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Re: One big thing people don’t know about single payer ( Medicare-for-All)

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Message 1 of 66

@GailL1 wrote:

@ChasKy53 wrote:



You are correct John. My employer based insurance in my retirement becomes my supplement when I go on Medicare this coming spring. In fact, I will also go on a free Medicare Advantage plan with lower co-pays than my insurance and I will retain my dental and eye care through my present insurance. The fund that provides my insurance will save money and I will save money, a win win situation.  A single payer universal health care plan would be a win win situation for everyone concerned.


And you think this would be translated into a single payer system?

What about the employer plan for those still working?

What about a union plan?

What about FEHB?

 

@A single payer system without some cost containments is just a division of the current cost @ over $10,000 per person ( see my CMS link in this thread on the 2015 National Health care Expenditures) divided by the current participants. 

 

Without saving cost it means little.  don't we need a single payer system with some teeth?

 

Would under a single payer system, a defined/ certain basic coverage item be included - those may be different than what coverage is available in many of our current health plan structure.

What about value-based medicine?  Pay for what is cheapest and works the best.

 

What about medicine - no national formulary in order to make negotiations the most successful.

 

Providers of every type may not like accepting the Medicare (or possible even Medicaid) rate and not decide to play. 

 

Was it not you that use to tout the praises of H.R. 676?

 

 

 

 

 

 

 


What about the sun rising and the moon setting?

Look at HR 535 for some answers.

Ga. has a former Gov. who want people to die in the streets.

Here is an answer from never never land.

 Now to reality.

There is no single payer system even being looked at so why all the discussion? Could it be to make people who love to think they know the current system feel they know what should be in the future. Well in the real world they do not know the current system, and want to punt to a never never land system of the future so they will be the experts as they are writing the system. Now that system will never be put in place so is that not just a waste of everyones time.

Some day we will have medi care for all. To get there faster we need a new President, and congress. So. vote all with a R out and we can look at what is left. If there are dumb Dems. we can then vote them out, and then we move to Medi Care for all type system which will be put together by real experts in the field.

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Re: One big thing people don’t know about single payer ( Medicare-for-All)

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Message 2 of 66

@GailL1 wrote:

@ChasKy53 wrote:



You are correct John. My employer based insurance in my retirement becomes my supplement when I go on Medicare this coming spring. In fact, I will also go on a free Medicare Advantage plan with lower co-pays than my insurance and I will retain my dental and eye care through my present insurance. The fund that provides my insurance will save money and I will save money, a win win situation.  A single payer universal health care plan would be a win win situation for everyone concerned.


And you think this would be translated into a single payer system?

What about the employer plan for those still working?

What about a union plan?

What about FEHB?

 

@A single payer system without some cost containments is just a division of the current cost @ over $10,000 per person ( see my CMS link in this thread on the 2015 National Health care Expenditures) divided by the current participants. 

 

Without saving cost it means little.  don't we need a single payer system with some teeth?

 

Would under a single payer system, a defined/ certain basic coverage item be included - those may be different than what coverage is available in many of our current health plan structure.

What about value-based medicine?  Pay for what is cheapest and works the best.

 

What about medicine - no national formulary in order to make negotiations the most successful.

 

Providers of every type may not like accepting the Medicare (or possible even Medicaid) rate and not decide to play. 

 

Was it not you that use to tout the praises of H.R. 676?

 

 

 

 

 

 

 


 

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Re: One big thing people don’t know about single payer ( Medicare-for-All)

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Message 3 of 66

@johnrmoser

 

You do realize that it is a rule in Medicare and other government health care programs that a doc ALWAYS prescribes a generic if one is available unless there is an exception given due to a patient physical problem.  Actually, I think that is even standard with private plans too.  A doc does not have to indicate that a generic is ok on his Rx.

 

Do you understand what medication value based pricing is?  Germany uses it in their determination of what drugs to approve because they use price of the drug as one of their criteria for approval - in competition with other drugs or on whatever is the current standard treatment for new drugs for a condition - every aspect of the drug approval process is based on a competitiveness - what's better, including price.

 

As far as formularies and drug negotiations - this older article from KFF says it pretty well - how to get the best price.

KFF 01/23/2017 - Searching for Savings in Medicare Drug Price Negotiations

 

The whole article give facts and history but this part is what is what we have to determine what the best way will be -

What has CBO said about the potential for savings?

CBO has said that giving the Secretary authority to negotiate lower prices for a broad set of drugs on behalf of Medicare beneficiaries would have “a negligible effect on federal spending.”14 It based this assessment on its view that the Secretary would not be able to leverage deeper discounts for drugs than risk-bearing private plans, given the incentives built into the structure of the Part D market, where plan sponsors bid to participate in the program, compete for enrollees based on cost and coverage, and bear some risk for costs that exceed their projections.

