I keep hoping that in my lifetime, I'm approaching 70 yrs. old, someone will write a piece on what Senator Mitch McConnell did the day after Barack Obama got elected president of the United States, the first time. He brought the members of the Republican Congress together and told them, from that day forward, they were to vote 'no' to everything Obama put on the table. How in the world did this not have lingering after-effects on Obamacare that last till this day?
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If single payer health insurance came about in the USA, think how much power big companies and major corporations would lose over their employees. These workers often put up with a lot to keep that health insurance package.
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Ask your doctor whether bipartisanship is right for you.
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Two comments - Wilbray Thiffault, Ottawa and Pat, Somewhere - tell us what is still missing in the discussion of the ACA as presented in the Times, a presentation of UHC as practiced in advanced countries.
Wilbray: "It will be a pleasure to show to your Senators and Congressmen how the Canadian Health Care System works… this is not that complicated. Even Donald Trump will be able to understand it."
Pat: "If only we had EXAMPLES of systems in other countries that cover everyone at less cost and with greater efficiency."
The Times leaves it to us commenters to provide examples. Here is one, 522 characters.
2007 chest discomfort when running, age 75
Diagnosis: Stunned myocardium, intervention needed
January 2008, “kallelse” from Linköping University Hospital: Come to cardiology, 26 January. I check in, 100 SEK ($12 USD). The next day 2 stents put in LADA. Must return in March for one more.
13 March 2008 stent put in circumflex – artery closed with Starclose clip – interventionist: "Larry you can start skiing in a week." I did!
Cost ZERO.
Now 2017 age 85 still running – slowly – not one incident of discomfort and no pain from medical bills.
I could tell more stories but there in a nutshell is Swedish UHC.
Your turn New York Times Health
Only-NeverInSweden.blogspot.com
Dual citizen US SE
Wilbray: "It will be a pleasure to show to your Senators and Congressmen how the Canadian Health Care System works… this is not that complicated. Even Donald Trump will be able to understand it."
Pat: "If only we had EXAMPLES of systems in other countries that cover everyone at less cost and with greater efficiency."
The Times leaves it to us commenters to provide examples. Here is one, 522 characters.
2007 chest discomfort when running, age 75
Diagnosis: Stunned myocardium, intervention needed
January 2008, “kallelse” from Linköping University Hospital: Come to cardiology, 26 January. I check in, 100 SEK ($12 USD). The next day 2 stents put in LADA. Must return in March for one more.
13 March 2008 stent put in circumflex – artery closed with Starclose clip – interventionist: "Larry you can start skiing in a week." I did!
Cost ZERO.
Now 2017 age 85 still running – slowly – not one incident of discomfort and no pain from medical bills.
I could tell more stories but there in a nutshell is Swedish UHC.
Your turn New York Times Health
Only-NeverInSweden.blogspot.com
Dual citizen US SE
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@Larry Lundgren you are awesome! Thanks for sharing a clear example of how other countries are doing healthcare way better than the US.
p.s. I hope you keep running and please post an update at 95 :)
p.s. I hope you keep running and please post an update at 95 :)
What if the best health care reform would require tax reform? I suspect no one in Congress wants to hear it.
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Hi Margot--
With the surname Patch, I really believe that we as an English-speaking nation need to come up with another, less demeaning word.
It does disservice to Sam Patch, my great-great-plus uncle who was the famous, first survivor of jumping Niagara Falls barefoot in 1829. As an example of his popularity, Andrew Jackson named one of his favorite horses after him.
Best,
--Keith
@KeithDPatch
With the surname Patch, I really believe that we as an English-speaking nation need to come up with another, less demeaning word.
It does disservice to Sam Patch, my great-great-plus uncle who was the famous, first survivor of jumping Niagara Falls barefoot in 1829. As an example of his popularity, Andrew Jackson named one of his favorite horses after him.
Best,
--Keith
@KeithDPatch
Where in the rules of Congress or The Constitution is it written that all bills can only be passed by "a majority of the majority"?
Both The Constitution and the written rules of Congress presume that all legislation will ultimately be bi-partisan, or simpler still, Congress listening to the Sovereign (We-the-People) in making legislative decisions.
Now it seems that bi-partisanship is some form of political treason and that if one party has to work with, instead of against, the other party it is a failure.
