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Fri Sep 15, 2017, 02:51 PM

The Urban Institute's Attack On Single Payer: Ridiculous Assumptions Yield Ridiculous Estimates

The Urban Institute and the Tax Policy Center today released analyses of the costs of Sen. Bernie Sanders’ domestic policy proposals, including single-payer national health insurance. They claim that Sanders’ proposals would raise the federal deficit by $18 trillion over the next decade.

We won’t address all of the issues covered in these analyses, just single-payer Medicare for all. To put it bluntly, the estimates (which were prepared by John Holahan and colleagues) are ridiculous. They project outlandish increases in the utilization of medical care, ignore vast savings under single-payer reform, and ignore the extensive and well-documented experience with single-payer systems in other nations - which all spend far less per person on health care than we do.

The authors’ anti-single-payer bias is also evident from their incredible claims that physicians’ incomes would be squeezed (which contradicts their own estimates positing a sharp rise in spending on physician services), and that patients would suffer huge disruptions, despite the fact that the implementation of single-payer systems elsewhere, as well as the start-up of Medicare, were disruption-free.

We outline below some of the most glaring errors in the Holahan analysis (which served as the basis for Tax Policy Center’s estimates) regarding health care spending under the Sanders plan.


more here: http://www.huffingtonpost.com/david-himmelstein/the-urban-institutes-attack-on-single-payer-ridiculous-assumptions-yield-ridiculous-estimates_b_9876640.html

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Reply The Urban Institute's Attack On Single Payer: Ridiculous Assumptions Yield Ridiculous Estimates (Original post)
melman Sep 2017 OP
BigmanPigman Sep 2017 #1
yallerdawg Sep 2017 #2
QC Sep 2017 #4
yallerdawg Sep 2017 #6
beam me up scottie Sep 2017 #8
yallerdawg Sep 2017 #9
beam me up scottie Sep 2017 #11
yallerdawg Sep 2017 #12
CherokeeFiddle Sep 2017 #15
yallerdawg Sep 2017 #20
sheshe2 Sep 2017 #25
CherokeeFiddle Sep 2017 #43
ehrnst Sep 2017 #103
George II Sep 2017 #40
CherokeeFiddle Sep 2017 #42
George II Sep 2017 #46
ehrnst Sep 2017 #76
George II Sep 2017 #87
ehrnst Sep 2017 #101
guillaumeb Sep 2017 #27
Lordquinton Sep 2017 #60
mythology Sep 2017 #21
yallerdawg Sep 2017 #23
sheshe2 Sep 2017 #31
George II Sep 2017 #35
Expecting Rain Sep 2017 #61
ananda Sep 2017 #14
yallerdawg Sep 2017 #18
George II Sep 2017 #36
ananda Sep 2017 #117
George II Sep 2017 #59
pnwmom Sep 2017 #69
ehrnst Sep 2017 #109
George II Sep 2017 #34
Ninsianna Sep 2017 #57
ehrnst Sep 2017 #111
Ninsianna Sep 2017 #113
ehrnst Sep 2017 #114
Ninsianna Sep 2017 #56
pnwmom Sep 2017 #68
ehrnst Sep 2017 #75
ehrnst Sep 2017 #77
workinclasszero Sep 2017 #110
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leftstreet Sep 2017 #3
Progressive dog Sep 2017 #5
JHan Sep 2017 #10
dgauss Sep 2017 #13
Progressive dog Sep 2017 #17
yallerdawg Sep 2017 #22
guillaumeb Sep 2017 #29
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whathehell Sep 2017 #54
George II Sep 2017 #37
guillaumeb Sep 2017 #39
George II Sep 2017 #44
guillaumeb Sep 2017 #45
George II Sep 2017 #47
guillaumeb Sep 2017 #48
ehrnst Sep 2017 #97
Warren DeMontague Sep 2017 #50
Lordquinton Sep 2017 #64
ehrnst Sep 2017 #98
Warren DeMontague Sep 2017 #102
ehrnst Sep 2017 #104
Warren DeMontague Sep 2017 #105
ehrnst Sep 2017 #106
ehrnst Sep 2017 #81
Warren DeMontague Sep 2017 #89
ehrnst Sep 2017 #99
Lordquinton Sep 2017 #63
George II Sep 2017 #65
Lordquinton Sep 2017 #66
George II Sep 2017 #67
Lordquinton Sep 2017 #71
George II Sep 2017 #72
Lordquinton Sep 2017 #73
ehrnst Sep 2017 #82
George II Sep 2017 #84
ehrnst Sep 2017 #86
whathehell Sep 2017 #53
Lordquinton Sep 2017 #62
Warren DeMontague Sep 2017 #41
guillaumeb Sep 2017 #49
MichMan Sep 2017 #51
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Progressive dog Sep 2017 #85
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Progressive dog Sep 2017 #90
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Progressive dog Sep 2017 #92
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Progressive dog Sep 2017 #95
Warren DeMontague Sep 2017 #96
Progressive dog Sep 2017 #112
ehrnst Sep 2017 #108
ehrnst Sep 2017 #107
beam me up scottie Sep 2017 #7
ismnotwasm Sep 2017 #16
Ninsianna Sep 2017 #55
Rob H. Sep 2017 #19
LostOne4Ever Sep 2017 #24
juxtaposed Sep 2017 #26
Post removed Sep 2017 #30
ehrnst Sep 2017 #79
guillaumeb Sep 2017 #28
Hoyt Sep 2017 #32
ehrnst Sep 2017 #78
Weekend Warrior Sep 2017 #58
pnwmom Sep 2017 #70
ehrnst Sep 2017 #83
ehrnst Sep 2017 #74
lapucelle Sep 2017 #94
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alarimer Sep 2017 #116

Response to melman (Original post)

Fri Sep 15, 2017, 02:54 PM

1. Are these alternative facts?

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Response to melman (Original post)

Fri Sep 15, 2017, 03:03 PM

2. The Urban Institute is a liberal think tank...

and the Tax Policy Center is non-partisan.

"Shoot the messenger!"

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Response to yallerdawg (Reply #2)

Fri Sep 15, 2017, 03:38 PM

4. The Urban Institute is funded by health insurance and pharma interests.

They're also high on vouchers and other such school profitization policies.

Doesn't sound too liberal to me.

http://www.sourcewatch.org/index.php/Urban_Institute

The Tax Policy Center is an Urban Institute project.

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Response to QC (Reply #4)

Fri Sep 15, 2017, 04:22 PM

6. Still shooting?

Let's go straight to the organizations, then.

https://www.urban.org/about/our-history

In 1968, President Lyndon Johnson founded the Urban Institute to “help solve the problem that weighs heavily on the hearts and minds of all of us—the problem of the American city and its people.”

http://www.taxpolicycenter.org/about

The Urban-Brookings Tax Policy Center aims to provide independent analyses of current and longer-term tax issues and to communicate its analyses to the public and to policymakers in a timely and accessible manner.