 

CBO has suggested that savings could potentially be achieved under a defined set of circumstances. For example, in addition to simply removing the non-interference clause and allowing the Secretary to negotiate drug prices, CBO has said that in order to obtain price discounts, the Secretary would need authority to establish a formulary that included some drugs and excluded others and imposed other utilization management restrictions, in much the same way that private Part D plans do. And yet, CBO has questioned whether the Secretary would be willing to exclude certain drugs or impose limitations on coverage, as private plans do, “given the potential impact on stakeholders.”15 Savings could also be achieved if the Secretary were authorized to set drug prices administratively or take regulatory action against companies that did not offer discounts of a certain magnitude. CBO has not estimated the potential savings associated with these options.16

 

In addition, CBO has suggested there is some potential for savings if the Secretary had authority to negotiate prices for a select number of drugs or types of drugs, such as unique drugs that lack competitor products or therapeutic alternatives.17 This would include many of today’s high-priced specialty drugs and biologics. But according to CBO’s assessment of this approach in 2007, if only a small share of Medicare drug spending was attributable to the selected drugs, overall federal savings from price negotiations would be “modest” and manufacturers could offset potential losses by setting higher launch prices for their drugs. Although this approach was included as a provision of President Obama’s proposed budgets for FY2016 and FY2017, neither the Office of Management and Budget (OMB) nor CBO scored any savings associated with this provision.18

 

BTW, of course the HEP C curative drugs are expensive but they have saved lots of lives and with competition, the prices have come down for all of them.  Course it took some court cases before Medicare, Medicaid and our prison health care system did away with their severe liver markers for folks in these programs to gain access to these life saving meds.

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: One big thing people don’t know about single payer ( Medicare-for-All)

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Message 4 of 66

Actually, a universal ban against formulary would have some ... interesting effects.

 

Drugs do cost a lot to develop, and then you get a 19-year patent.  Maintenance drugs with many patients are relatively-cheap, e.g. $300/month (or even $90/month with a manufacturer's coupon) for Suvorexant, about $150/month for Ramelteon, $500/month for Atomoxetine.  Two sleep drugs and an ADHD drug, take a pill every day.

 

When you get to Hepatitis-C drugs, you're talking about a month-long regimen for very few people.  You have to recover some $3 billion of amortized costs from a small number of sales, so you get ridiculous $92,000 asking prices for a treatment cycle--largely so they have a starting point from which to hold to around $12,000-$15,000 when dealing with insurers and Medicare.  It costs 20 cents a pill to manufacture, and yet you're not going to sell nearly enough pills to get your up-front costs back.

 

Put these all in the same risk pool, and the costs basically level.  The low-point cost for maintenance drugs is a good indicator of a no-formulary new-drug risk pool cost.  If you can shuffle more patients more-quickly onto new drugs--at their expense, of course--the cost tends to come down somewhat lower.

 

It's a huge dimemma.  On the one hand, sticking with generics and running a formulary for new drugs means lower out-of-pocket costs and lower insurance premiums.  On the other, taking the cheaper drugs even when a newer drug is better means the basic cost of new drugs (when funneled through the risk pool) is higher, reducing accessibility.  When the new drug is not as effective as the generic, the generic is the correct choice--and we need doctors to not push people toward new drugs in that situation.

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Re: One big thing people don’t know about single payer ( Medicare-for-All)

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Message 5 of 66

@ChasKy53 wrote:



You are correct John. My employer based insurance in my retirement becomes my supplement when I go on Medicare this coming spring. In fact, I will also go on a free Medicare Advantage plan with lower co-pays than my insurance and I will retain my dental and eye care through my present insurance. The fund that provides my insurance will save money and I will save money, a win win situation.  A single payer universal health care plan would be a win win situation for everyone concerned.


And you think this would be translated into a single payer system?

What about the employer plan for those still working?

What about a union plan?

What about FEHB?

 

@A single payer system without some cost containments is just a division of the current cost @ over $10,000 per person ( see my CMS link in this thread on the 2015 National Health care Expenditures) divided by the current participants. 

 

Without saving cost it means little.  don't we need a single payer system with some teeth?

 

Would under a single payer system, a defined/ certain basic coverage item be included - those may be different than what coverage is available in many of our current health plan structure.

What about value-based medicine?  Pay for what is cheapest and works the best.

 

What about medicine - no national formulary in order to make negotiations the most successful.

