.
Such a program would greatly reduce administrative costs since there would be no need to pay for advertising, increased dividends to stock holders, high CEO salaries and bonuses etc. The fact that the administrative costs of both Social Security, Medicare, and Medicaid are 6-8% per year -- vs 35% or more for private health insurance companies-- attests to this.
Further cost reductions should be easier to accomplish once having eliminated the "middlemen " who profit immensely under the current market-based system in which there is no real competition. Despite the many complaints of the health insurance companies, their earnings have sky rocketed !!
A Medicare-for-All program would obviate the need for an employer sponsored health care system. This would be a welcome relief to businesses. This is what enables Japanese manufacturers to sell their cars cheaper.
Such a program would greatly reduce administrative costs since there would be no need to pay for advertising, increased dividends to stock holders, high CEO salaries and bonuses etc. The fact that the administrative costs of both Social Security, Medicare, and Medicaid are 6-8% per year -- vs 35% or more for private health insurance companies-- attests to this.
Further cost reductions should be easier to accomplish once having eliminated the "middlemen " who profit immensely under the current market-based system in which there is no real competition. Despite the many complaints of the health insurance companies, their earnings have sky rocketed !!
12
Compromise? Republicans are giving in to Democrats who refused to compromise originally, insisted the ACA would create a Utopian system as all the single-payer advocates are doing now. Real compromise is giving states maximum choice to go single payer or something else. The ACA is wrong. It forced us all into a system for what purpose? So we can despise those who forced us into it? same with any other solution. With states offering choices we can leave NY for TX or the reverse and diffuse this issue.
1
State governments are even less efficient and effective than the federal one. The fatal flaw in your plan: what if you don't want to leave New York for Texas? What if your circumstances don't permit it?
The root cause of the huge increase in health care costs is soaring charges by the industry. Insurance created a market place where cost was no problem, treat me, I have insurance. Most of us do not know what our treatment costs or what was necessary and what was a padded bill or shooting in the dark treatment.
The congressman's total focus is on more competition, more federal payments for the high end patient, all geared to insurance. No mention on the actual cost of health care.
I recommend that the federal government create a patient advocacy agency that sole purpose is to review individual treatment procedures that doctors and hospitals superscribe in light of the patients needs. Granted, this would be very expensive, but probably cheaper than the test everything treat everything, pad the bill to get more money out of the insurance coverage.
Also, a centralized data bank that all doctors and hospitals are required to submit patient records to and use in establishment of treatment analysis.
Initially, this will cost a ton. But its goal is to get a grip on the exploding costs for health care. It may well eliminate the private health insurance industry, but the genie is out of the bag and the electorate will not support slipping back to a system that treats only those that can afford it.
The congressman's total focus is on more competition, more federal payments for the high end patient, all geared to insurance. No mention on the actual cost of health care.
I recommend that the federal government create a patient advocacy agency that sole purpose is to review individual treatment procedures that doctors and hospitals superscribe in light of the patients needs. Granted, this would be very expensive, but probably cheaper than the test everything treat everything, pad the bill to get more money out of the insurance coverage.
Also, a centralized data bank that all doctors and hospitals are required to submit patient records to and use in establishment of treatment analysis.
Initially, this will cost a ton. But its goal is to get a grip on the exploding costs for health care. It may well eliminate the private health insurance industry, but the genie is out of the bag and the electorate will not support slipping back to a system that treats only those that can afford it.
2
Give me a break! After 7+ years of watching the GOP do EVERYTHING nasty, mean spirited and impulsive act to repeal the ACA and NOW you want the Dems to play nice?!!! Have you lost your mind?! It's time for the 2x4s on the GOP. It's payback time!
4
I am shocked that the NYT actually has chosen, this time, to force feed its rabid and biased liberal progressive followers a dose of rational thinking with this article. Maybe Krugman, Fox News, Hannity, Bruni etc. will read this article. I doubt it. Yes, I am cynical. I swallowed the Obamacare lies, voted for Obama, and my middle class family has paid dearly ever since. All while the top 1% flourished, which liberal progressives enabled for the last 8 years. I doubt Trump will be able to top that, but he will try. Since then, I have learned that Obamacare was a "trick" to get my family moved to universal healthcare, and that the Democrats were so smart, that they knew all along that Obamacare was not going to be "perfect", and that Republicans were not going to support it. Then Hillary was foisted on me, and she and her blind followers were ready to dose my family with more of the same. I revolted and voted for idiot Trump, as did much of middle class America. Ignorant Republicans and liar Democrats, take note and be ready for the next election, because much of middle class America has figured out you and your rabid follower's insidious manipulations and are deeply skeptical.
3
Can we hope for a third party?
Many of the comments here emphasize the root cause problem with healthcare in the US, its costs, relative to other industrialized nations. I agree that this issue is paramount, yet the Congress will not grapple with it. But this bipartisan caucus's hope is going in the right direction....without this type of effort we will see even higher insurance premiums in a very few months. I am all for it!
6
It turns out that the Republicans don't even know what supply side economics really is.
While I personally believe some form of single payer, universal coverage would be best I understand that is not going to happen in today's climate. You folks are to be congratulated for your efforts and, like you, I think this is a viable first step toward fixing the problem.
6
Thank you for being leaders and setting forth a near-term idea to stabilize the current system. Please push this plan through both Houses quickly so we creat some certainty in 2018. Then, maybe fire-up the dog and pony show hearings so your colleagues can preserve their political sound bites. We all know the true problem to the high cost of health care in our country: health care spending represent almost 20 percent of the economy. A lot of companies are making a lot of money in health care. The system we allowed to develop is a wounderfu business model for everyone but consumers.
6
The basic problem is the power of those who profit from our broken system. Couple that with the ability to buy Congress and progress is somewhere between difficult and doubtful for fixing Obamacare. None of us will live long enough to see a well-run single-payer system in the United States, part of our confounding Exceptionalism!
Health care is not the only issue like this, where a minority can keep society from responding to a problem. The gun lobby is another example that comes immediately to mind -- and which can be considered part of the health issues if viewed broadly.
