Miscellaneous And Off Topic Subjects

[froot loops]

It's coming. And really, support for some form of socialized medicine goes back to Teddy Roosevelt...FDR, Truman, Nixon, etc, -and others- all tipped their hats toward it.

Yeah, single-payer is supposed to denote one entity writing checks to docs and hospitals. More accurate would be "single-check writer" I suppose.

It isn't coming absent a giant wave election win for the Democrats.

[AlabamAlum]

It isn't coming absent a giant wave election win for the Democrats.

Well, the republicans aren't putting up electible candidates and unless PPACA is repealed or retooled, there won't be much choice but to start it - regardless of the political affiliation of those in power.

[iam416]

The Rs aren't putting up electable candidates for President. They're doing fine in nearly every other type of election.

The Ds will have bare control of the Senate and likely no control of the House. There is no way "single payer" is possible with those numbers. And the numbers will almost certainly get considerably worse for the Ds in 2018.

[AlabamAlum]

Talent,

Regardless, it depends on PPACA being repealed or retooled. Unless it is, insurance companies will continue to drop their Exchange offerings. And that's been happening already in many markets.

[Hannibal]

Long term, it's almost inevitable. Thus, my harsh stance on illegal immigration and on third world immigration. The welfare state is absolutely incompatible with a lax immigration policy. Europe is finding this out the hard way right now and the Socialist democracies there don't share a long border with a third world country like we do.

And just imagine how wonderful it will be -- in addition to the hundreds of trillions of dollars of unfunded liabilities that we already have, health care for everybody will be a new taxpayer obligation, to be funded by an economy that is growing at 1-2% (if we're lucky) and a shrinking population of middle to upper income earners.

[iam416]

Talent,

Regardless, it depends on PPACA being repealed or retooled. Unless it is, insurance companies will continue to drop their Exchange offerings. And that's been happening already in many markets.

Right, so it's a gamble. The failures of Obamacare are predictable and were predicted. The question is the response. It remains more unpopular than not. Given that and a continued strong R presence in Congress, it's credible that the option will be repeal. Of course, that requires an R President.

Doubling down on the failed Obamacare, however, requires a massive D majority in Congress and a considerable shift in public opinion.

I think the latter is probably more likely, but I don't think it's written.

[froot loops]

The Republicans can run a ham sandwich in a lot of districts and win. Gerrymandering has baked it into the cake.

[entropy]

right now, I wish that ham sandwich was running for president..

[Jeff Buchanan]

In discussions about US health care, it is easy to conflate terms and then draw wrong conclusions. The FFS model is a dying one. To the extent it does exist, it has only a marginal impact on costs.

The solo practice that bills on a FFS basis is dissappearing and that trend has been in place for a decade, maybe more. Practices are either owned outright by large hospital systems or they are affiliated. Providers are hospital employees in some cases and can opt for a fixed salary or are paid by a formula that measures how many encounters you have in a given period and what ICD10 codes (services or procedures) you did in those encounters (the measure is called RVU and my explanation is a gross oversimplification).

For the most part, providers, practicing in the evolving model of care, are not the major players in a health care entitie's profitability. The suits managing these entities are. And it is profitability that is driving their health care delivery decisions. The big dogs here are the enlarging for profit hospitals, big pharmaceuticals and the insurance companies and if you're looking for lower costs and better essential care, curtailing the influence of this group on health care quality and delivery is important. It this reality that drives my view that a single payor system using an expanded Medicare model of delivery is not necessarily the best but probably the most likely to succeed in achieving that goal.

Back on point ........ Health care costs and outcome measures are not related in any direct way using some sort of simple equation. There are too many factors influencing each of these independently or in concert. This is one of the reasons understanding the health care system is so difficult and formulating policy changes to make the system better so elusive.

Complicating matters is the competing politics and economic viewpoints of stake holders. The system in its present form is not fixable by making adjustments. I think the compromises made to the various stake holders to bring us the ACA supports that view. It is not good legislation nor do I believe anyone who understands and has been involved in the process thinks it is good legislation.

If I had the answers to bring this country a decent health care system, I'd certainly be doing that. I don't. But I do know that the current system is not sustainable and more importantly it sucks at delivering good care to all citizens equally. What is discouraging to me is that there are so many models world wide for the delivery of good health care yet we continue to flail around trying to find something that makes all the stake holders happy. Isn't going to happen.

[iam416]

The Republicans can run a ham sandwich in a lot of districts and win. Gerrymandering has baked it into the cake.

A favorite D excuse. Perhaps they should try not getting fucked up the ass at the state level. Or perhaps the Ds should talk to their black members who are all to happy to horse trade with the Rs to preserve "safe black folk" districts.

In Ohio, the Secretary State wanted to address some gerrymandering issues, but he meant opposite from a coalition of Rs AND Ds.

I realize it's tough for Ds to NOT make excuses, but in a lot of places, D ideas don't play.

[iam416]

This is an oldie but a goodie -- some real insight into how Obama views the Voting Rights Act....do NOT enforce it with race neutrality: http://www.judicialwatch.org/wp-cont...es-3242011.pdf

[entropy]

Jeff.. Hospitals still are paid by FFS.. and so are practices.. who does the billing doesn't change the system. Most of it is still FFS.. almost all in fact.

Insurance pays for what is done based upon rules.. Medicare and Medicaid does the same.. It's all paid based upon services and why billing coding has such a large impact on Revenue.. It's still pay for what is performed. It's not a Fixed Fee or a captive $$

Perhaps I missed your first point.. If it's FFS doesn't exist, I don't agree. If it's more decisions are being made corporately than ever, I agree. Or again, maybe I misunderstood.

btw.. Still over 50% of physician practices and specialty offices are independently owned. Fewer than before, but nowhere near dead. I do think MACRA will push that % lower.

[froot loops]

A favorite D excuse. Perhaps they should try not getting fucked up the ass at the state level. Or perhaps the Ds should talk to their black members who are all to happy to horse trade with the Rs to preserve "safe black folk" districts.

In Ohio, the Secretary State wanted to address some gerrymandering issues, but he meant opposite from a coalition of Rs AND Ds.

I realize it's tough for Ds to NOT make excuses, but in a lot of places, D ideas don't play.

I'm not a Democrat, so whatever with the coarse language. It so happens that in many districts the Democrats could run a ham sandwich and get elected as well. In both 2012 and 1996 the Democratic congressional candidates won far more votes than the GOP candidates but the GOP held their majority, that bit of info elevates it from an excuse to a true reason.

It is exactly right that the Democratic party needs to win at the state level to compete in the gerrymandering race. That's a slow race divided up in 10 year increments. But that's not my concern, I think the practice is terrible on its face. It should be eliminated, not that either party wants to eliminate it both sides get their safe seats.

[Hannibal]

The Rs aren't putting up electable candidates for President.

They had at least a few electable candidates this cycle. IMHO the more electable guys never got any traction whatsoever, which was a little bit puzzling to me. Some of the guys who made it further probably couldn't get over the top because Repub voters had no trust that they would follow through on their promises (e.g. Bush, Rubio).

[iam416]

In both 2012 and 1996 the Democratic congressional candidates won far more votes than the GOP candidates but held their majority, that bit of info elevates it from an excuse to a true reason.

There are far more examples of near perfect correlation to vote totals, the most recent being, you know, 2014 when the Rs jackhammered the Ds. Two anomalous results isn't reason. If gerrymandering were the cause then it would show up in every election because, well, it's present in every election. There's neither correlation nor, more importantly, causation.

But hey, if you're going to insist you're not a D, then reason isn't going to play much of a role here.