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Re: Medicare for All - OUT / Public Option - Appears IN

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Message 1 of 39

Medicare for all is a chimera. that in my opinion will not work  We need a system that will insure all but Medicare for all is not it.

At this point, and for the next elections. the general public doesn't want a revolution, they simply want to get rid of Trump.
Those very radical ideas are at this time not good, they do not represent the majority o voters. perhaps in the future they will but this is not the time for them

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Re: Medicare for All - OUT / Public Option - Appears IN

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Message 2 of 39

@GailL1 wrote:

@john258 wrote:


You are correct it is going to depend on how it is designed, and it has to be designed by people who are experts in Insurance, law, Govt law. With that in mind why are you asking people who are the users of Insurance not experts in design of such programs. It would make sense to wait until there is a program on the table then ask people who will be the users of the program to comment. Why waste a lot of time on something that can not happen now.


If you don't know the details, how do you know if you want it or not?

People who use their own money successfully always want to know what they are buying - the details - that the product is worth the money.

And in this case, if you don't want it - why vote for somebody that is pushing it.

 

I like a lot of knowledge before I commit to anything - you should too.

 

 


But that's just it. The candidates are only going to put forward their ideas and how they think it might work. Some may support a bill already in the works, but those aren't really fleshed out, especially when it comes to cost and how they intend to pay for it. All we can do is look for the ideas that seem plausible.

 

Ideas are easy. But getting a bill actually written and agreed to that will pass Congress? Ask Barack Obama. 

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Re: Medicare for All - OUT / Public Option - Appears IN

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Message 3 of 39

@GailL1 wrote:

@john258 wrote:


You are correct it is going to depend on how it is designed, and it has to be designed by people who are experts in Insurance, law, Govt law. With that in mind why are you asking people who are the users of Insurance not experts in design of such programs. It would make sense to wait until there is a program on the table then ask people who will be the users of the program to comment. Why waste a lot of time on something that can not happen now.


If you don't know the details, how do you know if you want it or not?

People who use their own money successfully always want to know what they are buying - the details - that the product is worth the money.

And in this case, if you don't want it - why vote for somebody that is pushing it.

 

I like a lot of knowledge before I commit to anything - you should too.

 

 


You know the details after the experts design the system not before. There is no system, and no one in here knows enough to design a system. There will be no design until the problem stopping that from happens is solved. Trump That problem is Trump. Solve that problem now. After that push to have the experts design the system then you move forwarded by asking regular people to comment. That way you learn a lot. Great you and all of need a lot of knowledge on a subject, but just knowledge with nothing to relate it to can become nonsense. Right now there is no plan so it is in the nonsense stage. It is important to understand the stages of something like this.

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Re: Medicare for All - OUT / Public Option - Appears IN

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Message 4 of 39

@GailL1 wrote:

@Olderscout66 

Well, there will be little competition there if the government is gonna FORCE providers to participate in the system.  I think providers will push back ESPECIALLY if there are private insurers still available and they are paying a higher rate for services.  In fact, I think some doctors will leave the Medicare system - They don't sign up for the Medicaid system now because of the pay.

 

We still have more private hospitals than public ones. 

 

So you aren't really talking about a competition type Public Option.

 

Since payment schedules for private insurance providers is pretty much a trade secret, why should they share this info with some government entity?  They are still gonna be competing with one another - so why share this privy info?

 

NO cherrypicking - Insurance premiums are based on the cost of the plan in services - Medicare Part B premiums are even based on this fact.  Why would a Public Option type plan be any different - especially when it should be an easy computation COST + Administration.

 

So are you saying that you see cost level within the Public Option plan?  It too will offer 80/20, 70/30 and 60/40 coverage ??

 

I am pretty sure that all providers will not be "in service" - plenty of Psychiatrist don't participate in any insurance plan - public or private.  An sometimes those PARE providers don't take many types - (PARE = Pathologist, Anesthesiologist, Radiologist and ER Docs).  And Air Ambulance services can participate on only selective plans - the ones that pay them more and charge a higher premium.  Other select specialist or special providers could be the same.

