Trump's First 100 Days

[ariich]

Also, when it comes to health insurance, I'm a little dismayed how just pushing aside 10 mil people is brushed off. Yeah, some didn't want health insurance. Some did. I look at it this way. If you call 911, the cops will come help you. It doesn't matter if you're me, Stadler, Mark Cuban, Kate Upton, whoever. The cops protect everyone. We protect our people from domestic threats. Same with the military. We don't send our military off to wherever to protect rich Americans. If an American is killed and beheaded we don't ask what their income level was or how many taxes they paid. So we also protect our own equally from foreign threats. Yet, healthcare is treated as some kind of commodity that should abide by the capitalistic ideals - those that have money can afford it, if not, sucks for you. I ask - why? Why is a robber breaking into someone's house equally treated and police equally protect those of all income levels, but we don't grant the same equality to cancer, or lupus, or MS, or.... I don't get the disconnect here. I'm tired of seeing 10 mil people brushed aside in the name of economics (which don't make sense in themselves, healthy populations make more money and cost less, but that's a moot point I guess). We don't do that with so many other protections in our country, yet healthcare seems to be fair game. It makes no sense and falls apart under its own logic.

 

I think this is a good post. It reflects my thoughts way better than I could say myself.

Great post indeed... I am so glad that I live in a country where healthcare is provided by the state and does not depend upon me having an insurance that might or might not cover my injury or disease.

Yeah seriously. Countries that have universal healthcare look at America thinking "what the hell?"

And having universal healthcare is no walk in the park either, we're not dumb we know there's not such thing as "free" and  the different challenges involved in making it work are in the news almost everyday but stil, it seems better than the alternative.   

For sure, don't get me wrong it's bloody difficult. The capacity of the UK's health service is failing to keep up with increased demand due to the ageing population. But all citizens are covered.

[SwedishGoose]

Which country in the world has the highest per capita cost of healthcare and why?

[jsbru]

Which country in the world has the highest per capita cost of healthcare and why?

Is this question rhetorical?  Because the answer is the United States, and it's not even close.  And we don't have nearly the best outcomes to show for it.  Healthcare providers and pharmaceutical companies just rake in money here.

[Adami]

Which country in the world has the highest per capita cost of healthcare and why?

Assuming I read the right list, and as of 2015, it was America, but Luxembourg was in a not so distant second.

[portnoy311]

Luxembourg? Interesting. I wonder how much of that is legitimate and how much is statistical noise from having a population of 600,000 people. They're probably more susceptible to variance in rate stats than most countries.

[Cool Chris]

I think part of the problem, both from a politician side and a populous side, is that the concept of the single payer model can't be communicated well enough in order to sell it. Of course there are going to be those who would resist anything the "other side" proposes. But it would take a charismatic leader beyond which the US has any interest in electing to champion universal health care/single payer to the public.

[portnoy311]

The other thing that kills me is that the GOP - the same elected officials who authored this bill - are the ones who parrot the line that gun violence "isn't a gun issue, it's a mental health issue," yet are now cutting mental health provisions. If they actually thought that, why are they not expanding mental health coverage in particular. I have a long history of depression and anxiety. The only time I've been able to get fully treated is in my previous career when I could afford to pay $125 a week. (I'm 2 months out of starting a good job, so I'll be fine.) If I were mentally ill enough it had a negative effect on my ability to work? Well then I'm brushed aside as one of those 10 million people who maybe didn't want insurance anyway. Nevermind it goes beyond insurance as most mental health hasn't always been covered anyway. Then if someone in that situation does something to hurt others we're told it's a "mental health issue." So dumb. Just saying 'economics,' which again are suspect at best,  does not make this doublespeak OK. If your representatives support a bill that hurts access to mental health and they've ever once said, "gun violence is a mental health issue," CALL THEM ON IT. This is such a huge hypocrisy that is playing out in front of us and not getting enough attention.