The Tax Policy Center (TPC) is a joint venture of the Urban Institute and Brookings Institution.

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Response to QC (Reply #4)

Fri Sep 15, 2017, 04:27 PM

8. The president is a senior fellow at the Brookings Institution?

Robert D. Reischauer - President, also senior fellow at the Brookings Institution and on the boards of "several educational and nonprofit organizations."


From Sourcewatch:

Initially centrist, the Institution took its first step rightwards during the depression in response to the New Deal. In the 1960s, it was linked to the conservative wing of the Democratic party, backing Keynsian economics.

According to Paul Weyrich, the founder of a few dozen right-religious think-tanks (using Joseph Coors money), the drive to start the [[Mountain States Legal Foundation] and the Heritage Foundation in 1970 was to attempt to create research, policy and legal organisation for the conservatives that could be as influential in Washington DC as the Brookings Institution.

However, from the mid-70s, Brookings began to cement a closer relationship with the Republican party. Since the 1990s it has taken steps further towards the right in parallel with the increasing influence of right-wing think tanks such as the Heritage Foundation.

http://www.sourcewatch.org/index.php/Brookings_Institution

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Response to beam me up scottie (Reply #8)

Fri Sep 15, 2017, 04:38 PM

9. Show me the "liberal" analysis...

that supports the efficacy of the Sander's proposal?

Facts are incontrovertible, and assumptions can lead anywhere.

We are fond of CBO scoring? Shall we wait for that?

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Response to yallerdawg (Reply #9)

Fri Sep 15, 2017, 04:55 PM

11. It's in the article, didn't you read it?

We outline below some of the most glaring errors in the Holahan analysis (which served as the basis for Tax Policy Center’s estimates) regarding health care spending under the Sanders plan.

1. Administrative savings, Part 1: Holahan assumes that insurance overhead would be reduced to 6 percent of total health spending from the current level of 9.5 percent. They base this 6 percent estimate on figures for Medicare’s current overhead, which include the extraordinarily high overhead costs of private Medicare HMOs run by UnitedHealthcare and other insurance firms. However, Sen. Sanders’ proposal would exclude these for-profit insurers, and instead build on the traditional Medicare program, whose overhead is less than 3 percent. Moreover, even this 3 percent figure is probably too high, since Sanders’ plan would simplify hospital payment by funding them through global budgets (similar to the way fire departments are paid), rather than the current patient-by-patient payments. Hence a more realistic estimate would assume that insurance overhead would drop to Canada’s level of about 1.8 percent. Cutting insurance overhead to 2 percent (rather than the 6 percent that Holahan projects) would save an additional $1.7 trillion over the next 10 years.

2. Administrative savings, Part 2
: Holahan completely ignores the huge savings on hospital administration and doctors’ billing under a streamlined single-payer system. Every serious analyst of single-payer reform has acknowledged these savings, including the Congressional Budget Office, the Government Accountability Office, the Lewin Group (a consulting firm owned by UnitedHealth Group), and even Kenneth Thorpe (a former Clinton administration official who has criticized Sanders’ plan, although his recent estimates of savings are far lower than those he made prior to the current presidential campaign).

These provider savings on paperwork would, in fact, be much larger than the savings on insurance overhead. At present, U.S. hospitals spend one-quarter of their total budgets on billing and administration, more than twice as much as hospitals spend in single-payer systems like Canada’s or Scotland’s. Similarly, U.S. physicians, who must bill hundreds of different insurance plans with varying payment and coverage rules, spend two to three times as much as our Canadian colleagues on billing.

Overall, these administrative savings for doctors and hospitals would amount to about $2.57 trillion over 10 years. Additional savings of more than $1.5 trillion from streamlined billing and administration would accrue to nursing homes, home care agencies, ambulance companies, drug stores and other health care providers.

In total, the Holahan analysis underestimates administrative savings by about $6 trillion over 10 years.

3. Drug costs: Holahan projects that a single-payer plan would have to pay 50 percent higher drug costs than those paid at present by Medicaid. Moreover, their estimate assumes that the U.S. would continue to pay much higher prices for drugs than other nations, despite the fact that a U.S. single-payer system would have much greater negotiating leverage with drug companies than other national health insurance schemes.

Reducing drug prices to the levels currently paid by European nations would save at least $1.1 trillion more than Holahan posits over 10 years.

4. Utilization of care: Holahan projects a massive increase in acute care utilization, but does not provide detailed breakdowns of how big an increase they foresee for specific services like doctor visits or hospital care. However, it is clear that the medical care system does not have the capacity to provide the huge surge in care that he posits.

For instance Holahan’s figures for the increase in acute care suggest that Sanders’ plan would result in more than 100 million additional doctor visits and several million more hospitalizations each year. But there just aren’t enough doctors and hospital beds to deliver that much care. Doctors are already working 53 hours per week, and experience from past reforms tells us that they won’t increase their hours, nor will they see many more patients per hour.

Instead of a huge surge in utilization, more realistic projections would assume that doctors and hospitals would reduce the amount of unnecessary care they’re now delivering in order to deliver needed care to those who are currently not getting what they need. That’s what happened in Canada. Doctors and hospitals can adjust care to meet increasing demand, as happens every year during flu season.

Moreover, no surge materialized when Medicare was implemented and millions of previously uninsured seniors got coverage. Between 1964 (before Medicare) and 1966 (the year when Medicare was fully functioning) there was absolutely no increase in the total number of doctor visit in the U.S.; Americans averaged 4.3 visits per person in 1964 and 4.3 visits per person in 1966. Instead, the number of visits by poor seniors went up, while the number of visits by healthy and wealthy patients went down slightly. The same thing happened in hospitals. There were no waiting lists, just a reduction in the utilization of unneeded elective care by wealthier patients, and the delivery of more care to sick people who needed it.

Bizarrely, despite projecting a roughly $1.6 trillion increase in total payments to doctors over 10 years, Holahan says in his discussion that “Physician incomes would be squeezed by the new payment rates.”

***


In summary, Holahan grossly underestimates the administrative savings under single payer; projects increases in the number of doctor visits and hospitalizations that far exceed the capacity of doctors and hospitals to provide this added care; and posits that our country would continue to pay much more for drugs and medical equipment than people in every other nation with national health insurance.

Rather than increasing national health spending, as Holahan claims, Sanders’ plan (and the plan proposed by Physicians for a National Health Program) would almost certainly decrease total health spending over the next 10 years.

Drs. Himmelstein and Woolhandler are professors of health policy and management at the City University of New York School of Public Health and lecturers in medicine at Harvard Medical School. The opinions expressed do not necessarily reflect those institutions’.


