The fall of Trumpcare

[Oystein]

Trump, when dealing with Congress, was not able to use one of his most effective business weapons: threat of suing. The orange bully with a temperament of an eight-year-old was not able to bully Congress by threatening to sue them.

 

[joepistole]

Trump, when dealing with Congress, was not able to use one of his most effective business weapons: threat of suing. The orange bully with a temperament of an eight-year-old was not able to bully Congress by threatening to sue them.

Indeed he wasn't.

 

[Oystein]

Can you imagine such a thing?!! Oh, the horror! No Democrats voted for Trumpcare. What vile people they must be. This failure is completely their fault. No doubt.

Oh, wait a minute . . . I forgot . . . not a single Republican in the House or the Senate voted for the ACA (Obamacare).

 

[Jeeves]

Can you imagine such a thing?!! Oh, the horror! No Democrats voted for Trumpcare. What vile people they must be. This failure is completely their fault. No doubt.
Oh, wait a minute . . . I forgot . . . not a single Republican in the House or the Senate voted for the ACA (Obamacare).

Of course, most of the ideas Republicans had on health insurance - and when we use "ideas" in conjunction with Republicans, it actually means "objections" - were already accommodated by the bill in its final version. Their imaginations were hard pressed to come up with new ones in so short a time.
This was interesting:
http://affordablehealthca.com/timeline-obamacare/
My favourite paragraph: "August 2009: Lawmakers go home to find walls of worry erected over “Obamacare.” One lawmaker says citizens are “shell-shocked” over the many changes in the first eight months of Obama’s administration."

 

[sculptor]

Your friendly neighborhood freedom caucus strikes again.
If you didn't like the republicans stinking pile of excrement called the American Health Care Act------------which was actually about insurance, not health care.
Then you should thank the freedom caucus loonies.
...............................
Why, I wonder do idiots keep calling health insurance health care?
Is mass insanity the norm these days?
.................
meanwhile The USA(at 2.3) is 52nd in doctors per 1000 people.
That's less than almost all of Europe and Russia, and even Australia(at 2.5).

 

[Randwolf]

Is mass insanity the norm these days?

If not yet the norm, it is certainly on the rise.

What else would you expect when objective fact becomes the subject of ridicule and disdain? When inexperience is touted as an asset? When alternative facts run rampant? When Trump is elected president?

Yeah, I'll go with "mass insanity" - that explanation works for me...

 

[Oystein]

When Trump is elected president?

Yeah, I'll go with "mass insanity" - that explanation works for me...

True dat! In the future when the definition of "mass insanity" is looked up on the net, the primary definition should be "the 2016 election of Donald Drumpf to POTUS".

 

[joepistole]

Your friendly neighborhood freedom caucus strikes again.
If you didn't like the republicans stinking pile of excrement called the American Health Care Act------------which was actually about insurance, not health care.
Then you should thank the freedom caucus loonies.
...............................
Why, I wonder do idiots keep calling health insurance health care?
Is mass insanity the norm these days?
.................
meanwhile The USA(at 2.3) is 52nd in doctors per 1000 people.
That's less than almost all of Europe and Russia, and even Australia(at 2.5).

Probably because it's a distinction without a difference. As much as you don''t like to acknowledge it, obtaining access to healthcare requires either health insurance or cash on the barrel head and in which case the uninsured pays several fold more for that healthcare than an insured person would.

The American Healthcare Act was all about a trillion dollar tax cut for America's richest families.

On this I think we can agree, the American healthcare system is a very monopolistic system, and for decades, as prices continue to rise, we have been shifting healthcare costs from corporations to employees and private citizens to the government. Obamacare isn't a fix so much as it is a patch. Trumpcare was a regression. It was a throwback to the days where tens of millions of people were left without access to health insurance and healthcare. If you cannot pay for the drugs you need, you don't have access to healthcare. If you cannot pay for the surgery you need, you don't have access to healthcare.