Health care is not the only issue like this, where a minority can keep society from responding to a problem. The gun lobby is another example that comes immediately to mind -- and which can be considered part of the health issues if viewed broadly.
4
Health care does not operate as a market place as for instance like autos. Consumers are not repeat buyers who try different brands and shop around.
Insurance companies are merely middlemen that mostly add cost to the medical system. The companies have a fiduciary responsibility to make profit for their shareholders. Hence, they will fight for their survival independent of whether they are in the best interest of the US citizens.
The challenge we face is clear...we must somehow eliminate the cost-adding middleman.
Insurance companies are merely middlemen that mostly add cost to the medical system. The companies have a fiduciary responsibility to make profit for their shareholders. Hence, they will fight for their survival independent of whether they are in the best interest of the US citizens.
The challenge we face is clear...we must somehow eliminate the cost-adding middleman.
12
Too bad the "problem solvers group" in the House doesn't have 435 members dedicated to finding bipartisan solutions. I applaud these members, but feel that a significant number of their colleagues are problem creators.
7
First, congratulations. I am very happy to see bipartisan conversations and proposals; I am sure that sitting at the same table presents challenges but you both recognize that you represent all sorts of people and that have the obligation to work across the aisle.
Second, the health system in the US is a confounding mess-part for-profit, part-pseudo-not-for-profit, some really not-for-profit. Attaching health insurance to a job is nuts--keeps people from changing employment and unfairly pressures employers and would-be entrepreneurial job-creators. As a consumer (not a patient), I have been spectacularly unsuccessful in trying to find out what procedures and medicines really cost. I could go on.
One of my children happily graduated from medical school in June. His dream, now impossible, is to be a local GP. He is now in a competitive residency program but would happily earn less and have his own practice if insurance companies, hospitals and other pieces of health care would cooperate.
It is increasingly obvious that either universal coverage of some sort or an easily accessible public option similar to Medicare is the only real option. Hopefully, not too people will die before we do it.
Second, the health system in the US is a confounding mess-part for-profit, part-pseudo-not-for-profit, some really not-for-profit. Attaching health insurance to a job is nuts--keeps people from changing employment and unfairly pressures employers and would-be entrepreneurial job-creators. As a consumer (not a patient), I have been spectacularly unsuccessful in trying to find out what procedures and medicines really cost. I could go on.
One of my children happily graduated from medical school in June. His dream, now impossible, is to be a local GP. He is now in a competitive residency program but would happily earn less and have his own practice if insurance companies, hospitals and other pieces of health care would cooperate.
It is increasingly obvious that either universal coverage of some sort or an easily accessible public option similar to Medicare is the only real option. Hopefully, not too people will die before we do it.
17
He could possibly take his practice into his own hands as Dr. Unger has done in Wichita. Dr. Unger is very open to discussing his business model with others. https://atlas.md/wichita/
Duh....
3
Your proposal isn't perfect as you readily admit, but it strikes me as a damn good start. You have covered the most important aspects of health care debate and I hope (and pray) that everyone is listening.
As move deeper into your plans, please consider removing McConnell and Ryan from all deliberations. Especially McConnell.
Thank you!
As move deeper into your plans, please consider removing McConnell and Ryan from all deliberations. Especially McConnell.
Thank you!
9
You left out the most important part, controlling the of of health care and drugs. What you propose will do nothing to reduce insurance premiums, until you kill the 800 pound gorilla; the for profit, greedy doctors, hospitals, clinics and drug companies charging much more than the actual cost for profit. All you propose is something worse than the ACA and better than the garbage the GOP tried to thrust upon the country. And, add to this, no public option, make insurance pools much larger, and allow those over 60 to join Medicare.
And the right calls The New York Times "Liberal"?
And the right calls The New York Times "Liberal"?
9
This "greedy Doctor" who went hundreds of thousands of dollars into debt and spent 6 years after med school working 80 hour weeks at minimum wage, raced in at 2 AM last night to save a patient from bleeding to death while you were likely resting comfortably in your bed.
People like you who make inflammatory (and ignorant) statements add nothing to the conversation
People like you who make inflammatory (and ignorant) statements add nothing to the conversation
Reps.Gottheimer and Reed are papering over the basic problem with their undertaking: so far, McConnell, Ryan, Trump and many others, ALL of them on the Republican side of the aisle, were and are not interested in FIXING Obamacare, but in DESTROYING it, perhaps even not even replacing it with something better.
Ask the question: if your car is not getting as good mileage as was advertised, do you junk it or repair it? The Republicans were hell-bent on junking it, while the Democrats, who understood that the mileage was not optimal, were and are of the opinion that the car can be fixed. That at least some Republicans have come about, is a good sign. When the Republicans can finally drop their demand to "repeal", there will be progress, there will be a fix.
Ask the question: if your car is not getting as good mileage as was advertised, do you junk it or repair it? The Republicans were hell-bent on junking it, while the Democrats, who understood that the mileage was not optimal, were and are of the opinion that the car can be fixed. That at least some Republicans have come about, is a good sign. When the Republicans can finally drop their demand to "repeal", there will be progress, there will be a fix.
7
In this environment of bickering about trivial party disagreements, a real miracle is before us, the willingness to tackle healthcare affordability for all on a bipartisan effort. Returning to 'politics' (from 'politicking'), the are of the possible, and demanding compromise, is the only way to bridge a gap where spite, hate and division used to stop any viable and intelligent conversation, let alone needed action. Granted, we have a brutus ignoramus at the helm, who has not the faintest idea nor the inclination, to be of service to those in need, likely intent in screwing 'us' if we let him. So, we must remain alert, speak up, so something useful may come out of Trump's misrule. When was the last time 'our' representatives did something deserving their name?
1
Simpler, proven, and far less expensive solution:
FEDERALLY SPONSORED UNIVERSAL HEALTH CARE FOR ALL!
Time to join the rest of the Western world.
*****A Connecticut physician
FEDERALLY SPONSORED UNIVERSAL HEALTH CARE FOR ALL!
Time to join the rest of the Western world.
*****A Connecticut physician
23
How would this reduce costs ??
