WBUR interviews people who think a lot about health care, including the CEO of Boston Medical Center, on what happens now that Republicans who campaigned against Obamacare for seven years couldn't repeal it even after taking control of the federal government.
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Not to me
By Bob Leponge
Wed, 07/19/2017 - 12:53pm
Many people (myself included) flat out reject the entire concept of positive rights.
What this argument sounds like...
By Bob Leponge
Wed, 07/19/2017 - 1:21pm
How dare the evil, overreaching government force poor Joe to spend money on maintaining the brakes on his car? He needs that car to get to work, and he just doesn't have the money to spend on maintenance.
Bad analogy
By Will LaTulippe
Wed, 07/19/2017 - 1:34pm
You need the brakes fixed (almost) immediately. You might not need the health services you pay for until decades later.
Also, Joe not fixing his brakes is already paid for if he hits me in Massachusetts. We insure that too.
Also, Joe might still have that money if we didn't tax a quarter of his income to pay for tanks for small town police departments or for DEA agents chasing some guy selling marijuana.
You're still not getting the abstraction thing
By Bob Leponge
Wed, 07/19/2017 - 8:51pm
You used your health insurance last year even if you never got sick and never went to the doctor. Just like I used my life insurance last year even though I didn't happen to die.
Consider this (apologies to Nick Taleb):
You and I go out to lunch. We decide we'll flip a coin for who pays. We flip, I lose the flip and pick up the tab.
A concrete thinker is going to say that I paid for lunch. An abstract thinker is going to say that we split the cost of lunch 50 50.
Bad Analogy
By anon
Wed, 07/19/2017 - 2:48pm
if Joe can't afford to maintain his car, he can get rid of it, and rely on uber, friends/family, and his own two feet.
owning a car is a choice, owning a body is not.
if Joe can't afford to
By starstrewn
Thu, 07/20/2017 - 4:38pm
Unfortunately, Joe couldn't afford health care and his diabetes went untreated for too long. Joe had to crawl to the emergency room and had both feet amputated.
Now Joe has no car and no feet.
/s
Well said.
By Bill
Wed, 07/19/2017 - 9:43pm
That, Bob, is exactly why universal healthcare was a conservative idea to begin with. Everyone should be responsible for themselves and their family's healthcare so the rest of us don't end up on the hook. And the only way to pay is with insurance because no one can pay for even minor health misfortune without it drastically hitting you financially, if you can pay at all.
The downstream effect you described is already happening as hospitals anticipate a less insured population. It's affecting their contract negotiations with health plans like Blue Cross, especially in states where Medicaid expansion is likely to be reversed. The hospitals know they'll have less paying (insured) patients so they're asking for bigger rate increases from the insurers. Next stop higher trend premium increases, then on to employers passing along more of the cost to employees.
Still waiting
By Will LaTulippe
Wed, 07/19/2017 - 9:36am
For the provisions of either Obamacare or Trumpcare which allocate funds to get more hospitals built, more foreign doctors into our country, and more international pharmacy shipments into our country.
Both sets of legislation are obnoxious farces.
Why can't we educate more
By anon
Wed, 07/19/2017 - 9:55am
Why can't we educate more American doctors? Oh... that's right the AMA & friends crap the # of medical schools and seats available to artificially create a labor shortage.
Why can't .Gov stop that cartel crap?
Because
By Will LaTulippe
Wed, 07/19/2017 - 10:39am
Cartel operation is precisely the raison d'etre of big government.
Nope
By Nate
Wed, 07/19/2017 - 10:21am
Stop lumping things into all good or all bad. It's a cynical view that is destructive to any kind of progress. I absolutely agree that neither is the perfect solution or that we can stop worrying about improving our system, but to say both are terrible and throw up your hands is dumb.
One plan provides healthcare to tens of millions more, ensures that plans include actually useful benefits, and ensures preexisting conditions are covered by those benefits. This is the clearly better option. It's just not debatable.
Well
By anon
Wed, 07/19/2017 - 10:19am
Of course he agrees, the pre-existing conditions amendment was originally pushed by republicans during the passage of the ACA!
What? Do you have a source?
By Nate
Wed, 07/19/2017 - 10:26am
From during the ACA debate: "the Republican bill, unlike the Democratic bills, doesn't specifically bar insurers from excluding pre-existing conditions, even though that policy has broad support in both parties."
http://www.politifact.com/truth-o-meter/article/20...
I didn't throw up my hands
By Will LaTulippe
Wed, 07/19/2017 - 10:50am
I literally pointed out what the actual problems are in American health care in my initial post in this string. Here, I'll make it a little more pithy by offering my favorite rhetorical question: How much would treatment cost if you had it performed in the doctor's garage?
How much does it cost in money and time to become a physician? Hell, how much does it cost in money and time to become any kind of specialist? We demand that a person give up almost a decade of their lives and hundreds of thousands of dollars to enter the profession. And when they get there, they have but a handful of hospital owners for whom to work. You essentially have a handful of corporations who have an entire field of all-in professionals by the balls.