What we need is the opposite of what we have. Instead of a few suppliers and may buyers, we need a single purchaser and many suppliers. We need single payer health insurance. Even if you could route out all of the monopolistic aspects of our healthcare system at the state and federal levels, and keep them out, it would take decades to get to something resembling a free market. Schools would have to be built; people would need to be trained. And in the mean time, millions of people are dying because they don't have access to affordable healthcare.

 

[Jeeves]

sculptor --
meanwhile The USA(at 2.3) is 52nd in doctors per 1000 people.
That's less than almost all of Europe and Russia, and even Australia(at 2.5).

It's even a lot less than that, if you consider how many people with MD after their name do nothing useful - nip$tuck; weight loss and fertility clinics, administration; consulting - and how different the concentration is in a rich neighbourhood compared to a poor one. Where medicine is megabusiness in which one can make megabucks, why bother treating the sordid little ailments of inner city kids or retired factory workers for a modest fee? The people who would want to do that, products of those same poor neighbourhoods, can't get into medical school and can't afford it if they did get in. It's not that there is a natural shortage of talent or dedication; it's that exclusive clubs tend to protect their exclusivity - and doctors have one of the most guarded.

 

[sculptor]

When bill Clinton was president, he closed a medical school claiming that there were too many doctors. (If memory serves that was at a cost to taxpayers of $200 million/year)
So, we import doctors.
Real crazy that.
If Trump and congress really wanted to help the average american citizen, they could open dozens of new medical schools and have hundreds of new doctors within a decade.
Then, if the doctors were willing to work for the government(people), for 10 years at a fair salary, their schooling could be free.
In less than a generation, we could turn this ugly greedy piece of shit around and have healthcare for all.

But, we have a millionaire's congress who couldn't give a shit less about the average citizen.

 

[iceaura]

Why, I wonder do idiots keep calling health insurance health care?
Is mass insanity the norm these days?

A leftover from the concerted effort to block Wellstone's single payer initiative, way back in 1993. The vocabulary confusion worked, as government control of health care sounded a lot worse than government control of corporate health insurance. The vocabulary shift shows up even in Wellstone's own political arguments: http://www.nejm.org/doi/full/10.1056/NEJM199305203282013#t=article

 

[iceaura]

When bill Clinton was president, he closed a medical school claiming that there were too many doctors. (If memory serves that was at a cost to taxpayers of $200 million/year)

Oh bullshit.

Then, if the doctors were willing to work for the government(people), for 10 years at a fair salary, their schooling could be free.
In less than a generation, we could turn this ugly greedy piece of shit around and have healthcare for all.

The doctors aren't the bottleneck, doctors greed is not the main contributor to the cost spiral. Meanwhile, the government actually employing the docs and owning the hospitals and so forth is a very large expansion of bureaucracy over single payer.

 

[joepistole]

When bill Clinton was president, he closed a medical school claiming that there were too many doctors. (If memory serves that was at a cost to taxpayers of $200 million/year)

I don't know how Clinton could have closed a medical school as POTUS. The POTUS has no authority to close or open medical schools. That's normally something done at the state level and local level. Each state sponsors its own university system and determines what will be taught, the federal government has no role in that. Private medical schools operate independently but are dependent upon private and public (state) entities for credentialing.

So, we import doctors.
Real crazy that.

That we do.

If Trump and congress really wanted to help the average american citizen, they could open dozens of new medical schools and have hundreds of new doctors within a decade.

I absolutely agree.

Then, if the doctors were willing to work for the government(people), for 10 years at a fair salary, their schooling could be free.
In less than a generation, we could turn this ugly greedy piece of shit around and have healthcare for all.

But, we have a millionaire's congress who couldn't give a shit less about the average citizen.

I agree, but it will take more than that. The reason we have this problem is because special interest groups influence congress and state legislatures. So we need to change the way we elect our representatives and eliminate all the special interest money in Washington and state houses across the land. Our elected and appointed officials shouldn't have conflicts of interests and should be required to maintain a very high ethical code of conduct and be very transparent. Reversing Citizens United is a start. But I think this one will require an amendment to the Constitution.