 

The tax advantages for EHB (employer health benefits) for the employer and the EMPLOYEE is not just an advantage in income tax but also payroll taxes - since neither has to pay SS or Medicare taxes on the amount deemed for EHB -

 

I don't understand how you see better outcomes at a lower price with a Public Option plan - docs can still order unnecessary test, procedures - order the more expense med when something else would do.  The still have to practice defensive medicine.  In fact, they could in essence - keep scheduling people for visits even when not necessary.  Better outcomes materialize when there are best practices adhered to by providers - So are we gonna have the government develop best practices and monitor and force these before payment is made to the provider?  MORE Administration and rulemaking.

 

 

 


I am going to take a few moments to cover some of the things in your answer to 66.

1. Right there will be little competition as that is what we have today. There is only one health provider system today and that does not change. Hospital prices are not real now. The hospital just assigns cost to everything it does, but can not justify most of them. Look at the court cases when the hospital was told to justify all their charges. You will find most times they can not. All hospital want to have the latest procedures. Lets take heart transplant. One state some years ago stopped any more hospitals from adding this without state approval as the total costs were way out of line with over capacity.

2. Under the new system prices for the base plan will be set by medicare just as it is now. They are the gold standard every insurance Co. tries to get when making their deal with a provider. If a Dr leaves the system good chance they close. Where I live just about all are in and adv for people. The rural south has always been a problem for providers, and that will bring the rural south into line with the rest of the USA.

3. The question is not private VS public but profit chain vs non profit chain. Per me there would be no profit or chain owned hospitals. They are part of the problem.

4. There was never competition in the health care system so no change.

5. Payment schedules of private carriers for the base plan are gone, and they are not secret now, nor have they been. We always new what other carriers were doing in that area.

6. Under medicare, and all plans 2 main items in rate setting. loss payments (based on group insured) admin. which is a catch all, plus one you left out Inv. Income.

7. The mental health area will fall into line and their will be providers once it is included in a base plan.

8. Air service would be included I am sure in base plan. Have an accident where I live in parts of the country you get it when nearest hospital is close to 100 miles away.

9. There is a good chance both employer and employee will be paying a health care type tax in a new system. The over all cost to all will be less as the entire health care system is being reworked not just the insurance part of it. It will effect Fed., State, local taxes.

Your answer to 66 makes no sense and I do not understand why you gave it the way you did. You have knowledge from reading a lot about health care and that is fine but use that to better the system.

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Re: Medicare for All - OUT / Public Option - Appears IN

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Message 5 of 39

@john258 wrote:


You are correct it is going to depend on how it is designed, and it has to be designed by people who are experts in Insurance, law, Govt law. With that in mind why are you asking people who are the users of Insurance not experts in design of such programs. It would make sense to wait until there is a program on the table then ask people who will be the users of the program to comment. Why waste a lot of time on something that can not happen now.


If you don't know the details, how do you know if you want it or not?

People who use their own money successfully always want to know what they are buying - the details - that the product is worth the money.

And in this case, if you don't want it - why vote for somebody that is pushing it.

 

I like a lot of knowledge before I commit to anything - you should too.

 

 

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Medicare for All - OUT / Public Option - Appears IN

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Message 6 of 39

@GailL1 wrote:

@Olderscout66 wrote:

The Public Option is the way to go

 

The system for a Public Option is already in place - PPACA. All that is needed is to add a 4th option so people can chose a Bronze, Silver of Gold plan under PPACA or a Public Option with the same coverage as the first 3, but lower premiums because the OVERHEAD will be about 8% less. Companies can opt to replace their private insurance with the Public Option for all their employees and pass half the savings on to the workers (that should be a condition of their participation), current PPACA participants can switch and so can those who buy their own insurance.

 

Only "compulsion" would be EVERYBODY gets insurance.

 

We currently spend $10,200 for every man woman and child in America to finance our 37th best health care "system" - that's about $3.6 TRILLION EACH YEAR. In short, we're already paying for what SHOULD be the absolute best healthcare on earth for every American, not the 37th best and not with 84.2 million using the ER as their care provider because they're uninsured or underinsured.

 

 


Seems to me that all that is gonna depend on how the Public Option is designed -  That's what I am asking here with this thread.

 

How will the public option develop their list of providers and make it adequate for all areas?

 

How will the public option determine what to pay their providers?