In my thinking there is just too much money attached to the handful of big donors that elected officials listen to exclusively. Add in Gerrymandering and we have exactly the conditions that the founders wanted to avoid. A legislature owned by the wealthy and "Rotten-Districts" where there is virtually no competition for elective office.
Both The Constitution and the written rules of Congress presume that all legislation will ultimately be bi-partisan, or simpler still, Congress listening to the Sovereign (We-the-People) in making legislative decisions.
Now it seems that bi-partisanship is some form of political treason and that if one party has to work with, instead of against, the other party it is a failure.
In my thinking there is just too much money attached to the handful of big donors that elected officials listen to exclusively. Add in Gerrymandering and we have exactly the conditions that the founders wanted to avoid. A legislature owned by the wealthy and "Rotten-Districts" where there is virtually no competition for elective office.
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"Both The Constitution and the written rules of Congress presume that all legislation will ultimately be bi-partisan,"
Actually the Constitution says nothing bi-partisanship, for the simple reason that it did not foresee political parties. The Founders thought the big conflicts would be between branches of the government and even invented the check-and-balance system. to harness the conflicts. Nothing was done to keep political parties from doing damage.
Actually the Constitution says nothing bi-partisanship, for the simple reason that it did not foresee political parties. The Founders thought the big conflicts would be between branches of the government and even invented the check-and-balance system. to harness the conflicts. Nothing was done to keep political parties from doing damage.
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I agree, The Constitution did not envision political parties. However, the rules for both the House and Senate do recognize that political parties exist. Yet those rules do, at least, aspire to a focus on the needs of the nation as opposed to the demands of the political party.
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Illness is bipartisan. So are accidents, death, dismemberment, and the need for medical care. If our politicians don't comprehend that perhaps they need to walk around outside of their rarefied state capitols, our nation's capitol, and in places where the rest of us live, work and relax. A visit to some hospitals, nursing homes, and clinics could be a good idea too.
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Single payer is the only proven answer. How long will it take these hacks to understand this?
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I hope not. I really like my employer provided insurance. It's one of the reasons I decided to work with this organization.
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Yes, but you are riding on the backs of thousands of other Americans who are unable to access such insurance. There is NO logical reason for employers to be providing health insurance. It is costly and complicated, and the practice arose as a way around wage and price controls post-WWII.
It is unfortunate that the title of the post has such a negative connotation, when in fact, work to improve and shore up Obamacare represents a victory for reason and compassion.
A more accurate title for the post might have been "Delusions of replacing the ACA with something cheaper for both taxpayers AND working families have succumbed to reality"
A more accurate title for the post might have been "Delusions of replacing the ACA with something cheaper for both taxpayers AND working families have succumbed to reality"
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We all need to have access to medical care no matter what we earn, where we live, or how healthy we are now. The problem with the ACA is that it gave too much to the health insurance industry and very little to the patients. We are often paying large sums of money for plans that don't do much for us until we meet a very high deductible. That alone prevents many patients from going to the doctor before a problem becomes serious. The ACA placed no caps on what the various players in our "health care" system are allowed to charge us. We are still doing our own wallet biopsies before we go to any health care provider.
The fact is that America does a lousy job when it comes to any sort of medical or dental care for patients. Hookworm is resurgent as a problem. We are losing too many women during and right after childbirth. Too many Americans cannot afford regular dental care. There are too many places where medical care is not available. We are a first world country with a third rate health care system. It's easier for us to get medical care for our pets than for ourselves.
McCain and Scalise will never have to worry about bankruptcy while they get the best care possible. Why shouldn't it be that way for us too? Other countries do take care of their citizens with a mix of taxes on income, value added taxes on certain items, and more. Only in America are people forced to choose between health care, food, shelter, and medication.
The fact is that America does a lousy job when it comes to any sort of medical or dental care for patients. Hookworm is resurgent as a problem. We are losing too many women during and right after childbirth. Too many Americans cannot afford regular dental care. There are too many places where medical care is not available. We are a first world country with a third rate health care system. It's easier for us to get medical care for our pets than for ourselves.
McCain and Scalise will never have to worry about bankruptcy while they get the best care possible. Why shouldn't it be that way for us too? Other countries do take care of their citizens with a mix of taxes on income, value added taxes on certain items, and more. Only in America are people forced to choose between health care, food, shelter, and medication.
