Law Medicare for all? How about talk about changes actually happening

[cottagecheesefan]

I know Medicare for all is a hot topic right now, but even if someone is elected, who is in favor for that, what are the chances they will actually get a massive reform passed? I am writing a lot of this to a coworker, so I figured I would copy and paste a lot of it here

So here is something that is actually happening. This article is out dated and says potential changes, but the changes are actually going to happen at this point, starting October 1st of this year.

https://www.apta.org/PTinMotion/News/2018/04/30/ProposedSNFPPS2019/

I love this change, and even tho nursing/rehab centers will get more money, it will save the system as a whole a LOT.

So currently, when a Medicare patient goes to the hospital and determined it is unsafe to go home, they often go to rehab facilities (SNFs). Currently, Medicare only looks at the admitting diagnosis, and the SNFs bill Medicare pretty much solely based on the amount of therapy is able to do each day, to recover for that diagnosis. Billed every 15minutes, between Speech, Physical, and Occupation therapy, along with other specific therapy like lymphedema (which actually makes the SNF lose money usually).

Because of this, if a patient had a massive stroke, a nursing home would likely deny. Knowing the patient will pleateu with therapy within a few weeks and have to transition to MEDICAID. Medicaid pays much lower, and those beds a in much higher demand, as they are for Long Term Care.

The new system looks at each patient individually, so if they previously need oxygen, have a wound, need insulin checks, along with about 40 other things, all add to a poiont system. So like needing insulin checked is 1 point, needing oxygen is 2, just having HIV is 8 points, etc. And Medicare billing will be based on the point totals.

Anyways, in short, this will save money because there are a LOT of patients that need placement, but are denied because they are financial losses to the SNF. So the patients go home, or discharged to a place with shit care, like a poorly ran assisted living facility, or whatever, and are sent within weeks back to the hospital in a cycle. Now SNFs will make money off the patient, thus willing to accept, so they can "skill" the patient until a long term care bed becomes available.

I do wonder how this would work tho for Medicare for all. Because, for instance, there are lots of MEDICAID patients who already are denied, since no Medicaid beds. So like a gun shot wound quadraplegic, or someone who ODed and has a lot of residual deficits, or like someone who was KOed in a Bar fight and has a traumatic brain injury. By the time they have had Medicaid for 2 years, and qualify for Medicare, they are already with bedsores, have financial debts, along with a lot of other typical problems. Now they wouldn't have that 2 years of readmission cycle, where they deteriorate to a point where no facility would want to accept.

Granted, these patients fall into the same cycle of hospital readmission.. but that would dramatically increase the number of Medicare patients who would qualift for SNFs.

I am for this change as Medicare currently is. But if all of a sudden there is Medicare for all, the financial flood gates could be crazy.

Plus, as is, SNFs/Nursing homes basically buy their various Medicare and Medicaid beds from the state, which has a set number of each available. So I am not sure how that would be influenced either?

Just food for thought!


edit: even if a candidate knew even just a little about this change, it would be easy to bait another candidate while debating about Medicare and seem really knowledgable.

 

[JamesRussler]

We will never have Medicare for All. Too many people oppose it. Even if a bill gets passed, it will never be implemented because of legal and logistical obstacles. And even if a system is set up, it will bankrupt itself and collapse within a couple years. If you want government-funded health care, move to a small homogenous European country.

 

[cottagecheesefan]

We will never have Medicare for All. Too many people oppose it. Even if a bill gets passed, it will never be implemented because of legal and logistical obstacles. And even if a system is set up, it will bankrupt itself and collapse within a couple years. If you want government-funded health care, move to a small homogenous European country.

I see a lot of problems with the health exchange (basically Obamacare) on a daily basis. It is a huge mess, and adding Medicare into that mix is only going to make it worse, so I tend to agree.

We have enough problems with Medicare as it currently is, not just with Nursing homes, so I can't imagine how many more problems with arise by this. That is why it is kind of disappointing that the candidates seems to be all for Medicare, but do not really talk about it. So it is just a typical talking point, with no real thought/planning. I mean, they can give a general statement that they think some tax might pay for it, but do they know what they are actually paying for?

I do think this is a great change tho, for the current system at least.