 

I assume that premiums, assuming that there will be premiums, will be based on actual useage -

I have read that the public option might attract a sicker population, making it more expensive, if that be the case. 

 

From other post, it seems that the idea of start up cost will be borne by the government - we might as well add to that a few years of actual losses until premiums can be set more in line with actual usage - since in the beginning years it might be hard for actuaries to know what the cost are gonna be.

 

What will the Public Option actually pay based on actuarial value?

In the Individual ACA marketplace - Bronze pays 60/40; Silver 70/30, Gold 80/20, Platinum 90/10 and this is considered in premium setting - the less the co-insurance for a beneficiary; the higher the premium..

Will the whatever premiums be subsidized like ACA individual marketplace plans?

 

All of this is also balanced with co-pays, deductibles, etc.to build the plans.  Out of network coverage could also add to the cost or not depending on how it is designed. As well as other cost contol factors like pre-approvals, step therapy requirements, the cheapest place to receive a specific treatment.

 

Olderscout66 - that is what I am asking - will the Public Option look and act like (private) insurance plans just with the government or a non-profit backer?

 

If so, maybe we will save some money - as you said in administration but maybe not - will that savings be enough to better our world ranking in care outcome and cost?

 

I don't think companies of the larger variety will opt out of their own health plans because of the tax advantage which the employee and the employer receive.  Many people like their employer based coverage especially if they have a tax deductible health savings account and possibly an FSA - (flexible spending account) often funded by the employer.

 

AND you do know that people sure like their FEHB and the ones built by their unions.

This is part of their compensation - much of it is tax free.  What are we gonna do there - go back to the drawing board?

 

 


You are correct it is going to depend on how it is designed, and it has to be designed by people who are experts in Insurance, law, Govt law. With that in mind why are you asking people who are the users of Insurance not experts in design of such programs. It would make sense to wait until there is a program on the table then ask people who will be the users of the program to comment. Why waste a lot of time on something that can not happen now. The time would better be spent on making it possible for a program to be designed. The first problem that has to be solved is the current  President Trump. As long as he is in power there will be nothing. Fact is he wants to kill all programs we now have so once again why waste time in never never land. Lets end never never land by working to get rid of Trump in 2020 and all with an R behind their name. To have a disctraction like this serves no usefull purpose to further anything to help people.

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Message 7 of 39

@Olderscout66 

Well, there will be little competition there if the government is gonna FORCE providers to participate in the system.  I think providers will push back ESPECIALLY if there are private insurers still available and they are paying a higher rate for services.  In fact, I think some doctors will leave the Medicare system - They don't sign up for the Medicaid system now because of the pay.

 

We still have more private hospitals than public ones. 

 

So you aren't really talking about a competition type Public Option.

 

Since payment schedules for private insurance providers is pretty much a trade secret, why should they share this info with some government entity?  They are still gonna be competing with one another - so why share this privy info?

 

NO cherrypicking - Insurance premiums are based on the cost of the plan in services - Medicare Part B premiums are even based on this fact.  Why would a Public Option type plan be any different - especially when it should be an easy computation COST + Administration.

 

So are you saying that you see cost level within the Public Option plan?  It too will offer 80/20, 70/30 and 60/40 coverage ??

 

I am pretty sure that all providers will not be "in service" - plenty of Psychiatrist don't participate in any insurance plan - public or private.  An sometimes those PARE providers don't take many types - (PARE = Pathologist, Anesthesiologist, Radiologist and ER Docs).  And Air Ambulance services can participate on only selective plans - the ones that pay them more and charge a higher premium.  Other select specialist or special providers could be the same.

 

The tax advantages for EHB (employer health benefits) for the employer and the EMPLOYEE is not just an advantage in income tax but also payroll taxes - since neither has to pay SS or Medicare taxes on the amount deemed for EHB -

 

I don't understand how you see better outcomes at a lower price with a Public Option plan - docs can still order unnecessary test, procedures - order the more expense med when something else would do.  The still have to practice defensive medicine.  In fact, they could in essence - keep scheduling people for visits even when not necessary.  Better outcomes materialize when there are best practices adhered to by providers - So are we gonna have the government develop best practices and monitor and force these before payment is made to the provider?  MORE Administration and rulemaking.

