The 2016 Presidential Election Trainwreck

[SeattleUte]

I'm totally in favor of some type of "no-frills" single payer health care plan for all citizens that at least covers "catastrophic" health care events as well as standard preventive services.

Even after the Affordable Care Act I take care of this type of patient all the time: 60-year old construction worker taking his chances with no health insurance because he always considered himself healthy. Dude has a heart attack and gets awesome care that saves his life but legitimately very expensive care: $50K range hospital bill. The guy goes home seriously almost wishing he were dead because there is no possible way he could ever pay this.

A very large segment of society is never going to save a single dollar for retirement, not going to plan ahead for any type of insurance, health or other type of insurance. When you hear about Rondo Fehlberg's son with the head injury that will cost a million dollars, now begging for money from friends/families that will be transferred to wealthy health care institutions it is just a stupid, pathetic system.

The guy got his health care, he'll never pay for it, and you continue to live in your mansion, drive your fancy car, and educate your kids. And you couldn't have turned him away if you'd have wanted to.

I don't have all the answers, but I am sick of hearing Norway, the UK and Canada presented as a panacea. They aren't.

[PaloAltoCougar]

...I don't have all the answers, but I am sick of hearing Norway, the UK and Canada presented as a panacea. They aren't.

Nor do I, and I don't see any panaceas out there. But if we're paying at least 50% more than any other comparable country for poorer results (other than for cancer--we're number 1!), doesn't single payer at least deserve a closer look?

[SeattleUte]

This'll probably be a tl;dr post, but the health care issue is a mess. Sure, everyone currently has access to health care, if only through emergency rooms, but I assume we all find that unsatisfactory—it imposes a much greater cost on the rest of us, both because of the greater expense of ERs and because preventative care and early attention to problems would likely avoid more serious issues occasioned by delay.

Obamacare is fraught with problems, but the principal solution offered by Cruz and Trump is to repeal it on Day One. Cruz says he’ll provide for market-based health insurance but that seems awfully vague. Trump’s going to replace it with something really terrific, the best ever, but he’ll let us know later what that’s going to be.

I grew up with the notion that socialized medicine was a horror to be avoided at all costs, but honestly, I’m beginning to wonder if a move to a single payer system (and that’s where we’ve been slowly trending) wouldn’t be a better approach than the vague plans currently being offered by my party. Certainly our current system is a mess and needs a fix, for these reasons among others (and feel free to correct my understanding here): (i) for many years, costs have climbed substantially faster than the increase in pay to doctors, nurses and other health care professionals, (ii) compared with citizens of other first world nations, a significantly greater percentage of Americans do not receive routine medical care, (iii) health care in the U.S. costs at least 50% more than in comparable countries, and (iv) the U.S. has less favorable health outcomes than in comparable countries.

If the foregoing is accurate, what would be a better approach to fix it than a single payer system like that in, say, Germany, Australia or New Zealand (ERC, where are you?)? And no, I’m not voting for Bernie.

Very generally, and in a nutshell, this is what the ACA has done: (1) set up an Internet market called an "exchange" that in theory enables everyone to buy health insurance within their means--in general the participants are people who don't get health benefits from an employer. The market is made up of pre-existing health insurers. (2) Add a federal regulatory overlay to the already mostly well functioning state regulatory regime--the Department of HHS shoulders this. Mostly though it has determined that the states have had adequate rate review and let them proceed as the status quo ante. For those that don't, such as Texas, HHS will actually regulate. (3) The Department of HHS regulates rates as a last resort--mainly, health insurers re required to refund rates if according to formulae they made too much money. I think that's about it. Right?

It has been said that this is a uniquely American solution in that it involves a federalist solution, and a partnership with private enterprise. I'm not convinced it's "a mess".

I think this is a gross over-generalization: "the U.S. has less favorable health outcomes than in comparable countries." Source? Don't believe everything you read; it's not that simple.

When you have your stroke are you going to go to Canada to get treated in order to improve the chances of a "more favorable outcome"?

I'm about to add you to my list of board socialists, buddy.

[Uncle Ted]

I think canada has about 35,000,000 people. So it probably is a bit short of 1%.

I wasn't talking about all the hippy draft dodgers that moved there.

[Color Me Badd Fan]

The ACA has some real and significant problems, no doubt. I'm not even sure if it's going to survive without some major revisions. But I think it is helping more people than it is 'royally screwing'.



That's a shame. I really knocked it out of the park at the end.