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I'm trying to follow what you're saying, and agree with most of it, but I'm confused about your statement regarding pet health care. How exactly is it easier to for us to get medical care for our pets than for us (or our children)? I've had pets, and it seems to me that you're on your own when seeking care for them. At least my health insurance company has someone to cal lwhan I need assistance.
Trump and his gang of misfit Republicans can't get anything passed. They are a laughingstock. Holding majorities in both House of Congress and the presidency, and what do Republicans have to show for it: bupkis. The only thing that got accomplished today was when Trump played Ryan and McConnell for the chumps they are and worked a "deal" with the dreaded Pelosi and Schumer. As a lifelong Dem I love it. Trump is a joke and jerk and now he has to play ball with Dems of all people to get anything done. Is this what Trumpists thought "winning" would look like? Chumps indeed.
DD
Manhattan
DD
Manhattan
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With these guys in office, I keep praying for "bupkis". So far, so good.
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Republicans got their clocks cleaned yesterday, and that's just the beginning. Political veterans Pelosi and Schumer have got Trump's number, and they know what to do to get what they want. Unlike Ryan and McConnell they have the ability to line up their troops and deliver the votes. Republicans made an awful deal with the devil when they nominated Trump. They don't yet know how bad it is going to get, but it is coming.
DD
Manhattan
DD
Manhattan
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I don't see anything here that will help the real victims of the ACA: the 2-3% of the population forced to buy their insurance on the individual market without subsidy. Their costs have tripled under the ACA, and they are being priced out of the market. The other 97% are eligible for federal subsidies when they buy their insurance, and were largely unharmed by the ACA. Only the 3% are heavily penalized, in an effort to make them subsidize the premiums of the less healthy ACA subsidy-eligible group with whom they are lumped in the single risk pool dictated by the ACA. Enrollment data shows that they are rapidly dropping coverage, and becoming the "new uninsured."
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Bravo! Well stated.
Even those who laud the success of Obamacare programs note that best examples of ACA success are programs offered by companies specializing in serving the Medicaid population. Limited choice and limited access for full fees is a lousy deal. We were tossed under the bus.
Even those who laud the success of Obamacare programs note that best examples of ACA success are programs offered by companies specializing in serving the Medicaid population. Limited choice and limited access for full fees is a lousy deal. We were tossed under the bus.
This provocative article illuminates the real thorny issues inherent in reforming its health care. It puts the tragic involvement of the president in very clear perspective.
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Another option for affordable dependable health care for families and individuals is the fast-growing healthcare sharing ministry programs like Christian-based Liberty HealthShare, and Catholic-based Solidarity HealthShare. Ministry sharing programs like these are recognized and classified by the ACA as 501c3 non-profit, and unlike traditional health insurance, are exempt from State Insurance laws and ‘individual mandate’ requirements. Innovative programs where responsible Christian families and individuals, or organized denominations holding common ethical/religious beliefs, pay very low monthly rates & deductibles -medical guidance is provided, and funds are pooled then shared for medical expenses via advanced well-coordinated electronic payment process. Rates are unbeatable due to low admin costs ---not like commercial insurers paying skyrocketing HMO executive salaries! And members can see any hospital or doctor they choose, and in my opinion overall more attractive than Insurance Exchange Marketplace plans - check it out!
Unless Democrats gain control of the House, way off in 2018-19, only the barest minimum will happen to maintain the Affordable Care Act. And dirty tricks will abound. Let's be real. Even without Trump's participation, Republican legislators have made this mess and will continue to seek ways to undermine the ACA and enable backward states to strip it's effectiveness. Enough with the notion bipartisanship will emerge in any meaningful way.
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And what exactly will Democrates do? They alone created Obamacare.
Required Results of New Healthcare Act:
One: Expand the number of people covered, beginning with children, veterans, and the poor.
Two: Do not reduce the benefits of any person now eligible.
Three: Do not increase the costs to any person now covered.
Four: Pre-existing conditions covered.
Five: U. S. Government to negotiate drug, device, and service prices.
Six: U.S. Government to allow purchasing drugs and devices from foreign sources.
Seven: Companies that drop participation are not allowed to have any U.S. Government business. https://www.theatlantic.com/health/archive/2017/05/why-so-many-insurers-...