I paid a $521 fine to the feds last year for not buying what I deem to be an overpriced product for the services that I (don't) use. What has the federal government done with that money which they seized from me? Did it help one sick person get already overpriced care? Or did it go towards the actual betterment of health services in our community?
This is even bigger than the housing bubble and the student loan bubble, yet, mainstream media seems to report very little on this existing and still-looming paradox. I hope that this endless debate on how to get health services for Americans is finally the impetus which makes us all realize that you simply can't govern a country with this many people. Only two countries have more people than we do, and one of them has far less awareness among its populace due to the absence of a free press.
Do you have a problem with abstraction?
By Bob Leponge
Wed, 07/19/2017 - 11:06am
You "didn't use" your health coverage last year in precisely the same sense that I "didn't use" my life insurance or liability insurance.
That's a bullshit argument.
Except
By Will LaTulippe
Wed, 07/19/2017 - 11:32am
Insurance isn't a bank. I don't get paid interest on claiming the fruits of the premiums 40 years after I pay them. A corporation gets to control the float and use it as they see fit.
In this regard, I've gotten even: 50 shares of Berkshire Hathaway have proved to be a profitable investment since 2009.
You got even because Berkshire Hathaway invests in Health Care?
By Pete Nice
Wed, 07/19/2017 - 11:43am
Warren Buffet also invests heavily in Foreign drug makers....
I got even
By Will LaTulippe
Wed, 07/19/2017 - 12:15pm
Because Berkshire does a great job of spending insurance float to make money. That's $4,700 in appreciated value I'm sitting on before taxes. Honestly astonishing how many people will spend $1,600 a month on some studio apartment instead of buying stocks.
/r/Iamsmart is calling
By tachometer
Wed, 07/19/2017 - 1:51pm
.
Difference
By dmcboston
Wed, 07/19/2017 - 2:03pm
"You "didn't use" your health coverage last year in precisely the same sense that I "didn't use" my life insurance or liability insurance. "
There is a difference. Some people use their access to health care all the time. I don't use the car insurance, but I have no problem using the health insurance to avoid using the life insurance.
FU*# YOU, TICK.
(The above was meant for the tick, not you.)
Americans are Less Healthy than people in similar countries
By SwirlyGrrl
Wed, 07/19/2017 - 2:35pm
Lack of preventative care is a huge reason - that includes not getting primary care, not getting follow up care, and not getting care that is less expensive but keeps people out of crisis.
We spend a lot of money taking care of people in crisis.
https://www.bloomberg.com/news/articles/2016-09-29...
And...
By dmcboston
Wed, 07/19/2017 - 2:55pm
...this is why dental plans offer free checkups.
"Seized?" Seriously
By Bob Leponge
Wed, 07/19/2017 - 11:10am
In what sense does an agreement, made through a legitimate democratic process constrained by constitutional limits, that we're all going to pay for something collectively -- be it a road, an aircraft carrier, or anything else, constitute "seizure?"
Because the ultimate outcome of me not paying it
By Will LaTulippe
Wed, 07/19/2017 - 11:14am
Is somebody coming after me with a firearm.
Yes, I think it did help one sick person
By FootPad
Wed, 07/19/2017 - 11:30am
Yes, I believe John McCain is getting excellent care for his blood clot courtesy of tax revenue that pays for gold-plated health care for our elected officials.
help one person
By Bobp
Wed, 07/19/2017 - 2:24pm
Yes thousands of people are alive today because of the ACA and Medicare expansion, no lifetime maximums and no exclusions for preexisting conditions
International pharmacy shipments?
By Pete Nice
Wed, 07/19/2017 - 11:27am
Correct me if I'm wrong (and I could be), but these "shipments" are often drugs that were originally made in the US and eventually copied and patented in other countries when the US patents ran out. We have those drugs here, they just cost more because US companies aren't subsidized like other countries and there are no price controls.
Oh, US companies are subsidized
By SwirlyGrrl
Wed, 07/19/2017 - 2:36pm
Federal government R&D, anyone?
It is the massive marketing and advertizing and promotion budgets that blow the expenses massively out of proportion, not a lack of government subsidy.
more international pharmacy shipments into our country
By tachometer
Wed, 07/19/2017 - 1:49pm
Be careful with that. I've seen people make the argument that "The Canadian FDA is comparable to ours so why shouldn't we be able to get drugs from Canada?" Which sounds reasonable on its surface but without adequate regulatory protection there are holes you could drive a truck through to abuse that system. Even today companies sell drugs "from" Canada but they are not approved to be sold in Canada but are purchased through a Canadian company and what you're getting are drugs made in places like India where there is little or weak regulatory oversight that would not be approved for sale in the US or Canada.
The root of the problem in the US compared to other industrialized nations with drug prices is that other countries have a nationalized health care system where the country can negotiate prices for drugs sales to the entire population which gives them strong negotiating power. In the US we've essentially given that right away. The VA is allowed to do it but Medicare/Medicaid cannot. So the single largest drug purchaser in the US is currently tied to paying a set percentage related to the best price that a private insurance company pays. Now, do you really think that the largest insurance company in California has the same negotiating power of Medicare/Medicaid?
tl;dr The US gets screwed on drug pricing because we don't have single payer, not because we can't get drugs from another country.
