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Fri Sep 15, 2017, 08:30 AM

... Wait for the Medicare For All bill to be analyzed by a respected and independent think tank

The prudent thing to do would be to wait for the Medicare For All bill to be analyzed by a respected and independent think tank. We all believe achieving universal health care is a laudable goal, where we differ is on how to achieve that goal. As Deng Xiaoping said "it doesn't matter whether a cat is white or black, as long as it catches mice. "


I have seen so many numbers being bandied about that I don't know which one to believe. There is a difference between believing something because it has the ring of truth and believing something because it's feels good. The latter is easy.


We have Trump and the Deplorables on the ropes. I don't want to let him and them off them.


As an aside I am going to do my best to avoid the intramural bickering. I don't give a rat's ass what you call it as long as everybody from some unemployed guy or gal to Bill Gates can get medical care when he or she needs it, as long he or she needs it, and it meets quality standards. The rich get to get nicer stuff than us but not when it comes to health care and the right to live.



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Reply ... Wait for the Medicare For All bill to be analyzed by a respected and independent think tank (Original post)
DemocratSinceBirth Sep 2017 OP
frazzled Sep 2017 #1
BBG Sep 2017 #2
wasupaloopa Sep 2017 #5
BBG Sep 2017 #7
wasupaloopa Sep 2017 #12
BBG Sep 2017 #13
DemocratSinceBirth Sep 2017 #3
Ninsianna Sep 2017 #43
DemocratSinceBirth Sep 2017 #44
Ninsianna Sep 2017 #45
Tom Rinaldo Sep 2017 #4
TexasBushwhacker Sep 2017 #11
wasupaloopa Sep 2017 #14
mountain grammy Sep 2017 #25
JoeStuckInOH Sep 2017 #6
dsc Sep 2017 #18
JoeStuckInOH Sep 2017 #42
ehrnst Sep 2017 #8
LexVegas Sep 2017 #9
TCJ70 Sep 2017 #10
ehrnst Sep 2017 #16
TCJ70 Sep 2017 #17
ehrnst Sep 2017 #19
TCJ70 Sep 2017 #21
ehrnst Sep 2017 #22
TCJ70 Sep 2017 #24
ehrnst Sep 2017 #26
TCJ70 Sep 2017 #27
ehrnst Sep 2017 #28
TCJ70 Sep 2017 #30
ehrnst Sep 2017 #33
TCJ70 Sep 2017 #40
beachjustice Sep 2017 #37
ehrnst Sep 2017 #38
beachjustice Sep 2017 #47
Ninsianna Sep 2017 #46
wasupaloopa Sep 2017 #15
dsc Sep 2017 #20
ehrnst Sep 2017 #23
dsc Sep 2017 #29
andym Sep 2017 #31
TCJ70 Sep 2017 #32
ehrnst Sep 2017 #34
andym Sep 2017 #35
ehrnst Sep 2017 #36
ehrnst Sep 2017 #39
andym Sep 2017 #41
JCanete Sep 2017 #48

Response to DemocratSinceBirth (Original post)

Fri Sep 15, 2017, 08:45 AM

1. Whatever the numbers are

It is certain that additional government outlays will be necessary. So whatever it costs, since the Medicare for All bill doesn't contain any mechanism for raising those funds, it is merely a showpiece, as it stands.

It's pretty much like the Republicans' repeal of Obamacare bills (all kazillion of them). Without a viable "replace" mechanism, they were meaningless. And the "replace" was the impossible part.

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Response to frazzled (Reply #1)

Fri Sep 15, 2017, 08:57 AM

2. Not so certain additional govt funding required

If we spend more per capital for worse results by including for-profit entities in our medical system then elimination of same for-profit factions reduces overall costs. It is no certainty that any additional outlays will be required, just reallocating current costs should allow for improved care and expanded, universal coverage.

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Response to BBG (Reply #2)

Fri Sep 15, 2017, 09:13 AM

5. Spending on medical care and taxes can't be substituted for each other.

 

There are so many easy as pie talking points on the medicare for all side it is mind bending.

Just take somebody's business away make them work for what ever you want to pay them easy as pie!

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Response to wasupaloopa (Reply #5)

Fri Sep 15, 2017, 12:03 PM

7. Sure they can

In fact that's the point of socializing medical costs. It eliminates middleman profit centers, provides more efficient service delivery and substitutes new taxes for existing premiums. Easy peasy.

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Response to BBG (Reply #7)

Fri Sep 15, 2017, 01:04 PM

12. What makers you think you have any power or right to force people to play your rules?

 

I guess you can't understand why some people do not like government intruding into their lives.

