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Finding health care solutions
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Clinically Insane
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Nov 2, 2013, 05:32 PM
 
Let's see if we can have a civil discussion about health care solutions and see if we can come to something agreeable without venting about the ACA or our current leaders? Consider this the theoretical solutions thread. I mostly want to see if there is something a significant portion of us could come to an agreement upon, because the solutions both on the right and left seem completely fragmented to me.

I also want to understand these different solutions and vantage points, because I think sometimes it is hard to do so without emotions flaring up. So, I will do my very best to not judge or editorialize anything here, I just want to put everything on the table and go from there without commentary. That's the plan, at least...

Let's start with ebuddy's idea of allowing insurance companies to compete across state lines

The ACA does a part of this in its federal regulations, which would be necessary to make something like this work, to the best of my knowledge? Of course, this would come without individual mandates, presumably without subsidies (unless you leave Medicare in place?), but presumably with the ability to remove the pre-existing condition loophole, if so inclined?

Side musing: what would our debate look like now if this was enacted in the 90s or something? I know I said no commentary, but it seems like a part of the agitation with the ACA is the pains behind the largeness of the transition of getting the federal government more involved, it's kind of interesting to me to fantasize where we'd be at had some federal regulatory framework been installed years ago.

Is this representation of this solution and its implications fair? I hope the side musing doesn't become too much of a distraction, reading it again it sounds kind of leading, but if you want to do the time machine thing I'm kind of curious to hear your thoughts on this would mean today.


Medicare expansion

Can somebody please let me know how this would be paid for? I know this too sounds like a leading question, but I don't even want to try to represent this with my limited understanding of how this would work, because I would surely misrepresent and/or setup strawman arguments.

Secondly, how would this be different than a single-payer system, or would it be? I.e. would this be a complete or partial expansion?

Single-payer

If different than Medicare expansion, the lines between the two are blurred to me right now. I guess this all hinges on the scope of the Medicare expansion.

Fix what we have

This might be a strawman solution, I don't mean it to be, but BadKosh mentioned this so I just wanted to make sure this was included in case he wasn't the only one that felt this way. I don't know how one would do this, so I won't even try to explain this because it is guaranteed to be a misrepresentation.

ACA minus the individual mandate

IOW, the ebuddy solution but with the subsidies, no individual mandate. Is this a thing?


HSAs for everyone/personal responsibility

Don't change anything structurally, but just develop social security-esque tax free health care savings accounts to pay for stuff when it happens. Rely on personal responsibility to add to this account as needed. Is this a fair representation?



Am I missing anything here?
     
Clinically Insane
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Nov 2, 2013, 07:01 PM
 
I know he comes across as an angry fart, but Denninger is mostly right when it comes to what's rotten with our healthcare system.

These posts exemplify what's so wrong and screwed up about the current system:
Why The "Health System" Must Be DESTROYED in [Market-Ticker]

Please, at least read the link above. The otter ones just shed a light on varying aspects of it.

Need Heart Surgery? $1,583 -- or $106,385? in [Market-Ticker]

So Health "Insurance" Helps You, Right? Wrong in [Market-Ticker]

Your Doctor Sees You As An ATM Machine in [Market-Ticker]

No, Medical Technology Is Not a Panacea in [Market-Ticker]

The cure: break up the unholy alliance of big pharma, insurance, medical industry and politicians.
Let the free market work, and destroy the monopolistic structures that were allowed to develop over the past decades.

-t
     
Clinically Insane
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Nov 2, 2013, 08:19 PM
 
Must... Resist... Calling... Karl... Yamhead...




DAMMIT!
     
Clinically Insane
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Nov 2, 2013, 08:21 PM
 
And since I'm taking shots at people...


Originally Posted by besson3c View Post
Am I missing anything here?
Brevity?
     
Clinically Insane
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Nov 2, 2013, 08:23 PM
 
Originally Posted by turtle777 View Post
I know he comes across as an angry fart, but Denninger is mostly right when it comes to what's rotten with our healthcare system.

