Unit2Sucks;842848667 said:

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Sycasey - I wouldn't expect the tail to wag the dog here. The goal of this reform is to reduce taxes on the wealthy not to improve healthcare. The impact on health care is the tail in this instance but make no mistake, the dog is very much tax reduction.

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The thrust of the bill is to reduce medicaid as the third largest entitlement and one that is growing exponentially such that it will effect what can be spent in taxes on other necessities in our society. Right now medicaid ranks behind SS and Medicare at $350B per year and growing faster. It is out of control. Now if you wish to look at that as a tax transfer to the wealthy, so be it. I do not. I look at California, which historically funded roads, infrastructure and universities very effectively in the 50s and 60s, and can no longer do so for social services it has since deemed necessary. The state is strapped nastily and will only be mores when the pension crisis worsens. The government has gotten in the habit of spending like the 1%, but does not have the resources. Mean spirited, maybe, but if you don't have the dinero, you don't keep spending when you see what you are spending on is going up in cost. Can I afford it? In this case, NO.

OdontoBear66;842848789 said:

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The thrust of the bill is to reduce medicaid as the third largest entitlement and one that is growing exponentially such that it will effect what can be spent in taxes on other necessities in our society. Right now medicaid ranks behind SS and Medicare at $350B per year and growing faster. It is out of control. Now if you wish to look at that as a tax transfer to the wealthy, so be it. I do not. I look at California, which historically funded roads, infrastructure and universities very effectively in the 50s and 60s, and can no longer do so for social services it has since deemed necessary. The state is strapped nastily and will only be mores when the pension crisis worsens. The government has gotten in the habit of spending like the 1%, but does not have the resources. Mean spirited, maybe, but if you don't have the dinero, you don't keep spending when you see what you are spending on is going up in cost. Can I afford it? In this case, NO.

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Don't believe the hype. This bill is not an overhaul of Medicaid. It's a tax cut plan for the 1%.

Thanks to guys like Jeff Bezos, retail is going the way of coal mining. What are we supposed to do with this group of unemployed workers and the 74 million on Medicaid, let them die in the streets? What is the solution? I am willing to pay more taxes to fund the safety net.

https://mobile.nytimes.com/2017/06/23/health/medicaid-basic-facts.html?referer=https://www.google.com/

Here's a great article by what sounds like a mainstream conservative who has concerns about what has become of his party: http://www.politico.com/magazine/story/2017/06/24/intellectual-conservatives-lost-republican-trump-215259

In particular I think this nails it (and is true regardless of ideology):

Quote:

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The implementation of long-term, successful policy change cannot be short-circuited, it must be built on a solid foundation of thinking, analysis and research by smart, well-educated people. Listening to the common man rant about things he knows nothing about is a dead-end that leads to Trump and failure because there is no "there" there, just mindless rhetoric and frustration.

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NYCGOBEARS;842848798 said:

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Don't believe the hype. This bill is not an overhaul of Medicaid. It's a tax cut plan for the 1%.

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No, it's a tax cut for all the "moderates"

NYCGOBEARS;842848798 said:

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Don't believe the hype. This bill is not an overhaul of Medicaid. It's a tax cut plan for the 1%.

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As it stands spending would not be cut. It would just grow at a slightly lower rate, but then in 2025 Medicaid spending would be capped. Currently, it is an open ended entitlement with the feds matching states dollar for dollar. Paying for Medicaid is flawed as it chums states to overspend---they get another dollar for each one spent from the feds. Whoopee. So as a result in a majority of states it consumes over 20% of budgetary dollars and is rising daily. Next year in the states that expanded Medicaid under Obamacare they will see $9B in cost increases. Add to that it grossly, and I mean grossly, underpays doctors. California has a serious drop in doctors willing to treat them at the fee schedule losses, and emergency rooms are flooded.

But it is nothing but a tax cut for the rich? Huh? California may soon become a banana republic like Illinois with its indebtedness. Crappy plan snuck by when having a Democrat majority to do so?

How about two parties get together and do something about a serious problem, storing instead of throwing stones?