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Response to wasupaloopa (Reply #12)

Fri Sep 15, 2017, 01:08 PM

13. No escaping death, rent or taxes

It's a social compact. We pay taxes for the society we live in. Anyone wanting to go full tilt libertarian can head for other jurisdictions. Like Somalia.

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Response to frazzled (Reply #1)

Fri Sep 15, 2017, 08:57 AM

3. I have a lot of thoughts but I am wary of sharing them.

I have a lot of thoughts but I am wary of sharing them because everything ends up being seen through a Hillary-Bernie prism and I will leave DU or greatly, greatly... greatly curtail my posting before I go through primary season posting again. Life is too short ! Life under Trump is distressing enough. I come here to bash Trump and his band of Deplorables, not to fight over small differences that people magnify to give themselves a sense of identity.

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Response to DemocratSinceBirth (Reply #3)

Fri Sep 15, 2017, 04:00 PM

43. It's really a shame that we can't have actual substantive discussion

on literally anything without the hostility! No politician owns this, it's been something Dems have been working on for decades, and we should be able to discuss how we're going to achieve universal healthcare, and not be so stuck on labels, I want to see all the plans, talk about how we address all the issues and I know it's crazy, but I'd like some discussion on what those issues are.

Instead it's a lot of snarling about centrists and bribes and corporate blah, and neoliberal that. We can't just wave a wand and eradicate the entire insurance industry overnight. I don't care how evil anyone thinks it is. We need to consider the fall out and the effects and how it affects actual people and how we can deliver our goal of affordable universal care.

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Response to Ninsianna (Reply #43)

Fri Sep 15, 2017, 04:24 PM

44. Were you here during the primaries ?

It was a war. As Sam Rayburn said "There is no education in the second kick of a mule." I'm not going through that again. Life is too short to go to My Posts and find poison in response to yours.

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Response to DemocratSinceBirth (Reply #44)

Fri Sep 15, 2017, 05:09 PM

45. I read articles, not so much the replies.

Wasn't really fond of the formatting and saw no reason to register.

But I've gotten a taste of that poison in replies to my posts recently. Everything doesn't have to be seen through a toxic primary lens. It seems some people simply cannot let it go, not sure if that's an honest thing or just chaos agents. It really does feel like it's the latter sometimes.

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Response to frazzled (Reply #1)

Fri Sep 15, 2017, 09:02 AM

4. The original Medicare program was a non starter for decades...

Politically impossible, economically infeasible. Until it wasn't. Same with child labor laws. And clean air and water legislation, and so much else. The economics can be made to work if it is successfully sold to the public.

If the Republicans had invested a small amount of energy over the last 7 years into actually developing a plausible replacement for Obamacare rather than just running against it, Obamacare would already be history today. Their replacement could have been buggy, just somewhat plausible, and they would have had it in the bag today. Medicare and Social Security and pretty much every social safety net program introduced wasn't perfect out of the gate. It had to be returned to and subsequently modified.

Work is needed now to flesh out Medicare for All. This is a part of that process. It doesn't have to be politically feasible today. It just has to be ready for the day when political realities shift enough for it to actually stand a chance at passage.

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Response to Tom Rinaldo (Reply #4)

Fri Sep 15, 2017, 12:38 PM

11. YES! n/t

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Response to Tom Rinaldo (Reply #4)

Fri Sep 15, 2017, 01:10 PM

14. Those social programs started with nothing like them in place. We already have

 

a medical care delivery system that has to be dismantled and replaced. People are not going to go for that if they don't have any problem with things the way they are.

Medicare for all implementation is not like the first Medicare implementation. They are apples and oranges.

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Response to Tom Rinaldo (Reply #4)

Fri Sep 15, 2017, 01:43 PM

25. Exactly!

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Response to DemocratSinceBirth (Original post)

Fri Sep 15, 2017, 09:31 AM

6. The rich will always get better healthcare. Even with single payor or medicare for all.

 

They'll simply go to private practices where more skilled doctors (who don't accept Medicare) can charge a premium for their services. That already happens now... doctors that offer premium services uncovered by insurance or Medicare.

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Response to JoeStuckInOH (Reply #6)

Fri Sep 15, 2017, 01:34 PM

18. in some places that is illegal

The UK used to be that way for example.

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Response to dsc (Reply #18)

Fri Sep 15, 2017, 03:53 PM

42. There is literally zero chance the US outlaws private practices outside medicare.

 

Shit, where will Hollywood stars go to get new faces and boobs?