These posts exemplify what's so wrong and screwed up about the current system:
Why The "Health System" Must Be DESTROYED in [Market-Ticker]

Please, at least read the link above. The otter ones just shed a light on varying aspects of it.

Need Heart Surgery? $1,583 -- or $106,385? in [Market-Ticker]

So Health "Insurance" Helps You, Right? Wrong in [Market-Ticker]

Your Doctor Sees You As An ATM Machine in [Market-Ticker]

No, Medical Technology Is Not a Panacea in [Market-Ticker]

The cure: break up the unholy alliance of big pharma, insurance, medical industry and politicians.
Let the free market work, and destroy the monopolistic structures that were allowed to develop over the past decades.

-t

How would you suggest "letting the free market work"? I'm not criticizing or challenging this, I'm just interested if you care to lay out specifics in the form of a very broad birds-eye style overview sort of in the style of my lame summaries in my original post?
     
Clinically Insane
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Nov 2, 2013, 08:39 PM
 
Originally Posted by subego View Post
Must... Resist... Calling... Karl... Yamhead...

DAMMIT!
I know. He can be.... opinionated.

However, looking past his, uhm, style, let's discuss the issue: the US healthcare system is a racket, enabled by politicians and monopolistic structures.

-t
     
Clinically Insane
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Nov 2, 2013, 08:45 PM
 
Originally Posted by besson3c View Post
How would you suggest "letting the free market work"? I'm not criticizing or challenging this, I'm just interested if you care to lay out specifics in the form of a very broad birds-eye style overview sort of in the style of my lame summaries in my original post?
Well, I'm not sure how it can be easily done, because at the core, most politicians are in the pockets of those "players".

But since you asked, let's start allowing imported pharmaceutical products / medicine, making them available to US consumers at regular world market prices, rather than inflated rip-off charges.

Let's take an example. Yes, I know it is perhaps extreme, but it does show what's so wrong about the current system:

http://market-ticker.org/akcs-www?bl...ealth%20Reform

Post: "Another Example of Health Care Rape"

So, how on hell did we allow this kind of racketeering to be legal and standard practice in our country ?
I don't think there's any justification for it. This crap just has to stop.

-t
     
Clinically Insane
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Nov 2, 2013, 08:46 PM
 
Originally Posted by turtle777 View Post
I know. He can be.... opinionated.

However, looking past his, uhm, style, let's discuss the issue: the US healthcare system is a racket, enabled by politicians and monopolistic structures.

-t
Oh yeah. I'm not trying to kill the messenger. His head really looks like a yam. And he's a dork.

That said, in the stuff of his you've flown out in the past, he's been right about half the time. That's actually not a bad hit rate.
     
Clinically Insane
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Nov 2, 2013, 08:48 PM
 
I don't agree with him on everything, but on Healthcare, he's got some pretty good opinions.
And, to his credit, he's mostly bipartisan: he blasts both Republicans and Democrats.

-t
     
Clinically Insane
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Nov 3, 2013, 01:29 AM
 
Docs resisting ObamaCare | New York Post

Some real resistance from the other side of the program.
"Those who expect to reap the blessings of freedom must, like men, undergo the fatigue of supporting it."
- Thomas Paine
     
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Nov 3, 2013, 06:12 PM
 
My ideas for HSAs and compatible, catastrophic plans in moving around the McCarran Ferguson Act, charter states competing for status, and insurers competing for charter states, etc... all would've been much more elegant solutions coming off of the US health care system pre-ACA. Now that the ACA has passed, it will be very difficult to move forward. Folks have an inherent distaste for undoing several years' work even if it has turned out to be far less than ideal, but we'll see just how volatile the situation is by next November. Solutions will likely have to be delivered in careful modifications to each major provision of the ACA to the extent that they'd represent replacements without having to champion repeal altogether.