Let's highlight their credentials again for those who want to dismiss their summary as the opinion of mere 'bloggers':

Drs. Himmelstein and Woolhandler are professors of health policy and management at the City University of New York School of Public Health and lecturers in medicine at Harvard Medical School.



You're welcome!



We are fond of CBO scoring? Shall we wait for that?


The think tank didn't wait, and neither did you, so what changed after this article was posted?

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Response to beam me up scottie (Reply #11)

Fri Sep 15, 2017, 05:00 PM

12. The opinion of some HuffPo bloggers?

With disclaimer attached?

Thank you!



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Response to yallerdawg (Reply #12)

Fri Sep 15, 2017, 05:26 PM

15. Urban Inst. funded by Cigna & Pfizer

 

Well, there ya go. Time to maybe bring in Wendell Potter and see what he has to say about Urban Institute, seeing as he was CEO of Cigna, now turned whistle blower.

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Response to CherokeeFiddle (Reply #15)

Fri Sep 15, 2017, 05:58 PM

20. Cigna and Pfizer?

I don't see them listed as contributors, much less "funded by?"

https://www.urban.org/sites/default/files/2015-annual-report.pdf

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Response to yallerdawg (Reply #20)

Fri Sep 15, 2017, 06:22 PM

25. +++

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Response to CherokeeFiddle (Reply #43)

Mon Sep 18, 2017, 08:30 AM

103. That's a barely edited copy of the UI wikipedia page.

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

It adds "industry funded" then cuts out anything that refutes that they are "industry funded"

Like this:

Gradually, Urban's research and funding base broadened. In 2013, federal government contracts provided about 54% of Urban's operating funds, private foundations another 30%, and nonprofits, corporations and corporate foundations, state and local governments, international organizations and foreign entities, individuals, and Urban's endowment the rest.[5] Some of Urban's more than 100 private sponsors and funders include the Annie E. Casey Foundation, the Ford Foundation, the Robert Wood Johnson Foundation, the Henry J. Kaiser Family Foundation, the Charles Stewart Mott Foundation, and the Rockefeller Foundation.[6]


Please.

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Response to CherokeeFiddle (Reply #15)

Fri Sep 15, 2017, 09:11 PM

40. No they're not. They get less than 2% of their revenue from corporations.

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Response to CherokeeFiddle (Reply #42)

Fri Sep 15, 2017, 09:22 PM

46. That says "industry funders are Cigna and Pfizer", it doesn't say how much. Plus...

...that was in 2010, seven years ago.

Here's a breakdown of their funding from their 2016 Annual Report:

43.6% Federal Government
40.0% Foundations
5.9% Urban Institute Endowment Support
4.3% Nonprofits and Universities
2.0% State and Local Governments
1.4% Corporations
1.3% Individuals

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Response to CherokeeFiddle (Reply #42)

Sun Sep 17, 2017, 09:21 AM

76. A copy and paste of the Urban Institute WIKIPEDIA page?

That's some real journalistic and academic cred...

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

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Response to ehrnst (Reply #76)

Sun Sep 17, 2017, 09:40 AM

87. At least yours is reasonably current, not six years old, and has no mention of Cigna or Pfizer...

....who some are complaining (incorrectly) that they're "funded" by them.

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Response to CherokeeFiddle (Reply #15)

Mon Sep 18, 2017, 08:26 AM

101. Because Sourcewatch, which calls copy/paste from Wikipedia "research" says so?

Last edited Mon Sep 18, 2017, 09:11 AM - Edit history (1)

Barely edited - just enough to take out the contradictions to their "industry funded" claim....

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Response to beam me up scottie (Reply #11)

Fri Sep 15, 2017, 06:26 PM

27. Well done.

Really well done.

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Response to beam me up scottie (Reply #11)

Sat Sep 16, 2017, 02:43 PM

60. Amazing

detailed analysis, and prestigious authors, and you get a in response.

Some aren't interested in dissenting facts.

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Response to beam me up scottie (Reply #8)

Fri Sep 15, 2017, 06:04 PM

21. Wait so SourceWatch thinks Keynesian economics is conservative?

 

And you think anybody should take them seriously?

Also that article lacks any real sources, it's just a bad opinion piece trying to follow the look and feel of Wikipedia without any actual standards.

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Response to mythology (Reply #21)

Fri Sep 15, 2017, 06:08 PM

23. Thank you!

Reading IS fundamental!

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Response to mythology (Reply #21)

Fri Sep 15, 2017, 06:32 PM

31. +++

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Response to beam me up scottie (Reply #8)

Fri Sep 15, 2017, 08:55 PM

35. Sarah Rosen Wartell is the President of the Urban Institute.

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Response to beam me up scottie (Reply #8)

Sat Sep 16, 2017, 02:48 PM

61. Wait...Keynsian ecomomics is now a hall-mark of "the conservative wing of the Democratic party?"

 



Good grief.

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Response to QC (Reply #4)

Fri Sep 15, 2017, 05:25 PM

14. Sounds hardright conservative to me.

nt

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Response to ananda (Reply #14)

Fri Sep 15, 2017, 05:47 PM

18. Most recent revenue report (2015)



https://www.urban.org/sites/default/files/2015-annual-report.pdf

From "Funding Principles":

Independence from funders:  No funder shall determine research findings or the insights and recommendations of our experts. Urban will not accept any support that implies or requires endorsement of a position or product. We welcome comment, correction, and substantive engagement from all informed parties to enhance the quality of our work, but the board and management of the Institute will defend the independence of researchers and experts even if funders disagree with their findings or conclusions.  

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Response to yallerdawg (Reply #18)

Fri Sep 15, 2017, 08:58 PM

36. How did you do that? I typed out the breakdown of their funding below (sans last two, got tired!!!)

1.4% is from corporations.

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Response to yallerdawg (Reply #18)

Wed Sep 20, 2017, 10:26 AM

117. I tell you what.

I did say "sounds like" hard right.

And just because they might not be hard right
doesn't mean they're right (lol).

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Response to ananda (Reply #14)

Sat Sep 16, 2017, 08:56 AM

59. If the information being provided is inaccurate, it would sound that way. But...

...that statement "the Urban Institute is funded by health insurance and pharma interests" is outright false. Only 1.4% of their funding comes from corporations, ALL corporations. Even if that 1.4% from "health insurance and pharma interests", that's only one out of ever 70 dollars.

They certainly aren't "funded by health insurance and pharma interests", only a very vert small part of their funding comes from all corporations.

That link isn't even accurate with respect to the President of the Urban Institute.

Might we call that "fake news"?

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Response to ananda (Reply #14)

Sat Sep 16, 2017, 03:14 PM

69. With 1.4% of funding from corporate sources? Hardly. n/t

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Response to ananda (Reply #14)

Tue Sep 19, 2017, 10:21 AM

109. Actually it's a left leaning research org, as indicated by their partnerships

The person you are responding to has incomplete and misrepresented information from a source that has been debunked elsewhere in the thread.