[Stadler]

the best, in my view, is single-payer

So, I'd never heard this phrase before. But I keep seeing you mentioning it, so I looked it up and yeah I think this is so obviously the right approach (disclaimer: I'm from the UK which has universal state-funded healthcare!). I was of the impression that this is ideally what Obama and many other democrats would have ideally liked but that the concept is not paletable to republicans.

It's simplistic to think it's just "Dems want it, Reps don't".   It faces a lot of uncertainty, even from policy experts.  Obama wanted it (it's essentially what the Clinton's proposed some ten years before) but he couldn't convince his own team to accept it.    Some polls have only about 50% of the population in favor of it. That's the biggest hurdle, right there.    Not every Republican is against it, and not every Democrat is for it.   (EDIT:  I just found one poll with over 25% of Republicans in favor of single payer)   And it won't be without problems - it's essentially Medicare for everyone - and we in the States don't do a phenomenal job of execution in government operations, at least not the public ones. 

[Stadler]

Also, when it comes to health insurance, I'm a little dismayed how just pushing aside 10 mil people is brushed off. Yeah, some didn't want health insurance. Some did. I look at it this way. If you call 911, the cops will come help you. It doesn't matter if you're me, Stadler, Mark Cuban, Kate Upton, whoever. The cops protect everyone. We protect our people from domestic threats. Same with the military. We don't send our military off to wherever to protect rich Americans. If an American is killed and beheaded we don't ask what their income level was or how many taxes they paid. So we also protect our own equally from foreign threats. Yet, healthcare is treated as some kind of commodity that should abide by the capitalistic ideals - those that have money can afford it, if not, sucks for you. I ask - why? Why is a robber breaking into someone's house equally treated and police equally protect those of all income levels, but we don't grant the same equality to cancer, or lupus, or MS, or.... I don't get the disconnect here. I'm tired of seeing 10 mil people brushed aside in the name of economics (which don't make sense in themselves, healthy populations make more money and cost less, but that's a moot point I guess). We don't do that with so many other protections in our country, yet healthcare seems to be fair game. It makes no sense and falls apart under its own logic.

 

I think this is a good post. It reflects my thoughts way better than I could say myself.

Great post indeed... I am so glad that I live in a country where healthcare is provided by the state and does not depend upon me having an insurance that might or might not cover my injury or disease.

It's only a great post if you a) make the false connection that Portnoy311 did, that somehow it's a conscious and overt attempt to specifically exclude anyone (and I'd have to ask, by whom, since even Obama's vaunted program didn't reach that 10 million), or b) if you make ridiculous, self-serving, self-justifying comments like this one:

Great post indeed... I am so glad that I live in a country where healthcare is provided by the state and does not depend upon me having an insurance that might or might not cover my injury or disease.

It's just so frickin' weird how simple and awesome a solution this is--and yet so many people in this country are totally against it because of partisan politics alone.

What a surprise; you're miraculously RIGHT and everyone who disagrees with you is a partisan hack.    Honestly, it's YOUR thinking that is the problem.   It's that constant "I'm right, you're CLEARLY wrong, and too stupid to even know it" attitude that makes so many people dig in their heels.

No one said the "10 million were expendable", least of all not me.   Look closer at what the argument is:   we're not anywhere NEAR getting that 10 million covered, either under Obamacare, Ryancare, Trumpcare, Portnoycare, or Kardashiancare.    But we're USING that metric, to justify any and all incremental change, at the expense of hundreds of other variables.    There's no easy way to describe this, but it's a common thing in manufacturing:  you have x defects.  And you want to get to zero.  One solution will get you to x-y defects, at a cost that is radically out of whack with achieving the x defects, and makes it practically, if not virtually, impossible to get to zero.    And some of us - me included - think that that's where we're at with Healthcare.  It's a complete misstatement of reality to just assume that we're "costing" these 10 million people out of coverage.     If Obamacare ACTUALLY covered those 10 million people, you might be right.  But every provision in the world was given to get these people covered and they are STILL not.  What does that tell you?