 

 

 

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Medicare for All - OUT / Public Option - Appears IN

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Message 8 of 39

@GailL1 wrote:

@Olderscout66 wrote:

The Public Option is the way to go

 

The system for a Public Option is already in place - PPACA. All that is needed is to add a 4th option so people can chose a Bronze, Silver of Gold plan under PPACA or a Public Option with the same coverage as the first 3, but lower premiums because the OVERHEAD will be about 8% less. Companies can opt to replace their private insurance with the Public Option for all their employees and pass half the savings on to the workers (that should be a condition of their participation), current PPACA participants can switch and so can those who buy their own insurance.

 

Only "compulsion" would be EVERYBODY gets insurance.

 

We currently spend $10,200 for every man woman and child in America to finance our 37th best health care "system" - that's about $3.6 TRILLION EACH YEAR. In short, we're already paying for what SHOULD be the absolute best healthcare on earth for every American, not the 37th best and not with 84.2 million using the ER as their care provider because they're uninsured or underinsured.

 

 


Seems to me that all that is gonna depend on how the Public Option is designed -  That's what I am asking here with this thread.

 

How will the public option develop their list of providers and make it adequate for all areas? Easiest would be to make acceptance of P.O. patients a condition of retaining their "non-profit" tax status. State and local hospitals would participate, leaving only 18% of hospitals (the "for profits") and clinics as potential nay-sayers.

 

How will the public option determine what to pay their providers? Average of what the existing payment schedules are for the 3 levels of coverage in ACA.

 

I assume that premiums, assuming that there will be premiums, will be based on actual useage -Why? Since everyone will have to have insurance, no need to discriminate to cherrypick healthy clients.

I have read that the public option might attract a sicker population, making it more expensive, if that be the case. At first, but the new patients will also include the young and healthy who Republicans allow to freeload.

 

From other post, it seems that the idea of start up cost will be borne by the government - we might as well add to that a few years of actual losses until premiums can be set more in line with actual usage - since in the beginning years it might be hard for actuaries to know what the cost are gonna be.Premiums will be based on the average of existing private plans, reduced for the lower admin cost and to remove profits, using the same 3-tier coverage options as PPACA.

 

What will the Public Option actually pay based on actuarial value?

In the Individual ACA marketplace - Bronze pays 60/40; Silver 70/30, Gold 80/20, Platinum 90/10 and this is considered in premium setting - the less the co-insurance for a beneficiary; the higher the premium..Exactly so.

Will the whatever premiums be subsidized like ACA individual marketplace plans?Gotta- Capitalist bosses don't pay many workers enough to have to pay Federal Income tax, and there's young prople working part time, students, the disabled and injured/recovering AND ELDERLY - this will become an alternative to private MA plans.

 

All of this is also balanced with co-pays, deductibles, etc.to build the plans.  Out of network coverage could also add to the cost or not depending on how it is designed. As well as other cost contol factors like pre-approvals, step therapy requirements, the cheapest place to receive a specific treatment.Since all those factors are just to restrict a patient to "in service" providers, which means the providers have agreed to the payment schedule offered by the insurer,  and the Public Option will have EVERYBODY "in service" (with the possible exception of the 18% that are for-profits) none of this applies.

 

Olderscout66 - that is what I am asking - will the Public Option look and act like (private) insurance plans just with the government or a non-profit backer?Yep - with a much longer list of covered services and providers, but lower premiums.

 

If so, maybe we will save some money - as you said in administration but maybe not - will that savings be enough to better our world ranking in care outcome and cost? No doubt about it. Private insurers will figure out how the rest of the developed World handles 10% lower premiums OR they will go out of business.

 

I don't think companies of the larger variety will opt out of their own health plans because of the tax advantage which the employee and the employer receive.  Many people like their employer based coverage especially if they have a tax deductible health savings account and possibly an FSA - (flexible spending account) often funded by the employer.Make insurance premiums/FSAs 100% tax deductable if they represent more than 1% of income.  That should insure no cnange in tax status of your cost of insurance for AT LEAST the bottom 90% of Americans

 

AND you do know that people sure like their FEHB and the ones built by their unions.

This is part of their compensation - much of it is tax free.  What are we gonna do there - go back to the drawing board?Again, plans that offer excellent value will survive, those which cannot compete will not.