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Response to QC (Reply #4)

Fri Sep 15, 2017, 08:49 PM

34. Here's a breakdown of their revenue:

43.6% Federal Government
40.0% Foundations
5.9% Urban Institute Endowment Support
4.3% Nonprofits and Universities
2.0% State and Local Governments
1.4% Corporations
1.3% Individuals

So where do you get that they're funded by "health insurance and pharma interests"?

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Response to George II (Reply #34)

Sat Sep 16, 2017, 03:37 AM

57. Much more recent, but I guess that 1.4% is enough to make it impure.

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Response to Ninsianna (Reply #57)

Tue Sep 19, 2017, 10:35 AM

111. Not really. It completely depends on the project. Look at NPR.

There are corporations that give large amounts.

This report was funded by JP Morgan Chase, and it's simply collecting of data on CDFI loans, who they went to, what communities got them, etc:

We have assembled the most comprehensive dataset to date on CDFI lending activities to understand their reach. Data cover 2011 through 2015, tracking 214,490 loans worth $34.3 billion


https://www.urban.org/sites/default/files/publication/93396/cdfi_factsheet_0.pdf

Yes, JP Morgan Chase would find the data useful, and giving a grant for the experienced research staff of UI to gather and crunch the numbers would have been way easier and more cost effective than hiring a full staff for that study. But they also know that they have no say over what does and does not get reported. This is something that they would need to agree to prior to the project beginning.

They also agree that the information is also then available to anyone else free of cost.



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Response to ehrnst (Reply #111)

Tue Sep 19, 2017, 07:26 PM

113. But if a corporation touches anything, it becomes impure! Unless it has been blessed of course

by the pure ones.

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Response to Ninsianna (Reply #113)

Wed Sep 20, 2017, 07:29 AM

114. Of course. (nt)

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Response to QC (Reply #4)

Sat Sep 16, 2017, 03:28 AM

56. Well, not really.

54% from federal grants
30% non profits

So this is a misleading statement there.

It "sounds" pretty liberal to people who actually check their facts and know what they're talking about. 11th most liberal, ranking between the NAACP and PETA,( "A Measure of Media Bias." The Quarterly Journal of Economics Vol. CXX November Issue 4, pp. 1191–1237.)

Oh and:
https://mediabiasfactcheck.com/urban-institute/

So it's pretty liberal for a independent think tank.

Really sounds like this is a bad faith attack on an entity that's evaluating something without bias, because it does not cheer lead for the preferred cult of identity.

Doesn't sound like something a liberal does to me.

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Response to QC (Reply #4)

Sat Sep 16, 2017, 03:13 PM

68. Your link provides no evidence of significant funding. No dollar amounts, and no corporate donors

except for a couple in 2010.

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Response to QC (Reply #4)

Sun Sep 17, 2017, 08:38 AM

75. Again with the misrepresentation of the numbers to kill the messenger....

"High on vouchers and other such school profitization policies"

Show me where you see that on their material on their actual website. Not seeing that in the sourcewatch site..

What I see on the sourcewatch site is a cut and paste of the WIKIPEDIA PAGE which is totes legit independent research:

http://www.sourcewatch.org/index.php/Urban_Institute


Are you talking about this? Because I wouldn't say it was "high" on Charter Schools:

https://www.urban.org/urban-wire/what-charter-school-growth-means-cities-and-neighborhoods

https://www.urban.org/urban-wire/so-do-private-school-vouchers-work

I guess because they're not screeds, instead of an academic approach looking at numbers, so they are CORPORATE LACKEYS!!!!

This is probably the reason Al Franken won't run for president. His daughter works for a Charter School organization, and if he was to DARE challenge Bernie, those that are now savaging Kamal Harris for meetiing with some donors that supported HRC will turn on his daughter.


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Response to QC (Reply #4)

Sun Sep 17, 2017, 09:22 AM

77. A copy and paste of the Urban Institute WIKIPEDIA page?

Really?

That's your standard for a watchdog group?

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Response to QC (Reply #4)

Tue Sep 19, 2017, 10:30 AM

110. Damn, that's liberal???

 

SMH

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Response to workinclasszero (Reply #110)

Wed Sep 20, 2017, 07:35 AM

115. No, that's misinformation

The poster got that "damning evidence" from a website that posts barely edited wikipedia entries as "research."

If they were a high school student's research paper, they would be failed for plagiarism.

See for yourself....

The UI entry on Sourcewatch:

http://www.sourcewatch.org/index.php/Urban_Institute

The UI entry on Wikipedia (with the information that doesn't support their conspiracy theory left in)

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







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Response to melman (Original post)

Fri Sep 15, 2017, 03:05 PM

3. DURec

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Response to melman (Original post)

Fri Sep 15, 2017, 04:14 PM

5. 18 trillion is probably low

If Himmelstein is going to claim cost savings, he has to do more than pick a number that fits his preference.
If the government paid the total cost of health care in 2015, it was $3.2 trillion. Over 10 years, that is $32 trillion without accounting for inflation or higher delivery of care that is completely free to the consumer. Since the federal government paid for 29% of health care in 2015 or just less than $950 billion, then the government would have to chip in $2.25 trillion per year or $22.5 trillion over the 10 year.
The $18 trillion is likely to be a low estimate of the redistribution of economic costs and benefits.

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Response to Progressive dog (Reply #5)

Fri Sep 15, 2017, 04:45 PM

10. +++++++++++++

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Response to Progressive dog (Reply #5)

Fri Sep 15, 2017, 05:14 PM

13. It doesn't sound like Himmelstein is just picking numbers to fit his preference.

For example, insurance overhead:

Holahan [from the Urban Center] assumes that insurance overhead would be reduced to 6 percent of total health spending from the current level of 9.5 percent. They base this 6 percent estimate on figures for Medicare’s current overhead, which include the extraordinarily high overhead costs of private Medicare HMOs run by UnitedHealthcare and other insurance firms. However, Sen. Sanders’ proposal would exclude these for-profit insurers, and instead build on the traditional Medicare program, whose overhead is less than 3 percent. Moreover, even this 3 percent figure is probably too high, since Sanders’ plan would simplify hospital payment by funding them through global budgets (similar to the way fire departments are paid), rather than the current patient-by-patient payments. Hence a more realistic estimate would assume that insurance overhead would drop to Canada’s level of about 1.8 percent. Cutting insurance overhead to 2 percent (rather than the 6 percent that Holahan projects) would save an additional $1.7 trillion over the next 10 years.


So he is basing his numbers on a currently existing system that more closely resembles what Sanders is proposing. He also does this with hospital administration and doctors’ billing, which would involve even greater savings.

If people choose to accept the Urban Center's numbers but dismiss a critique of those numbers and call it a day, that may be what is being picked to fit a preference.