Health care providers charge what they do because they're not subjected to normal market forces. After all, they're not really charging you, they're charging monolithic corporations. The monolithic corporation could be ACMECORP or GOVT, it really doesn't matter. Unless this changes, health care costs will continue to increase. Health care insurers charge premiums that enable voluminous clientele and a meager profit margin they can roll into much more lucrative ventures. There's no reason individuals cannot do likewise and/or administer through larger firms offering a much broader array of services in a market not regulated 50 different ways. A number of firms exist merely to inform consumers and such systems can work.

Again, the problem now is undoing the Law of the Land®.
ebuddy
     
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Nov 4, 2013, 10:24 AM
 
Let's start with ebuddy's idea of allowing insurance companies to compete across state lines
This from a WSJ article
A Stage-4 Gallblader Cancer Survivor Says: I Am One of ObamaCare's Losers - WSJ.com
Before the Affordable Care Act, health-insurance policies could not be sold across state lines; now policies sold on the Affordable Care Act exchanges may not be offered across county lines.
That doesn't make any sense. States like CA and TX have a bazillion counties, with some communities crossing multiple county lines.
     
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Nov 4, 2013, 02:40 PM
 
Get the lawyers out of the mix too.
     
Games Meister
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Nov 4, 2013, 02:51 PM
 
Originally Posted by Chongo View Post
That doesn't make any sense. States like CA and TX have a bazillion counties, with some communities crossing multiple county lines.
Is this accurate? Because that sounds absurd.
     
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Nov 4, 2013, 04:36 PM
 
The US county map


Dallas TX is is in five counties
Dallas, Collin, Denton, Kaufman, Rockwall
List of U.S. cities in multiple counties - Wikipedia, the free encyclopedia

According to this list, CA does not have any incorporated areas in multiple counties
     
Games Meister
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Nov 4, 2013, 04:39 PM
 
I was asking about this:
now policies sold on the Affordable Care Act exchanges may not be offered across county lines.
     
Clinically Insane
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Nov 4, 2013, 07:00 PM
 
The literalism made me smile.
     
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Nov 5, 2013, 03:18 PM
 
Originally Posted by The Final Dakar View Post
I was asking about this:

now policies sold on the Affordable Care Act exchanges may not be offered across county lines.

You posted this:
Originally Posted by The Final Dakar View Post

Originally Posted by Chongo
That doesn't make any sense. States like CA and TX have a bazillion counties, with some communities crossing multiple county lines.

Is this accurate? Because that sounds absurd.



Anyway, O's teleprompter must have been hacked

Watch ""If You Like Your Plan..." Supercut" Video at New York Magazine
( Last edited by Chongo; Nov 5, 2013 at 06:58 PM. )
     
Clinically Insane
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Nov 5, 2013, 03:32 PM
 
I'll never understand the obsession some of you guys have with the teleprompter... Seriously, it's just weird.

Obama has many weaknesses, speaking is not one of them.
     
Clinically Insane
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Nov 5, 2013, 03:34 PM
 
He runs into problems when he goes off-book.

Not Reagan level problems, mind you, but still not a position I'm sure he likes a lot.
     
Clinically Insane
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Nov 5, 2013, 03:42 PM
 
Originally Posted by subego View Post
He runs into problems when he goes off-book.

Not Reagan level problems, mind you, but still not a position I'm sure he likes a lot.

Unusual problems for a human being or any president we've had that warrant this teleprompter obsession?
     
Games Meister
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Nov 5, 2013, 03:44 PM
 
Originally Posted by besson3c View Post
Unusual problems for a human being or any president we've had that warrant this teleprompter obsession?
I don't play this card often, but...

A well spoken black? Surely something else must be at work!
     
Clinically Insane
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Nov 5, 2013, 03:47 PM
 
Originally Posted by besson3c View Post
Unusual problems for a human being or any president we've had that warrant this teleprompter obsession?
No. I was only making a general assessment of his speaking ability.
     
Clinically Insane
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Nov 5, 2013, 03:47 PM
 
Originally Posted by The Final Dakar View Post
I don't play this card often, but...

A well spoken black? Surely something else must be at work!
He's clean, too.
     