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Response to DemocratSinceBirth (Original post)

Fri Sep 15, 2017, 12:22 PM

8. Sanders' 2016 bill was analyzed by the Urban Institute

Last edited Fri Sep 15, 2017, 02:06 PM - Edit history (1)

Summary:

We estimate that current state and local spending will be $319.8 billion in 2017 and $4.1 trillion between 2017 and 2026. Because this would be absorbed by the federal government under the Sanders plan, some might suggest requiring states to pay maintenance-of-effort costs to offset the increased federal acute care and long-term care costs. Some dispute exists about whether maintenance-of-effort requirements are legal, however, given National Federation of Independent Business v. Sebelius; that decision may call into question whether such payments amount to coercion.

However, many other issues would be raised by a single-payer system. Providers would be seriously affected. Hospitals would see only small financial effects in the aggregate because payment rates would be increased for those otherwise insured by Medicare and Medicaid and revenue from the otherwise uninsured would increase, but they would receive less revenue for providing care to those who would otherwise be privately insured. Different types of hospitals would be advantaged and disadvantaged, depending upon their patient mix. Growth in revenues over time would be slower than under current law, however. Physician incomes would be squeezed by the new payment rates because such rates would be considerably below what physicians are paid by private insurers. Again, whether providers were financial winners or losers from the reform would depend upon their current payer mix. The pharmaceutical and medical device industries would be squeezed perhaps more than is sustainable.

Behavioral responses by the range of health care providers to such a vast change are uncertain. If provider incomes fall, additional federal investment in medical education might be necessary to achieve a sufficient level of supply. Choices would need to be made about the treatment of existing private longterm care insurance contracts and the reserves the companies that issued these policies now hold.

We assume a 6 percent administrative cost across the board; this may be too low given the many functions that would need to be carried out, including a range of care management functions, rate setting, bill paying, and oversight responsibilities for a wide variety of providers across the nation. By eliminating copayments, coinsurance, deductibles, and service limits of all types, the Sanders plan would increase demand for services. We have assumed supply constraints such that not all of the increased demand would be met. But the failure to meet all demand could lead to public outcry. Any remaining role for private health insurance would also have to be determined. If higher-income people purchase private insurance, it could give them faster access to desired providers, increasing their satisfaction with the system. Yet it could also lead to longer queues for those relying on the remaining providers,
causing dissatisfaction in other quarters.

Finally, moving to a single-payer system would be highly disruptive in the near term. When the ACA required people to give up private insurance plans that were less costly than those available in the reformed nongroup market, some vocal complaints led to quick administrative action to increase opportunities for people to keep non-ACA compliant plans longer. The ACA’s changes to the health insurance system and the number of people affected by those changes has been small compared to the upheaval that would be brought about by the movement to a single-payer system.




https://www.urban.org/sites/default/files/alfresco/publication-pdfs/2000785-The-Sanders-Single-Payer-Health-Care-Plan.pdf?fref=gc&dti=880771098707085

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Response to ehrnst (Reply #8)

Fri Sep 15, 2017, 12:27 PM

9. $319.8 trillion in 2017?

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Response to LexVegas (Reply #9)

Fri Sep 15, 2017, 12:36 PM

10. That has to be a typo...in one year?

Or I'm misreading whatever it is they're talking about.

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Response to TCJ70 (Reply #10)

Fri Sep 15, 2017, 01:29 PM

16. The Urban Institute doesn't let typos get through.

Here is the abstract:

Presidential candidate Bernie Sanders proposed a single-payer system to replace all current health coverage. His system would cover all medically necessary care, including long-term care, without cost-sharing. We estimate that the approach would decrease the uninsured by 28.3 million people in 2017. National health expenditures would increase by $6.6 trillion between 2017 and 2026, while federal expenditures would increase by $32.0 trillion over that period. Sanders’s revenue proposals, intended to finance all health and nonhealth spending he proposed, would raise $15.3 trillion from 2017 to 2026—thus, the proposed taxes are much too low to fully finance his health plan.

https://www.urban.org/research/publication/sanders-single-payer-health-care-plan-effect-national-health-expenditures-and-federal-and-private-spending

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Response to ehrnst (Reply #16)

Fri Sep 15, 2017, 01:34 PM

17. That's fine, but are they saying that all healthcare spending in the country would add up to...

...$320 Trillion in one year? There's no way that's accurate.

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Response to TCJ70 (Reply #17)

Fri Sep 15, 2017, 01:35 PM

19. I think that you are reading it wrong

We estimate that current state and local spending will be $319.8 trillion in 2017 and $4.1 trillion between 2017 and 2026.

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Response to TCJ70 (Reply #21)

Fri Sep 15, 2017, 01:37 PM

22. Again:

We estimate that current state and local spending will be $319.8 trillion in 2017 and $4.1 trillion between 2017 and 2026.