It tells me that a) there's a shit load of people that don't think like party Democrats (and thank God for that!), and b) jsbru's partisan politics screed applies equally, if not moreso, to the people that keep INSISTING Obamacare was working when BY THEIR OWN SELF-APPOINTED METRIC (wrong though it is) it wasn't.    It just WASN'T.     

[Stadler]

Which country in the world has the highest per capita cost of healthcare and why?

Is this question rhetorical?  Because the answer is the United States, and it's not even close.  And we don't have nearly the best outcomes to show for it.  Healthcare providers and pharmaceutical companies just rake in money here.

Yeah, RAKING it in.  Those insurers' single digit profit margins are just OBSCENE.    Especially since they have NO RISK AT ALL!   It's not like if someone gets sick and they have to cover it... oooopps.    (Profits, as a percentage of revenue, for 2015:  United Health, 3.7%;Anthem, 3.2%; Aetna, 4.0%; Humana, 2.4%; Cigna, 5.5%)  KILLING IT (NOT)!

Look, I totally get that it's not working, but this knee-jerk, "blame the corporations" mentality is part of the problem.    Pharmaceuticals are a different story, since Obama stepped all over his dick in trying to get his legacy package passed by promising them reduced regulation and guaranteed profits (you'd think - listening to the partisan people here - that he was a REPUBLICAN!  I guess when Democrats do it, it's okay, and doesn't qualify for "partisan political positions"), but insurers are not the problem.  It's the lack of transparency, lack of bureaucracy, and artificial constraints on the businesses.   Let them underwrite!   Let them use efficiencies, even if those efficiencies cross state lines!    Get rid of the 10, 15 , 20 layers of interaction!   

THIS is in part why we don't have single payer, and why our healthcare is a clusterfuck.  Because most people DON'T know how it works, and aren't plugged into what it costs - and more importantly, WHO it costs - when we go get our hemorrhoids looked at.

[Podaar]

Which country in the world has the highest per capita cost of healthcare and why?

Is this question rhetorical?  Because the answer is the United States, and it's not even close.  And we don't have nearly the best outcomes to show for it.  Healthcare providers and pharmaceutical companies just rake in money here.

Yeah, RAKING it in.  Those insurers' single digit profit margins are just OBSCENE.    Especially since they have NO RISK AT ALL!   It's not like if someone gets sick and they have to cover it... oooopps.    (Profits, as a percentage of revenue, for 2015:  United Health, 3.7%;Anthem, 3.2%; Aetna, 4.0%; Humana, 2.4%; Cigna, 5.5%)  KILLING IT (NOT)!

I don't think he mentioned insurance companies. I may be wrong, but it appears he was talking about providers and pharma, not insurance companies. I think it's pretty clear to everyone that health insurance companies aren't doing spectacularly.

[Stadler]

Nevermind it goes beyond insurance as most mental health hasn't always been covered anyway.

Of course the hypocrisy is ALL GOP, all the time.

Look, I know (some of) your situation, and I'm incredibly sensitive to it.    I consider you one of my friends here (not "internet friend", but "friend").    But while I get your anger, I can't help but respectfully think it is a little misplaced.   What does this have to do with the "10 million"?  Under the Dem plan passed by a Dem President, and a Dem Congress, they weren't covered.  They were NEVER going to be covered.  It's not "GOP hypocrisy".    And as for coverage, I've been in therapy basically constantly since 2010, and every session I've ever taken has been covered in some way.   My son (step) is considered "disabled", and has therapy and meds covered almost 100%.   My daughter (step), not "disabled", but is in therapy and on meds as well, COVERED.   That's not "GOP", that's your plan.   Again, part of the lack of transparency, and one of the problems with the state-by-state regulation (you know, the one that John Oliver - BRIT - makes fun of). 

[Stadler]

Which country in the world has the highest per capita cost of healthcare and why?

Is this question rhetorical?  Because the answer is the United States, and it's not even close.  And we don't have nearly the best outcomes to show for it.  Healthcare providers and pharmaceutical companies just rake in money here.