The ACA is destroying the individual health insurance market, it's royal screwing a lot of people right now and will start screwing a lot more people. The law was supposed to allow people with preexisting conditions to buy health insurance. Turns out, that health insurance has a $5000 deductible and a huge premium. Those people who it was supposed to help aren't buying it.

Let's just cut to the chase here, Obamacare is an Medicaid expansion bill that has ruined the individual health insurance market. Between the full time jobs cut, health insurance cuts at small businesses and the "affordable insurance for preexisting conditions" fiction, I'm not convinced at all that more people are benefiting.

[CardiacCoug]

The guy got his health care, he'll never pay for it, and you continue to live in your mansion, drive your fancy car, and educate your kids. And you couldn't have turned him away if you'd have wanted to.

I don't have all the answers, but I am sick of hearing Norway, the UK and Canada presented as a panacea. They aren't.

Sure we just cost-shift from the paying well-insured customers to those who don't pay but I really am not a fan of the emotional/psychological burden of these ridiculous health-care bills. People should be able to just focus on getting well and not be more stressed out about the bill than the fact that they almost died.

Under single payer you would still have plenty of incentive for hospitals and providers to deliver high-quality and efficient care in order to maximize their profits. I agree that government generally is the problem rather than the solution. However government is already so involved in financing of health care that I just don't think we can unring the bell. Rather than continue with this horribly inefficient and often cruel/inhumane cost-shifting system I think going all the way to single payer is inevitable and wouldn't change all that much honestly.

[PaloAltoCougar]

Very generally, and in a nutshell, this is what the ACA has done: (1) set up an Internet market called an "exchange" that in theory enables everyone to buy health insurance within their means--in general the participants are people who don't get health benefits from an employer. The market is made up of pre-existing health insurers. (2) Add a federal regulatory overlay to the already mostly well functioning state regulatory regime--the Department of HHS shoulders this. Mostly though it has determined that the states have had adequate rate review and let them proceed as the status quo ante. For those that don't, such as Texas, HHS will actually regulate. (3) The Department of HHS regulates rates as a last resort--mainly, health insurers re required to refund rates if according to formulae they made too much money. I think that's about it. Right?

It has been said that this is a uniquely American solution in that it involves a federalist solution, and a partnership with private enterprise. I'm not convinced it's "a mess".

I think this is a gross over-generalization: "the U.S. has less favorable health outcomes than in comparable countries." Source? Don't believe everything you read; it's not that simple.

When you have your stroke are you going to go to Canada to get treated in order to improve the chances of a "more favorable outcome"?

I'm about to add you to my list of board socialists, buddy.

I should have said the U.S. doesn't have better health outcomes, on average, than those in comparable countries. Here are the first two sources, that Google provided: Forbes and the Commonwealth Fund.

And no, I'm not going anywhere else for my health care, and I'm able to pay my $700/month premium (despite making only one visit to my doc annually), but I'm a bit of an outlier. Why should we, as a country, be paying >50% more for medical care than nearly everyone else (although per the World Bank the poor bastards in Tuvalu pay more than we do, which means when it comes to spending on health care, we're definitely no. 2)?

[Northwestcoug]

I think canada has about 35,000,000 people. So it probably is a bit short of 1%.

You're right. My bad math.

[Clark Addison]

I'll make a prediction that a lot of you will think is completely stupid. Maybe it is.

Today, we have a lot of small government people who want to minimize government's role and size, but most of them recognize that there are many areas (roads, national parks, military, etc.) that can really only be performed by government. Over the next couple of decades, health care will become one of those things. So today you don't really have many people saying things like "I want a small government, but support a single payer health system", and if they do say it, most other small government types will dismiss them as not understanding what being "small government" means. In another 20 years, I think there will be a lot of people who say that, and it won't be seen as laughable or inconsistent.

I know some of you are shaking your heads at this, but if you went back not even 100 years and said "I favor limited government, but I do support spending 21% of the federal budget, and 7% of total GDP, on our military", people would feel the same way about you that you feel about "small government" people who favor single payer.

[PaloAltoCougar]

Sure we just cost-shift from the paying well-insured customers to those who don't pay but I really am not a fan of the emotional/psychological burden of these ridiculous health-care bills. People should be able to just focus on getting well and not be more stressed out about the bill than the fact that they almost died.