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Response to ehrnst (Reply #22)

Fri Sep 15, 2017, 01:39 PM

24. Maybe I'm misreading...

...but they're saying that in one year (2017) we'll spend $320 trillion then spend only $4.1 trillion over the next 10? That makes no sense.

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Response to TCJ70 (Reply #24)

Fri Sep 15, 2017, 01:44 PM

26. The costs of implementation on that timeline

And that is supposed to be offset by increased taxes - although they would have to be higher than what Sanders indicates:

Here is the paragraph that comes before:

Analysis by the Urban-Brookings Tax Policy Center indicates that Sanders’s revenue proposals, intended to finance all new health and nonhealth spending, would raise $15.3 trillion in revenue from 2017 to 2026 (Sammartino et al. 2016). This amount includes the increased revenue that would be produced by eliminating the tax exclusion for employer-based health insurance discussed above. The total $15.3 trillion that would be raised is approximately $16.6 trillion less than the increased federal cost of his health care plan estimated here, suggesting that fully financing the Sanders approach would require additional sources of revenue be identified, that is, the proposed taxes appear to be too low to fully finance the plan.

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Response to ehrnst (Reply #26)

Fri Sep 15, 2017, 01:48 PM

27. That paragraph is about revenue...

...I'm talking specifically about the sentence you quoted. It says it's based on current spending and that would come up to $320 trillion in 2017. That's 16x the total national debt. That has to be some kind of error.

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Response to TCJ70 (Reply #24)

Fri Sep 15, 2017, 01:49 PM

28. Do you know how large a project gutting and rebuilding that section of the GDP would be?

When you build a building, or a road, the initial construction costs are greater than the cost of maintaining it.

In the case of demolition, prior to building, like this would be, those costs add to the initial costs in the first year.


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Response to ehrnst (Reply #28)

Fri Sep 15, 2017, 01:50 PM

30. 16 times the national debt? Yeah, no. n/t

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Response to TCJ70 (Reply #30)

Fri Sep 15, 2017, 01:54 PM

33. I would suggest that you contact the Urban Institute with questions.

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Response to ehrnst (Reply #33)

Fri Sep 15, 2017, 02:24 PM

40. You edited your post. I guess they can have typos, eh? n/t

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Response to ehrnst (Reply #28)

Fri Sep 15, 2017, 02:00 PM

37. plenty of other countries have transitioned from a market system to single-payer

...wthout breaking the bank (and now they spend considerably less than the US on healthcare and boast better outcomes almost across the board). It's all a matter of organization and I'm a bit skeptical of an initial cost estimate hundreds of times the size of the private market.

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Response to beachjustice (Reply #37)

Fri Sep 15, 2017, 02:06 PM

38. Actually, no, they didn't transition from what we have to Single Payer.

Can you name which countries that did, in case I'm not aware of one? And please define what your defintion of "market system" is - no insurance mechanisms whatsoever, where it's between you and the doctor alone? Or a system where there was private insurance as "the market?"

Also, do you know how many countries actually have single payer? Very, very few - the vast majority have multi payer systems.

There is much confusion on the difference between universal health care coverage and Single Payer. And apparently much confusion and misunderstanding on how other countries acheived universal health care coverage.

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Response to ehrnst (Reply #38)

Sat Sep 16, 2017, 02:06 AM

47. the US already has a single payer system, it's called Medicare

And Canada's system wasn't unlike ours until single payer was adopted nation wide.
As one of the wealthiest countries in terms of per capita income, the US should be able to successfully implement single payer. It may not happen overnight but there's no reason that if it works in smaller countries it can't simply be scaled up to work in the US.

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Response to LexVegas (Reply #9)

Fri Sep 15, 2017, 05:12 PM

46. Billion, not trillion.

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Response to ehrnst (Reply #8)

Fri Sep 15, 2017, 01:23 PM

15. I hope all the facts about going from what we have now to single payer are put on the table.

 

Right now I think supporters of single payer have on rose colored glasses.

I believe everyone has a right to medical care but we won't get their by not examining all the ramifications of switching to single payer from our current system.

And mouthing simple talking points is not helping.

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Response to ehrnst (Reply #8)

Fri Sep 15, 2017, 01:36 PM

20. should be billion not trillion

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Response to dsc (Reply #20)

Fri Sep 15, 2017, 01:38 PM

23. Which?

Over 9 years?