OdontoBear66;842848810 said:

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As it stands spending would not be cut. It would just grow at a slightly lower rate, but then in 2025 Medicaid spending would be capped. Currently, it is an open ended entitlement with the feds matching states dollar for dollar. Paying for Medicaid is flawed as it chums states to overspend---they get another dollar for each one spent from the feds. Whoopee. So as a result in a majority of states it consumes over 20% of budgetary dollars and is rising daily. Next year in the states that expanded Medicaid under Obamacare they will see $9B in cost increases. Add to that it grossly, and I mean grossly, underpays doctors. California has a serious drop in doctors willing to treat them at the fee schedule losses, and emergency rooms are flooded.

But it is nothing but a tax cut for the rich? Huh? California may soon become a banana republic like Illinois with its indebtedness. Crappy plan snuck by when having a Democrat majority to do so?

How about two parties get together and do something about a serious problem, storing instead of throwing stones?

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Do you support a single payer healthcare plan? If not, please give up Medicare. It's costing us $. Thanks.

NYCGOBEARS;842848813 said:

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Do you support a single payer healthcare plan? If not, please give up Medicare. It's costing us $. Thanks.

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Purchase that which you can afford, and cut back when and if needed. Sure doesn't sound like Medicaid or our pension system indebtedness. Politicians giving perks for votes while we pay down the road. So Pat Quinn raised taxes on the 1% to pay for Illinois' woes before he was voted out of office and they are $14.5 billion in arrears. Just about junk bond status. So just keep adding to our indebtedness because something feels good, or assuages guilt knowing it won't work fiscally? Doesn't sound too smart to me.

OdontoBear66;842848819 said:

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. So just keep adding to our indebtedness because something feels good, or assuages guilt knowing it won't work fiscally? Doesn't sound too smart to me.

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This is the OT board so please don't bring the CMS remodel financing into this discussion.

For the vast majority of government workers pensions are not under funded; however a powerful conservative minority (hint, they carry guns) gets the big unfunded benefits for a much longer time. Even though the GOP knows this group hasn't been paying their way for a long time, they are protected, even by haters of government employees like Gov. Walker. And the Grump protected their benefits in his latest budget.

OdontoBear66;842848819 said:

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Purchase that which you can afford, and cut back when and if needed. Sure doesn't sound like Medicaid or our pension system indebtedness. Politicians giving perks for votes while we pay down the road. So Pat Quinn raised taxes on the 1% to pay for Illinois' woes before he was voted out of office and they are $14.5 billion in arrears. Just about junk bond status. So just keep adding to our indebtedness because something feels good, or assuages guilt knowing it won't work fiscally? Doesn't sound too smart to me.

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OdontoBear66;842848789 said:

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The thrust of the bill is to reduce medicaid as the third largest entitlement and one that is growing exponentially such that it will effect what can be spent in taxes on other necessities in our society. Right now medicaid ranks behind SS and Medicare at $350B per year and growing faster. It is out of control. Now if you wish to look at that as a tax transfer to the wealthy, so be it. I do not. I look at California, which historically funded roads, infrastructure and universities very effectively in the 50s and 60s, and can no longer do so for social services it has since deemed necessary. The state is strapped nastily and will only be mores when the pension crisis worsens. The government has gotten in the habit of spending like the 1%, but does not have the resources. Mean spirited, maybe, but if you don't have the dinero, you don't keep spending when you see what you are spending on is going up in cost. Can I afford it? In this case, NO.

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So what about all of the people who currently receive health insurance through Medicaid? What does the Republican plan do for them?

I see this as a matter of priorities. For some, the priority is to reduce government spending and cut taxes, period. For others, it's to help people in need. Looks like the Republican Party has chosen the former, regardless of what happens to the latter.

sycasey;842848922 said:

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So what about all of the people who currently receive health insurance through Medicaid? What does the Republican plan do for them?

I see this as a matter of priorities. For some, the priority is to reduce government spending and cut taxes, period. For others, it's to help people in need. Looks like the Republican Party has chosen the former, regardless of what happens to the latter.

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It throws them into the emergency room.

GB54;842848924 said:

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It throws them into the emergency room.

