The 2016 Presidential Election Trainwreck

[PaloAltoCougar]

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.

[imanihonjin]

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.

Sounds great, until you realize that the government would be responsible for running any such program. I can't wait for my hospital visits to resemble my visits to the DMV. Handing this thing over to the government isn't going to solve the expense problem unless you give up your right to access medical care in the way you prefer. If you go to a single payer, be prepared to wait weeks if not months for an MRI on an ailing knee. If you have back pain, no worries the government will be able to provide you some pain meds until you can get that back taken care of....sometime in the future. Sorry, the medical care we receive is already a mess in so many regards, but I have zero confidence that turning it over to the government can possibly make it better in any regard. I don't want them telling me when I can receive the care that want and need. Sure insurance companies can already do this but at least there is some semblance of competition among the insurance companies to keep them grounded....where do you go when the only provider, the government, says no?

[Uncle Ted]

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.

Cruz's plan, as I understand it, is:

0. Repeal Obamacare

1. Create a nationwide marketplace for health insurance. I believe Drumpf has mentioned this as well (of course, that may have changed 3-4 times). In short, raise the competition in the health insurance market. Obamacare should have done this but it didn't.

2. Expand health saving accounts. Obamacare seemed to try to kill HSAs for some reason or another. My HSA became a lot less useful, anyway.

3. De-link health from the workplace. I can relate to this. I tend to work as a contract engineer and change jobs. It would be nice to just keep the same insurance where ever I go. It would be nice for people that get laid off or what not so they don't lose their coverage.

I have no idea how any of this is going to be better than Obamacare.

[Maximus]

Sounds great, until you realize that the government would be responsible for running any such program. I can't wait for my hospital visits to resemble my visits to the DMV. Handing this thing over to the government isn't going to solve the expense problem unless you give up your right to access medical care in the way you prefer. If you go to a single payer, be prepared to wait weeks if not months for an MRI on an ailing knee. If you have back pain, no worries the government will be able to provide you some pain meds until you can get that back taken care of....sometime in the future. Sorry, the medical care we receive is already a mess in so many regards, but I have zero confidence that turning it over to the government can possibly make it better in any regard. I don't want them telling me when I can receive the care that want and need. Sure insurance companies can already do this but at least there is some semblance of competition among the insurance companies to keep them grounded....where do you go when the only provider, the government, says no?

friends from canada I ask about this laugh at the suggestion of these supposed problems with their system. Why cant there be oth private and public options?

[Clark Addison]

Sounds great, until you realize that the government would be responsible for running any such program. I can't wait for my hospital visits to resemble my visits to the DMV. Handing this thing over to the government isn't going to solve the expense problem unless you give up your right to access medical care in the way you prefer. If you go to a single payer, be prepared to wait weeks if not months for an MRI on an ailing knee. If you have back pain, no worries the government will be able to provide you some pain meds until you can get that back taken care of....sometime in the future. Sorry, the medical care we receive is already a mess in so many regards, but I have zero confidence that turning it over to the government can possibly make it better in any regard. I don't want them telling me when I can receive the care that want and need. Sure insurance companies can already do this but at least there is some semblance of competition among the insurance companies to keep them grounded....where do you go when the only provider, the government, says no?

That sounds reasonable. But how do you reconcile it with the fact that in places like the UK, Canada, Germany, Scandinavia, etc. people are overwhelmingly satisfied and supportive of their systems, and they pay far less than we do on a per capita basis.

And, question #2, what is the answer, if this isn't it, bearing in mind that most people don't want a pure market solution if it means that a large group of people do not get care.

[SeattleUte]

I agree with Imanihonjin that Lebowski applies a double standard when it comes to personal insults.

In any event, I think we're both speaking to other people. There ensconced in Happy Vally it's hard to appreciate the contempt and hatred for business that is widespread in the left wing (though Frank gives us a taste of it)--and is evident in the success of the Sanders campaign (guess which state has donated the mosts per capita to Sanders) and Donald Trump as well. And I'm talking about a thoughtless, reflexive, yes, dogmatic kind of reaction.

For example, the ignorant, knee jerk condemnation of privileged liberals to genetically engineered foods that has even been condemned by the New York Times. As the Times recently noted, nothing, not vaccines, nothing has saved m ore lives of poor people--saved them from the terrible death of starvation--than genetically engineered foods.

Business ended our dependance on foreign oil, and it is the only thing that can end our dependance on fossil fuels. Every country that manufactures Apple phones represents a reduced or eliminated risk of terrorism exported, female circumcision, etc.