Eight: Elected officials have the same coverage as ordinary Americans.
Nine: Preventive Life Style screenings with first visit of a calendar year
Ten: “Smart” electronic medical records (EMR)
Eleven: No restrictions of funding for Planned Parenthood
Twelve: Better policy on the disposition of “expired”, but still safe and effective drugs.
Thirteen: Mandatory reporting of fraud by all healthcare employees.
One approach would be Medicare/ Medicaid for all Americans.
https://en.m.wikipedia.org/wiki/Single-payer_healthcare
One: Expand the number of people covered, beginning with children, veterans, and the poor.
Two: Do not reduce the benefits of any person now eligible.
Three: Do not increase the costs to any person now covered.
Four: Pre-existing conditions covered.
Five: U. S. Government to negotiate drug, device, and service prices.
Six: U.S. Government to allow purchasing drugs and devices from foreign sources.
Seven: Companies that drop participation are not allowed to have any U.S. Government business. https://www.theatlantic.com/health/archive/2017/05/why-so-many-insurers-...
Eight: Elected officials have the same coverage as ordinary Americans.
Nine: Preventive Life Style screenings with first visit of a calendar year
Ten: “Smart” electronic medical records (EMR)
Eleven: No restrictions of funding for Planned Parenthood
Twelve: Better policy on the disposition of “expired”, but still safe and effective drugs.
Thirteen: Mandatory reporting of fraud by all healthcare employees.
One approach would be Medicare/ Medicaid for all Americans.
https://en.m.wikipedia.org/wiki/Single-payer_healthcare
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Send this comment on to Reps and Sens.
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A few republican senators/reps are looking out for their own survival and not losing ACA for their people so they are more ready to compromise.
Don't look for anything groundbreaking from this group, other than a quick fix to save ACA in the short term.
The dogma addict Sen Paul is the biggest hypocrite among the group. His state Ky., routining leads, near the top in gov't welfare handouts including one of the highest percentages of ACA members but yet he is religiously driven to end all these programs.
It is baffling. It's like the old joke, a famous comic said back in prohibition. The voters of a certain dry state would give their lives up to fight for the right to go to the polls stone drunk to vote for prohibition.
Don't look for anything groundbreaking from this group, other than a quick fix to save ACA in the short term.
The dogma addict Sen Paul is the biggest hypocrite among the group. His state Ky., routining leads, near the top in gov't welfare handouts including one of the highest percentages of ACA members but yet he is religiously driven to end all these programs.
It is baffling. It's like the old joke, a famous comic said back in prohibition. The voters of a certain dry state would give their lives up to fight for the right to go to the polls stone drunk to vote for prohibition.
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Obamacare is crushing the middle class buyers with no subsidies! I am paying pediatric dental premiums built in and I have no kids. The people who get a free ride may like it but for the rest of us it is spiraling out of control! Fix it now!
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Thanks for your comment. As a freelancer, I buy my own insurance. My premiums have increased 22% two years in a row, while my deductibles have gone up by $1500. This is getting a little scary. I don't know if I'll actually be able to afford health insurance in another two years.
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We're subsidizing a lucrative industry to motivate them to sell a flawed product (high deductible, high out-of-pocket silver plans) to poor people. It's no wonder that our health care system is the laughing stock of the developed world.
Calling the subsidies "market stabilization payments" or "cost sharing reductions" doesn't make us look any less silly - or change the fact that this is corporate welfare for a sector that redistributes huge amounts of wealth upward.
Calling the subsidies "market stabilization payments" or "cost sharing reductions" doesn't make us look any less silly - or change the fact that this is corporate welfare for a sector that redistributes huge amounts of wealth upward.
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Although conservatives will howl, another option is to expand a Medicare buy in option to those 55+ and a Medicaid buy in option for other eligible ACA members. The reality is that insurers have little interest in the ACA market (due to huge losses, uncertainties from day 1 re: regulatom, the bungled roll out, and a customer population base which is less healthy and older than predicted).
Both Medicare and Medicaid feature significantly lower provider payment rates than the relatively small ACA insurers could "negotiate" with the health system cartels that control much of US health care pricing. (They stipulate prices and don't need to negotiate with monopolistic health system cartels). Ironically, Medicaid offers much better access (list of providers), including major academic medical centers than does the more limited provider networks found in the ACA plans.