The bottom line is that I'd like to see a lot more analysis of the numbers, including from the CBO, and a LOT of discussion around it.

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Response to dgauss (Reply #13)

Fri Sep 15, 2017, 05:42 PM

17. Sure they would and the people put out

of work by this would no longer be paying taxes. I'll bet the CBO will have a figure much higher than $18 trillion (an almost 60% increase in federal spending) over a decade. Cherry picking individual numbers to critique is a deceptive practice, the urban institute already shows more than $450 billion per year lower than current costs.
The medicare HMO's are programs that provide better coverage by contracting with providers for lower rates. Most also charge the medicare recipient an additional premium. You have no coverage (except emergency) at a non participating provider. You cannot save money that has not been spent. The advantage plans (HMO's etc.) are supposed to cost the government the same as original medicare.

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Response to Progressive dog (Reply #17)

Fri Sep 15, 2017, 06:07 PM

22. People are freaking out about our national debt...

and the entitlement programs we are already running in the red! That we don't want to pay for!

60% of Medicare today is "paid" out of General Revenue - no one wants to spell it all out, or we'd be in deep shit keeping what we have!

The idea of the Federal government doubling it's annual budget (at the very least) is a battle we are not going to win in a national Republican environment?

What flipped the US to Republican? The Affordable Care Act!!!

Are we really wanting to start up another round of health care reform?

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Response to yallerdawg (Reply #22)

Fri Sep 15, 2017, 06:28 PM

29. So the ACA caused Reagan and Bush to win?

Interesting logic there.

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Response to guillaumeb (Reply #29)

Fri Sep 15, 2017, 07:21 PM

33. Where do you get "Reagan and Bush" from this?

2010 we got shellacked. After ACA.

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Response to yallerdawg (Reply #33)

Fri Sep 15, 2017, 09:09 PM

38. You said: What flipped the US to Republican? The Affordable Care Act!!!

Reagan and Bush Sr. both won prior to the ACA. And the GOP has been setting the agenda and essentially defining the debate since 1980.

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Response to guillaumeb (Reply #38)

Sun Sep 17, 2017, 09:27 AM

80. Trying very hard to make a faulty strawman into a brilliant reposte...

Not working.

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Response to yallerdawg (Reply #33)

Fri Sep 15, 2017, 10:45 PM

54. Too many democrats vote only in Presidential elections. n/t

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Response to guillaumeb (Reply #29)

Fri Sep 15, 2017, 09:02 PM

37. I don't see any mention of Reagan or Bush there, do you?

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Response to George II (Reply #37)

Fri Sep 15, 2017, 09:10 PM

39. Please see reply #38.

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Response to guillaumeb (Reply #39)

Fri Sep 15, 2017, 09:17 PM

44. But that's a post from you. And...

If the GOP has been setting the agenda since 1980 we wouldn't have the ACA.

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Response to George II (Reply #44)

Fri Sep 15, 2017, 09:20 PM

45. The ACA is a renamed "Romney care" that the GOP called Obamacare to play to the racism

of their base.

The ACA is founded on subsidizing the insurance industry as a way of covering more people, but it does not represent a solution to the problems of the US health care system.

So yes, the ACA is evidence that the GOP is setting the agenda when only a conservative solution is what was proposed and passed by liberals.

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Response to guillaumeb (Reply #45)

Fri Sep 15, 2017, 09:25 PM

47. No, the ACA is the ACA, nicknamed "Obamacare". Has nothing to do with Romneycare except...

....that they're similar in some ways, but entirely different in many other ways.

That's a pretty circuitous way of getting from a state program to the ACA and blaming it on conservatives.

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Response to George II (Reply #47)

Fri Sep 15, 2017, 09:27 PM

48. The differences are that the ACA is Federal, the other is state.

Both subsidize the insurance industry.

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Response to guillaumeb (Reply #48)

Mon Sep 18, 2017, 08:10 AM

97. Most countries do it with multi-payer system, some of which use private insurance companies to

manage payments.

Compulsory insurance[edit]

This is usually enforced via legislation requiring residents to purchase insurance, but sometimes the government provides the insurance. Sometimes, there may be a choice of multiple public and private funds providing a standard service (as in Germany) or sometimes just a single public fund (as in Canada). Healthcare in Switzerland and the US Patient Protection and Affordable Care Act are based on compulsory insurance.[26][27]

In some European countries in which private insurance and universal health care coexist, such as Germany, Belgium, and the Netherlands, the problem of adverse selection is overcome by using a risk compensation pool to equalize, as far as possible, the risks between funds. Thus, a fund with a predominantly healthy, younger population has to pay into a compensation pool and a fund with an older and predominantly less healthy population would receive funds from the pool. In this way, sickness funds compete on price, and there is no advantage to eliminate people with higher risks because they are compensated for by means of risk-adjusted capitation payments. Funds are not allowed to pick and choose their policyholders or deny coverage, but they compete mainly on price and service. In some countries, the basic coverage level is set by the government and cannot be modified.[28]

The Republic of Ireland at one time had a "community rating" system by VHI, effectively a single-payer or common risk pool. The government later opened VHI to competition but without a compensation pool. That resulted in foreign insurance companies entering the Irish market and offering cheap health insurance to relatively healthy segments of the market, which then made higher profits at VHI's expense. The government later reintroduced community rating by a pooling arrangement and at least one main major insurance company, BUPA, then withdrew from the Irish market.


Tomasky, Michael (March 21, 2010). "Healthcare vote: Barack Obama passes US health reform by narrow margin". Michael Tomasky's blog. London: The Guardian. Retrieved March 23, 2010.

Jump up ^ Roy, Avik. "Switzerland - a case study in consumer driven health care". Forbes.

Jump up ^ Varkevisser, Marco; van der Geest, Stéphanie (2002). "Competition among social health insurers: a case study for the Netherlands, Belgium and Germany" (PDF). Research in Healthcare Financial Management. 7 (1): 65–84. Retrieved November 28, 2007.

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

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Response to George II (Reply #47)

Fri Sep 15, 2017, 09:51 PM

50. ...to be fair, Romney got it from the Heritage Foundation.

Last edited Tue Sep 19, 2017, 03:39 AM - Edit history (1)

https://krugman.blogs.nytimes.com/2011/07/27/conservative-origins-of-obamacare/



Look, the ACA is a definite improvement over the pre-ACA status quo, no question, AND it is certainly one of the signature accomplishments of Obama's two terms.

But Obama himself said that logically, if one was buiding a health system from scratch, a SPHC system would be the way to go- morally, fiscally, etc.

It is a measure of how successful conservatives have been in moving the overton window, in that what once were conservative proposals (look at carbon credits, as another example) now are pilloried as the most liberal policies anyone could hope to achieve.