Would Doctors take less pay ??
Pay the drug companies less and the spend no money on R&D so no new drugs.
Insurance companies process payments and control fraud...do you think the government would process payments better & reduce fraud ??? You live in CT..you know how bad the CT DMV is !!
THe only way to reduce the total money spent on health care is to stop spending 50% of payments on 5% of the people.
Would Doctors take less pay ??
Pay the drug companies less and the spend no money on R&D so no new drugs.
Insurance companies process payments and control fraud...do you think the government would process payments better & reduce fraud ??? You live in CT..you know how bad the CT DMV is !!
THe only way to reduce the total money spent on health care is to stop spending 50% of payments on 5% of the people.
How refreshing! Working together to solve an immediate problem! Holy guacamole! Reassure those insurers that we will keep lining their pockets despite the fact that they are the vampires sucking the financial blood out of the system.
Next step for SERIOUS "problem solvers": survey all the other countries in the world who have established health care systems for all or most of their citizens (you weren't going to leave anyone out, were you?). Cherry pick the elements that work the best from each. There is no need to reinvent the wheel when it has been effectively been going round and round elsewhere for decades.
Ultimately, you will solve the problem by admitting that when you take the profits out of healthcare, costs are reduced and care is more equitably delivered. Just do it. Solve it the smart and compassionate way. Why wouldn't you want to cover everyone at the lowest possible price? Don't answer that.
Next step for SERIOUS "problem solvers": survey all the other countries in the world who have established health care systems for all or most of their citizens (you weren't going to leave anyone out, were you?). Cherry pick the elements that work the best from each. There is no need to reinvent the wheel when it has been effectively been going round and round elsewhere for decades.
Ultimately, you will solve the problem by admitting that when you take the profits out of healthcare, costs are reduced and care is more equitably delivered. Just do it. Solve it the smart and compassionate way. Why wouldn't you want to cover everyone at the lowest possible price? Don't answer that.
5
Bipartisanship, fine with me. But here are the problems with these proposals. First, more subsidies for insurance aren't going to solve much of any health care problem. Second, high-cost care isn't avoided by reinsurance unless reinsurance is a eupemism for rationing. Third, a bit more promising but still problematic, employer-provided health care may be a factor in the future, but it will be in the frills category, for the upper crust. We're already mostly single payer, people, wake up. And it sucks at least in the Medicaid and VA iterations. And if it's Medicare for everyone, well, kiss the fisc goodbye. This system is broken, and medical device taxes aren't going to fix it. Now, a true inter-state market in insurance might be interesting. It's the most provocative of these proposals. But why is this proposal tacked on almost as an afterthought? If the House Problem Solvers want to talk turkey with someone who has lived these issues as a lawyer for Georgia and the 26 states challenging the constitutionality of Obamacare, they can call people like me. Obviously, the Problem Solvers are not talking to people like me. They are talking to people invested in the system. Which is broken. SMH.
3
I fully agree with the point that the dialogue is controlled by those "invested in the system."
Thank you. I have grave doubts that anything "bipartisan" would make it to an actual vote, let alone law, but it gives me a tincture of hope that there are still at least a few people left who actually want to get things done and recognize that adult compromise is a virtue--rather than juvenile extremism that treats policy as a partisan pinata to be used to motivate a radical base.
Most of all, I'm happy to see that there are people who recognize that while no one would design the system we have now, in the real world we have to deal with it and make adjustments to improve it. The ACA is far from ideal from the left or the right and has serious problems, but in many ways it was an improvement on what we had before. Our healthcare system just doesn't work very well and its the sort of policy domain where nothing is going to make people happy. The crux is accepting where we are and what we have and asking where we should go from here. For too long our political class has lived in a self-crafted bubble of partisan purity where there either is no actual healthcare policy beyond demonizing the other side and the status quo or the policy that if stated is a fantastic flight of fancy. President Trump's "replace Obamacare with something great" was a little bit of both.
The problem is that reality is patient and unyielding. When it comes time to do something, it intrudes. Thus the latest quagmire. Maybe this plan is the sort of adult move we need....
Most of all, I'm happy to see that there are people who recognize that while no one would design the system we have now, in the real world we have to deal with it and make adjustments to improve it. The ACA is far from ideal from the left or the right and has serious problems, but in many ways it was an improvement on what we had before. Our healthcare system just doesn't work very well and its the sort of policy domain where nothing is going to make people happy. The crux is accepting where we are and what we have and asking where we should go from here. For too long our political class has lived in a self-crafted bubble of partisan purity where there either is no actual healthcare policy beyond demonizing the other side and the status quo or the policy that if stated is a fantastic flight of fancy. President Trump's "replace Obamacare with something great" was a little bit of both.
The problem is that reality is patient and unyielding. When it comes time to do something, it intrudes. Thus the latest quagmire. Maybe this plan is the sort of adult move we need....
5
Where, in anyone's plan is a reference to reducing (or at least disclosing) the price of medical care itself? Universal coverage and participation would provide, at least, some leverage to containing or even reducing those costs.
9
How is putting yet another band-aid on a critically flawed health care system getting us any closer to the only sensible solution for providing efficient, affordable and accessible health care in America? Medicare For All.
10
Medicare for all at this point would have 50% of the country trying to destroy it. Only solution is to support block grants to states with total freedom to implement whatever each state wants. Repubs will gravitate to AL and Dems to VT, NY,CA etc
What took congress so long? This could have happened at least 5 years ago and we could have moved on to even better solutions like a public option by now. However, I'll take this as it allows those of us in Health Care to plan and eventually deliver high quality care to ALL Americans.
Why not embrace the idea of a "compassionate democracy" and once and for all establish a universal heath care system like those in place in countries near and far throughout the world? All citizens are insured, the costs are far lower than our system, and they are healthier. Wake up and look beyond our shores rather than try to patch together a broken system.
27
Because half the country doesn't want it. Why force people into something they don't want knowing the result will be constant efforts to sabotage the outcome? Let states have total flexibility to create their own systems and people choose the system they want.
Won't work with Republicans trying to tear it down. Let Repubs create their systems in the states they control via block grants and they'll leave the states that offer single payer.
