Author Topic: The ACA/Obamacare Thread  (Read 11657 times)

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Offline Chino

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Re: The ACA/Obamacare Thread
« Reply #595 on: August 01, 2017, 06:18:36 AM »
http://www.ibtimes.com/political-capital/bernie-sanders-drug-price-bill-would-save-billions-congressional-analysts-say

Looking to take advantage of President Donald Trumpís promise to lower drug prices,  Vermont Sen. Bernie Sanders, along with 21 Democratic lawmakers, introduced the Affordable and Safe Prescription Drug Importation Act on Feb. 28. The bill was referred to the Senateís Committee on Health, Education, Labor, and Pensions.

CBO estimates that the change would in total reduce federal government drug spending by more than $6.8 billion over ten years, including a reduction of $5.1 billion in direct spending and roughly $1.7 billion in increased revenue.

Before introducing the new legislation, Sanders and Democratic Sen. Amy Klobuchar of Minnesota in January introduced a budget amendment allowing Americans to purchase drugs from Canada. In contrast to typical party-line votes, 13 Republicans voted with the Democrats in supporting the amendment, while 13 Democrats joined the remaining Republicans in voting it down. The tally was 52-46 against the amendment.



I don't think something like this would be a bad start.

Offline Stadler

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Re: The ACA/Obamacare Thread
« Reply #596 on: August 01, 2017, 06:41:54 AM »
Don't disagree, but it can't be done in a vacuum.   

One of the things I would have done as part of the ACA (or any meaningful reform) was do away with the $80 billion profit guarantee to the pharmaceuticals, but I would have provided government subsidies for R&D that couldn't be recouped from sales.   The Gov wouldn't pay to R&D things like Viagra or other drugs that have a ready market, but for those formulations where the R&D is exhorbitant compared to the expected return, I would give the "$80 billion" in the form of R&D subsidies. 

This will, as far as I understand it (there are those here that know far more about this than I do) make the "buy from Canada" a far more attractive proposition for those doing the selling.   I fear that this is not going to result in savings, but rather jack up the prices in Canada. 

Offline Chino

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Re: The ACA/Obamacare Thread
« Reply #597 on: August 01, 2017, 07:05:47 AM »
Don't disagree, but it can't be done in a vacuum.   

One of the things I would have done as part of the ACA (or any meaningful reform) was do away with the $80 billion profit guarantee to the pharmaceuticals, but I would have provided government subsidies for R&D that couldn't be recouped from sales.   The Gov wouldn't pay to R&D things like Viagra or other drugs that have a ready market, but for those formulations where the R&D is exhorbitant compared to the expected return, I would give the "$80 billion" in the form of R&D subsidies. 

This will, as far as I understand it (there are those here that know far more about this than I do) make the "buy from Canada" a far more attractive proposition for those doing the selling.   I fear that this is not going to result in savings, but rather jack up the prices in Canada.

But if Canada raised their prices, wouldn't people then just move onto a different country? If Canada wanted to remain competitive in the market place and was okay with maintaining their current level of profitability (which would increase anyway if the US started buying from them), they wouldn't want to give countries like India a competitive edge by pricing themselves out.

Offline jingle.boy

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Re: The ACA/Obamacare Thread
« Reply #598 on: August 01, 2017, 07:26:12 AM »
As for your numbers, no, not with your math.  But that's not how it works; every minute ISN'T $230.   Some minutes are unbillable.  The paperwork, the administration.  Some minutes are only billable at a fixed, pre-negotiated rate.   When you average out that "$230" out over the total number of seconds for the year, it's absolutely NOT $26.7 M or whatever.

Fair point... but take other service industries, Law for instance which you would be well versed in.  Not every minute/hour of your time is billable (though, that is the goal in many service industries).  What would a client of yours do if you charged $230 for a simple add-on question made by a client at the end of a 10 minute meeting?  I wasn't trying to say that Doctor's actually make $14k/hr, but this fee would equate it to that, which hardly seems fair/reasonable to me.

the don't ask/don't tell isn't normalized by the customers, it's normalized by the system itself (which is an oxymoron, but still).