Which is PRECISELY WHY it is so important, vital even, that good Democratic Senators like Warren and Harris and Gillibrand and Booker and Franken are signing on to Single Payer in principle. We need to move that window BACK.

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Response to Warren DeMontague (Reply #50)

Sat Sep 16, 2017, 02:51 PM

64. In other countries

Sanders would be maybe left of center.

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Response to Warren DeMontague (Reply #50)

Mon Sep 18, 2017, 08:19 AM

98. Obama also said that it would not be wise to go directly to Single Payer from our current system

There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada's -- (applause) -- where we would severely restrict the private insurance market and have the government provide coverage for everybody. On the right, there are those who argue that we should end employer-based systems and leave individuals to buy health insurance on their own.

I've said -- I have to say that there are arguments to be made for both these approaches. But either one would represent a radical shift that would disrupt the health care most people currently have. Since health care represents one-sixth of our economy, I believe it makes more sense to build on what works and fix what doesn't, rather than try to build an entirely new system from scratch. (Applause.) And that is precisely what those of you in Congress have tried to do over the past several months.


https://www.cbsnews.com/news/transcript-obamas-health-care-speech/


"For us to transition completely from an employer-based system of private insurance to a single-payer system could be hugely disruptive, and my attitude has been that we should be able to find a way to create a uniquely American solution to this problem that controls costs but preserves the innovation that is introduced in part with a free-market system," Obama said in Annandale, Va., on July 1, 2009.

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Response to ehrnst (Reply #98)

Mon Sep 18, 2017, 08:26 AM

102. He did. He also pushed for a public option, which a couple Senators killed.

Yeah... what happened to that public option?

Regardless, now here we are, with a number of good Democrats in the Senate- Warren, Booker, Harris, Gillibrand, Franken etc.- endorsing a principle which other good Democrats in the house- with John Conyers at the helm- have been advocating for years as well.


Obama accomplished great things with the ACA, however, I think it is a failure of both vision and imagination to think that that is the full extent of progressive change we can ever expect to see in our lifetimes. And we all know there are still gaps. There are poor people who pay too much for not enough coverage, for instance.

What Single Payer or a similar proposal would look like, how we would get there, etc are all necessary parts of the discussion- but the important thing is that we are bringing it into the national conversation.

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Response to Warren DeMontague (Reply #102)

Mon Sep 18, 2017, 08:33 AM

104. I guess that he didn't actually think it was the "only moral, fiscal" solution.

The ACA puts us farther down the road than we have ever been towards UHC. That's not a failure.

You can complain and want to get out of the car because it wasn't a ferrari, and didn't get you to your destination already, or you can keep driving.

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Response to ehrnst (Reply #104)

Mon Sep 18, 2017, 05:50 PM

105. you didn't answer.

what happened to that public option?

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Response to George II (Reply #47)

Sun Sep 17, 2017, 09:28 AM

81. Like going down a rabbit hole, isn't it?

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Response to ehrnst (Reply #81)

Sun Sep 17, 2017, 05:24 PM

89. it's a "rabbit hole" to point out that the ACA has its origins in a Heritage Foundation proposal?

https://krugman.blogs.nytimes.com/2011/07/27/conservative-origins-of-obamacare/?mcubz=1&_r=0

Was Krugman "mansplaining" back in 2010 when he tracked the history, here?

https://healthcarereform.procon.org/view.resource.php?resourceID=004182

The essence of Obamacare, as of Romneycare, is a three-legged stool of regulation and subsidies: community rating requiring insurers to make the same policies available to everyone regardless of health status; an individual mandate, requiring everyone to purchase insurance, so that healthy people don’t opt out; and subsidies to keep insurance affordable for those with lower incomes.

The original Heritage plan from 1989 had all these features.

These days, Heritage strives mightily to deny the obvious; it picks at essentially minor differences between what it used to advocate and the plan Democrats actually passed, and tries to make them seem like a big deal. But this is disinformation.


pesky facts, again.

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Response to Warren DeMontague (Reply #89)

Mon Sep 18, 2017, 08:21 AM

99. My bad

I was responding to this post:

But that's a post from you. And...

If the GOP has been setting the agenda since 1980 we wouldn't have the ACA.


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Response to George II (Reply #37)

Sat Sep 16, 2017, 02:50 PM

63. So, the claim was that the ACA flipped us to republican

but both Reagan and Bush were before there, discrediting that claim.

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Response to Lordquinton (Reply #63)

Sat Sep 16, 2017, 02:54 PM

65. Do you folks forget that between Reagan and Bush (not sure which, probably the first) were...

....two Democratic Presidents who each served two terms? Why doesn't anyone find some aspect of Reagan/Bush policy to claim that it flipped us to Democratic?

Its an illogical comment to say or imply that something that happened in 2010 flipped us to Reagan/Bush.

What's the connection?

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Response to George II (Reply #65)

Sat Sep 16, 2017, 03:04 PM

66. What two democratic presidents were those?

Between Reagan and Bush?

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Response to Lordquinton (Reply #66)

Sat Sep 16, 2017, 03:10 PM

67. Between Reagan and Bush and today. I'm sure you knew that is what was meant.

I'd stay and nit on semantics with you but my wife and I are getting ready to go to church this afternoon.



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Response to George II (Reply #67)

Sat Sep 16, 2017, 04:45 PM

71. This whole subthread is based on semantic nitpicking

You know what was meant by the original comment.

Matthew 6:5

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Response to Lordquinton (Reply #71)

Sat Sep 16, 2017, 05:07 PM

72. I really don't. It connected the ACA with Presidents Reagan and Bush, which occurred almost....

.....20 years apart, the ACA coming after the two Presidents.

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Response to George II (Reply #72)

Sat Sep 16, 2017, 05:18 PM

73. No it didn't

go back and re-read the exchange with an open mind.

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Response to George II (Reply #65)

Sun Sep 17, 2017, 09:29 AM

82. Logic isn't going to work here. (nt)

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Response to ehrnst (Reply #82)

Sun Sep 17, 2017, 09:30 AM

84. I realized that yesterday and just gave up. It was like....



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Response to George II (Reply #84)

Sun Sep 17, 2017, 09:39 AM

86. It's a way that people who feel a need to Mansplain

can just keep posting, even when they have run out of rebuttals.

It's a similar style to Kellyanne Conway. She's a genius at the art of saying that something that can't really be defended by facts is totally your fault for not "understanding" the facts, or you just heard was not what she just said at all.

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Response to yallerdawg (Reply #22)

Fri Sep 15, 2017, 10:40 PM

53. Those would be Republican people..

and most of those are the leadership, not the rank and file. I don't know any democrats who are very concerned.

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Response to yallerdawg (Reply #22)

Sat Sep 16, 2017, 02:48 PM

62. "entitlement programs we are already running in the red!"

You... You don't understand how this works, don't you? That's 100% a republican line about our entitlement programs.