Glad to see some bipartisanship, This is moving in a good direction but very little here to really drive down costs.
After six years, the Medical Device Tax is now fully passed on to cost of product, and given that it was designed to pay for the subsidies, what is the point of removing it now? This is a windfall corporations can no longer claim they need.
I don't see anything here to really get at the root of the problem of increasing costs.
There's nothing in Obamacare that prohibits insurance companies from selling across state lines. This is an old Republican canard, recycled ad infinitum. Go ahead, try it, it really won't make any difference: as any underwriter will tell you, all insurance is local, with plans worked around municipalities and counties.
As for the high cost of drugs, the yearly premium increases, the difficulty of finding providers in rural counties, the pay for service model and the insanity of running insurance companies as for-profit enterprises-- nothing here helps any of that.
After six years, the Medical Device Tax is now fully passed on to cost of product, and given that it was designed to pay for the subsidies, what is the point of removing it now? This is a windfall corporations can no longer claim they need.
I don't see anything here to really get at the root of the problem of increasing costs.
There's nothing in Obamacare that prohibits insurance companies from selling across state lines. This is an old Republican canard, recycled ad infinitum. Go ahead, try it, it really won't make any difference: as any underwriter will tell you, all insurance is local, with plans worked around municipalities and counties.
As for the high cost of drugs, the yearly premium increases, the difficulty of finding providers in rural counties, the pay for service model and the insanity of running insurance companies as for-profit enterprises-- nothing here helps any of that.
14
The Trump administration is considering suspending cost-sharing payments because a federal court has ruled them unconstitutional.
The Obama administration kept insurance providers in the Affordable Care Act market by transferring money from the Treasury to cover their losses. But a federal court has ruled this transfer of funds is unconstitutional. District Court Judge Rosemary Collyer ruled that the Constitution says "No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law.” She said “Paying [those] reimbursements without an appropriation thus violates the Constitution. Congress is the only source for such an appropriation, and no public money can be spent without one." Continuing the payments is an option only if the House votes to appropriate the money.
The Obama administration kept insurance providers in the Affordable Care Act market by transferring money from the Treasury to cover their losses. But a federal court has ruled this transfer of funds is unconstitutional. District Court Judge Rosemary Collyer ruled that the Constitution says "No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law.” She said “Paying [those] reimbursements without an appropriation thus violates the Constitution. Congress is the only source for such an appropriation, and no public money can be spent without one." Continuing the payments is an option only if the House votes to appropriate the money.
2
Theses people are just sophists dancing around a candle. They will continue to empower private entities to collect taxes for profit rather than tax you directly for the benefit package provided, relabeling the taxes as insurance premiums, co-payments, etc.
6
1-Single Payer, Not for Profit, Universal Healthcare for all. Includes Dental, Mental Health, Vision and Hospice.
2-Federal- not state by state.
3-Give a tax credit to expatriates as they are not here to use the coverage.
No sense in all this complexity.
2-Federal- not state by state.
3-Give a tax credit to expatriates as they are not here to use the coverage.
No sense in all this complexity.
53
How do you propose to collect the money to fund this?
Yeah, whose going to pay for your pipe dream? Not me!!
1
One suggestion for a fix is to set up a federal insurance company to operate alongside the private insurers. This requires a floor on care levels, so insurers can't offer a policy so barebones that it's better described as skeletal. It does mean that laws require coverage for pre-existing, chronic, preventive, and catastrophic needs, to limit cherry-picking.
It can operate within the existing system. By offering a base policy, Fedicare would set a standard that all insurers would have to match, or risk losing business. It's not "Medicare for all" or single-payer, but a real test of the marketplace model. If the for-profit insurers choose to compete, there will be a standard they will have to match. In those areas where there are few providers, a current complaint about Obamacare, Fedicare fills the need. The competitive pressure on for-profit health insurance companies will cause them to get by with slimmer margins, thus putting more of the premiums where they belong - toward patient care.
Politically, it might be enough of a change from Obamacare that moderate Republicans could support the idea. Of course it would get major pushback from the insurance and pharmaceutical lobbies. But if the AMA wants to relieve doctors and hospitals of the onerous insurance claims process, they might get on board. And because it is within a competitive market environment, it's not "socialized medicine" and thus not (quite) anathema to the far right.
It can operate within the existing system. By offering a base policy, Fedicare would set a standard that all insurers would have to match, or risk losing business. It's not "Medicare for all" or single-payer, but a real test of the marketplace model. If the for-profit insurers choose to compete, there will be a standard they will have to match. In those areas where there are few providers, a current complaint about Obamacare, Fedicare fills the need. The competitive pressure on for-profit health insurance companies will cause them to get by with slimmer margins, thus putting more of the premiums where they belong - toward patient care.
Politically, it might be enough of a change from Obamacare that moderate Republicans could support the idea. Of course it would get major pushback from the insurance and pharmaceutical lobbies. But if the AMA wants to relieve doctors and hospitals of the onerous insurance claims process, they might get on board. And because it is within a competitive market environment, it's not "socialized medicine" and thus not (quite) anathema to the far right.
10
Dave your idea is thoughtful but will go nowhere because half the country will hate it. It could only be implemented on a state by state basis and that can only happen with states having total freedom to implement different healthcare solutions. The fire breathing Repubs in a single payer state will move out and same for Dems living in AL and both states will have freedom to innovate and eventually join with other states to create a defacto national or multi state solution.
It's about time that they start working together. This is why they are there. To work together for legislation for the benefit of the public. Republicans can stop the derogatory "Obama" Care and think in terms of health care for Americans.
And Democrats can continue the goal towards Universal Health Care with fixes needed now.
Most importantly, we the public, we the people need to remind the members of Congress that they are in DC as renters. They do not hold their positions for life and can and should be voted out when they no longer do their job. Terms limits are for another day's argument.
Get working Problem Solvers, it is a start in the right direction.
And Democrats can continue the goal towards Universal Health Care with fixes needed now.