 

[Rational Poster]

We will never have Medicare for All. Too many people oppose it. Even if a bill gets passed, it will never be implemented because of legal and logistical obstacles. And even if a system is set up, it will bankrupt itself and collapse within a couple years. If you want government-funded health care, move to a small homogenous European country.

What does homogeneity have to do with it?

France and Germany are both neither small or homogeneous, and both have a better health care industry than America.

The problem isn't that there are too many people or too many brown people.

The problem is that the special interests groups from the health care industry are deeply embedded in our government and political discourse and they simply will not allow a change to the status quo.

 

[cottagecheesefan]

What does homogeneity have to do with it?

France and Germany are both neither small or homogeneous, and both have a better health care industry than America.

The problem isn't that there are too many people or too many brown people.

The problem is that the special interests groups from the health care industry are deeply embedded in our government and political discourse and they simply will not allow a change to the status quo.

I agree with the homogeneity not being a factor and the special interests. I would go into how Obama's team had a lot of ties to healthcare lobbyists, and they went on to pass Obamacare, and since then a lot of health insurance companies' stocks have gone up. But, we are beyond his administration and that would just turn this into partisan debate.

The biggest problem tho is the fraud and inefficiency. This is just one scam in South FL, in just nursing homes, costing over a billion. This shit goes on all over the country and in many different realms within healthcare. There have been endless scams in South FL, the number 1 healthcare fraud capital in the coutry, but still going on all over. It is so fucking hard to oversee all this stuff. The logistics are mind numbing. Not to mention the fall out that his nursing homes were shut down, and now they cannot place the patients, and it creates yet another cycle of hospital readmission and further costs.

https://www.chicagotribune.com/investigations/ct-philip-esformes-jailed-met-20161002-story.html

I am pretty surprised by this tho, as I was going to say that decreasing military spending would solve a lot. But healthcare is almost twice as much as military spending in the budget??? I thought it would be the opposite

Major categories of FY 2017 spending included: Healthcare such as Medicare and Medicaid ($1,077B or 27% of spending), Social Security ($939B or 24%), non-defense discretionary spending used to run federal Departments and Agencies ($610B or 15%), Defense Department ($590B or 15%), and interest ($263B or 7%).[1]

https://en.wikipedia.org/wiki/Expenditures_in_the_United_States_federal_budget

 

[Rational Poster]

I agree with the homogeneity not being a factor and the special interests. I would go into how Obama's team had a lot of ties to healthcare lobbyists, and they went on to pass Obamacare, and since then a lot of health insurance companies' stocks have gone up. But, we are beyond his administration and that would just turn this into partisan debate.

The biggest problem tho is the fraud and inefficiency. This is just one scam in South FL, in just nursing homes, costing over a billion. This shit goes on all over the country and in many different realms within healthcare. There have been endless scams in South FL, the number 1 healthcare fraud capital in the coutry, but still going on all over. It is so fucking hard to oversee all this stuff. The logistics are mind numbing. Not to mention the fall out that his nursing homes were shut down, and now they cannot place the patients, and it creates yet another cycle of hospital readmission and further costs.

https://www.chicagotribune.com/investigations/ct-philip-esformes-jailed-met-20161002-story.html

I am pretty surprised by this tho, as I was going to say that decreasing military spending would solve a lot. But healthcare is almost twice as much as military spending in the budget??? I thought it would be the opposite

Major categories of FY 2017 spending included: Healthcare such as Medicare and Medicaid ($1,077B or 27% of spending), Social Security ($939B or 24%), non-defense discretionary spending used to run federal Departments and Agencies ($610B or 15%), Defense Department ($590B or 15%), and interest ($263B or 7%).[1]

https://en.wikipedia.org/wiki/Expenditures_in_the_United_States_federal_budget

Both the healthcare and military industries have basically become massive state subsidies unrivaled in human history.

These systems will not change simply because of what you've just discovered yourself, there is too much money on the table. You're talking about tens of millions of jobs all told when you talk about making sweeping changes to the military budget or health care system. Inefficiency is bad, but that's what's paying all these salaries, the existing inefficiency of those systems. The guy who paints railings on navy cruiser to the medical debt collector and all the way to the hot shot pharmaceutical lobbyist in a $2000 suit wouldn't have a cent right now without this type of government spending.

Never before has a state been able to invest so much money into their economy for such a long period. It has created a voracious level of dependency that just wants more and more every year. The conservative's welfare queen boogeyman is nothing compared to this sort of dependency.

