America can save $1 trillion and get better health care

BipolarFuk

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US health care costs are out of sight, more than $10,000 per person per year, compared with around $5,000 per person in Canada, Germany and France. Obamacare expanded coverage without controlling costs. The Republican plan would ruthlessly and cruelly limit coverage without controlling costs.

Of the two options, Obamacare is vastly more just. The Republican plan is ghastly. But America has a much better choice: health for all at far lower costs.

This might seem like an out-of-reach goal or a political slogan, but it is neither. Every other rich country uses the same medical technology, gets the same or better health outcomes, and pays vastly lower sums.

Why the disparity? Health care in America is big business, and in America big business means big lobbying and big campaign contributions, the public interest be damned.

Health care is our biggest economic sector, far ahead of the military, Wall Street and the auto and tech industries. It is pushing 18% of national income, compared with 10% to 12% of national income in the other high-income countries.

In line with its economic size, it ranks first in total lobbying, with a recorded $152 million in lobbying spending in 2017 and an estimated $273 million in federal campaign contributions in the 2016 election cycle, divided roughly equally between the parties.

Both parties have therefore ducked the hard work of countering the health care sector's monopoly power. Health care spending is now at $10,000 per person per year, roughly twice or more the total of other high-income countries, or a staggering $3.25 trillion a year.

We should aim to save at least $1 trillion in total annual outlays, roughly $3,000 per person per year, through a series of feasible, fair and reasonable measures to limit monopoly power. Our system would look a lot more like that of the other more successful and less expensive nations.

Here's a 10-point plan Congress should consider.

First, move to capitation for Medicare, Medicaid and the tax-exempt private health insurance plans. Under capitation, hospitals and physician groups receive an annual "global budget" based on their patient population, not reimbursement on a fee-for-service basis.

Second, limit the compensation of hospital CEOs and top managers. The pay of not-for-profit hospital CEOs and top managers, for example, could be capped at $1 million per year.

Third, require Medicare and other public providers to negotiate drug prices on a rational basis, taking account of research and development incentives and the manufacturing costs of the medicines.

Fourth, use emergency power to override patents (such as compulsory licensing of patent-protected drugs) to set maximum prices on drugs for public health emergencies (such as for HIV and hepatitis C).

Fifth, radically simplify regulatory procedures for bringing quality generic drugs to the market, including through importation, by simplifying Food and Drug Administration procedures.

Sixth, facilitate "task shifting" from doctors to lower-cost health workers for routine procedures, especially when new computer applications can support the decision process.

Seven, in all public and private plans, cap the annual payment of deductibles and cost-sharing by households to a limited fraction of household income, as is done in many high-income countries.

Eight, use part of the annual saving of $1 trillion to expand home visits for community-based health care to combat the epidemics of obesity, opioids, mental illness and others.

Nine, rein in the advertising and other marketing by the pharmaceutical and fast-food industries that has created, alone among the high-income world, a nation of addiction and obesity.

Ten, offer a public plan to meet these conditions to compete with private plans. Medicare for all is one such possibility.

There really no mystery to why America's health industry needs a drastic corrective.

Visit the website of your local not-for-profit hospital system. There's a good chance the CEO will be earning millions per year, sometimes $10 million or more. Or go to treat your hepatitis C with Gilead drug Sofosbuvir. The pills list for $84,000 per 12-week dose, while their production cost is a little over $100, roughly one-thousandth of the list price. Or go in for an MRI, and your hospital might have an $8,000 billable price for a procedure that costs $500 in a discount clinic outside your provider network.

All of these are examples of the vast market power of the health care industry. The sector is designed to squeeze consumers and the government for all they're worth (and sometimes more, driving many into bankruptcy).

As a result, the sector is awash in profits and compensation levels, and the stock prices of the health care industry are soaring. In the meantime, human and financial resources are pulled away from low-cost (but also low-profit) disease prevention, such as low-cost community health workers and wellness counselors who work within the community, including household visits.