Most importantly, we the public, we the people need to remind the members of Congress that they are in DC as renters. They do not hold their positions for life and can and should be voted out when they no longer do their job. Terms limits are for another day's argument.
Get working Problem Solvers, it is a start in the right direction.
9
The first thing of course is to actually have a heath care system rather than a bunch of ad hoc bits and pieces that are there to protect all the different "providers" including Drs hospitals drug companies and last but not least insurance companies with their wall street partners. To miss apply Lincoln "we must disenthrall ourselves" and perhaps we could have areal health care system.
3
Although I applaud the effort to offer a temporary bipartisan fix, No U.S. healthcare policy will work - from Either Party - because the major underlying cost issues have not even begun to be solved including burdensome regulations, fragmented and uncoordinated care, expensive technologies & procedures, fee-for-service, high administrative costs, hospital monopolies, medical-related tort, unhealthy behaviors, and lack of cost consideration from patients themselves.
And U.S. healthcare costs are the biggest threat to GDP growth - not corporate tax rates. Back in the 1960s corporate taxes were about 4% of GDP. Now they are about 2%. By contrast, healthcare costs have ballooned and neither Party is addressing the multitude of underlying cost issues. 50 years ago healthcare was about 5% of U.S. GDP, and now it is over 17% and growing. Germany's healthcare costs stand about 11% of GDP, Japan 10%, Britain 9%, China 5.5%. And compared to all these other countries the speed at which the healthcare costs have risen in the U.S. in the last 20-30 years is significantly faster - at least 5 times faster - than any other advanced nation.
Remember, Obamacare is run by PRIVATE INSURERS. Also, there are no cost controls or pricing controls. We have no negotiating power when it comes to pricing for healthcare products and services. Competition through the years has done nothing to keep pricing in ALL aspects of healthcare from rising substantially.
And U.S. healthcare costs are the biggest threat to GDP growth - not corporate tax rates. Back in the 1960s corporate taxes were about 4% of GDP. Now they are about 2%. By contrast, healthcare costs have ballooned and neither Party is addressing the multitude of underlying cost issues. 50 years ago healthcare was about 5% of U.S. GDP, and now it is over 17% and growing. Germany's healthcare costs stand about 11% of GDP, Japan 10%, Britain 9%, China 5.5%. And compared to all these other countries the speed at which the healthcare costs have risen in the U.S. in the last 20-30 years is significantly faster - at least 5 times faster - than any other advanced nation.
Remember, Obamacare is run by PRIVATE INSURERS. Also, there are no cost controls or pricing controls. We have no negotiating power when it comes to pricing for healthcare products and services. Competition through the years has done nothing to keep pricing in ALL aspects of healthcare from rising substantially.
11
Imagine the great political 'victory' Mr. Trump could enjoy if he were able to preside over such a sensible move to address the short term challenges of the health insurance market. Why it would be the ultimate deal. Instead he will likely continue the scorched earth policy of attempting to obliterate the legacy of Barrack Obama. Pity.
5
At last some bipartisan cooperation instead of polarization. It's not perfect but at least it's the beginning of a fix. I still say that one way, perhaps the only way, to really bring down costs is to have a public option, Medicare for all if you will, supplemented by reinsurance plans offered by private carriers to those who want and can afford it. Please Congress, start studying the various health care systems in other countries, get experts to do the cost analyses and pick the one you like best.
6
These are NOT fixes !
They, like Obamacare do nothing to reduce the costs of heath care.
Insurance isn't high...the problem is US health care spending is too high.
The easy answer is in the article....but the authors and politicans do not want to address the problem.
5% of people are 50% of the costs.
Be a leader and fix the problem.
They, like Obamacare do nothing to reduce the costs of heath care.
Insurance isn't high...the problem is US health care spending is too high.
The easy answer is in the article....but the authors and politicans do not want to address the problem.
5% of people are 50% of the costs.
Be a leader and fix the problem.
2
Euthanasia was the solution for another country in the 1930's as I recall.
Are you suggesting we institutionalize it here in the US?
Are you suggesting we institutionalize it here in the US?
1
Yeah, just shoot the 5%.
Euthanasia was the solution for another country in the 1930's as I recall.
1
"Ultimately, everyone had to give a little and endorse provisions that purists in both our parties may not like. This is how American democracy is supposed to work, even if it has not for quite some time"
The Problem Solvers Caucus is a good start to addressing all problems, including the healthcare system. I offer further challenge to the group: Expand your membership by enlisting more of the 435 members of the House. Encourage the Senate to form a similar alliance of those who have right, clear intention: Intention to solve problems that affect the citizens you represent, not the just the wealthy few. Re-ignite the spirit of true progress and the underpinnings of our democracy, messy as it can be.
The Problem Solvers Caucus is a good start to addressing all problems, including the healthcare system. I offer further challenge to the group: Expand your membership by enlisting more of the 435 members of the House. Encourage the Senate to form a similar alliance of those who have right, clear intention: Intention to solve problems that affect the citizens you represent, not the just the wealthy few. Re-ignite the spirit of true progress and the underpinnings of our democracy, messy as it can be.
6
There's much talk about Trump's approval ratings. Congressional approval ratings are at about 15%, less than half of what Trump's is.
Perhaps House Problem Solvers Caucus can help change the tide. The job of the elected officials is to work to solve the problems facing the country and not to bicker and score points against the other party.
It should be obvious that healthcare and many other issues are not Democratic or Republican issues. It affects the country as a whole and a joint effort is needed to find lasting solutions to healthcare and other issues.
Bipartisanship should not be a dirty word and elected official should strive to be bipartisan after the election is over.
It is great that you two gentlemen and some of your colleagues are trying. Let's hope it's contagious.
Perhaps House Problem Solvers Caucus can help change the tide. The job of the elected officials is to work to solve the problems facing the country and not to bicker and score points against the other party.
It should be obvious that healthcare and many other issues are not Democratic or Republican issues. It affects the country as a whole and a joint effort is needed to find lasting solutions to healthcare and other issues.
Bipartisanship should not be a dirty word and elected official should strive to be bipartisan after the election is over.
It is great that you two gentlemen and some of your colleagues are trying. Let's hope it's contagious.