 

[cottagecheesefan]

Both the healthcare and military industries have basically become massive state subsidies unrivaled in human history.

These systems will not change simply because of what you've just discovered yourself, there is too much money on the table. You're talking about tens of millions of jobs all told when you talk about making sweeping changes to the military budget or health care system. Inefficiency is bad, but that's what's paying all these salaries, the existing inefficiency of those systems. The guy who paints railings on navy cruiser to the medical debt collector and all the way to the hot shot pharmaceutical lobbyist in a $2000 suit wouldn't have a cent right now without this type of government spending.

Never before has a state been able to invest so much money into their economy for such a long period. It has created a voracious level of dependency that just wants more and more every year. The conservative's welfare queen boogeyman is nothing compared to this sort of dependency.

I pretty much agree with all of that. That is why I said that was just one story, one small facet of health care, in one local area, yet still cost over a billion in fraud. I didn't uncover that, it just comes up a lot at work recently.

But are you for all that inefficiency tho, as it would come out of taxes? I know you're more of a liberal poster, so I figure you are for the big government healthcare, and as far as I can tell, no real change in the military complex? Having the government get even more involved in healthcare will lead to even more inefficiency?

I mean, I don't expect a concrete answer or anything, as it is just such a complex, cluster fuck of an issue.

If only politicians campaigned for more legit over sight on all these issues, but most of them (on both sides) would laugh at any real legislation that would be effective.

 

[cottagecheesefan]

Both the healthcare and military industries have basically become massive state subsidies unrivaled in human history.

These systems will not change simply because of what you've just discovered yourself, there is too much money on the table. You're talking about tens of millions of jobs all told when you talk about making sweeping changes to the military budget or health care system. Inefficiency is bad, but that's what's paying all these salaries, the existing inefficiency of those systems. The guy who paints railings on navy cruiser to the medical debt collector and all the way to the hot shot pharmaceutical lobbyist in a $2000 suit wouldn't have a cent right now without this type of government spending.

Never before has a state been able to invest so much money into their economy for such a long period. It has created a voracious level of dependency that just wants more and more every year. The conservative's welfare queen boogeyman is nothing compared to this sort of dependency.

also, just as a btw. There are politicians on BOTH sides of the isle with stocks and interests in healthcare, despite what the might say. And this healthcare fraud is rampant in both red and blue states, NY, FL, CA, TX (2 blue 2 red) being the worst. So it isn't like I want to put blame on Obama or the left.

 

[Happy Man]

What does homogeneity have to do with it?

France and Germany are both neither small or homogeneous, and both have a better health care industry than America.

The problem isn't that there are too many people or too many brown people.

The problem is that the special interests groups from the health care industry are deeply embedded in our government and political discourse and they simply will not allow a change to the status quo.

They can’t afford it. They keep taking money away from native French via austerity. On top of that they keep upping taxes on native french.

This goes to pay for goodies like healthcare that the foreign hordes come and leech off of.

Thus you get the yellow vests revolt.

 

[Rational Poster]

I pretty much agree with all of that. That is why I said that was just one story, one small facet of health care, in one local area, yet still cost over a billion in fraud. I didn't uncover that, it just comes up a lot at work recently.

But are you for all that inefficiency tho, as it would come out of taxes? I know you're more of a liberal poster, so I figure you are for the big government healthcare, and as far as I can tell, no real change in the military complex? Having the government get even more involved in healthcare will lead to even more inefficiency?

I mean, I don't expect a concrete answer or anything, as it is just such a complex, cluster fuck of an issue.

If only politicians campaigned for more legit over sight on all these issues, but most of them (on both sides) would laugh at any real legislation that would be effective.

I don't believe there is anything that can be done within a lifetime. These would have to be a very well thought out series of reforms over a period of decades. The planning should take decades. Just flipping a switch and giving everyone free health care tomorrow isn't the solution. Taking hundreds of billions out of the military budget likewise isn't a solution. Cutting the military budget is a whole other equally complicated and similar can of worms. Any major changes to either industry will cost tens of millions of jobs in the short to medium term, and in the case of both it will also cost lives. An affordable public healthcare option undercuts the entire private insurance market and sends them all to the unemployment office

In think in regards to healthcare, it's not about the government making it more or less inefficient, the inefficiencies in the health care is more the middle men creating bloat. All the medical billers, hospitals, insurance agencies, pharmaceutical companies etc, etc all look for a bigger take year after year. Having just a one stop shop for medical care would obviously be more efficient and there is clear evidence of this in other countries. Whether it's a government or private entity, it doesn't really matter I don't think. All the middle men making their living off the healthcare industry are what makes it inefficient. Just a simple doctor visit is a legal dispute between your doctor and sometimes multiple third parties.