Here in Seattle, within the space of about five years Amazon has occupied vast areas of the city that hadn't really changed since the World's Fair--ugly low slung motels and greasy spoons and vacant lots--and turned it into world class high rises and eateries. Amazon's employees are multi-racial, they come from all over the world, and most of them walk to work or take mass transit. But I hear all the time how Amazon has ruined the city and it's a teutonic, slave driving organization---essentially the complaints are on behalf of Ivy League graduates or the like who earn hundreds of thousands of dollars a year.

It's only because of private activity that the world is today better than ever before by any measure. And the horrors that remain and that are in our past are overwhelmingly because of government--and religion.

Actually, I know I'm preaching to the choir here. Lebowski and I don't disagree by much if at all. But I react to Bernie Sanders like some of you react to the Bundys (about whom I care very little) because of the particular dogma that grips my own community.

[Topper]

friends from canada I ask about this laugh at the suggestion of these supposed problems with their system. Why cant there be oth private and public options?

People here who blithely suggest we jettison the current patchwork of public/private options for payment and mostly private options for delivery are just naive.

We have the largest, most complex healthcare system in the world.

Other smaller countries developed their systems mostly after World War II. If the US had wanted a single or multi-tiered comprehensive, universal system, it was then. To do it now, will result in massive disruption. Remember Obamacare, that will pale in comparison to the mishaps and disruption.

The US spends according to government sources $3.0 Trillion on healthcare for 2014. Medicare accounted for $618 Billion for 49.5 million beneficiaries. Medicaid accounted for another $489 Billion. Right now there is about Ten Percent (10%) unaccounted for. Seniors and the medically indigent utilize higher than the other groups. Where do we come up with another $2 Trillion to pay for Sanders option or $300 to $400 Billion to cover the rest of the uninsured?

Delivery is mostly private. Do you really want to add a service through the public sphere which already does a poor job in its other service sectors? Maybe we replace Medicaid reimbursement by creating indigent care employees removing the choice for the medically indigent. That way we cap costs more easily. You laugh about problems but every system rations care. In Canadian care, specialty and "elective" care is rationed and delayed. If government is paying for it, it gets to tell you what and when you get it. I can only imagine the compassion of the DMV setting in through government delivered healthcare.

To the final point, we have public, population based healthcare in terms of immunizations and clean water, et al. We have "sick" care in terms medical treatment. The former is done at the societal level, and the latter is delivered at the personal level. It is far more complex than this, but simply wanting a "two tier" system which even socialized medicine such as Britain, retains. In short, the rich will always have alternatives, but it will cost even more.

[Jeff Lebowski]

I agree with Imanihonjin that Lebowski applies a double standard when it comes to personal insults.

In any event, I think we're both speaking to other people. There ensconced in Happy Vally it's hard to appreciate the contempt and hatred for business that is widespread in the left wing (though Frank gives us a taste of it)--and is evident in the success of the Sanders campaign (guess which state has donated the mosts per capita to Sanders) and Donald Trump as well. And I'm talking about a thoughtless, reflexive, yes, dogmatic kind of reaction.

For example, the ignorant, knee jerk condemnation of privileged liberals to genetically engineered foods that has even been condemned by the New York Times. As the Times recently noted, nothing, not vaccines, nothing has saved m ore lives of poor people--saved them from the terrible death of starvation--than genetically engineered foods.

Business ended our dependance on foreign oil, and it is the only thing that can end our dependance on fossil fuels. Every country that manufactures Apple phones represents a reduced or eliminated risk of terrorism exported, female circumcision, etc.

Here in Seattle, within the space of about five years Amazon has occupied vast areas of the city that hadn't really changed since the World's Fair--ugly low slung motels and greasy spoons and vacant lots--and turned it into world class high rises and eateries. Amazon's employees are multi-racial, they come from all over the world, and most of them walk to work or take mass transit. But I hear all the time how Amazon has ruined the city and it's a teutonic, slave driving organization---essentially the complaints are on behalf of Ivy League graduates or the like who earn hundreds of thousands of dollars a year.

It's only because of private activity that the world is today better than ever before by any measure. And the horrors that remain and that are in our past are overwhelmingly because of government--and religion.

Actually, I know I'm preaching to the choir here. Lebowski and I don't disagree by much if at all. But I react to Bernie Sanders like some of you react to the Bundys (about whom I care very little) because of the particular dogma that grips my own community.

No, we don't disagree by much. Which is why you lashing out the way you are in this thread is so bizarre.

[Jeff Lebowski]

I agree with Imanihonjin that Lebowski applies a double standard when it comes to personal insults.

Stop it. The only thing I objected to was you insulting my family. I already told you that if you want to go after me, go right ahead. I have a very thick skin.

If I have ever insulted your family or shared private information about them without your permission, please let me know and I will delete it immediately.