That's a better way of putting it for sure.
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Offline Stadler

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Re: The ACA/Obamacare Thread
« Reply #599 on: August 01, 2017, 08:44:10 AM »
As for your numbers, no, not with your math.  But that's not how it works; every minute ISN'T $230.   Some minutes are unbillable.  The paperwork, the administration.  Some minutes are only billable at a fixed, pre-negotiated rate.   When you average out that "$230" out over the total number of seconds for the year, it's absolutely NOT $26.7 M or whatever.

Fair point... but take other service industries, Law for instance which you would be well versed in.  Not every minute/hour of your time is billable (though, that is the goal in many service industries).  What would a client of yours do if you charged $230 for a simple add-on question made by a client at the end of a 10 minute meeting?  I wasn't trying to say that Doctor's actually make $14k/hr, but this fee would equate it to that, which hardly seems fair/reasonable to me.

Well, let's go back to the start here; it is an ethics requirement that when the agreement is entered into to represent someone, the fee schedule is clearly and completely laid out.   So they know.  I can't do anything that they don't know.  If my fee schedule said that - "Any stand alone 10-minute blocks shall be billed at the rate of $23/minute" - then we'd be fine, and as is usually the case in a capitalist transaction, they'd have the opportunity to weigh the cost/benefit and decide if they want the service.   

The point here, Jingle, isn't to argue with you, it's to refocus.  The problem ISN'T THE RATE, nor the "make up" practice.  it's the lack of transparency.   If the ENTIRE transaction - from negotiation to delivery to payment - was limited to the two parties, we'd be fine.  The doc could propose a rate, the patient could agree, and we move on.  But that's not how the U.S. healthcare system works.   

Essentially, our healthcare system is one big, massive example of me walking into my living room, seeing my kid comatose in front of the TV, me saying "what gives?" and my kid saying "Mom said I could."

Offline bosk1

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Re: The ACA/Obamacare Thread
« Reply #600 on: August 01, 2017, 09:15:14 AM »
Stadler, I think you've done a good job of highlighting some of the specifics of what the actual problem is and why it generally isn't what it may seem on the surface.  But to go back to Chino's example and to play devil's advocate, despite that what you say about how the system generally works is true, it could also just be an example of a doctor who is somewhat of a crook.  Or who may not be a crook, but is overzealous about his billing when he shouldn't be.  Or whatever. 

But I say that to say that NO system can really prevent individual outliers who push the boundaries or prevent individuals from gaming the system and being crooks.  You can have penalties and sanctions that can act as a deterrent and/or to remedy the problem after the fact if these guys get caught.  But you can never 100% prevent all such abuses from even happening in ANY system.
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Offline jingle.boy

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Re: The ACA/Obamacare Thread
« Reply #601 on: August 01, 2017, 10:11:35 AM »
The point here, Jingle, isn't to argue with you, it's to refocus.  The problem ISN'T THE RATE, nor the "make up" practice.  it's the lack of transparency.   If the ENTIRE transaction - from negotiation to delivery to payment - was limited to the two parties, we'd be fine.  The doc could propose a rate, the patient could agree, and we move on.  But that's not how the U.S. healthcare system works.   

Gotchya... and I ain't gonna argue any of that.  Despite the root cause being the system, I still think there's a responsibility on of those with the power (ie, Doctors have the power of providing the "care") not to take advantage of the system and/or those without the power.  The system allows for Chino's Doc to bill the way he did, and there isn't a damn thing anyone can do about it.  The doc billed it the way he did, because he could, and wasn't forthcoming with his patient.  Ethically questionable, IMO.  If he had told Chino "this is gonna cost $230", guaran-damn-tee (as Chino already said), he'd pass on it and go to Urgent Care.  So (and not saying this was intentional on the part of the Doc), his lack of transparency generated that income for him.

"Do no harm" I guess doesn't extend to insert "financial" before "harm". 

Essentially, our healthcare system is one big, massive example of me walking into my living room, seeing my kid comatose in front of the TV, me saying "what gives?" and my kid saying "Mom said I could."

 :rollin
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Offline Stadler

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Re: The ACA/Obamacare Thread
« Reply #602 on: August 01, 2017, 10:44:29 AM »
Stadler, I think you've done a good job of highlighting some of the specifics of what the actual problem is and why it generally isn't what it may seem on the surface.  But to go back to Chino's example and to play devil's advocate, despite that what you say about how the system generally works is true, it could also just be an example of a doctor who is somewhat of a crook.  Or who may not be a crook, but is overzealous about his billing when he shouldn't be.  Or whatever. 