Getting the government to handle all of this would be more efficient, but it would also make every single person earning their living off the transaction between you, your doctor, and those third parties immediately obsolete.

 

[Rational Poster]

They can’t afford it. They keep taking money away from native French via austerity. On top of that they keep upping taxes on native french.

This goes to pay for goodies like healthcare that the foreign hordes come and leech off of.

Thus you get the yellow vests revolt.

They still spend less on healthcare per capita than we do and it's a better quality of service and it's available to all citizens.

They also have less debt to gdp than we do.

 

[Deleted member 159002]

I see a lot of problems with the health exchange (basically Obamacare) on a daily basis. It is a huge mess, and adding Medicare into that mix is only going to make it worse, so I tend to agree.

If suddenly every patient had Medicare, Medicare wouldn't be "added" into the mix; Medicare is already there. It's just more patients would have it. How would all patients having Medicare (with the exception of worker's comp and no fault insurance) make things worse? I work in the billing office for a large group of doctors and nurses. Each billing specialist has their assigned list of companies we participate with that they're responsible for getting money from. It's far more complicated having 15 different companies, each with their own contract that the billing specialist assigned to them has to learn the intricacies of, than having one contract with one insurer. And that's not even taking into account the patients who have insurance we don't participate with.

We have enough problems with Medicare as it currently is, not just with Nursing homes, so I can't imagine how many more problems with arise by this. That is why it is kind of disappointing that the candidates seems to be all for Medicare, but do not really talk about it. So it is just a typical talking point, with no real thought/planning. I mean, they can give a general statement that they think some tax might pay for it, but do they know what they are actually paying for?

Medicare for all with no out of pocket expenses is the most equitable healthcare system.

 

[cottagecheesefan]

If suddenly every patient had Medicare, Medicare wouldn't be "added" into the mix; Medicare is already there. It's just more patients would have it. How would all patients having Medicare (with the exception of worker's comp and no fault insurance) make things worse? I work in the billing office for a large group of doctors and nurses. Each billing specialist has their assigned list of companies we participate with that they're responsible for getting money from. It's far more complicated having 15 different companies, each with their own contract that the billing specialist assigned to them has to learn the intricacies of, than having one contract with one insurer. And that's not even taking into account the patients who have insurance we don't participate with.

But see, you are denying a lot of people for various reasons. Which means someone, somewhere is spending less money.

Not be too cold, but currently, because there is so many insurances and issues with them, a lot of people do not get the healthcare they need and fall through the cracks and die a lot sooner than they would with proper healthcare. I mean, this process takes place over a couple years or more, but for instance, someone with proper care might last 10 years or so longer than the current medicaid person who fell through the cracks. Yea they have a PEG tube, but they deteriorate much quicker outside of a nursing home. A lot of them pass on, before they even make it the 2 years before they qualify for Medicare (if under 65).

So there will be a lot of bed ridden people sitting in nursing homes and eating costs that likely would have died earlier. Moreover, as those people begin to be placed it nursing homes, it takes up beds that would generally be reserved for an old person who fell and broke their hip and need nursing home placement.

Over the years, those patient will exponentially increase.

In addition to the costs, there are not nearly enough skilled medical personnel to take care of all those patients.

Medicare for all with no out of pocket expenses is the most equitable healthcare system.

Yes, that is equitable by definition. Something for all is the most equal of things. But is equitable practical? How can you even begin to estimate the changes in costs, given so many aspects of healthcare? Or the number of health care professionals. There is already a shortage of qualified nurses and good nursing assistants in nursing homes. How could we ever staff all of that increased burden?

 

[JamesRussler]

What does homogeneity have to do with it?

France and Germany are both neither small or homogeneous, and both have a better health care industry than America.

The problem isn't that there are too many people or too many brown people.

The problem is that the special interests groups from the health care industry are deeply embedded in our government and political discourse and they simply will not allow a change to the status quo.