[Northwestcoug]

Sounds great, until you realize that the government would be responsible for running any such program. I can't wait for my hospital visits to resemble my visits to the DMV. Handing this thing over to the government isn't going to solve the expense problem unless you give up your right to access medical care in the way you prefer. If you go to a single payer, be prepared to wait weeks if not months for an MRI on an ailing knee. If you have back pain, no worries the government will be able to provide you some pain meds until you can get that back taken care of....sometime in the future. Sorry, the medical care we receive is already a mess in so many regards, but I have zero confidence that turning it over to the government can possibly make it better in any regard. I don't want them telling me when I can receive the care that want and need. Sure insurance companies can already do this but at least there is some semblance of competition among the insurance companies to keep them grounded....where do you go when the only provider, the government, says no?

LOL at angry iman, thinking that health care in the US isn't already controlled by the government. You do realize that Medicare and Medicaid already make up over a third of insured people in America, right? And of those who are privately insured, those companies that insure them closely follow medicare trends. Government is already in your health care, whether directly or indirectly it really doesn't matter.

This is such a perfect illustration of the libertarian argument we're having. My wallet would love to have a free market health care system, where we could charge whatever we want for each biopsy read, and not worry about the 50% 'adjustment' medicare and medicaid automatically make. Why, every clinic could charge whatever the hell they wanted to, and they could compete with each other for patients. Health care costs would naturally decrease, and government would be out of our health care decisions. And everyone could find somewhere that would be willing to accept whatever they could pay for health care. Sunshine and lollipops!

Before the ACA, our community had a free care clinic that a few physicians participated in. It offered mostly basic services, but some physicians would rarely give more extensive care like endoscopies and minor surgeries. Our practice would typically see biopsies from ~5 patients a week, and we just wrote off the costs like everyone else. There was a big demand for this clinic, and I heard of 2-3 month waits to get in. After the ACA passed, that clinic essentially dissolved. Pretty much everyone qualified for some form of insurance. A lot of that is Medicaid, sure. But we have seen increased patients getting more comprehensive care.

You can't tell me that excellent health care is available for everyone in the US. Like PAC said, the ER isn't turning anyone away. But before the ACA, a lot of those uninsured patients weren't participating in 'world-class' health care. I assure you they were falling through the cracks. The question you need to ask is, is having MRIs with no wait lists worth relegating a significant proportion of our population to worse health care than yours?

[Color Me Badd Fan]

LOL at angry iman, thinking that health care in the US isn't already controlled by the government. You do realize that Medicare and Medicaid already make up over a third of insured people in America, right? And of those who are privately insured, those companies that insure them closely follow medicare trends. Government is already in your health care, whether directly or indirectly it really doesn't matter.

This is such a perfect illustration of the libertarian argument we're having. My wallet would love to have a free market health care system, where we could charge whatever we want for each biopsy read, and not worry about the 50% 'adjustment' medicare and medicaid automatically make. Why, every clinic could charge whatever the hell they wanted to, and they could compete with each other for patients. Health care costs would naturally decrease, and government would be out of our health care decisions. And everyone could find somewhere that would be willing to accept whatever they could pay for health care. Sunshine and lollipops!

Before the ACA, our community had a free care clinic that a few physicians participated in. It offered mostly basic services, but some physicians would rarely give more extensive care like endoscopies and minor surgeries. Our practice would typically see biopsies from ~5 patients a week, and we just wrote off the costs like everyone else. There was a big demand for this clinic, and I heard of 2-3 month waits to get in. After the ACA passed, that clinic essentially dissolved. Pretty much everyone qualified for some form of insurance. A lot of that is Medicaid, sure. But we have seen increased patients getting more comprehensive care.

You can't tell me that excellent health care is available for everyone in the US. Like PAC said, the ER isn't turning anyone away. But before the ACA, a lot of those uninsured patients weren't participating in 'world-class' health care. I assure you they were falling through the cracks. The question you need to ask is, is having MRIs with no wait lists worth relegating a significant proportion of our population to worse health care than yours?

I come across people all the time who lost their health insurance through work because the cost increase or they opted out of it because the deductible was outrageous and unaffordable. The ACA caused this.

As an example, I know a guy with an okay job, opted out of his health insurance through work because the premiums and deductibles skyrocketed after the ACA. His wife is diabetic and it was still cheaper to come out of pocket then to go the insurance route. He has Hispanics that work for him bring insulin up from Mexico whenever they travel down there.

Medicaid was expanded, but a ton of other people have been royally screwed.