But I say that to say that NO system can really prevent individual outliers who push the boundaries or prevent individuals from gaming the system and being crooks.  You can have penalties and sanctions that can act as a deterrent and/or to remedy the problem after the fact if these guys get caught.  But you can never 100% prevent all such abuses from even happening in ANY system.

Well, I agree, but there's this:   under the current system, there's NO controls.  The concept wasn't even discussed, and had it been covered by insurance, he never would have known.  Under a more transparent system, there STILL will be outliers, but there would be a large subset that would be an arm's length transaction, with checks and balances.  I don't think we should be trying to get a system where there is no possibility of malfeasance.  I think we should be trying to get a system that doesn't ACTIVELY PROMOTE malfeasance, and deal with the problem children as we go. 

Offline Dave_Manchester

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Re: The ACA/Obamacare Thread
« Reply #603 on: September 22, 2017, 02:19:33 PM »
McCain again proving a thorn in Trump's side...

http://www.bbc.com/news/world-us-canada-41367128

A wiser man than me (Lenin) once observed that taking a politician to the brink of his own death is the only sure way to haul a conscience out of him. I'm not saying that relates completely to McCain's refusal to vote for the new Repeal plan, but there is a definite trend I've noticed (British MPs Diane Abbott and Ronnie Campbell for example, both very ill with cancer now, and both no longer caring about "what's good for the Labour Party") of politicians setting aside idiotic party loyalty for the good of the country when they no longer have anything political to lose.

Offline El Barto

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Re: The ACA/Obamacare Thread
« Reply #604 on: September 22, 2017, 02:25:31 PM »
This was their sleaziest attempt yet. The formula they used in determining block grant amounts essentially took money from democrat states to give to republican states. And yet two GOP states that get shit on with this thing are Murkowski's and Collins's, whose vote they desperately needed.  :lol

As for McCain, I think it's pretty reasonable to assume he's just taking bullets for the team. Since he's leaving us he can afford to kill things so that sensible politicians with an actual future won't have to. I suspect that's why he thumb downed RAGFY. McConnel keeps putting his own folk in terrible situations. McCain keeps bailing them out.
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Online portnoy311

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Re: The ACA/Obamacare Thread
« Reply #605 on: September 22, 2017, 08:20:32 PM »
Yeah, this is so abysmal. I really think the GOP is seeing the writing on the wall that 2018 is going to be very bad for them so they're trying to push things through while there's at least an outside chance. No, I don't think Republican = bad, Democrat = good - but I do think this Republican Congress and White House are proving to be toxic.


As for McCain, the one big former Washington insider (GOP) I'm friends with and routinely talk to HATES McCain. Always has. I've only half jokingly told him multiple times that makes me like John. To use a probably ridiculous analogy, he's like a "feel" poker player. There's two types of poker players - mathematically game theory centered players, and feel players. I'm the former (or was what I tried to be when I took it seriously, at this point I'm basically just a guy looking to have fun), whereas the latter are the stereotypical players who get a "read" based on whatever the hell, and go with it even if their overall strategy doesn't make sense. It only works if someone is really, really good at it as any small mistake can blow up on you quickly if you're not 100% right. That's John. He does whatever he thinks is right even if his overall strategy and principles aren't entirely coherent. I've never really vilified him like many on both sides of the aisle have. I think with how Congress is balanced right now he's incredibly important and an asset.
« Last Edit: September 22, 2017, 09:19:51 PM by portnoy311 »

Offline XeRocks81

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Re: The ACA/Obamacare Thread
« Reply #606 on: September 23, 2017, 08:23:08 AM »

 I really think the GOP is seeing the writing on the wall that 2018 is going to be very bad for them

Man I'm sill too traumatized by the 2016 election to even think of saying something like that.   Feels like anything can happen now.

Offline pogoowner

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Re: The ACA/Obamacare Thread
« Reply #607 on: September 23, 2017, 02:06:35 PM »
Yeah, this is so abysmal. I really think the GOP is seeing the writing on the wall that 2018 is going to be very bad for them so they're trying to push things through while there's at least an outside chance.
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