And then they need to address patent protection laws which allow drug companies to have extended patents. We need to revise how drugs are developed, produced, and marketed.

 

[wellwisher]

What needs to be done is we need to divide medical care into two sectors. One sector will be all the high risk people, those with long term preexisting conditions, and special needs. The other sector will the more healthy people, who periodically require some medical care. The second group would be treated using free market insurance. Since this is a fairly low risk and usage pool, the cost of premiums should be quite low. The first group, which is high risk and very expensive, should be addressed with a government program. Many countries do it this way.

I would combine high risk pool with the VA, to make a single health care entity which covers both military and high risk civilian needs. This is not new, but is the way it is during war. The Military not only fights and get wounded but is also responsible for civilians needs during times of high risk.

 

[Beer w/Straw]

What needs to be done is we need to divide medical care into two sectors. One sector will be all the high risk people, those with long term preexisting conditions, and special needs. The other sector will the more healthy people, who periodically require some medical care. The second group would be treated using free market insurance. Since this is a fairly low risk and usage pool, the cost of premiums should be quite low. The first group, which is high risk and very expensive, should be addressed with a government program. Many countries do it this way.

I would combine high risk pool with the VA, to make a single health care entity which covers both military and high risk civilian needs. This is not new, but is the way it is during war. The Military not only fights and get wounded but is also responsible for civilians needs during times of high risk.

Get universal health care and show others you actually care about their well being.

 

[sculptor]

sculptor said: ↑
When bill Clinton was president, he closed a medical school claiming that there were too many doctors. (If memory serves that was at a cost to taxpayers of $200 million/year)

Oh bullshit.

... .

This from http://www.cnn.com/HEALTH/9708/24/doctor.glut/

Report: U.S. to pay hospitals not to train doctors

August 24, 1997
Web posted at: 10:22 a.m. EDT (1422 GMT)
WASHINGTON (CNN) -- In an effort to reduce a glut of physicians in the United States, the federal government will pay training hospitals hundreds of millions of dollars not to train doctors, The Washington Post reported Sunday.

The initiative, part of the new federal budget agreement, also for the first time essentially forbids hospitals from increasing the size of their residency programs, the paper reported.

Medicare underwrites residency training programs heavily. Taxpayers spend $7 billion a year on the training, with each resident translating into an average subsidy of $100,000 a year.

Under the new plan, Medicare will instead pay hospitals to shrink their residency programs. Hospitals that voluntarily reduce residency training programs by 20 to 25 percent over five years will get the full amount of the lost subsidies...

.........................................
OK Doctors ain't the only bottleneck.
It is really rare that one can just walk in and see a doctor------------so much of my medical care is done by PAs and nurses.

as/re greed
Insurance companies have a fiduciary responsibility that has nothing to do with medical care.
Call it greed? Call it capitalism? Hell man call it Fred if it makes you feel better.


From: http://www.nytimes.com/1997/02/18/n...spitals-not-to-train-doctors-easing-glut.html

In a plan that health experts greeted as brilliant and bizarre, Federal regulators announced yesterday that for the next six years they would pay New York State hospitals not to train physicians.

Just as the Federal Government for many years paid corn farmers to let fields lie fallow, 41 of New York's teaching hospitals will be paid $400 million to not cultivate so many new doctors, their main cash crop.

The plan's primary purpose is to stem a growing surplus of doctors ....

In 1990 it was 1.8 doctor per 1000 people in the USA-------------still well under the density of Europe and Russia.

So where was this so called glut of "surplus of doctors"?

and, from: http://www.taxpayer.net/library/wee...s-pay-hospitals-millions-to-not-train-doctors

Two years ago, Congress passed a law to pay $400 million in Medicare funds to teaching hospitals as an incentive to reduce the number of doctors they train by 20 to 25 percent during a six-year period.