 

Providers of every type may not like accepting the Medicare (or possible even Medicaid) rate and not decide to play. 

 

Was it not you that use to tout the praises of H.R. 676?

 

 

 

 

 

 

 

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: One big thing people don’t know about single payer ( Medicare-for-All)

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Message 6 of 66

@johnrmoser wrote:

 . . . .   It's more-expensive in Canada, although they get more healthcare and have a vibrant private system; their prescription medications are cheaper.

 

So if you want $4,500/year healthcare in America, you're looking at denying access to healthcare.  Deny access to more drugs.  Deny more claims.  Make sure people have healthcare access for basic things, but keep them from getting less-basic, more-expensive things.  That's the long and short of it.

 

Good luck figuring out what healthcare really costs.  Some folks argue that Medicare has a hidden tax in that it calculates costs of service below actual cost, and so the prices paid by everyone in the private market go up to make up the difference.  Other folks argue that Medicare doesn't always have the lowest price, because their guesses are wrong.

 

That's cute and all, until you get to the third argument:  the actual government investigation a few years ago into Medicare paying inflated prices due to supposed collusion of providers claiming medical services cost more than they really do, driving up the cost above the market average.

 

 . . . . . We do need to address the big span across which providers charge for the same service; the answer isn't simply magical free market invisible hand or magical single-payer.


1.  Canada does not have prescription drug coverage within their national health care policy.

At the national level, they do negotiate the price of new medications but it is not that much lower than ours because they use us as a comparison basis.  Provinces and Territories who actually administer the national health care plan can add prescription drug coverage - some or all - specific populations usually.  Their local citizen pay for it via taxation - the National government does not cover prescription drug coverage. 

 

2.  Not sure if a $ 4500 health care would be realistic here but there are definitely ways to cut back on the cost rather than start denying too much - but there would probably be some denying - denying what cost more without any better results. -we pay for what is the cheapest with the best results.

 

There are many ways that other countries control their health care cost that would make sense doing here. 

  • Value-based medicine (medications and procedures),
  • global budgets with local control of administration - since actual health care is a local commodity,
  • a national formulary from which we could negotiate the prices of drugs,
  • gatekeeper policy,
  • medical infrastructure and resources control (local level) - everything from the number of primary care physicians to the number of MRI available in an area.

I could go on - these are just some I remember from the last International Health Care System Profile which the Commonwealth Fund reported.

 

3.  What the U.S. health care actually cost is easy and the National Expenditure report comes up with this data every year under the CMS - Research and Stats.  It is even broken down in different ways for a complete analysis - private, public - types of providers.

 

It is isn't Medicare cost that are complained about being cost sharing - it is Medicaid or people who do not pay their bills, or their part of the bills, when they get care which is built into the overall cost of a medical provider or service.  Bad debt is handled just the same as in any other business - it is all within the cost of doing business for private entities.

 

Guess we could continue to lower the cost of Medicare's payment to providers until we start seeing a mass exodus of them from the system.

 

4.  Charging vastly different prices for the same service, isn't just in the private realm and involves a lots of scrutiny as to the reason(s).  There are a lot of them and sometimes it is just based on the advertizing budget or how much places might pay for malpractice insurance if they have had a number of claims. 

 

But what's charged is not that important to the insured - public or private - for the majority of us, it is the negotiated rate that is the telling.

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: One big thing people don’t know about single payer ( Medicare-for-All)

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Message 7 of 66

@john258 wrote:

@GailL1 wrote:

Just catching up on some of my reading and found this to be absolutely funny.

So much for what people think and IMO the way they vote too ~

 

Axios - 11/02/2017 - One big thing people don’t know about single payer

 by Drew Altman -

 

It is generally assumed that the biggest obstacle to a national health plan like Medicare for All will be the large tax increase needed to pay for it. But new polling shows another challenge: Almost half of the American people don't know that they would have to change their current health insurance arrangements if there was a single-payer plan.

 

The details: Overall, the general idea of a national health plan is pretty popular, with 53% of the American people favoring a national health plan — 30% strongly favoring it and 23% somewhat favoring it. On the other side, 31% strongly oppose it and 13% somewhat oppose it. Democrats and Republicans split on the idea, as expected.

 

But as the chart shows, somehow, 47% of the American people think they would be able to keep their current health insurance — even though a single payer Medicare for All style plan would do away with employer-based insurance.

  • 52% of Democrats, the group most supportive of single payer as an idea, think they will be able to keep their plan.
  • Notably, 44% of people with employer-based insurance think they would be able to keep their current plan.