Under single payer you would still have plenty of incentive for hospitals and providers to deliver high-quality and efficient care in order to maximize their profits. I agree that government generally is the problem rather than the solution. However government is already so involved in financing of health care that I just don't think we can unring the bell. Rather than continue with this horribly inefficient and often cruel/inhumane cost-shifting system I think going all the way to single payer is inevitable and wouldn't change all that much honestly.

Years ago, I would have thought physicians would be the most strident opponents of single payer, but among the few (maybe no more than 10) docs I've discussed this with, most of them support the idea, although with varying levels of enthusiasm. Of course, my sample is meaninglessly small, but my sense is the actual health care providers are more supportive of the idea than those outside the field.

[Jeff Lebowski]

John Kasich in Orem, Utah!

http://www.heraldextra.com/news/loca...dca6c9506.html

[CardiacCoug]

It has been said that this is a uniquely American solution in that it involves a federalist solution, and a partnership with private enterprise. I'm not convinced it's "a mess".

I think this is a gross over-generalization: "the U.S. has less favorable health outcomes than in comparable countries." Source? Don't believe everything you read; it's not that simple.

When you have your stroke are you going to go to Canada to get treated in order to improve the chances of a "more favorable outcome"?

I think it's pretty clear that the US is the best country in the world when it comes to two types of health care for those with the financial and cognitive means to navigate the system:

1. Rescue/emergency care. You are more likely to survive a comparable car accident, heart attack, or stroke in an urban/suburban US setting than anywhere else in the world.

2. Sophisticated specialty health care (cancer, orthopedics, cardiovascular, neonatal, intensive care unit care, etc.).

There have been pretty strong financial incentives in the US that have prioritized those two aspects of health care above preventive/primary care. Don't kid yourself, access to primary care (e.g. blood pressure, cholesterol treatment) is way too time-consuming and expensive for a lot of urban and rural Americans and that's where we need to improve.

Obviously the majority of "health care outcomes" have nothing to do with the "health care system." We all know plenty of 90+ year olds who have not really interacted with the health care system and have amazing health and plenty of people with self-inflicted terrible health who die in their 50s or 60s despite really amazing, high-quality medical care.

[Uncle Ted]

Nor do I, and I don't see any panaceas out there. But if we're paying at least 50% more than any other comparable country for poorer results (other than for cancer--we're number 1!), doesn't single payer at least deserve a closer look?

How about we allow for the re-importation of drugs so price discrimination goes away? In canada drug prices are regulated by the government (aka, price controls). In mexico they sell the same drug (imported from the US) at a much lower price. So with free trade I should be able to go to mexico and get a truck load of american made drugs and bring them back. Then I could undercut what these companies are charging the pharmacies here with their own drugs.

[Color Me Badd Fan]

John Kasich in Orem, Utah!

http://www.heraldextra.com/news/loca...dca6c9506.html

That looks like the gym at the Orem Fifth Stake building.

[Omaha 680]

Over the years, voters have grown accustomed to quick, painless primaries, in which a handful of early states anoint an obvious front-runner, and everyone else soon falls in resigned line. That hasn’t happened this time. Yet voters nonetheless cling to certain long-held assumptions about how all this is supposed to work. “Winning” is about coming out on top in states. “Winning” is about earning lots of delegates. “Winning” is about a particular candidate’s getting his name in neon, and taking command of the party.

First and foremost—and potentially hardest—Mr. Kasich must make the case that this race isn’t about any one man, but about the cause. He has to argue that the goal must be winning the White House for Republicans. The goal must be beating Hillary Clinton.

The upside for Mr. Kasich is that, technically, he’s right. The Republican Party rules were in fact set up to benefit the cause (the party), not the man. The downside is that few voters know that, and many might not agree. Mr. Kasich has to convince them that 1,237 (half the delegates) is the only number that matters, and that anything less counts for zero. He has to argue that if no candidate arrives in Cleveland having proven he can consolidate a majority of voters, then any candidate has as great a claim to the nomination as any other.

The other reality? It may not matter. While the Ohio governor would no doubt benefit from convincing many voters of his rationale, he may be more than satisfied simply convincing a few. If Mr. Kasich’s operating philosophy is that anything might happen at the convention—that there is no telling the future, that there is a always a chance, that the reputation of the Republican Party is on the line—then why not soldier on, regardless of pressure to bow out? And indeed, in this crazy, upturned, nutty primary, that seems as good a motto as any: Why not?

http://www.wsj.com/articles/john-kas...7007?mg=id-wsj

I am glad he is staying in so there is one candidate for whom I can happily cast my vote.