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Response to Progressive dog (Reply #5)

Fri Sep 15, 2017, 09:12 PM

41. Sure, and it could be fiftytwenty majilliozillion!

I mean, as long as we're just making up numbers.

http://www.businessinsider.com/bernie-sanders-wsj-18-trillion

"18 Trillion" is bullshit. If Government "pays" - or to be more precise, if everyone is put into a government managed non-profit single payer insurance pool, the money spent on for-profit insurance (including the 20% overhead added by the for-profit insurance industry) diminishes accordingly. The entire Gross National Product for 2017 was 17 Trillion Dollars. Health Care Spending was approx 3.4 Trillion. Moving everyone to a single-payer system would not magically increase the amounts spent on health care, because the net amount of health care required by people is not market-dependent, among other things. If anything, total HCS is likely to go down, because more people have access to preventative care. This, too, is one of the logical underpinnings of the ACA.

It is a disingenuous argument (to put it mildly) to play funny games with big, scary-sounding numbers as if a SPHC is going to "cost us way more". It's bullshit, and illogical. It's the same as saying "oh, it wouldn't be free, people would pay for it in taxes". Yes, but they wouldn't be paying outrageous premiums to for-profit insurance companies, would they.

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Response to Warren DeMontague (Reply #41)

Fri Sep 15, 2017, 09:28 PM

49. A welcome dose of reality in an overheated debate.

Thank you.

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Response to Warren DeMontague (Reply #41)

Fri Sep 15, 2017, 09:55 PM

51. You don't think demand would go up?

You don't think demand would go up when people don't have to pay anything for doctor visits, dental, vision and hearing?

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Response to MichMan (Reply #51)

Fri Sep 15, 2017, 09:57 PM

52. When people go see the doctor for checkups and get regular dental care

do you suppose that ends up costing more, or less money?

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Response to Warren DeMontague (Reply #41)

Sun Sep 17, 2017, 09:37 AM

85. Someone who can't multiply 10

times 3.4 and get 34 is not someone who should be handling (or advising about) money. BTW 34 is greater than 18.

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Response to Progressive dog (Reply #85)

Sun Sep 17, 2017, 05:14 PM

88. And someone who doesn't understand that when you pay for something with cash

instead of paying for it with a credit card, you're not paying for it twice, shouldn't be handling money either.

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Response to Warren DeMontague (Reply #88)

Sun Sep 17, 2017, 05:39 PM

90. I don't even get what you are talking about

Credit and cash have nothing to do with understanding simple arithmetic, like multiplication.

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Response to Progressive dog (Reply #90)

Sun Sep 17, 2017, 05:42 PM

91. And a Single Payer System isn't going to magically create more health care spending.

Health Care spending isn't market dependent. People don't run out and get more heart bypasses just because they can. If anything, universal coverage makes the total nut cheaper, because people have access to preventative care.

A SPHC system is going to change the way the current health care spending is paid for. And, in the process, remove the up to 20% overhead added to the mix by the for-profit insurance industry.

So it's total fucking disingenuousness to argue that it's gonna "cost us these huge amounts of money". Bullshit. It will end up being cheaper, and everyone fucking knows it.

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Response to Warren DeMontague (Reply #91)

Sun Sep 17, 2017, 06:02 PM

92. The math is easy, no one other than the proponents

are abusing the math. Really really simple. If $3.4 trillion er year is spent on health care and the federal government pays for about 30% of it, the (1-.3)X$3.4 trillion =$2.38 trillion per year that the feds do not pay for. If we forget inflation (and just pretend that free health care will not be used more than expensive health care), then, over ten years 10 X $2.38 trillion or $23.8 trillion will have to be raised in new taxes.
Of course health care spending is market related. People do worry about their health and they will use more care if it is free.
Even so, the $18 trillion new federal cost over the next decade assume $5.38 trillion in savings and no inflation. In other words, for those who are math challenged, health care will cost huge amounts of money, as it already does, and everybody who can do simple math should know it.

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Response to Progressive dog (Reply #92)

Sun Sep 17, 2017, 06:08 PM

93. You're deliberately ignoring the point.

Yes, health care costs a lot of money. As you say, it already costs a lot of money. Exactly.

Of course health care spending is market related. People do worry about their health and they will use more care if it is free.


The only way covering everybody works out to be more expensive, is if fewer people die. You want to make that moral argument, knock yourself out. As it is, when people "worry about their health" and go see a doctor or a dentist, they end up getting preventative care that avoids them having to show up at the ER with a potentially life-threatening situation.

Which is what happens when people aren't covered, and if they're poor, guess what? We end up paying for it anyway.

I'm right. I know I'm right, everyone paying attention knows I'm right, and the fact that you toss out insults instead of addressing the central point, here, just proves it even more.

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Response to Warren DeMontague (Reply #93)

Sun Sep 17, 2017, 08:58 PM

95. You are missing the point, not me

Aparently you do not understand than 23.8 trillion is more than 18 trillion. You seem to be arguing that it is.
Guess what, we are already paying for it a pretty ignorant statement. The we that is paying for it now will be different than the we that will be paying for it under medicare for all. People who negotiated health care as part of their compensation will lose that part of their compensation.
The 8.4% regressive tax on payrolls to pay for a small part of this will not help families or anyone else. Note that Bernie already claims to be eliminating over $6 triilion dollars from the US economy over 10 years. I wonder how many jobs that pays for.

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Response to Progressive dog (Reply #95)

Sun Sep 17, 2017, 11:44 PM

96. "People do worry about their health and they will use more care if it is free"

how would you characterize that statement, o self-proclaimed arbiter of ignorance?


I know how I would characterize it.

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Response to Warren DeMontague (Reply #96)

Tue Sep 19, 2017, 04:19 PM

112. An easy truth

In fact data shows that doctor visits and hospital stays drop during recessions. I'm sure you do know how you would characterize, but I'll take provable facts over anyone's characterization.

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Response to Warren DeMontague (Reply #93)

Tue Sep 19, 2017, 10:19 AM

108. Actually, the increase in the number of people using health care is a cost issue in implementation

It's factored in separately than the estimated costs going forward to maintain it.

I'm right. I know I'm right, everyone paying attention knows I'm right, and the fact that you toss out insults instead of addressing the central point, here, just proves it even more.

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Response to Warren DeMontague (Reply #41)

Tue Sep 19, 2017, 10:16 AM

107. I guess any dissent from that bill is "making up numbers."

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Response to melman (Original post)

Fri Sep 15, 2017, 04:23 PM

7. K & R!

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Response to melman (Original post)

Fri Sep 15, 2017, 05:34 PM

16. You mean I read a 5 author 30 page analysis

With projected numbers and graphs and charts and everything for NOTHING?