 

 


 

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Re: Medicare for All - OUT / Public Option - Appears IN

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Message 9 of 39

@Olderscout66 wrote:

The Public Option is the way to go

 

The system for a Public Option is already in place - PPACA. All that is needed is to add a 4th option so people can chose a Bronze, Silver of Gold plan under PPACA or a Public Option with the same coverage as the first 3, but lower premiums because the OVERHEAD will be about 8% less. Companies can opt to replace their private insurance with the Public Option for all their employees and pass half the savings on to the workers (that should be a condition of their participation), current PPACA participants can switch and so can those who buy their own insurance.

 

Only "compulsion" would be EVERYBODY gets insurance.

 

We currently spend $10,200 for every man woman and child in America to finance our 37th best health care "system" - that's about $3.6 TRILLION EACH YEAR. In short, we're already paying for what SHOULD be the absolute best healthcare on earth for every American, not the 37th best and not with 84.2 million using the ER as their care provider because they're uninsured or underinsured.

 

 


Seems to me that all that is gonna depend on how the Public Option is designed -  That's what I am asking here with this thread.

 

How will the public option develop their list of providers and make it adequate for all areas?

 

How will the public option determine what to pay their providers?

 

I assume that premiums, assuming that there will be premiums, will be based on actual useage -

I have read that the public option might attract a sicker population, making it more expensive, if that be the case. 

 

From other post, it seems that the idea of start up cost will be borne by the government - we might as well add to that a few years of actual losses until premiums can be set more in line with actual usage - since in the beginning years it might be hard for actuaries to know what the cost are gonna be.

 

What will the Public Option actually pay based on actuarial value?

In the Individual ACA marketplace - Bronze pays 60/40; Silver 70/30, Gold 80/20, Platinum 90/10 and this is considered in premium setting - the less the co-insurance for a beneficiary; the higher the premium..

Will the whatever premiums be subsidized like ACA individual marketplace plans?

 

All of this is also balanced with co-pays, deductibles, etc.to build the plans.  Out of network coverage could also add to the cost or not depending on how it is designed. As well as other cost contol factors like pre-approvals, step therapy requirements, the cheapest place to receive a specific treatment.

 

Olderscout66 - that is what I am asking - will the Public Option look and act like (private) insurance plans just with the government or a non-profit backer?

 

If so, maybe we will save some money - as you said in administration but maybe not - will that savings be enough to better our world ranking in care outcome and cost?

 

I don't think companies of the larger variety will opt out of their own health plans because of the tax advantage which the employee and the employer receive.  Many people like their employer based coverage especially if they have a tax deductible health savings account and possibly an FSA - (flexible spending account) often funded by the employer.

 

AND you do know that people sure like their FEHB and the ones built by their unions.

This is part of their compensation - much of it is tax free.  What are we gonna do there - go back to the drawing board?

 

 

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Medicare for All - OUT / Public Option - Appears IN

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Message 10 of 39

The Public Option is the way to go, and the only thing preventing Americans from having the same level of health care as the citizens of EVERY OTHER DEMOCRACY are the elected Republicans.

 

Sweep away that odifferous obsticle, and we can join the 21st Century.

 

We currently spend $10,200 for every man woman and child in America to finance our 37th best health care "system" - that's about $3.6 TRILLION EACH YEAR. In short, we're already paying for what SHOULD be the absolute best healthcare on earth for every American, not the 37th best and not with 84.2 million using the ER as their care provider because they're uninsured or underinsured.

 

The system for a Public Option is already in place - PPACA. All that is needed is to add a 4th option so people can chose a Bronze, Silver of Gold plan under PPACA or a Public Option with the same coverage as the first 3, but lower premiums because the OVERHEAD will be about 8% less. Companies can opt to replace their private insurance with the Public Option for all their employees and pass half the savings on to the workers (that should be a condition of their participation), current PPACA participants can switch and so can those who buy their own insurance.

 

Only "compulsion" would be EVERYBODY gets insurance. No more Republican freeloaders, 4 million of which lil donny put on OUR backs when he let them skate for free on the ER like they'd done before PPACA.

 

So GOPers - what would be wrong with something like that?

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