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At which point we wind up paying for their healthcare anyway.

sycasey;842848927 said:

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At which point we wind up paying for their healthcare anyway.

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Yes, but it's worse than that. What Odonto wants to do would throw vulnerable people into the streets before they hit the emergency rooms. Particularly the mentally ill or otherwise disabled. We are America. We have the wealth to not be the only advanced country that does not treat our sick and poor. Please tax me for this purpose.

dajo9;842848962 said:

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Yes, but it's worse than that. What Odonto wants to do would throw vulnerable people into the streets before they hit the emergency rooms. Particularly the mentally ill or otherwise disabled. We are America. We have the wealth to not be the only advanced country that does not treat our sick and poor. Please tax me for this purpose.

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Incomes for the top 0.001% richest Americans surged 636% during the 34-year period from 1980 to 2014. Business Insider

From 1935 to 1980 90% of the growth in the GNP was spread amongst 70% of Americans; From 1980 to 2016 100% of the growth of the GNP went to the Top 10% of Americans.

It's going to trickle down eventually. I can feel it.

It was under Reagan that Medicaid was mandated for eligible children and pregnant women and emergency treatment mandated for individuals whether citizens or not. Mandates and health care for illegals- Republicans at one time

dajo9;842848962 said:

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Yes, but it's worse than that. What Odonto wants to do would throw vulnerable people into the streets before they hit the emergency rooms. Particularly the mentally ill or otherwise disabled. We are America. We have the wealth to not be the only advanced country that does not treat our sick and poor. Please tax me for this purpose.

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Again dajo, you know what others think and presuppose same. Interesting.

36 years of practicing dentistry for fee and for free, but I want to throw people to the streets? Think again.

And finally, you are welcome to be taxed for that purpose. Just write a bigger check. Go for it.

The richest 1% has not enough dinero to afford all that you would legislate were it possible. The death knell of Obamacare is the cost and most of that can be traced to Medicaid additions. Something must be done there, but do remember it was just added five years ago. Not cost effective, subtract it, and then figure out how to solve the problem. I leave that to the politicians.

Bearister - I know your numbers are correct but one misleading conclusion that can be drawn is that the people in the top 0.01% is an unchanging group. Many of these massively wealthy started out middle class or lower. I would love to know what the top 0.01% from 1980 and their heirs represent in today's wealth and what sort of growth they've seen.

I'm not saying we don't have massive wealth inequality and a system that leads to extremes, but we do at least still have some mobility.

Not all states handle emergency room cases the same. some simply deny treatment to the uninsured.
A very good friend died in Charlotte, North Carolina because the ER refused him treatment.
In Louisiana where there is a shortage of health care providers and a large uninsured population,
the ERs in 2010-2011 were remarkably uncrowded compared to ERs we visited in Chula Vista.

It's a night and day comparison. In California people losing Medicaid will likely go to the ER,
but in other states they may simply stay home and die...

GB54;842848924 said:

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It throws them into the emergency room.

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sycasey said:

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So what about all of the people who currently receive health insurance through Medicaid? What does the Republican plan do for them?

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OdontoBear66;842849029 said:

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Again dajo, you know what others think and presuppose same. Interesting.

36 years of practicing dentistry for fee and for free, but I want to throw people to the streets? Think again.

And finally, you are welcome to be taxed for that purpose. Just write a bigger check. Go for it.

The richest 1% has not enough dinero to afford all that you would legislate were it possible. The death knell of Obamacare is the cost and most of that can be traced to Medicaid additions. Something must be done there, but do remember it was just added five years ago. Not cost effective, subtract it, and then figure out how to solve the problem. I leave that to the politicians.

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You don't get to support a policy and claim to not support it's repercussions.

dajo9;842849192 said:

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You don't get to support a policy and claim to not support it's repercussions.

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Or what, you gonna take your ball and go home. The game ain't necessarily played by your rules dajo. Tried it, can't afford as demonstrated, change it.

https://apple.news/AR76mcFVYRHCFITqhiFmW3Q

OdontoBear66;842849201 said:

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Or what, you gonna take your ball and go home. The game ain't necessarily played by your rules dajo. Tried it, can't afford as demonstrated, change it.