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Response to ismnotwasm (Reply #16)

Sat Sep 16, 2017, 02:55 AM

55. You should have just read a blog where people say stuff they don't back up.

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Response to melman (Original post)

Fri Sep 15, 2017, 05:56 PM

19. K&R nt

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Response to melman (Original post)

Fri Sep 15, 2017, 06:11 PM

24. K&R nt

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Response to melman (Original post)

Fri Sep 15, 2017, 06:24 PM

26. They HATE unions!

 

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Response to juxtaposed (Reply #26)


Response to juxtaposed (Reply #26)

Sun Sep 17, 2017, 09:26 AM

79. Who? (nt)

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Response to melman (Original post)

Fri Sep 15, 2017, 06:27 PM

28. Recommended.

And this negativity is presented as "common sense" and is absorbed as such by many from both parties.

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Response to melman (Original post)

Fri Sep 15, 2017, 06:50 PM

32. That was written over a year ago.

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Response to Hoyt (Reply #32)

Sun Sep 17, 2017, 09:24 AM

78. Yes, for the plan that Sanders submitted last year

Sanders isn't known for accepting criticism or disagreement.

I don't imagine that his bill would change very much.

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Response to melman (Original post)

Sat Sep 16, 2017, 08:04 AM

58. Poorly written legislation forces speculation.

 

Hack article here. It's not a complete piece of legislation. Same problem the Republicans have been having. Putting legislation forward by people who don't understand how to do it. This isn't about passing this legislation and it's not even close to complete in the first place. Sanders lack of knowledge in this area is biting us in the ass on messaging. More thought should have been put into it but then Sanders would have had to of included others early on. That's not what it's about to Sanders.

Most people get this. These authors don't. Political neophytes.

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Response to Weekend Warrior (Reply #58)

Sat Sep 16, 2017, 03:16 PM

70. I want to know why Sanders chose to announce his single payer on the same day everyone knew

Cassidy/Graham were releasing their plan to repeal Obamacare and destroy Medicaid and Medicare.

That's where our focus should be for the next two weeks -- stopping Cassidy/Graham before it's too late. Not getting distracted by a half-baked single payer plan that could have and should have waited till the immediate crisis was over.

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Response to pnwmom (Reply #70)

Sun Sep 17, 2017, 09:30 AM

83. That's a strategy that Sanders has used before to draw focus.

But talking about it would be re-hashing the primary.

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Response to melman (Original post)

Sun Sep 17, 2017, 08:30 AM

74. OMG, a liberal think tank decided to take a closer look at the actual numbers.

And they had the NERVE to reply to the outrage over that.. WHAT SHILLS!!!

The Sanders campaign and David Himmelstein and Steffie Woolhandler reacted with sharp criticisms to our recent report, The Sanders Single-Payer Health Care Plan: The Effect on National Health Expenditures and Federal and Private Spending (Holahan et al. 2016). The campaign argues that we understated reductions in the cost of prescription drugs, understated administrative cost savings, and ignored the availability of state and local funds to finance the plan. Himmelstein and Woolhandler (hereinafter referred to as HW) argue that our “ridiculous assumptions yield ridiculous estimates”; specifically, they argue that we overstated administrative costs, ignored administrative cost savings for providers, understated reductions in drug spending, and overstated utilization increases.1



Our analysis was based on detailed modeling of acute care for the nonelderly, acute care for the elderly, and long-term care services and supports. It is impossible to wholly impose a new health care system in the United States that changes the way all residents receive and finance their health care, even one that may be successful in another country, without disrupting many existing institutions, such as insurance companies, integrated health systems, hospitals, physicians, and pharmaceutical manufacturers. To be politically acceptable, compromises would have to be made, and those compromises are reflected in our assumptions.


In this brief, we discuss our key assumptions in these areas of disagreement and highlight ways in which we may have actually underestimated overall costs of the Sanders proposal. By and large our assumptions are laid out thoroughly in the original paper, but here we use them to address the specific statements made by the campaign and HW, and we provide additional reliable evidence to counter some of HW’s claims.

The increases in federal spending that we estimated ($32 trillion between 2017 and 2026) are so large because all current public and private spending would be transferred to the federal government, benefits would be expanded, and out-of-pocket costs to consumers would be eliminated.

Payment rates would have to be acceptable to providers. We assume a substantial reduction from current rates paid by private insurers and some increases over current rates paid by public programs. For example, the program would pay 25 percent less than current Medicare levels for prescription drugs, and physicians would be paid at Medicare rates. Both of these are increases relative to current Medicaid payment rates.

Utilization of health care services will increase if benefits are expanded and cost sharing is eliminated. Our estimates include modest increases in the use of services based on actuarial standards and the health economics literature. Contrary to HW’s claim in their article, health care use and spending for the elderly population did increase substantially once the Medicare program was implemented in 1965.

We assume administrative costs of 6 percent. A new system would have a host of important administrative functions necessary to effective operations, such as rate setting for many different providers of different types; quality control over care provision; development, review, and revision of regulations; provider oversight and enforcement of standards; bill payment to providers; and other functions. We base our administrative cost estimates on Medicare’s costs to administer the entire Medicare program. But even if we have modestly overestimated the appropriate administrative load, the difference in costs for the federal government would be only about 1 percent of total added federal spending per percentage-point reduction, a tiny fraction of the additional $32 trillion in federal funding that we estimate would be needed to fully finance the Sanders health plan.

We provide estimates of current state and local spending on health care through the Medicaid program and on payments for uncompensated care. Requiring state governments to give the amount they currently spend on Medicaid to the federal government to help finance the single-payer system is of very uncertain legality given the Supreme Court’s ruling in National Federation of Independent Business v. Sebelius.

We may have underestimated the costs of the Sanders plan in several important areas. These were described in the original paper and are summarized below.


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

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Response to melman (Original post)

Sun Sep 17, 2017, 08:43 PM

94. The text of the actual bill that was introduced

in the Senate last week is not available yet.

The HuffPo story you cited was written 2016 and updated last May. Unless Sanders introduced the same bill that he has proposed in the past, the story might not even be relevant to the present situation.

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Response to lapucelle (Reply #94)

Mon Sep 18, 2017, 08:24 AM

100. Yes, this is the analysis of the 2016 plan.

And Sanders is not known to gladly accept advice or critiques. His defensive response to the independent analysis of his 2016 plan indicates this.

I don't see him acknowledging that he made any errors in his 2016 plan, so I don't see much possible in the way of change in the 2017 plan.

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Response to melman (Original post)

Wed Sep 20, 2017, 08:57 AM

116. Yes, money from Cigna talks.

But people believe what they want to, especially if it is critical of Sanders' bill (though it now has many cosponsors, even centrists ones). And single payer scares Cassidy and Kennedy so much they want to ban states from even trying it.

Get this fucking straight: HEALTH CARE IS A RIGHT. To hell with "incrementalism". PEOPLE ARE FUCKING DYING.

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