Propping up a failed (and many cases non-existent) ACA "market" versus using an effective, lower cost efficient public sector solution, which uses much lower provider payment rates and which has huge administrative and risk pooling scale (and efficiencies) makes a lot of sense. Approximately 25% of ACA members have only one insurer choice today, and that % will grow).
Time to acknowledge that a "competitive market" paradigm no longer works in a world dominated by monopolistic health system cartels and insurers.
Both Medicare and Medicaid feature significantly lower provider payment rates than the relatively small ACA insurers could "negotiate" with the health system cartels that control much of US health care pricing. (They stipulate prices and don't need to negotiate with monopolistic health system cartels). Ironically, Medicaid offers much better access (list of providers), including major academic medical centers than does the more limited provider networks found in the ACA plans.
Propping up a failed (and many cases non-existent) ACA "market" versus using an effective, lower cost efficient public sector solution, which uses much lower provider payment rates and which has huge administrative and risk pooling scale (and efficiencies) makes a lot of sense. Approximately 25% of ACA members have only one insurer choice today, and that % will grow).
Time to acknowledge that a "competitive market" paradigm no longer works in a world dominated by monopolistic health system cartels and insurers.
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I think the 55+ Medicare and Medicaid option could work as a baby-step effort toward universal payer healthcare (which I favor). But in the short run, it puts the major costs on the government (older, less healthy participants) and increases profits for private insurance companies (younger, healthier participants).
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Unfortunately, most of your claims simply aren't true. And considering that your native Pennsylvania narrowly went Trump and re-elected Pat Toomey, I am not at all sure how you intend to get any of this stuff done.
1
Having been a user of our health care system twice in recent years, it will be a pleasure to show to your Senators and Congressmen how the Canadian Health Care System works. And I may assure your politicians that this is not that complicated. Even Donald Trump will be able to understand it.
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It's all so complicated. If only we had examples of systems in other countries that cover everyone at less cost and with greater efficiency. If only we had a program that works pretty darn well for everyone currently in it that we could just expand.
Luckily the technology of the wheel is pretty much settled, otherwise imagine how much time Congress would have to spend on that.
Luckily the technology of the wheel is pretty much settled, otherwise imagine how much time Congress would have to spend on that.
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See Canada.
The Times' Margot Sanger-Katz claims that, "After years of partisan bickering about health reform, truly bipartisan hearings represent a change that could be more than ceremonial."
That statement begs the question of whether Ms Sanger-Katz was around in 2009 when congressional Democrats chaired months of bipartisan hearings on health reform that were anything but "ceremonial." Those hearings led the majority Democrats to adopt more than 150 proposals from Republicans that were incorporated into the ACA.
It is the Republicans who have refused to hold bipartisan hearings. And whether the Republicans, who desperately want to eliminate health insurance for tens of millions of Americans, really intend to listen to Democrats or their constituents is highly doubtful.
That statement begs the question of whether Ms Sanger-Katz was around in 2009 when congressional Democrats chaired months of bipartisan hearings on health reform that were anything but "ceremonial." Those hearings led the majority Democrats to adopt more than 150 proposals from Republicans that were incorporated into the ACA.
It is the Republicans who have refused to hold bipartisan hearings. And whether the Republicans, who desperately want to eliminate health insurance for tens of millions of Americans, really intend to listen to Democrats or their constituents is highly doubtful.
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The critical fix is to have effective and appropriate cost regulation.
Until we have that, our nonsystem of disease care will continue to hurt both patients and the economy.
Until we have that, our nonsystem of disease care will continue to hurt both patients and the economy.
8
If you are an optimist by nature, as I am, the best element in this article is the potential return to bipartisan law making through the give and take of open exchange of perspective and ideas. Fundamental to the effectiveness of future legislation is detailed analysis and ample consideration, even more so if members also decide to always put country over party! Let's encourage this step forward in the hope that Congress returns to their usual rules and committee process for other pending critical matters. Maybe moderates on both sides will get us on track regarding the debt ceiling, helping fix damage due Hurricane(s), a sensible federal budget, fairness for Dreamers, and protecting our constitutional system of checks and balances, to name only a few pending national issues.
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