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But you don't know what you want to change it to, and you don't know what will become of the people potentially left behind by the changes.

I thought you wanted to talk about policy. Seems like your policy ideas are half-formed at best.

sycasey;842849235 said:

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But you don't know what you want to change it to, and you don't know what will become of the people potentially left behind by the changes.

I thought you wanted to talk about policy. Seems like your policy ideas are half-formed at best.

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We had a lot less medicaid spending prior to Obamacare, a lot less. Obamacare did not work for it is not fiscally feasible. So go back to the way it was before the problems arose, and then add back only that which you can. The government is not responsible for everyone's medical care. It would be nice, if we had the money, but it is not so. So go back, do a restart and add what and where you can until you limit out. I just don't look at politics with the same "givens" as a lot of you do.

OdontoBear66;842849237 said:

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We had a lot less medicaid spending prior to Obamacare, a lot less. Obamacare did not work for it is not fiscally feasible. So go back to the way it was before the problems arose, and then add back only that which you can. The government is not responsible for everyone's medical care. It would be nice, if we had the money, but it is not so. So go back, do a restart and add what and where you can until you limit out. I just don't look at politics with the same "givens" as a lot of you do.

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Of course there is enough money. It's all in how the money is distributed. The capital markets are through the roof there is so much money sloshing around out there in the hands of the few and in corporate coffers.

Yet somehow we find a way to light hundreds of billions on fire for the biggest republican entitlement: the military.

OdontoBear66;842849201 said:

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Or what, you gonna take your ball and go home.

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I'm going to keep jamming your inconsistencies in your face

OdontoBear66;842849237 said:

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We had a lot less medicaid spending prior to Obamacare, a lot less. Obamacare did not work for it is not fiscally feasible. So go back to the way it was before the problems arose, and then add back only that which you can. The government is not responsible for everyone's medical care. It would be nice, if we had the money, but it is not so. So go back, do a restart and add what and where you can until you limit out. I just don't look at politics with the same "givens" as a lot of you do.

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As with dajo and Unit2 I find your assertion that the United States doesn't have the money to pay for everyone's health care dubious. Partially because there is a lot of wealth in this country, and also because so many other countries of comparable wealth manage to do it.

So to me it's still a matter of priorities. I thank you for at least being honest that universal health care is not a priority for you. I think Republican leadership largely agrees, though most of them don't want to admit that to the public.

sycasey;842849287 said:

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As with dajo and Unit2 I find your assertion that the United States doesn't have the money to pay for everyone's health care dubious. Partially because there is a lot of wealth in this country, and also because so many other countries of comparable wealth manage to do it.

So to me it's still a matter of priorities. I thank you for at least being honest that universal health care is not a priority for you. I think Republican leadership largely agrees, though most of them don't want to admit that to the public.

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It can be a government guided program, but certainly not a necessity of government. I believe we differ there. I guess a very simplistic way to look at it is that you have doctors and you have politicians. I know many don't trust doctors and in isolated cases doctors have violated that trust, but c'mon, who do you want to trust? (Guess I shouldn't ask a question where I know the answer, and it isn't compatible with my beliefs). American medicine was the finest in the world, it was just too expensive. The expense is being dealt with while quality is slipping due to the changes. JMHO

OdontoBear66;842849294 said:

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It can be a government guided program, but certainly not a necessity of government. I believe we differ there. I guess a very simplistic way to look at it is that you have doctors and you have politicians. I know many don't trust doctors and in isolated cases doctors have violated that trust, but c'mon, who do you want to trust? (Guess I shouldn't ask a question where I know the answer, and it isn't compatible with my beliefs). American medicine was the finest in the world, it was just too expensive. The expense is being dealt with while quality is slipping due to the changes. JMHO

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I don't understand this thinking. Medicare generally doesn't intrude in the doctor-patient relationship nearly as much as private insurance companies, at least according to my physician wife. The question of trusting doctors vs. politicians seems misguided.