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Response to ehrnst (Reply #23)

Fri Sep 15, 2017, 01:49 PM

29. the first number

it should be 300 and some odd billion in 2017

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Response to ehrnst (Reply #8)

Fri Sep 15, 2017, 01:50 PM

31. Typo in that post. Here is a direct copy from the PDF-- it's 319 billion not trillion!

"State and local governments could save $319.8 billion in 2017 and $4.1 trillion between 2017
and 2026 as the federal government absorbs these costs under the Sanders plan (not shown in
table 1). A maintenance-of-effort requirement could make state and local funds available to
help pay for the plan, but the legality of such a requirement is in question."

on page 3 of the pdf

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Response to andym (Reply #31)

Fri Sep 15, 2017, 01:51 PM

32. Oh just wait...

...they'll tell you what they told me. The Urban Institute doesn't DO typos. What they have there is a direct copy and paste from the end of the report. There's just no way that number is accurate.

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Response to TCJ70 (Reply #32)

Fri Sep 15, 2017, 01:55 PM

34. Yes, that is the direct copy and paste from the report.

From the summary.

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Response to ehrnst (Reply #34)

Fri Sep 15, 2017, 01:57 PM

35. Page 3 disagrees with page 25 of the PDF! The Urban Institute does do typos! nt.

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Response to andym (Reply #35)

Fri Sep 15, 2017, 01:58 PM

36. I suggest you write them.

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Response to andym (Reply #35)

Fri Sep 15, 2017, 02:20 PM

39. This also explains a few things

https://www.urban.org/research/publication/response-criticisms-our-analysis-sanders-health-care-reform-plan

In short, the estimates are large because of the shift of all current public and private spending to the federal government, the expansion of benefits, and the elimination of out-of-pocket costs to consumers. For several reasons, we estimate the Sanders health plan would increase federal spending by $32 trillion between 2017 and 2026. Primarily, the plan would shift a large amount of existing public and private spending to the federal government, but there would also be additional spending in the health care system as a whole. Of the $32.0 trillion in additional federal costs, only $6.6 trillion reflects new health spending in the system; the remaining $25.4 trillion is produced by shifting existing state and local government spending and private spending to the federal government. Those amounts account for changes in the pricing of health care services, encompassing both decreases in prices relative to current-law private levels and increases in them relative to current-law Medicaid levels.

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Response to ehrnst (Reply #39)

Fri Sep 15, 2017, 02:25 PM

41. Urban Institute's analysis is fine

There is room for improvement in Senator Sander's (And Rep Conyer's) bills.

Here's what I wrote in your other thread:

Sanders plan is a great start, but there is a need to flesh out the details.

For example, modest co-pays for all but those who could not afford health care should probably be incorporated, to prevent the drain on resources. Having more physicians would be a big improvement-- one of the reasons medical cost is so high is problems with the limited amount of medical training opportunities (caused by the AMA among others)-- so more training is a must. Negotiation of fees/drug costs would be key. Having a private system co-exist for a longer transition period would probably be necessary as well.

These ideas are in accord with the Urban Institute's analysis.

Senator Sanders and Rep. Conyers should be working with their colleagues and experts to flesh out the details and make this more than a symbolic exercise.

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Response to ehrnst (Reply #8)

Sat Sep 16, 2017, 04:21 AM

48. First, who gives a fuck if it costs the government a

 

Last edited Sat Sep 16, 2017, 02:21 PM - Edit history (2)

lot of money to give the people what they should have at the expense of the only people who have all that money? I certainly don't and that shouldn't be a consideration, so long as it isn't too unreasonable, and I have to say, I have a high tolerance for what is reasonable in this regard.

Second, when they talk about what this will cost the government, do they bother to talk about the fact that some of this money will come out of the pockets of businesses and individuals who will no longer have to foot the bill for the insurance they pay for on the market, since this theoretically replaces that? Edit: yes, I see the excerpt...so now we're talking about 6 trillion, not the far far bigger number.

Restructuring costs all go back into the economy, new positions emerge, new expertise is needed, and whether those jobs be private sector, or government, that generates tax revenue. It doesn't go into some black hole never to be seen again. Less of this money goes into a black hole never to be seen again. That is economic stimulation, and the beauty is that the more of that there is, the more money goes back to the government. And given that this should save people money compared to the skyrocketing costs of healthcare in our current markets, (assuming we actually fund this in the right way), that is also more money that goes into the economy, at least theoretically, and not simply into a handful of wealthy shareholders pockets.

Is there anything in the study about the increased productivity that a healthy workforce provides,

or how about the cost decreases to patient treatment when preventative care becomes the norm over late term treatments and emergency room visits?

The study may have its merits, but these are all things that a robust study would have to incorporate to try to get a fuller sense of how medicare for all might impact the economy over all.

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