To get this doctor prevention subsidy, hospital groups lobbied on behalf of this legislation that would decrease the number of doctors they trained.

Before this law was passed, hospitals received approximately $100,000 a year from the government through Medicare for each resident they trained.

Hospital administrators wanted to cut the number of training slots for specialists in the industry, so they decided to train 2,000 fewer residents during a five-year period. But this cutback would translate to less federal funding for training hospitals that are primarily located in New York.

The law’s passage ensured that hospitals in New York and a few other states will receive the same money from the government even though they teach fewer doctors.

This program amounts to a multimillion-dollar pork program for hospitals in states with powerful political ties. ...

 

[Jeeves]

joepistole -- And then they need to address patent protection laws which allow drug companies to have extended patents. We need to revise how drugs are developed, produced, and marketed.

A little more transparency wouldn't hurt.
Like: where does the funding for research actually come from? How much of it is capital risked by the drug companies and how does that investment compare to long-term profits? How much pharmaceutical research is actually done in publicly-supported laboratories, such as hospitals and universities; what data comes from public institutions and how much government subsidy are they receiving?

It would be useful to know the figures on health-care facilities, as well.
Just the other day, when discussing tax exemption for churches, with regard to the charity work of religious institutions, I was astonished to learn how much government money they receive.
I suppose the information is available to anyone who takes the trouble to look for it. But I do not suppose the average voter goes looking for it before making such decisions as who ought to hold the purse-strings of their nation. It would be the responsibility of public information media to publish such information.

 

[sculptor]

I don't know how Clinton could have closed a medical school as POTUS. The POTUS has no authority to close or open medical schools.
... .

OK by the early 1990s we had moved to Iowa and I most likely read that in the Cedar Rapids Gazette ----------so, either the article I read had gotten it wrong, or my memory is in error. Not "closed" it would seem (from the above)...(but the core of "Us to pay schools/hospitals to not train doctors" seems accurate)..and, I could not find the original C.R. Gazette article.
"Close, no cigar"

 

[sculptor]

This from Tulsi Gabbard who is joining with Sanders, et.al in support of the Affordable and Safe Prescription Drug Importation Act

All people deserve access to affordable, quality healthcare and a system of care that is transparent and efficient. Congress is considering legislation in the House and Senate that would allow wholesalers, pharmacies and individuals to import drugs from Canada.

 

[Jeeves]

Congress is considering legislation in the House and Senate that would allow wholesalers, pharmacies and individuals to import drugs from Canada.

Seriously? That raises some issues.
http://www.slate.com/articles/news_...2000/05/why_do_drugs_cost_less_in_canada.html
"In recent months, members of Congress from both parties have introduced bills to stop this drug price discrimination, either by allowing the re-importation of drugs from Canada and Mexico or by requiring U.S. drug companies to offer drugs at one price for all of North America. If drug companies had to charge the same price in the U.S. and Canada, what would that price be? It would have to cover R&D costs, so it would be higher than the current Canadian price. But those costs would be spread over more pills, so it should be lower than the current American price. (This assumes that companies will maintain the same profit levels they currently enjoy.) Canada would have to abandon or modify its price controls, or its citizens would not be able to buy these drugs."

However, there are several problems. Thing One is the lie buried at the center of that statement. Thing Two is influence/pressure on the government of another country. Not least is the unknown quantity at the top of the current US political pyramid, who doesn't know or care what effect a sudden, whimsical tariff policy might have.

Thing One: http://truecostofhealthcare.net/the_pharmaceutical_industry/
As you see, more of their outlay is in advertising than in research, and there is quite a nice profit margin - and some hardship for consumers - even at the Canadian prices;
Therefore : Thing Two: It would be better for the US to regulate the price of drugs than for Canada to stop doing so.

Here's a simpler view of just how well pharmaceuticals are doing: http://www.drugchannels.net/2015/06/profits-in-2015-fortune-500.html