The bottom line: There is no sweeping health reform plan without tradeoffs, as we learned with both the ACA and the Republican repeal-and-replace plans. The fact that so many people don't know that a national health plan would require them to change their insurance arrangements underscores the challenge of making the transition from a popular idea to a reality for a single-payer national health plan.

 

HA, HA, HA, HA . . . . . . Woman LOL. . . . . . Woman LOL

 


I really do not understand what you are trying to do here. It would seem you just want to trash a single payer system which by a lot of your recent posts you call for.

Lets start with the fact that people already have to switch their main carrier now when they reach the Medi Care age and there has never been a problem with that. We see most people looking forwarded to going on Medi Care, and most do not even have to switch their providers. I know I did not, and do not know anyone who did. All that happened was my costs went down in the Co-Pay area. So it would seem to me that is a bogus argument by someone who wants to spread false information.

The statement that single payer would do away with employer based health insurance is not true. I have an employer based health policy as my Medicare supp coverage. It is provided by the employer I retired from, and that employer pays part of the premium.

The article you post is false, and you try and explain it as if it is true which shows you do not understand the system in any way shape or form.


You are correct John. My employer based insurance in my retirement becomes my supplement when I go on Medicare this coming spring. In fact, I will also go on a free Medicare Advantage plan with lower co-pays than my insurance and I will retain my dental and eye care through my present insurance. The fund that provides my insurance will save money and I will save money, a win win situation.  A single payer universal health care plan would be a win win situation for everyone concerned.


"The only thing man learns from history is man learns nothing from history"
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Re: One big thing people don’t know about single payer ( Medicare-for-All)

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Message 8 of 66

@ChasKy53 wrote:

Departments of the government would not administer the plan, insurance companies would be contracted to administer the plan with controls on the administrative fee.

Nor referring to day to day administration, but to overall adminstration at the upper levels.  For instance, various insurance companies wins bids to administer TRICARE' program, but overall administrative responsibility is with the Tricare Administration Agency.  The insurance companies have to administer the administrative regulations from DOD.

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Re: One big thing people don’t know about single payer ( Medicare-for-All)

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Message 9 of 66

@GailL1 wrote:

@MIseker wrote:

 


@GailL1 wrote:

@ChasKy53

I am not mentioning anything - just stating what the poll showed - they like single payer - but it will not affect them.

 

Think proponents better get to work - OH, but maybe they don't - keep 'em dumb and they will be for it since they think it does not affect them.

 

HA, HA, HA . . . . . . . Woman LOL. . .  . Woman LOL


HAHAHAHA!! . I addressed your topic and asked you a question..which you always duck. Not the first time i have asked.


You might be one of the ones which the poll takers thinks needs single payer - a fair percentage of them jjust don't think their coverage would have to change - just other people - how would that work !  Woman LOL 

 

They may have really good employer coverage, perhaps an employer that self insures.  They may have TriCare and are pleased.  Heck, they might have Medicaid and think it is great or Medicare/Medicaid.

 

Either way, they think single payer is good for other people but they are satisfied with what they have and don't think they would have to change.  The same way people who had individual coverage before Obamacare thought they could keep their plan - "If you like your plan . . . . . famous last words .


Well none of that really matters anyway, does it Gail? People would not get to vote on a single payer health care plan. If our politicians were to go to a single payer and that plan covered people just as well as Medicaid and the others you mention then they wouldn't have a complaint anyway, would they? If that plan covered you as well as your present insurance does then you wouldn't have a complaint either, would you? If your tax for a single payer and even a premium for a supplement (if it were even necessary) added up to be less than your present premium you would also have no complaint. If employers didn't provide health insurance as part of a wage agreement then workers could make a higher wage and offset some or all of the tax they would pay, so they would have no complaint either.

 

A single payer system is a win win win and it's time for us to do it.


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Re: One big thing people don’t know about single payer ( Medicare-for-All)

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Message 10 of 66

@TxGrandpa2 wrote:

@ChasKy53 wrote:

You forgot to mention that a single payer would eliminate the costs of health care for our military, both active and retired.


To the contrary.  It would only switch the burden of this health care from the Department of Defense to whichever federal department would be charged with administering the plan.  That would be true with the other federal programs where the administration would be shifted to that new federal department, more than likely the Department of Health and Human Services.


Right now those plans are run on tax payer dollars, everyone's taxpayer dollars. Going to a single payer plan ran on everyone's tax would lower the cost because there would only be one plan. Just having one plan for providers to deal with would lower the cost of health care per person. Departments of the government would not administer the plan, insurance companies would be contracted to administer the plan with controls on the administrative fee.


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