This conversation wouldn't
By DonnieBoston
Wed, 07/19/2017 - 9:59am
This conversation wouldn't even exist if Obama and the Democrats didn't destroy our healthcare system in the first place!! Why isn't this mentioned?
Because it's a moronic point
By adamg
Wed, 07/19/2017 - 10:25am
Destroyed? You can't see a doctor anymore?
But I speak as somebody on a Romneycare/Obamacare policy. Millions of people now have insurance. Perfect? No, but far, far better than the alternative.
It was mentioned by people
By Kinopio
Wed, 07/19/2017 - 10:26am
It was mentioned by people who don't know anything like Trump. It just wasn't true. Millions of people have access to healthcare now that didn't before because of Obamacare. Lets stick to facts here.
Democracy is the worst form of government
By Sock_Puppet
Wed, 07/19/2017 - 11:40am
Except all those other forms that have been tried.
And Obamacare is the worst health care reform, except all those other forms the Republicans can think up.
Good thing
By Will LaTulippe
Wed, 07/19/2017 - 12:16pm
There's more than two parties then. The French grew a pair and figured that out. Our turn.
Republicans, you had 8 years
By anon
Wed, 07/19/2017 - 1:13pm
Republicans, you had 8 years to come up with a plan. You have NO IDEAS.
Oh, no, they have ideas
By Will LaTulippe
Wed, 07/19/2017 - 1:30pm
It's just not in their interest to implement all of them. I have the idea of giving a million dollars to Planned Parenthood, I just don't have the means to actually do it.
Since we've nearly
By anon
Wed, 07/19/2017 - 1:43pm
Since we've nearly conclusively proven that the country does not have the stomach for a cash & carry approach to healthcare we are probably drifting towards Medicare for all in some way or form. No politician that rejects the Medicaid cuts as cruel is going to want to spearhead a push to reverse EMTLA for example and then move healthcare to the same level as any other service industry.
You're not going to buy a coffee if you can't pay for it, and you're not going to buy treatment in the ER after you get rear-ended by someone if you can't pay. But do we want to live in that type of society? There's no appetite for that type of approach, at least I don't think there is. The closest people to that argument are the ones saying they don't need to pay for obstetric services, prostate exams, or whatever pool of individuals they happen to latch onto that they don't see a need for. Pooling risk and money spreads the costs out and given the "right" amount of government support makes it affordable for everyone.
We're still not anywhere near the level of rational discourse that we need after the monstrosity that failed in the Senate. At best there will be some thoughtful fixes applied to the cost sharing subsidies for ACA. But I expect there will be a deliberate effort to not make them thoughtful enough and keep the ACA teetering because it's more important to score a political win than to actually provide healthcare for people.
Just implement a single payer
By Scauma
Wed, 07/19/2017 - 3:05pm
Just implement a single payer system and be done with it already.
Two states already tried and
By CCD
Wed, 07/19/2017 - 3:29pm
Two states already tried and failed. Vermont and California abandoned single payer before it even got started. Why? Overwhelming and crippling costs. How would the entire US be any different?
Not the whole story
By SwirlyGrrl
Wed, 07/19/2017 - 3:48pm
Send us a link and we'll discuss it.
Vermont is really too small to pull it off alone - no leverage against the drug and healthcare lobbies who colluded to squash the attempt.
California has had a bill fail in the senate ... but has never tried to actually implement a program. That's not a failure to IMPLEMENT or a failure of a PROGRAM - its a failed attempt to LEGISLATE a program. Very very very very very different things. Something that never happened is very different from something that isn't sustainable.
You're my hero, Swirls. Wish
By starstrewn
Thu, 07/20/2017 - 5:03pm
You're my hero, Swirls. Wish you were running the show in politics...
Doesn't work on that level
By Scauma
Fri, 07/21/2017 - 11:16am
I think its important to remember that Americans don't use more healthcare than other countries, its that we pay a lot more for everything compared to other countries. A national single payer system would allow the government to negotiate with pharma companies for better rates. The health insurance industry isn't the problem, their profits aren't through the roof. It's how much we pay for all the services we get.
Not on the national level, yet
By lbb
Thu, 07/20/2017 - 9:24am
The past eight-year (and beyond) saga of national healthcare policy suggests to me that we're a long, long way of implementing any change on the national level, except for systems like Obamacare that do have significant shortcomings (my personal beef is the conflation of "health insurance" with "healthcare"), and that are hard to reform for reasons that should be obvious to anyone with even a room temperature IQ. But I think we could do it in some states with enough population and facilities, and Massachusetts would not be a bad place to start. In fact, there's an effort under way now to do just that. I believe that single-payer/Medicare for all in Massachusetts would be a significant improvement over anything else.
I believe that single-payer
By starstrewn
Thu, 07/20/2017 - 5:05pm
Let's do it!
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