No, their health care is not "better" than the USA's. The USA has the best doctors, best hospitals, best research universities, and most advanced treatments in the world. Yes, it costs money, but it is the best. If you have a common health problem in France (e.g., a broken leg in France, an STD, etc.), maybe you'll get to see a doctor, the treatment will be satisfactory, and maybe it won't cost you much (aside from paying half of your income in taxes). But if you have cancer or some rare disease/condition, and you want the best chance of surviving, you will want to go to the USA.

Also, France and Germany are roughly 1/5 and 1/4 the size of the USA, respectively, and 85% and 90% white, respectively. They are (or were) relatively homogenous. Now they are dealing with an unprecedented influx of unskilled, unproductive, culturally incompatible, low-income migrants. This will not go over well, either socially or fiscally.

 

[Rational Poster]

No, their health care is not "better" than the USA's. The USA has the best doctors, best hospitals, best research universities, and most advanced treatments in the world. Yes, it costs money, but it is the best. If you have a common health problem in France (e.g., a broken leg in France, an STD, etc.), maybe you'll get to see a doctor, the treatment will be satisfactory, and maybe it won't cost you much (aside from paying half of your income in taxes). But if you have cancer or some rare disease/condition, and you want the best chance of surviving, you will want to go to the USA.

Also, France and Germany are roughly 1/5 and 1/4 the size of the USA, respectively, and 85% and 90% white, respectively. They are (or were) relatively homogenous. Now they are dealing with an unprecedented influx of unskilled, unproductive, culturally incompatible, low-income migrants. This will not go over well, either socially or fiscally.

I didn't say their health care was better, I said their health care industry is better.

They spend less on it per capita and they have better results for a larger portion of their citizens, which is what matters. I don't care what care the ultra wealthy have access to and you shouldn't either, because you're certainly not part of that class. I care what kind of care everyone has access to.

You're really just completely wrong about everything else here objectively. The French health care industry is cheaper. They have more doctors, shorter wait times, higher life expectancy, lower rate of infant mortality, and are slightly to significantly better at basically any other metric you can lie about.

And the race of the patients and citizens still has nothing to do with it.

 

[Happy Man]

They still spend less on healthcare per capita than we do and it's a better quality of service and it's available to all citizens.

They also have less debt to gdp than we do.

All of that is true. So you’d support trump trying to get these nations to pay for their defense in NATO. And that we need better trade deals with them that finally serve our country, not just our wealthy.

 

[JamesRussler]

They spend less on it per capita and they have better results for a larger portion of their citizens, which is what matters.

Since when do you care about "citizens?" All of your 2020 candidates support health care for illegal aliens, and you will be voting for one of them.

You're really just completely wrong about everything else here objectively. The French health care industry is cheaper. They have more doctors, shorter wait times, higher life expectancy, lower rate of infant mortality, and are slightly to significantly better at basically any other metric you can lie about.

And the race of the patients and citizens still has nothing to do with it.

If you're so convinced of your bullshit, why don't you move to France? I'm serious. Why not?

 

[Rational Poster]

All of that is true. So you’d support trump trying to get these nations to pay for their defense in NATO. And that we need better trade deals with them that finally serve our country, not just our wealthy.

France was already on track to meet their NATO spending goals before Trump even took office.

I don't think you know anything about trade to really bother commenting on it in a thread about health care.

 

[Rational Poster]

Since when do you care about "citizens?" All of your 2020 candidates support health care for illegal aliens, and you will be voting for one of them.



If you're so convinced of your bullshit, why don't you move to France? I'm serious. Why not?

Well I think the US economy with the guidance of the US government is well capable of taking care of all its citizens and even some non-citizens to a higher standard if we actually had the political willpower to do so.

I don't move to France because I don't speak French and it's not like I get all the benefits of French citizenship just for moving there.

I'd rather just learn from the French and the Germans and apply their methods to our country instead of just pretending their results don't exist out of political convenience and a lifelong subscription to partisan dogma.

 

[Happy Man]

France was already on track to meet their NATO spending goals before Trump even took office.

I don't think you know anything about trade to really bother commenting on it in a thread about health care.

They are finally starting to pay more. But they are only paying 40 billion a year. And counting on our defense spending to keep them forever protected.

NATO is a bum deal that uses the American taxpayer for European defense.