Yeah, RAKING it in.  Those insurers' single digit profit margins are just OBSCENE.    Especially since they have NO RISK AT ALL!   It's not like if someone gets sick and they have to cover it... oooopps.    (Profits, as a percentage of revenue, for 2015:  United Health, 3.7%;Anthem, 3.2%; Aetna, 4.0%; Humana, 2.4%; Cigna, 5.5%)  KILLING IT (NOT)!

I don't think he mentioned insurance companies. I may be wrong, but it appears he was talking about providers and pharma, not insurance companies. I think it's pretty clear to everyone that health insurance companies aren't doing spectacularly.

That's my fault; I have a tendency to conflate the two, because of the lack of transparency I was talking about.   The gateway is the insurer, and more often than not, the rates set by the provider is a negotiated rate entered into by the insurer.   You buy the plan from the insurer.   You pay the premium to the insurer.   The insurer is the one with all the risk.    We here in the States don't deal with the provider, at least monetarily, until the very end, when they opt to bill you for stuff they then claim isn't covered.      When's the last time you bartered a "rate" from your doctor?   You're actually PREVENTED from doing that in many cases.   So to blame any individual corporation is misleading, because all this was supposed to be sorted out by Obamacare.  But it wasn't, because they didn't understand how it worked (and went and guaranteed profits to one leg of the stool, because, well, LEGACY!).   

This is in part why I advocate for single payer.  You can either go full on universal healthcare, or go full on marketplace; no insurers per se, I just contract with the doctor/hospital of my choosing.   This blending of the two DOES NOT WORK.  You can't half-ass social medicine or half-ass free market medicine. 

[Podaar]

I don't disagree at all.

[antigoon]

I think the public appetite for universal healthcare is larger than it's ever been. I mean, Trump basically ran on that, at least in amorphous terms, didn't he? I hope we'll see a single-payer eventually as I do feel that healthcare is a right and what we have now is totally unsustainable. 

[Podaar]

I guess we should point out that while a blend has not shown to work out for critical care, private health insurance and private patient care (for those with the means) as a supplement to a national system or single-payer system is still alive and well in every developed country.

[mikeyd23]

So what steps would the US have to actually take in order to implement a single-payer system? Honestly asking, because I feel like we are so, so far away from that currently.

[jsbru]

Is this question rhetorical?  Because the answer is the United States, and it's not even close.  And we don't have nearly the best outcomes to show for it.  Healthcare providers and pharmaceutical companies just rake in money here.

Yeah, RAKING it in.  Those insurers' single digit profit margins are just OBSCENE.    Especially since they have NO RISK AT ALL!   It's not like if someone gets sick and they have to cover it... oooopps.    (Profits, as a percentage of revenue, for 2015:  United Health, 3.7%;Anthem, 3.2%; Aetna, 4.0%; Humana, 2.4%; Cigna, 5.5%)  KILLING IT (NOT)!

If you actually read my post, you'll notice that I didn't include insurers.  I said "providers and pharmaceutical companies."  I did that on purpose...it wasn't an accident.  So this post is pretty much a strawman.

[jsbru]

So what steps would the US have to actually take in order to implement a single-payer system? Honestly asking, because I feel like we are so, so far away from that currently.

I don't think we're as far away as we think, because we currently have two single-payer systems set up for parts of the population: Medicare and Medicaid.  It would obviously take some work to expand those programs to everyone, but the mechanisms for determining pricing, the legality and regulations, and the payment processes are already in place.  They might have to be tweaked, but it's not like we're starting from scratch.

I'd be fine with providing universal coverage just at a more basic level and letting people buy supplemental plans to cover more stuff, similar to Medicare Advantage programs.

[Chino]

The hardest part about going single payer will be redesigning all the backend database systems across the industry and getting them all to talk to each other. It'll take years and billions of dollars for that alone.

