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Old 03-13-2017, 09:51 PM
 
Location: Ohio
24,623 posts, read 19,105,746 times
Reputation: 21738

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Quote:
Originally Posted by gallowsCalibrator View Post
Seems this one has flown a bit under the radar with the GOP Healthcare bill getting all the spotlight, but a Democrat has put forth one as well. A system designed to give everyone insurance under the Medicare blanket.

You can read the contents of the bill here

I think Medicare's funding and how it's managed would need to be completely revamped to handle this kind of expansion. T'would be interesting to see the CBO's take on it.
(1) IN GENERAL.—There are appropriated to the Medicare For All Trust Fund amounts sufficient to carry out this Act from the following sources:
(A) Existing sources of Federal Government revenues for health care.
(B) Increasing personal income taxes on the top 5 percent income earners.
(C) Instituting a modest and progressive excise tax on payroll and self-employment income.
(D) Instituting a modest tax on unearned income.
(E) Instituting a small tax on stock and bond transactions.


As I've said many times, a 25.6% HI Payroll Tax would generate about $2.4 TRILLION, which is what is needed to cover current medical costs.



Medicaid is $545.1 Billion, so if government keeps funding it out of the General Fund, you could drop the HI Tax to 18% (9% each for employers and employees).


It's unlikely that a "small" tax on stock and bond transactions or a "modest" tax on unearned income would fly.



If personal income taxes on the top 5% of income earners does fly, it might generate up to $500 Billion annually, you could reduce the HI Payroll Tax to 12% (6% for employers and employees).


SEC. 401. Treatment of VA and IHS health programs.
(a) VA health programs.—This Act provides for health programs of the Department of Veterans’ Affairs to initially remain independent for the 10-year period that begins on the date of the establishment of the Medicare For All Program. After such 10-year period, the Congress shall reevaluate whether such programs shall remain independent or be integrated into the Medicare For All Program.


It might be tough getting support of veteran's groups for that.

(2) ESTABLISHMENT OF GLOBAL BUDGETS.—The global budget of a provider shall be set through negotiations between providers, State directors, and regional directors, but are subject to the approval of the Director. The budget shall be negotiated annually, based on past expenditures, projected changes in levels of services, wages and input, costs, a provider’s maximum capacity to provide care, and proposed new and innovative programs.

And here's where the words of the former German Minister of Health come into play:

"In the past 20 years, our overriding philosophy has been that the health system cannot spend more than its income.

Virtual budgets are also set up at the regional levels; these ensure that all participants in the system—including the health insurance funds and providers— know from the beginning of the year onward how much money can be spent."


Source: How Germany is reining in health care costs: An interview with Franz Knieps

This is when rationing starts, when there's not enough money for the month, healthcare gets diluted, delayed or denied altogether.

(1) IN GENERAL.—No institution may be a participating provider unless it is a public or not-for-profit institution. Private physicians, private clinics, and private health care providers shall continue to operate as private entities, but are prohibited from being investor owned.
(2) CONVERSION OF INVESTOR-OWNED PROVIDERS.—For-profit providers of care opting to participate shall be required to convert to not-for-profit status.
(3) PRIVATE DELIVERY OF CARE REQUIREMENT.—For-profit providers of care that convert to non-profit status shall remain privately owned and operated entities.
(4) COMPENSATION FOR CONVERSION.—The owners of such for-profit providers shall be compensated for reasonable financial losses incurred as a result of the conversion from for-profit to non-profit status.
(5) FUNDING.—There are authorized to be appropriated from the Treasury such sums as are necessary to compensate investor-owned providers as provided for under paragraph (3).

You can see a constitutional challenge there.

SEC. 102. Benefits and portability.
(a) In general.—The health care benefits under this Act cover all medically necessary services, including at least the following:
(1) Primary care and prevention.
(2) Approved dietary and nutritional therapies.
(3) Inpatient care.
(4) Outpatient care.
(5) Emergency care.
(6) Prescription drugs.
(7) Durable medical equipment.
(8) Long-term care.
(9) Palliative care.
(10) Mental health services.
(11) The full scope of dental services, services, including periodontics, oral surgery, and endodontics, but not including cosmetic dentistry.
(12) Substance abuse treatment services.
(13) Chiropractic services, not including electrical stimulation.
(14) Basic vision care and vision correction (other than laser vision correction for cosmetic purposes).
(15) Hearing services, including coverage of hearing aids.
(16) Podiatric care.