The health care sector is a system of monopolies and oligopolies -- that is, there are few producers in the marketplace and few limits on market power. Government shovels out the money in its own programs and via tax breaks for private plans without controls on the market power. And it's getting worse.

Every other high-income country has solved this problem. Most hospitals are government-owned, while most of the rest are not for profit, but without allowing egregious salaries for top management. Drug prices are regulated. Patents are respected, but drug prices are negotiated.

None of this is rocket science. Nor is the United States too dumb to figure out what Canada, the UK, France, the Netherlands, Germany, Japan, Sweden, Norway, Denmark, Finland, Austria, Belgium, Korea and others have solved. The problem is not our intelligence. The problem is our corrupt political system, which caters to the health care lobby, not to the needs of the people.
 

L.T. Fan

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Uh, yeah, 22 million losing coverage under the current (R) plan is pretty ghastly.
Other than a random number off the top of someone's head, where is the compilation and source for this number? All I have heard from the Schumers and Peloci types are shock numbers of how many are going to die.
 

Cowboysrock55

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Uh, yeah, 22 million losing coverage under the current (R) plan is pretty ghastly.
Yeah and a shit ton of people lost their plans and got screwed under Obama care, but totally fair and stuff.

Or is it only fair if some people's hard work pays for other people's benefit?
 

jsmith6919

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peplaw06

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The problem is our corrupt political system, which caters to the health care lobby, not to the needs of the people.
This is a hilarious conclusion. Our political system is corrupt. But the article argues that the answer to health care woes is to let the politicians run it all?
 

Cowboysrock55

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An argument is that America is better off w/o the majority of these 22M ppl. Isn't this the implied and desired consequence of something like this?
Yeah not at all. Most of the 22 million are healthy Americans who make good money and realize that the majority of money they pay in health insurance will never go to actually providing themselves medical care. Those are the intellegent and successful people we want breeding and surviving.
 

BipolarFuk

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Paul Ryan Explains Why 22 Million Will Be Uninsured, and He’s Got a Point

Paul Ryan Explains Why 22 Million Will Be Uninsured, and He’s Got a Point

Speaker Paul Ryan on Tuesday defended the Republican health care plan that would mean over 22 million more people would be uninsured, arguing the uninsured would only be exercising their new freedom to do so.

“What they’re basically saying at the Congressional Budget Office is if you’re not going to force people to buy Obamacare, if you’re not going to force people to buy something that they don’t want, then they won’t buy it,” Ryan said on Fox News of the CBO analysis that cited the 22 million uninsured. “So, it’s not that people are getting pushed off a plan, it’s that people will choose not to buy something they don’t like or want.”

A number of Republicans have argued that it’s unfair to judge the coverage numbers in their legislation against measures that require people to get insured. Under Obamacare, individuals have to get insurance or pay a financial penalty of 2.5 percent of income or $695 per adult, whichever is higher.

Ryan and other Republicans have a point: CBO estimates of the House and Senate bills found large numbers of people would forgo insurance without a mandate to buy it. In the Senate’s case, the CBO estimated 15 million more people would be uninsured in 2018 alone “primarily because the penalty for not having insurance would be eliminated.”

But it’s not the whole story: The changes to health policy in the House and Senate bills would also affect people’s decision to drop insurance or stay uninsured — and which groups of Americans, in particular, would go without coverage.

“Ryan’s explanation is not entirely wrong, but it misses the main points of the CBO report,” Timothy Jost, a professor at Washington and Lee University School of Law who specializes in health policy, said in an email.

The CBO reports on the House and Senate bills found the increase in uninsured would disproportionately come from relatively low-income customers between age 50 and 64, for example, who get less government assistance under the Republican plans and could be charged higher premiums than under current law.

In the case of the House bill, CBO found that its changes would raise annual premiums for a 64-year-old making $26,500 in 2026 from just $1,700 under current law to $16,100. Technically, such a person could choose to go uninsured without a mandate, but they would also be choosing between spending over 60 percent of their income on premiums versus about 6 percent.