[PaloAltoCougar]

Sounds great, until you realize that the government would be responsible for running any such program. I can't wait for my hospital visits to resemble my visits to the DMV. Handing this thing over to the government isn't going to solve the expense problem unless you give up your right to access medical care in the way you prefer. If you go to a single payer, be prepared to wait weeks if not months for an MRI on an ailing knee. If you have back pain, no worries the government will be able to provide you some pain meds until you can get that back taken care of....sometime in the future. Sorry, the medical care we receive is already a mess in so many regards, but I have zero confidence that turning it over to the government can possibly make it better in any regard. I don't want them telling me when I can receive the care that want and need. Sure insurance companies can already do this but at least there is some semblance of competition among the insurance companies to keep them grounded....where do you go when the only provider, the government, says no?

Yes, those are the standard rips on a single payer system, but as Maximus noted from his Canadian friends, and based on recent conversations I've had with Europeans and Anzacs, this isn't their experience at all. The wait times and quality of care they report seem every bit as good as mine (and mine is very good, unlike that for the poor schmucks with no health plan).

[I.J. Reilly]

LOL at angry iman, thinking that health care in the US isn't already controlled by the government. You do realize that Medicare and Medicaid already make up over a third of insured people in America, right? And of those who are privately insured, those companies that insure them closely follow medicare trends. Government is already in your health care, whether directly or indirectly it really doesn't matter.

This is such a perfect illustration of the libertarian argument we're having. My wallet would love to have a free market health care system, where we could charge whatever we want for each biopsy read, and not worry about the 50% 'adjustment' medicare and medicaid automatically make. Why, every clinic could charge whatever the hell they wanted to, and they could compete with each other for patients. Health care costs would naturally decrease, and government would be out of our health care decisions. And everyone could find somewhere that would be willing to accept whatever they could pay for health care. Sunshine and lollipops!

Before the ACA, our community had a free care clinic that a few physicians participated in. It offered mostly basic services, but some physicians would rarely give more extensive care like endoscopies and minor surgeries. Our practice would typically see biopsies from ~5 patients a week, and we just wrote off the costs like everyone else. There was a big demand for this clinic, and I heard of 2-3 month waits to get in. After the ACA passed, that clinic essentially dissolved. Pretty much everyone qualified for some form of insurance. A lot of that is Medicaid, sure. But we have seen increased patients getting more comprehensive care.

You can't tell me that excellent health care is available for everyone in the US. Like PAC said, the ER isn't turning anyone away. But before the ACA, a lot of those uninsured patients weren't participating in 'world-class' health care. I assure you they were falling through the cracks. The question you need to ask is, is having MRIs with no wait lists worth relegating a significant proportion of our population to worse health care than yours?

Most of the people who decry single payer healthcare have not really seen how savage the system is for the uninsured unhealthy. They pontificate from behind their employer (and government!) subsidized healthcare about how great our system is in opposition to all available data and facts. These know-nothings prefer the old way because it benefits them and fail to acknowledge the massive benefits already realized under Obamacare and even greater benefits that would be realized from further granting of access.

[imanihonjin]

LOL at angry iman, thinking that health care in the US isn't already controlled by the government. You do realize that Medicare and Medicaid already make up over a third of insured people in America, right? And of those who are privately insured, those companies that insure them closely follow medicare trends. Government is already in your health care, whether directly or indirectly it really doesn't matter.

This is such a perfect illustration of the libertarian argument we're having. My wallet would love to have a free market health care system, where we could charge whatever we want for each biopsy read, and not worry about the 50% 'adjustment' medicare and medicaid automatically make. Why, every clinic could charge whatever the hell they wanted to, and they could compete with each other for patients. Health care costs would naturally decrease, and government would be out of our health care decisions. And everyone could find somewhere that would be willing to accept whatever they could pay for health care. Sunshine and lollipops!

Before the ACA, our community had a free care clinic that a few physicians participated in. It offered mostly basic services, but some physicians would rarely give more extensive care like endoscopies and minor surgeries. Our practice would typically see biopsies from ~5 patients a week, and we just wrote off the costs like everyone else. There was a big demand for this clinic, and I heard of 2-3 month waits to get in. After the ACA passed, that clinic essentially dissolved. Pretty much everyone qualified for some form of insurance. A lot of that is Medicaid, sure. But we have seen increased patients getting more comprehensive care.

You can't tell me that excellent health care is available for everyone in the US. Like PAC said, the ER isn't turning anyone away. But before the ACA, a lot of those uninsured patients weren't participating in 'world-class' health care. I assure you they were falling through the cracks. The question you need to ask is, is having MRIs with no wait lists worth relegating a significant proportion of our population to worse health care than yours?

I stopped right there. If you are going to mischaraterize what i said I don't really care to read more.

[CardiacCoug]

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.