Clinically Insane
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Nov 5, 2013, 04:13 PM
 
Is it just me, or does it seem that a pretty significant number of people on the right just absolutely suck at knowing what fights to wage, and how to best wage them? I've been speaking in an attempt to be humorously egotistical about knowing how the Republicans can help win elections, but I have to wonder if maybe I really would be better equipped than many ideologically invested in the Republican party.

Sorry, I'm derailing my own thread.
     
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Nov 5, 2013, 04:15 PM
 
Originally Posted by besson3c View Post
Is it just me, or does it seem that a pretty significant number of people on the right just absolutely suck at knowing what fights to wage, and how to best wage them?
Let's not make this a partisan issue, particularly when one might argue that despite those traits, they have the far more successful or mainstream political machine.
     
Clinically Insane
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Nov 5, 2013, 04:18 PM
 
Originally Posted by The Final Dakar View Post
Let's not make this a partisan issue, particularly when one might argue that despite those traits, they have the far more successful or mainstream political machine.
That's true, I guess it's just for right now they are kind of lost in the woods. It's funny that the citizenry kind of follows suit though.
     
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Nov 5, 2013, 04:51 PM
 
Originally Posted by besson3c View Post
That's true, I guess it's just for right now they are kind of lost in the woods. It's funny that the citizenry kind of follows suit though.
Dude are you high? We've been right about this the entire time. We warned you three years ago this would be an unmitigated disaster, and we're lost in the woods? The citizenry isn't lost in the woods, besson, they're just coming out of it.
     
Clinically Insane
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Nov 5, 2013, 04:52 PM
 
Originally Posted by Snow-i View Post
Dude are you high? We've been right about this the entire time. We warned you three years ago this would be an unmitigated disaster, and we're lost in the woods? The citizenry isn't lost in the woods, besson, they're just coming out of it.
We're talking about political strategy
     
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Nov 5, 2013, 04:55 PM
 
Originally Posted by besson3c View Post
We're talking about political strategy
Oh ok, my b. It's been a long day
     
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Nov 5, 2013, 07:58 PM
 
No-one is asking why health care is costing more? Just how to make it so people pay less? I'd like to point out that emergency medical care is not a free market system. Once you get in / or are put in an ambulance you have no choice and they certainly don't provide you with a price list. And thats assuming you live in a major metropolitan area with multiple hospital. Call you're local hospital and ask how much they charge for 2 aspirin. If you're GP decides you need to see a specialist off you go.

IMHO
One of the big issues is the Fed Government mandated that for profit businesses provide services irregardless of the ability to pay WITHOUT covering the costs. If these costs were directed directly to the fed budget then visibility on that consequence would be increased and those costs would't be coming to us through the 25% markup of out insurance provider.
     
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Nov 6, 2013, 07:48 AM
 
The real problem starts when you can't afford to pay the deductible. The Democrats and Obama lied about the specifics when they knew the facts, so now they face a severe credibility issue, and nothing they say is accepted as truth. How smart was that tactic?
( Last edited by BadKosh; Nov 7, 2013 at 10:32 AM. )
     
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Nov 6, 2013, 07:49 AM
 
Originally Posted by BLAZE_MkIV View Post
irregardless
Um........
     
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Nov 6, 2013, 09:50 AM
 
Originally Posted by BadKosh View Post
The real problem starts when you can't afford to pay the deductible. The Democrats and Obama lied about the specifics when they new the facts, so now they face a severe credibility issue, and nothing they say is accepted as truth. How smart was that tactic?
My company had it's open enrollment meeting last month. The out of pocket max just went up $1000 ($2K to $3k) for individuals and $2000 for families. ($4K to $6K) Had the OOP max remained the same we would be subject to the 40% surcharge. We are "lucky" that was all it took. Our Director of Benefits said there companies that are scaling back their coverage to avoid the 40% surcharge. I can't remember which ones at this moment.
     
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Nov 6, 2013, 10:02 AM
 
Originally Posted by BadKosh View Post
Um........

Sometimes it's fun to taunt the grammar Nazis.
     