The Senate bill’s subsidies for premiums scale up by income while the House bill's are fixed by age, but the leaps in premiums would still be significant. A Kaiser Family Foundation report on Tuesday estimated that, on average, effective premiums would rise 74 percent by 2020 for an insurance plan comparable to what’s available today.



The average increase would be 115 percent for people ages 55 to 64 — more than double what they would pay under current law. By contrast, younger customers between 18 and 34 would see smaller average increases in their premiums of 17 percent.

Both the House and Senate CBO reports concluded that many people would go without insurance either because they were no longer covered by Medicaid, because they couldn’t find premiums they considered affordable, because their deductibles were too high to justify their premiums, or (in the case of the House bill) because a pre-existing condition made plans unaffordable.

In the Senate bill, for example, reversing Obamacare’s Medicaid expansion and capping the program’s spending would leave 15 million fewer people covered by 2026. But the CBO concluded that “few low-income people would purchase any plan” afterward even though they were eligible for subsidies to help, because they would pay “a significantly higher percentage of income” in deductibles under the new law.

This stems from clear policy choices in the Senate bill. It provides less generous subsidies aimed at herding people into plans with higher deductibles — the equivalent of about $6,000 for individuals versus about $3,500 under current law. It would also, like the House bill, end additional subsidies for that lower deductibles for low-income customers.

The Kaiser Family Foundation estimated that someone making about $18,000 would have a $255 deductible today, but a deductible of over $6,000 under the Senate plan as a result of these changes. Again, these people could choose to go uninsured, but that choice would factor in a deductible that’s nearly 24 times as large as it would be under Obamacare.

The bottom line: While many people would decide they don’t want insurance without Obamacare’s mandate, the House and Senate bills would also put their finger on the scale in making their decision.
 

boozeman

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What is needed is massive health care reform, not another bullshit shell game. Never happen though, too much money to be made.
 

Cowboysrock55

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What is needed is massive health care reform, not another bullshit shell game. Never happen though, too much money to be made.
We do, hell somedays I wonder if we all wouldn't be better off with no insurance at all. At least then medical facilities would actually be forced to price compete and prices would dramatically drop. Of course for people who are sick all the time or have serious medical conditions that still sounds terrible.
 

peplaw06

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We do, hell somedays I wonder if we all wouldn't be better off with no insurance at all. At least then medical facilities would actually be forced to price compete and prices would dramatically drop. Of course for people who are sick all the time or have serious medical conditions that still sounds terrible.
I'm with you, but real reform would have to come not just in the arena of insurance specifically, but also in government regulation, phamaceuticals, etc. The problems are so rooted in the system, that booze is right... will never happen with all the money on the table.

These programs and regulations rarely get decreased or eliminated once they are in place. They put something in place that doesn't work, they don't just walk away... they say well this approach didn't work, let's do MORE and maybe that will work.

That's how you build a citizenry's dependence.
 

shane

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Enacting direct primary care at the state level is the only hope for reform. At least in that case, people can pay reasonable out of pocket costs for medical care and the system works like a market. The current health care system is so bureaucratic that there is no hope for a solution other than collapse.
 

mcnuttz

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What is needed is massive health care reform, not another bullshit shell game. Never happen though, too much money to be made.
Exactly.

I wish they could study the countries where UHC works and determine what could be done here.

To start with, they should make it much simpler & cheaper for employers to offer benefits to their employees.

Then start creating these jobs he talked about and we should be set.
 

Cowboysrock55

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This sounds quite odd, are there people you don't want "breeding" and "surviving"?
It was a joke because Pdom was suggesting that we want the poor and useless to not have insurance so that they die. That those 22 mil are the "unwanted." Which I believe Pdom was just using satire in an attempt to mock the Republican Party.
 

L.T. Fan

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We do, hell somedays I wonder if we all wouldn't be better off with no insurance at all. At least then medical facilities would actually be forced to price compete and prices would dramatically drop. Of course for people who are sick all the time or have serious medical conditions that still sounds terrible.
That's along the line of my thought process. I believe there is a segment of our society that need government intravention but the rest of the population should be able to take out insurance or not take insurance. You will never get government completely out of health care but you could limit their involvement.
 
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