[mikeyd23]

The hardest part about going single payer will be redesigning all the backend database systems across the industry and getting them all to talk to each other. It'll take years and billions of dollars for that alone.

That's the kind of stuff I was thinking of as well. Lots of logistics that would cost a lot and take a lot of time.

[cramx3]

The hardest part about going single payer will be redesigning all the backend database systems across the industry and getting them all to talk to each other. It'll take years and billions of dollars for that alone.

That's the kind of stuff I was thinking of as well. Lots of logistics that would cost a lot and take a lot of time.

Not an insurmountable task though.  I know data cross talk in the medical field is a big thing in the IT world.  I don't trust the government to contract this out to work efficiently, but I dont think things like this should stop us from progressing.

[Chino]

The hardest part about going single payer will be redesigning all the backend database systems across the industry and getting them all to talk to each other. It'll take years and billions of dollars for that alone.

That's the kind of stuff I was thinking of as well. Lots of logistics that would cost a lot and take a lot of time.

That was actually one of the things that really irked me with the early criticisms of the ACA. Reading things online like "the ACA is dead on arrival. They can't even get the website to work".

1) The usability of a website or an application have nothing to do with the policy they're being built to work alongside
2) Do you (not you specifically) have any clue whatsoever as to what make a database system work? I'm not saying this just because I work in the industry, but the degree to which people don't know anything technical is astounding. This isn't meant as an insult, just acknowledging the reality. The amount of resources needed to do what was needed for the ACA was staggering. I'm actually amazed they got it working so well in such a short period of time. I've seen projects 1/50 as complicated take just as long to implement.

[Chino]

The hardest part about going single payer will be redesigning all the backend database systems across the industry and getting them all to talk to each other. It'll take years and billions of dollars for that alone.

That's the kind of stuff I was thinking of as well. Lots of logistics that would cost a lot and take a lot of time.

Not an insurmountable task though.  I know data cross talk in the medical field is a big thing in the IT world.  I don't trust the government to contract this out to work efficiently, but I dont think things like this should stop us from progressing.

No doubt, but that doesn't mean it's easy. If I remember correctly, Google, Yahoo, and Facebook offered their employees free of charge to help get the ACA system working.

[mikeyd23]

The hardest part about going single payer will be redesigning all the backend database systems across the industry and getting them all to talk to each other. It'll take years and billions of dollars for that alone.

That's the kind of stuff I was thinking of as well. Lots of logistics that would cost a lot and take a lot of time.

That was actually one of the things that really irked me with the early criticisms of the ACA. Reading things online like "the ACA is dead on arrival. They can't even get the website to work".

1) The usability of a website or an application have nothing to do with the policy they're being built to work alongside
2) Do you (not you specifically) have any clue whatsoever as to what make a database system work? I'm not saying this just because I work in the industry, but the degree to which people don't know anything technical is astounding. This isn't meant as an insult, just acknowledging the reality. The amount of resources needed to do what was needed for the ACA was staggering. I'm actually amazed they got it working so well in such a short period of time. I've seen projects 1/50 as complicated take just as long to implement.

Yup, I agree. That being said, I was working for a government contractor at that point in time who built, you guessed it, data collection systems for government data of all sorts. We actually had worked mostly in health related data for HHS groups at federal and state levels. I distinctly remember the contractor that got awarded the work had no clue what they were doing, lots of people we worked with in the industry were baffled at the time.

So, I agree that this stuff isn't easy, especially on that scale, but lets not pretend the government always selects the most qualified candidates for these gigs either.

[Stadler]

Is this question rhetorical?  Because the answer is the United States, and it's not even close.  And we don't have nearly the best outcomes to show for it.  Healthcare providers and pharmaceutical companies just rake in money here.

Yeah, RAKING it in.  Those insurers' single digit profit margins are just OBSCENE.    Especially since they have NO RISK AT ALL!   It's not like if someone gets sick and they have to cover it... oooopps.    (Profits, as a percentage of revenue, for 2015:  United Health, 3.7%;Anthem, 3.2%; Aetna, 4.0%; Humana, 2.4%; Cigna, 5.5%)  KILLING IT (NOT)!