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Nov 6, 2013, 11:09 AM
 
Originally Posted by BLAZE_MkIV View Post

Sometimes it's fun to taunt the grammar Nazis.
Even the non-grammar Nazi's know this word isn't a real word.
     
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Nov 6, 2013, 11:22 AM
 
Originally Posted by BadKosh View Post
Even the non-grammar Nazi's know this word isn't a real word.
We also know that you don't make things plural with apostrophes, even when we're talking about Nazis.
     
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Nov 6, 2013, 12:11 PM
 
Besson. Do you think Sebelius is the right person to lead the HHS? Are you happy with this person overseeing our healthcare system?
     
Clinically Insane
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Nov 6, 2013, 03:54 PM
 
Originally Posted by BadKosh View Post
Even the non-grammar Nazi's _____ know this word isn't a real word.

a) dictionaries
b) kids
c) dogs
Fixed that for you.

-t
     
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Nov 6, 2013, 09:35 PM
 
This one sounds like the Mrs and myself. Fortunately we don't have to go through the exchanges.

Obamacare Restrictions Lead Brooklyn Couple To Consider Divorce � CBS New York

The issue for Aronowitz and Cassara is that together as family of only two, they make more than the $62,000 level to qualify for subsidies under the Affordable Care Act. But if they lived together unmarried, they would qualify for the subsidies and could literally save hundreds of dollars a month on their health care.

A single person can qualify for subsidies if they make less than $46,000 a year.
     
Clinically Insane
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Nov 6, 2013, 11:05 PM
 
So, besson, has Obamacare panned out the way you expected it would ?
Are you happy with it ?
Do you think it has made health care in America better ?

-t
     
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Nov 6, 2013, 11:21 PM
 
Originally Posted by Snow-i View Post
Besson. Do you think Sebelius is the right person to lead the HHS? Are you happy with this person overseeing our healthcare system?
Probably not, but I suspect how things played out makes things a little too complicated to paint a line directly from the failings to her.

I mean, the site was built by a private contractor, but instead of the Obama administration taking the advice of people like Larry Summers they decided to manage the project themselves, from what I understand. Was having a non-governmental entity plan the whole rollout a possibility? Practical? Was there a specific reason or reasons for how the management of this played out?

I think it was unrealistic to expect a flawless rollout, but clearly this level of difficulty is unacceptable. I don't know if this was the fault of Sibelius, the Obama admin itself, some unfortunate aspects to how things played out (e.g. funding availability). I'm sure there are many pieces to this mess, there usually are with something this complicated.

Therefore, I'm not sure if we can just clap our hands and say "Sibelius was a f-up" and call it a day. There are probably a number of things to learn from this debacle. It is also possible that she wasn't as responsible as people think.

All of this being said, while it is sure satisfying for all of us to say "wow, more evidence that the government sucks at everything", that may very well be the case, but this project was *extremely* complicated. I mean, with the discussions we've had here about our current system we can all see how much of an entangled mess all of this is, it could be that literally Jesus himself would be unable to sort out this mess without ugliness like we are seeing now.

So, I don't know, but let me be clear, I'm in no way defending her either. She probably should be fired, but I just don't want to take the attitude of "fire her, problems solved" necessarily.

I sound pretty wishy washy about this, but you asked. I'm just being honest.
     
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Nov 6, 2013, 11:24 PM
 
Originally Posted by turtle777 View Post
So, besson, has Obamacare panned out the way you expected it would ?
Are you happy with it ?
Do you think it has made health care in America better ?

-t

Like I told Snow-i, the roll-out has sure been ugly, but it is still far too early to say whether it will make America better. I mean, it hasn't even been implemented yet. It could be that what we are seeing now is the tip of the iceberg in ugliness to come, or it could be that things improve to some extent. It could also be that this is the tip of iceberg of the sort of ugliness we'd see in literally any sort of fathomable change to a system this messy and complicated, I'm of a set mind that what we had was not worth hanging onto, it seems like we all agree on this. Gun to my head, I honestly can't really say how this will play out. I'm taking a wait-and-see approach, I'm done with looking at charts and graphs and reading positive and negative anecdotes and trying to figure out which ones to assign value to

I'm not happy, I don't think anybody is, I just don't think any of us can draw conclusions so soon. Give it until a few months after March or so. That time will fly by quickly, so... patience, and shut up until then? Just kidding
     
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Nov 6, 2013, 11:39 PM
 
I should also add that I'm finding these times and this whole debate exciting, because no matter how things play out it seems like we're all on the same page that settling for what we have is not an option. I'm happy that we are moving on!