How is your trust level for insurance companies? When they tried to drop my Aunt because she got leukemia my trust level for them went down pretty low.

dajo9;842849297 said:

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I don't understand this thinking. Medicare generally doesn't intrude in the doctor-patient relationship nearly as much as private insurance companies, at least according to my physician wife. The question of trusting doctors vs. politicians seems misguided.

How is your trust level for insurance companies? When they tried to drop my Aunt because she got leukemia my trust level for them went down pretty low.

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Yeah, "doctors vs. politicians" seems like an overly simplistic and possibly wrong-headed framing here. (I mean, if you want to know what doctors in general think of the Republican plan, check out the AMA's position on the AHCA.) There are multiple interests at play here, including insurance companies, pharmaceutical companies, medical equipment manufacturers, etc. All of them have skin in the game and exert pressure on the system. It's not doctors' jobs to navigate or understand all of this. Whose job is it? Imperfect as they are, it seems to me that it does fall to the politicians (or perhaps more accurately, to our elected representatives) to sort this out.

So it comes down to what priorities your representatives have. Based on the last reform effort, it seems clear that the priority for Democrats is to help more people gain access to health care. Based on the current reform effort, it seems like the priority for Republicans is to reduce spending so they can cut taxes (but their promises to their voters suggest otherwise). I believe the former is a far more pressing need than the latter.

sycasey;842849304 said:

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Yeah, "doctors vs. politicians" seems like an overly simplistic and possibly wrong-headed framing here. (I mean, if you want to know what doctors in general think of the Republican plan, check out the AMA's position on the AHCA.) There are multiple interests at play here, including insurance companies, pharmaceutical companies, medical equipment manufacturers, etc. All of them have skin in the game and exert pressure on the system. It's not doctors' jobs to navigate or understand all of this. Whose job is it? Imperfect as they are, it seems to me that it does fall to the politicians (or perhaps more accurately, our elected representatives).

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And does the AMA know why doctors leave the profession early due to dire financial constraints? No, the AMA, like the ADA puts out a palatable PR notion to look professionally acceptable. Doctors not making money and being squeezed down has already had a large effect on medicine's availability. It is a matter of dollars available, and it not cutting it from any angle.

Just today on read on Yahoo how Seattle's minimum wage $15 mandate is totally backfiring (note, not BI, not Fox, but Yahoo)----cutting back time of work, letting go workers, etc. Whoops? There is only so much to go around and another liberal feel good item goes awry. When you have it, and you are greedy, you deserve having such mandates. But when you run on slim margins or are being seriously cut back, the monies should stay with those taking the risk.

OdontoBear66;842849308 said:

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And does the AMA know why doctors leave the profession early due to dire financial constraints? No, the AMA, like the ADA puts out a palatable PR notion to look professionally acceptable. Doctors not making money and being squeezed down has already had a large effect on medicine's availability. It is a matter of dollars available, and it not cutting it from any angle.

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Curious: do you have sources on this claim about doctors not making enough money in the U.S.? My understanding is that they are already (as a group) much better-paid than their counterparts overseas.

sycasey;842849311 said:

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Curious: do you have sources on this claim about doctors not making enough money in the U.S.? My understanding is that they are already (as a group) much better-paid than their counterparts overseas.

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This is what Odonto considers "dire financial constraints". From what I've read, about 20% of our healthcare dollars go to physician pay so it's not the only place where we can save money but it's a meaningful expense.

[URL="https://thedoctorweighsin.com/how-much-money-do-us-doctors-make/"][/URL]

sycasey;842849311 said:

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Curious: do you have sources on this claim about doctors not making enough money in the U.S.? My understanding is that they are already (as a group) much better-paid than their counterparts overseas.

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I haven't heard about any doctors leaving the profession due to "dire" financial constraints. I do know that most specialist doctors expect their salary to decrease in upcoming years. We currently have a pay-for-procedure system which overpays specialists who do procedures all day and underpays those who don't, such as general practitioners and pediatricians. Therefore, in America we have shortages of doctors in fields which do fewer procedures. The powers-that-be are trying to figure out how to pay more for results rather than procedures. This is very challenging and does present uncertainty for physicians. My wife has a specialty and believes her pay will go down in the future.