If you actually read my post, you'll notice that I didn't include insurers.  I said "providers and pharmaceutical companies."  I did that on purpose...it wasn't an accident.  So this post is pretty much a strawman.

I most certainly read your post, that's why I responded to it.  I've already addressed this; it may not have been an accident, but it was still misleading.    Those weren't the entities that Obama beat up, and in fact, in one case, actually GUARANTEED them the ability to "rake it in".   

[Cyclopssss]

So can anyone explain to me why Ivanka Trump, who has no official status gets an office in the White House and has access to sensitive classified information? Am I missing something? 

[Chino]

So can anyone explain to me why Ivanka Trump, who has no official status gets an office in the White House and has access to sensitive classified information? Am I missing something?

Her daddy's the president. This also allows Trump to have an indirect, international means of communication in order to continue running the businesses he never put in a blind trust.

[Sir GuitarCozmo]

But Benghazi

[Stadler]

So can anyone explain to me why Ivanka Trump, who has no official status gets an office in the White House and has access to sensitive classified information? Am I missing something?

You are.  She's hot, and he'd be dating her if she wasn't his daughter.   Duh.   

[cramx3]

She seems to have her father's ear.  I don't know if that justifies having an office, I have no idea what the requirements are for that, but I think it's best to keep her close to her father since she comes off as way more reasonable than him.

[gmillerdrake]

She seems to have her father's ear.  I don't know if that justifies having an office, I have no idea what the requirements are for that, but I think it's best to keep her close to her father since she comes off as way more reasonable than him.

This, and anyone who has listened to or watched any length of interviews with her should be able to understand that she's not just a 'pretty' face. That woman is super smart, infinitely more than her father and I'd wager she's more intelligent than 98% of the congressmen/congresswomen that are in Washington right now. I wouldn't be surprised if she doesn't make a run for Senate or even President one day.

[El Barto]

Yeah, I'd agree with that. Still, there's an uneasiness with this whole thing. Trump himself seems to think like a king, rather than a president, and placing his entire family in positions like this give it more of an air of a monarchy.

And I'm unsure why he's not just setting her up as the first lady. Seems pretty clear that his wife is ill-suited for the role, and there's plenty of precedent for sticking somebody like a daughter in there.

[gmillerdrake]

And I'm unsure why he's not just setting her up as the first lady. Seems pretty clear that his wife is ill-suited for the role, and there's plenty of precedent for sticking somebody like a daughter in there.

I think she is more or less assuming that role, I mean....it certainly 'appears' to everyone that is what's going on. It doesn't bother me that she's going to undertake some of those first lady tasks, they are usually social and international relationship issues anyway and trump can certainly use the help in those departments.

As far as him surrounding himself with his family, I think he's just surrounding himself with familiar faces and personalities. Every President does that. obama did the same thing with all his pals, they just weren't blood relatives. I don't see the difference other than the family aspect makes it look a bit more odd.

[Chino]

And I'm unsure why he's not just setting her up as the first lady. Seems pretty clear that his wife is ill-suited for the role, and there's plenty of precedent for sticking somebody like a daughter in there.

I think she is more or less assuming that role, I mean....it certainly 'appears' to everyone that is what's going on. It doesn't bother me that she's going to undertake some of those first lady tasks, they are usually social and international relationship issues anyway and trump can certainly use the help in those departments.

As far as him surrounding himself with his family, I think he's just surrounding himself with familiar faces and personalities. Every President does that. obama did the same thing with all his pals, they just weren't blood relatives. I don't see the difference other than the family aspect makes it look a bit more odd.

In my opinion that's a really big, borderline uncomfortable aspect though. Trump's family is different than other first families. They are just as much (maybe moreso) business partners as they are family. It bothers me that his children, the ones who are handling his day-to-day business operations worldwide, have so much access to national security information and foreign entities.