9
This is a good temporary fix. I agree with Mark Kottler. We need to fix the delivery system and healthcare administration system. The goal should be a 50% reduction of cost in terms of GDP in five years.
And what modeling underlies your goals? Let me guess, nice round numbers that sound good? A fleeting comparison to another country with a different system? Uh huh.
RE: Employer mandate. Have lawmakers considered the tax hike that would hit all those thrown off their employer-sponsored insurance? The self-employed can deduct their premiums, but those who work for employers who offer no health insurance cannot. So not only would middle class individuals and families face much higher premiums and deductibles, but they would be subject to a major tax hike as well - furthering the erosion of the middle.
3
"Our plan would stabilize markets by making the cost-sharing payments mandatory"
First, I applaud the bipartisan effort of the Problem Solvers Caucus to stabilize the insurance markets. A first step in a long road back to civility and a productive Congress.
With your efforts the Administration just may back off their position to de-stabilize markets. Just as they did when Congress overwhelming voted for sanctions on Russia.
Good luck, and it's refreshing to read articles like this. There is light in the tunnel, a flicker, but light!
First, I applaud the bipartisan effort of the Problem Solvers Caucus to stabilize the insurance markets. A first step in a long road back to civility and a productive Congress.
With your efforts the Administration just may back off their position to de-stabilize markets. Just as they did when Congress overwhelming voted for sanctions on Russia.
Good luck, and it's refreshing to read articles like this. There is light in the tunnel, a flicker, but light!
8
McConnell is being downright disingenuous in that the very premise of the healthcare bill he keeps repeating is an out and out lie. The ACA, "Obamacare" is not collapsing. It is not failing. Whatever difficulties the program is having is entirely due to deliberate brazen GOP sabotage efforts- both by refusing the Medicare expansion, and by destabilizing the insurance markets through Trump's threats, and the AHCA legislation.
14
It's a good start. What about doing something about prescription drug prices???
6
We cannot fix the failing health care system yet! We have to improve ourselves first!
The politicians in Washington D.C. are not the source of the problem. We are! We have sent them over there, haven’t we?
We are fooling ourselves. We are just imagining that the Obamacare and the Affordable Care Act exist. They don’t exist!
See, when LeBron James endorses some product, that’s not HIS product. He is just advertising it! The same happened with president Obama. He didn’t create the ACA, he just signed or endorsed it.
The law as any other recent legislative act in America wasn’t written by the White House or the Congress. It was written by the lobbyists and the special interests to protect THEIR INTERESTS.
As such, the law resulted in the health care system that is two times more expensive per capita than in the other developed countries, so such a law cannot be called AFFORDABLE CARE ACT but just the SPECIAL INTEREST CARE or as acronym SIC.
Now, don’t think for a single second that if the federal government is currently subsidizing it that you are somehow better off because of that.
That’s just a credit line and all of us will be worse off in the long term. We will not pay just the principle back but all the interests accumulated on that credit line too!
Remember, when you take a loan, you make the lenders wealthier!
The politicians in Washington D.C. are not the source of the problem. We are! We have sent them over there, haven’t we?
We are fooling ourselves. We are just imagining that the Obamacare and the Affordable Care Act exist. They don’t exist!
See, when LeBron James endorses some product, that’s not HIS product. He is just advertising it! The same happened with president Obama. He didn’t create the ACA, he just signed or endorsed it.
The law as any other recent legislative act in America wasn’t written by the White House or the Congress. It was written by the lobbyists and the special interests to protect THEIR INTERESTS.
As such, the law resulted in the health care system that is two times more expensive per capita than in the other developed countries, so such a law cannot be called AFFORDABLE CARE ACT but just the SPECIAL INTEREST CARE or as acronym SIC.
Now, don’t think for a single second that if the federal government is currently subsidizing it that you are somehow better off because of that.
That’s just a credit line and all of us will be worse off in the long term. We will not pay just the principle back but all the interests accumulated on that credit line too!
Remember, when you take a loan, you make the lenders wealthier!
1
You guys missed the boat. Beside the obvious inclusion of a government option, insurance should pay for in-office doctor visits with a reasonable copay before the deductible kicks in. I used to pay $30 to see any doctor I wanted. I would gladly pay a $50 copay for a consultation. Now, I'm forced to pay the full amount until the deductible is met. That could easily be over $300 for a specialist. I don't go.
These huge deductibles cause us to avoid going. That's bad. It's going to cause serious conditions to worsen, which is even more expensive.
We pay for insurance. We should be able to go to the doctor.
These huge deductibles cause us to avoid going. That's bad. It's going to cause serious conditions to worsen, which is even more expensive.
We pay for insurance. We should be able to go to the doctor.
11
Lower your deductible and your premium will go up. The rationing you describe keeps down healthcare costs on average as people have skin in the game. Bad idea.
DRS,
Please tell me how having a $6000 deductible is not having skin in the game?
Please tell me how having a $6000 deductible is not having skin in the game?
1
@Bruce - a $6000 deductible is skin in the game and therefore entirely appropriate. Exempting office visits from said deductible would encourage overuse and defeat the purpose.
I'm glad to see a sensible proposal, even if it is just a bandaid. However, politicians really need to be held responsible for addressing the real problem: US Healthcare is too expensive and the quality is too low. I work in healthcare quality improvement in the Texas Medical Center where we are trying to lower costs, improve access, and improve quality. However, that is difficult to do when almost every incentive in our "system" rewards expensive, low quality care, and when we have decades of politicians ignoring the social and economic factors that contribute to unhealthy conditions and behaviors in our communities. So while I appreciate the bandaid, please work on these other issues. Of course, both parties would need to start with real data and facts instead of making things up and pointing fingers.
9
Single Payer is the solution. Medicare for all will save trillions of dollars and provide better care for millions o Americans.
5
I'm sorry, but it's not just the cost of services, drugs, and hospital stays that are the problem. It is also that the delivery system is broken. Our group medical practices and hospitals are terribly mismanaged. What ever happened to the family doctor? Why is there many pay scales for the same diagnosis and treatment?