Notice that it does not specifically mention abortion.

Coverage is extensive and would inflate costs above the $2.4 TRILLION currently spent. For example, Dental Care was $111 Billion in 2012, but that amount would increase substantially as coverage is expanded.

(d) Freedom of choice.—Patients shall have free choice of participating physicians and other clinicians, hospitals, and inpatient care facilities.

I'm assuming this would apply to both Veterans and Indians who have their own programs.

SEC. 104. Prohibition against duplicating coverage.
(a) In general.—It is unlawful for a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act.
(b) Construction.—Nothing in this Act shall be construed as prohibiting the sale of health insurance coverage for any additional benefits not covered by this Act, such as for cosmetic surgery or other services and items that are not medically necessary.

That for sure will raise constitutional challenges. The intent is obviously to prevent a dual-tiered system, but the reality is that many States with universal healthcare systems are privatizing or allowing private insurance options.

 
Old 03-13-2017, 10:08 PM
 
18,794 posts, read 8,420,430 times
Reputation: 4125
Quote:
Originally Posted by katzpaw View Post
Single payer via Medicare expansion is the way to go, to catch up to the rest of the world.

https://twitter.com/Penalosa_G/statu...59821283774469
As a general internist I watched the US transition towards specialist care starting in the early '80's. Specialist care can be better and very necessary for some subsets of patients, but it is much more expensive. It used to be that I would call in a specialist to consult on the relatively few patients needing a higher level of care that I could provide. The patient would be treated for that problem, and then sent back to me. Now the patient goes over to the specialist forever, sometimes having multiple specialists, and now multiple forever docs including me the primary doc. Unnecessary in a large portion of these patients.
 
Old 03-13-2017, 10:09 PM
 
18,794 posts, read 8,420,430 times
Reputation: 4125
Quote:
Originally Posted by gallowsCalibrator View Post
I'm thinking that, in order to gain more public traction in the first "pass" of moving to single-payer, it might be prudent to roll back most (if not all) of ACA and make the Medicare expansion optional. So if someone wanted to keep their private insurance, they could choose to do. But nobody who opts into Medicare would be denied.

With rolling back ACA the pricing and coverage benefits are between private insurance companies and their customers is between them.
I agree and still support a public option and let the privates do as they may. Most docs also would appreciate the options.
 
Old 03-13-2017, 10:11 PM
 
18,794 posts, read 8,420,430 times
Reputation: 4125
Quote:
Originally Posted by Kibby View Post
Don't hold your breath on Socialized Medicine for all or some sort of Medicare for all.
I hate Medicare and would love to go back to the Insurance I had before I was forced onto Medicare.
Gotta have some crazy reason!

I love it now that I am finally on Medicare. Cheaper and easier.
 
Old 03-13-2017, 10:16 PM
 
2,956 posts, read 2,333,635 times
Reputation: 6475
Fully support single payer.
 
Old 03-14-2017, 12:00 AM
 
13,586 posts, read 13,077,256 times
Reputation: 17786
Best possible solution. This was what was on the table during the Clinton administration, but Bill put Hillary in charge and what they came up with was rubbish. More selling out to the for- profit insurance companies.

Next step: allow Medicare to negotiate drug prices like private insurance companies and other countries do. Tremendous waste there.

Call your congressional rep, people!
 
Old 03-14-2017, 07:13 AM
 
9,871 posts, read 7,639,617 times
Reputation: 2487
Have a Controlled Healthcare Market.

Why don't States just pool together various insurance companies with various tiers of coverage at various cost. Takes burden away from the employer. Individuals can add on eye insurance, health insurance for travel, dental, and pet insurance.

Have Crystal, Platinum, and Gold that cover pretty existing conditions, most expansive coverage, and low deductibles ($500, $1000, $1500).