No matter how you feel about the ACA, history might prove this to be a lubricant for change, if nothing more.
     
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Nov 7, 2013, 07:53 AM
 
Now that folks' NIMBY votes have ended up in their back yards, they're complaining to their Senators; particularly those 14 or so vulnerable Democrat Senators who met with the President yesterday to air their grievances that the ACA is really as bad as Republicans have been warning about for 3 years. The sooner we get healthcare.gov back online, the sooner we'll realize what a colossal failure this whole legislation really is.

I'm afraid there is no rake strong enough to move all the shit this has dumped in the yards of their constituents and it seems we've found our only real, shovel-ready project.
ebuddy
     
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Nov 7, 2013, 10:29 AM
 
Originally Posted by besson3c View Post
We also know that you don't make things plural with apostrophes, even when we're talking about Nazis.
You're right.
     
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Nov 8, 2013, 11:01 PM
 
Let me ask you guys something...

In years past when people like myself would criticize the American health care system, specifically its cost/accessibility, IIRC many right-leaning individuals in here would defend it (IIRC one of those people was ebuddy). Is my recollection here incorrect, or have some of you changed your minds?

It has been a very long time since I've seen somebody try to defend what we have. It is actually pretty satisfying to see advocating systems other than what we have now.
     
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Nov 9, 2013, 09:50 AM
 
Originally Posted by besson3c View Post
Let me ask you guys something...

In years past when people like myself would criticize the American health care system, specifically its cost/accessibility, IIRC many right-leaning individuals in here would defend it (IIRC one of those people was ebuddy). Is my recollection here incorrect, or have some of you changed your minds?

It has been a very long time since I've seen somebody try to defend what we have. It is actually pretty satisfying to see advocating systems other than what we have now.
I won't speak for others, but I can't think of a single discussion around the US healthcare system where I didn't acknowledge the challenges in it. What I had maintained is that we must also consider what we do well so as not to throw the baby out with the bath water in trying to fix problems. What you might be recalling is that I did not accept the premises too often presented to me in comparing systems that a piece of paper called coverage = access or that other systems had actually done a thing for costs. I reminded the audience what types of tax structures are required to even pretend you're managing such an insolvent system, why it remains a top-tier voting concern among those countries being compared to the US, dispelled a number of myths about mortality rates and the like, and essentially ended most of those conversations with a wealth of incontrovertible evidence others refer to as "walls of text". Because of course, they're here for the pictures and quips.

Otherwise, an outright repeal of the more recent health insurance reforms would go a long way toward addressing the problems in the US health care system.
ebuddy
     
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Nov 9, 2013, 01:38 PM
 
What ebuddy said.

The only thing I want to preserve is the good parts of our health care system.

One of those good parts is newer and better treatments. We get those because you can make bank with them.

If you can preserve that, go nuts.
     
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Nov 9, 2013, 04:35 PM
 
Originally Posted by ebuddy View Post
Otherwise, an outright repeal of the more recent health insurance reforms would go a long way toward addressing the problems in the US health care system.
I disagree.

At the core, what needs to be broken up is the cartel-like structures between big pharma, insurance companies and big health care providers.

I don't see how repealing Obamacare would address any of those issues at all.

Neither do I see how putting the Republicans back in the drivers seat would fix anything, because ether are paid and bought for by the lobbyists of the health care cartel.

Excellent facts and examples of how prices are kept unnecessarily high:

Healthcare - Hospital Billing   Print this Section                   Watch Video               

Healthcare - Medications: What Your Pharmacist Won't Tell YouAs Featured in Huffington post  Print this Section   Watch Video

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