3
@Mark Kottler Boca Raton, Florida
They're not terribly mismanaged. Most of them are in the business of making money and most are rather good at it including those calling themselves non profits. The family doctor disappeared because it was an economically inefficient model that society couldn't afford.
They're not terribly mismanaged. Most of them are in the business of making money and most are rather good at it including those calling themselves non profits. The family doctor disappeared because it was an economically inefficient model that society couldn't afford.
2
Yes, a short-term fix is needed, especially for the "individual" market. But, think about that for a second. You are an "individual" in this context if you happen to not work for an employer who can offer you health insurance. There are a LOT of "individuals" in this predicament, and not just the less well off. "Cobra" and "Obamacare" policies for individuals are the only short-term answer, but it remains so obvious that universal health care insurance for all citizens, employed or not, is the real answer. And yes, once we have a universal system in our country, as in all other advanced democracies (note: not "socialist" states"), the private insurance companies contracted to administer the national insurance system will make only a reasonable, regulated profit. And yes, the prices paid for health services and to health providers will also tend to come down, again with reasonable profit margins built in for the providers (virtually all of which are private sector hospitals, medical practices, pharmaceutical companies, etc.). Final outcomes: (1) everyone is insured; (2) costs come down; (3) the private sector still provides the services and makes money; and (4) we have not become a "socialist" country (the ultimate canard that those opposing national health insurance always drag out).
How many times do I have to write this? As long as it takes before it sinks in.
How many times do I have to write this? As long as it takes before it sinks in.
269
And, for those who will come back with the argument that national health insurance will mean a lot higher taxes to pay for it, please do your own calculations comparing what your increased taxes may indeed be, but vs. what you are now paying for your health insurance. If you are an individual, my bet is that you will come out even at worst. If you are employed, maybe you will end up paying more. If you are an employer, you will almost definitely come out ahead, no longer being required or offering to partially pay for your employees' health insurance. And, for all of us, there will be a net reduction in total costs due to savings via the regulated private insurance administration profit margins.
Maybe single payor will work in theory and the US will continue to be the leading innovator in medical research and treatments but your confidence in "the private insurance companies contracted to administer the national insurance system will make only a reasonable, regulated profit" is naive. We will end up with a new generation of federal, unionized employees with great benefits, short hours and questionable work motivation, supported by higher taxes on the employed.
But when 49% of the children born in this country are covered by Medicaid now we are headed for universal healthcare in any event because who doesn't like " free" when it is paid for by "other people's money"
But when 49% of the children born in this country are covered by Medicaid now we are headed for universal healthcare in any event because who doesn't like " free" when it is paid for by "other people's money"
1
"The Constitution of the Russian Federation has provided all citizens the right to free healthcare since 1996."
What you propose is a bit like the Swiss system except the private insurers may make NO profit on the basic required plan in Switzerland. They cover everyone and get better results than we do, but no better than other European countries.
BUT while we pay about 38% more per person than the Swiss do for health care, Switzerland pays 83% more than the average of other developed countries and 53% more than France which is ranked number 1 by WHO. (figures from OECD)
There are just more efficient systems than the private public hybrid you propose.
What you propose is a bit like the Swiss system except the private insurers may make NO profit on the basic required plan in Switzerland. They cover everyone and get better results than we do, but no better than other European countries.
BUT while we pay about 38% more per person than the Swiss do for health care, Switzerland pays 83% more than the average of other developed countries and 53% more than France which is ranked number 1 by WHO. (figures from OECD)
There are just more efficient systems than the private public hybrid you propose.
2
I like this approach which is pragmatic. I reject the premise that it represents a departure from partisan bickering. The republicans have been engage in a solitary effort to destroy the Affordable Care Act. There have been no public hearings and no discussion with democrats. And, despite erroneous statements to the contrary, when a democratic administration and Congress passed the ACA, there were months of public hearings and months of public discussions with republicans. At a point, the republicans retreated from those discussions, but democrats never shut the republicans out.
7
Joe S. is absolutely correct, and I'd like to add another fact that is intentionally overlooked by Republicans: to court the moderate votes and make the plan politically viable, the ACA was structured around conservative, Republican market-based principles. It's ironic that the shortcomings of the ACA are because of the attempt to use Republican free-market ideas, yet the Republicans blame the problems on "government takeover", when a single-payer, Medicare-For-All plan would have been far, far better.
Republicans had more than ample opportunity to participate, especially since the ACA was from its inception a compromise designed with their own ideas. But no, Mitch McConnell in a campaign tantamount to treason, whipped his party into line, bullying them to oppose any plans that might help the country in any way during Obama's tenure. That included a war against the ACA, dishonestly calling it a "government takeover of health care", and manufacturing countless lies about it.
Republicans had more than ample opportunity to participate, especially since the ACA was from its inception a compromise designed with their own ideas. But no, Mitch McConnell in a campaign tantamount to treason, whipped his party into line, bullying them to oppose any plans that might help the country in any way during Obama's tenure. That included a war against the ACA, dishonestly calling it a "government takeover of health care", and manufacturing countless lies about it.
There are some ideas there, but the plan does not address the biggest cost driver of all: fee for service.
6
You are absolutely correct. As long as doctors, hospitals, drug companies and the other health care providers continue to be primarily motivated by the desire to increase profits, the American public will continue to experience inefficiencies and unreasonably escalating costs.
I am in NY, one of the sanctuary city, if there is no mechanism in checking for the widespread abuse of Medicaid, the cost is continue to rise and we will continue to pay. Tourist comes to NY to enjoy our healthcare and leave us with the bill. How is it fair?
2
I had one of those days yesterday. I got to explain to an unreceptive provider that I do understand my insurance policy and the services they provided should have been covered at 100%. As usual the provider was sure they were right to the point of being demeaning and dismissive. But I persisted and insisted the provider go to the online benefits tab for my insurance. Guess who was right? No apology was offered for what I had to go through to get to that point. My claim is now being sent to another department to try and figure out what they did wrong... I am sure I will spend another couple hours on this issue.