Silver and Bronze mid range. Does not cover pretty existing conditions. Covers decent portion of care. Deductible is mid range ($2,000 & $3,000)

Copper (S) is basic and income adjusted. However, low deductible ($1,500). Not as extensive coverage. Added 2% fee added on to insurance payments goes to the State.

Copper is not income adjusted. Similar to Copper (S) basic, not extensive coverage and high deductible ($5,000). Eligible for tax rebate based off of the percentage yearly insurance cost deducted from yearly income. So say insurance cost $2,400 yearly and you make $80K. That's 3% of your income multiplied into $2,400 receive $72 back by the end of the year.

Then State Insurance eligible for individuals who are below threshold for living wage based off of size of household. In addition to, must be in Social Security database and must not be incarcerated to apply for these health insurances.

Tier 1 - Two year temporary insurance for individuals who are homeless or unemployed. No cost insurance paid by the State via taxes. Extensive coverage with no need for deductible. Basically universal health care.

Tier 2 - Similar to Tier 1. It is for individuals on Disability. Small payment for insurance that is adjusted based off disability income and not regular income.

Tier 3 - Is Income adjusted. For individuals receiving State Benefits. Extensive coverage and low deductible of ($1000).

Copper S would fall into Tier 4.

Then Religious Organizations, Universities, Hospitals, and Bussinesses can choose to open up their own Health Savings Account for others to use.

Universal health care for individuals over 65.

Universal mental health care.

Universal health care for active duty military members and dependents. Government pays 50% of National Guard and Reserve insurance payments. Universal Healthcare for individuals who left military on good terms and served 2 or more year's of Active Duty. Universal Care is extended based on length of service. Say you did 10 year's of Active Duty be eligible for 10 years of Universal Healthcare. In addition to, once universal care expires can apply to a Government insurance plan that has extensive coverage, low deductible, low payments, and low cost of care.

Healthcare rebates takes off X amount of money off payments for the following year of plan you choose. Say if you haven't smoked in a year, annual dentist cleaning, physical a year, joined a gym, and so forth you receive $500 off your total insurance cost.

If cost is too much for States to operate can pool together with other States. For example New Hampshire, Vermont, and Maine can pool together. Massachusetts, Rhode Island, and Connecticut.

Cost are transparent. Each individual insurance plan should explain what they cover and what percentage of do they cover for.

Individuals are not mandated to purchase insurance. With that said outside of Emergency Services Healthcare facilities can refuse to treat and individual who has no insurance.

Tax on Catastrophic Healthcare as well.

Also reduce costs to Healthcare do away with medical patents. In regarda to pharmaceuticals government gives funding to smaller pharmaceutical businesses to create a competitive market. Reduces FDA regulation on pharmaceuticals to make market competitive.

Tax paid childcare for those on Government assistance. Those who are not and make under $120,000 the Government will designate various day cares to use in the area or a work sponsored day care. The Government pays the percentage of how much child care cost deducted from yearly income. So if you make $100K and it cost $24K a year 24% is covered, $5,760.

Legalized and tax marijuana. Decriminalize other illegal narcotics. Individuals caught are fined, but not sent to jail. Individuals can use in designated safe zones set up by the Government. They avoid any fines or involvement with the law if using in safe zones.

Last edited by RunD1987; 03-14-2017 at 07:53 AM..
 
Old 03-14-2017, 07:19 AM
 
Location: Fredericktown,Ohio
7,168 posts, read 5,355,764 times
Reputation: 2922
Quote:
Originally Posted by mightleavenyc View Post
How about free market healthcare?
You think there is a free market in the U S? LMAO that"s a knee slapper.
 
Old 03-14-2017, 07:26 AM
 
7,264 posts, read 4,192,096 times
Reputation: 5464
The system is rigged. Until the system becomes un-rigged nothing meaningful will happen.
 
Old 03-14-2017, 07:33 AM
 
Location: Inland FL
2,518 posts, read 1,841,673 times
Reputation: 4194
This bill won't pass because it makes too much sense.
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