Americans not only pay too much for their insurance, have reduced medical results and higher costs, we also spend way too much time with gatekeepers. We have to fight for every service and question every out-of-pocket cost. When families should be focusing on the health of a loved one, they have to expend energy and time on approvals and finances instead.
ACA is better than no healthcare system but let's stop wasting energy and look at successful healthcare systems around the world and pick one!!
Americans not only pay too much for their insurance, have reduced medical results and higher costs, we also spend way too much time with gatekeepers. We have to fight for every service and question every out-of-pocket cost. When families should be focusing on the health of a loved one, they have to expend energy and time on approvals and finances instead.
ACA is better than no healthcare system but let's stop wasting energy and look at successful healthcare systems around the world and pick one!!
22
When the group speaks of families losing coverage, they are absolutely right. It can't be the subsidized exchange buyers they are referring to: 80% of that group get their premiums, deductibles and co-pays largely covered by the government under the ACA. Rather, it is the 3% of the population who have to buy on the individual market without subsidy who are dropping coverage in droves because of the tripling of their premiums/deductibles since pre-ACA. All the rest of us get coverage subsidized by the federal government and were unscathed by the ACA. The underlying cause is the single risk pool dictated by the ACA for the entire individual market in an effort to have the healthier non-subsidized buyers support the premiums for the less healthy subsidized group (actually, to reduce the ACA direct premium support from the gov.) This might work in a balanced market, but the total individual market is not balanced.There is a gross imbalance in size and cost between the two groups. The subsidized group is 78% of that market, and appears to have about three times the per capita health care costs of the non-subsidized group. This means that every non-subsidized family must bear its own costs plus a share of the costs of four more expensive families. Covering the government's cost-sharing obligation will help keep the premiums from going up even more, but it will not attack the underlying cause of the tripling in costs, which will continue to increase.
1
Correction: the ACA created the subsidized market, so it is incorrect to say that you were "unscathed" by the ACA. You likely have insurance because of the ACA, unless you were on Medicaid or Medicare before the ACA. I continue to be amazed how the beneficiaries of the ACA seem oblivious to the help it provides. Pre ACA, we only had Medicaid for the very poor, Medicare for the old, employer group coverage for most workers, and a very expensive and unpredictable (and sometimes completely unavailable) private insurance market for individuals. Amazing how history is so quickly forgotten.
2
"unscathed" means not hurt.
Until we find the political will to address the root causes of the much higher health care costs in the US than those in other high-income developed countries for similar overall outcomes, then any fixes will only be half measures. Those extra costs, as everyone knows by now, go to the profits for certain segments of the industry - insurance companies, drug companies, hospitals, and physicians - to varying degrees.
The question is do we accept that those segments should continue to have higher profits that greatly increase the overall costs of our health care system or come up with the fix that lowers those profits to enable a universal health care system (can include private industry as it does in other countries with lower costs) that costs less and is sustainable over the long term.
That fix requires political courage, but it is the approach needed to greatly lower costs. It also requires push-back against the big money ideological interests who oppose any health care systems partly run or regulated by state and/or federal government because they want to keep their slices of the pie as large as possible.
These are the core problems that need to be addressed to lower costs to levels comparable to those of other developed countries that have similar outcomes overall. Spend more on higher profits for certain segments of the industry or lower the overall costs of the entire system for all people - that is the trade-off. We know where we are now.
The question is do we accept that those segments should continue to have higher profits that greatly increase the overall costs of our health care system or come up with the fix that lowers those profits to enable a universal health care system (can include private industry as it does in other countries with lower costs) that costs less and is sustainable over the long term.
That fix requires political courage, but it is the approach needed to greatly lower costs. It also requires push-back against the big money ideological interests who oppose any health care systems partly run or regulated by state and/or federal government because they want to keep their slices of the pie as large as possible.
These are the core problems that need to be addressed to lower costs to levels comparable to those of other developed countries that have similar outcomes overall. Spend more on higher profits for certain segments of the industry or lower the overall costs of the entire system for all people - that is the trade-off. We know where we are now.
11
It’s been said that the definition of a committee is “12 stomachs and no brain.”
The fundamental problem that any functional reform must deal with is that health care services do NOT respond to normal market expectations.
When deciding life and death issues depending upon perfectly informed patients with consumer sovereignty to decide between multiple available substitute treatments available from numerous providers, none of which has monopoly power is a Fool’s Errand.
Or as Nobel laureate economist Kenneth Arrow explained that health services are a special case: "The failure of the market ... has created [health care] institutions in which the usual assumptions of the market ... are contradicted." That’s Economese for "Markets" don't work for health services.
Get over yourselves and roll out Medicare-for-all over the next few years.
The fundamental problem that any functional reform must deal with is that health care services do NOT respond to normal market expectations.
When deciding life and death issues depending upon perfectly informed patients with consumer sovereignty to decide between multiple available substitute treatments available from numerous providers, none of which has monopoly power is a Fool’s Errand.
Or as Nobel laureate economist Kenneth Arrow explained that health services are a special case: "The failure of the market ... has created [health care] institutions in which the usual assumptions of the market ... are contradicted." That’s Economese for "Markets" don't work for health services.
Get over yourselves and roll out Medicare-for-all over the next few years.
13
While laudable, I do not think their proposal goes far enough. A single payer health insurance program would.
17
And anyone who thinks a single payer plan will be accepted in America any time soon is delusional.
And there it is. They way to fix ACA, more spending.
Of course, and that spending is constructive. The father of modern capitalism Adam Smith (in "The Wealth of Nations") stated that free-market capitalism can flourish only with essential government institutions, and to fund these he proposed a progressive tax system.
Your knee-jerk reaction to spending is not helpful.
Your knee-jerk reaction to spending is not helpful.
1
Really? ACA is going to cost $2T incremental over 10 years. (from 2015 CBO estimate) Now your solution is just more taxpayer money thrown at it? I think you need to reevaluate who is 'not being helpful'.
Money WILL be spent on healthcare, and the issue is whether that money will be administered via taxation and a national program or via private insurance and payments. The rest of the developed world follows Smith's prescription and gets a better result at substantially less cost than the US.
1