Friday, May 5, 2017

Peter Radford — Trumpcare


A realistic look in bullet points. This is far from a done deal.

The Radford Free Press
Trumpcare
Peter Radford

26 comments:

Matt Franko said...

Lots of numbers here.... not...

Matt Franko said...

The only complaint anybody here should have is maybe that the credit isn't high enough... that's it...

Tom Hickey said...

The only complaint anybody here should have is maybe that the credit isn't high enough... that's it...

Well, that's the nub of it, isn't it?

People expect that they will be treated with medical procedures that providers deem are indicated, and that their insurance will cover this affordably as part of their monthly nut, with the option of a lower cost based on a deductible. They also don't want to be subject to lifetime limits.

Noah Way said...

The only complaint anybody here should have is maybe that the credit isn't high enough... that's it...

Matt, your true colors are showing. You don't give a shit about eviscerating Medicaid or increased costs for the elderly and the sick. It's only about money, as if that was the only measure of value. GFY.

Dan Lynch said...

Pretty good rundown by Radford despite no mention of soap or economies of scale.

Hard to say how this will play out other than I think Krauthammer nailed it about universal care being inevitable, the only question being how many election cycles will be required for Washington to get the message.

I'm not convinced that Trump has a well thought out strategy. He seems to think he can BS his way out of it. That works on some issues but it won't work on health care because it affects so many people, especially with our aging demographics.

Another problem looming is when the next recession kicks in and millions lose their employer provided insurance. Neither O-Care nor TrumpCare offer much to people who are temporarily unemployed.

Ryan Harris said...
This comment has been removed by the author.
Tom Hickey said...

The economic liberal ideologues want to define health care as a private good that is rivalrous and excludable, access to which is a "privilege" based on ability to pay instead of a right.

The public by and large has come to see universal access to quality affordable health care as a public good and a right.

Matt Franko said...

Static analysis Noah.

Why would anyone need Medicaid if govt credited your bank account every month with conditional currency amount adequate to purchase medical services ?

The providers need to grow up and write a number down like everyone else in the economy does...

Matt Franko said...

Sprint cellular telephone: "Unlimited voice, data, text $99/month"

Providers: "Duuuaaahh.... we don't know...."

Matt Franko said...

Providers: "We'd rather not have to commit to a number...... Just pay us a shit load of munnie whenever you have to use us"

This is BS....

Dan Lynch said...

@Matt who decides the amount adequate to purchase medical services?

Does everyone require the same services, or do different people have different needs?

Agree with you about the difficulty of getting firm prices. The last time I went to a doctor, I asked how much everything would cost. I wanted to pay cash on the spot so I needed to know. They could not tell me and they would not allow me to pay up front. I did not know the cost until I got the bill and then it was much more than I expected.

You would think they would encourage cash up front and maybe even give a cash discount but the opposite is true. They charge different rates to different insurance companies. People without insurance pay the highest rate of all because they have no bargaining power.

It's screwed up.

Matt Franko said...

"Who decides?" The providers put coverage on offer in your state, cut out the insurance middle man....

Well the "Cash up front" is what you could consider the monthly tax credit doing... iow the providers could take the whole credit on the 1st of the month and then if you needed something, you made an appointment or FaceTime with a provider, etc... govt would regulate standards and levy fines...

The issue is MAYBE the credit is going to be inadequate... I agree static analysis indicates the credit is inadequate... this is what Trump should be being pressed on.... i.e. his credit is looking inadequate...

Matt Franko said...

Dan I think there are a lot of people in your same boat... I was talking to this woman the other day she was short of Medicare and what she was doing was buying a catastrophic plan with high deductible and crossing her fingers... BUT imo there are many out there who don't even get the catastrophic coverage... I have a friend who works under a 1099 and just pays his $600 Obamacare fine and hopes for the best...

So, you take ALL of those people people who today are not paying in (btw including current illegals...who will now get the $4k too) ) and then give them ALL $4k annual and those people now assign those USD balances to a provider of their choice and what happens?

Trump is saying the price on offer is going to drop.... what say left/Democrats? "They went and got some beers!!!!"

Tom Hickey said...

The providers need to grow up and write a number down like everyone else in the economy does...

As I said, the numbers are written down by code. The problem is that it is difficult for most people to get to the actual prices.

The reason for this is that different payers pay different prices based on different discounts.

It's similar in wholesale. Walmart pays a different price than a mom & pop store and the wholesalers is not going to reveal the actual prices anymore than employers publicly reveal individual employees compensation.

In retail there is a suggested retail price but different vendors apply different discounts.

The idea that is a single market price that fluctuates with the market doesn't apply to goods markets like it does to commodities and financial markets.

Penguin pop said...

Yeah that is weird to me how I've never seen these health insurance companies come up with some solid hard number, and plans for their services like we see w/ cellphone companies. I do see how there's also a problem with the medical industry as a whole when there are these professionals making absurd amounts from this already broken system. People love to focus on "big Pharma!" but how is it that these "doctors" are making WAY more than the average doctor in some other country, even in developed nations?

I do agree there would need to be some serious government regulation of the industry, set some real standards and make the playing field fair. Not just about getting more people to train in the medical industry and what not, which is an idea I've been advocating for. So it seems to be no matter what system we use, there would still potentially be the issue of such highway robbery occurring in the industry itself that would need to addressed and fully regulated. Now I'm hearing Canada is not the best model for healthcare either, and I'm going to need to look up Finland more and look into how the VA works as of now.

Tom Hickey said...



Mosst people are not going to be dealing direct with providers but with insurance cos. Those individuals that deal directly with providers will not have bargaining power and therefore will pay retail.

It's true that individuals can bargain with providers but generally that's impractical for a variety of reasons.

The "market" for medical services is not a market in the ordinary sense, and I doubt it can be turned into a commodity market, again for a variety of reasons.

These are specialized and speciality markets rather than goods markets in which standardized products are vended.

Tom Hickey said...

The only way to get a handle on health care is to recognize that it is a public good and not a private good.

The assumption now is that health care is a private good and price should be left to "the market."

However, distribution of public goods by price rationing is not appropriate. Won't work.

Krauthammer is correct. After the ACA, the American public has come to view health care differently than it did before and it not going back.

Obama admitted that the ACA wasn't the final stage but the best that could be negotiated at the time and that in the future the program would need to be revised to make it better.

This is what the public expects now.

The only way to do this ultimately is single payer, and even conservatives like Krauthammer are recognizing this.

The US is the only developed country that hasn't gotten it yet and the performance of its system is poor in comparison.

The good news is that this is going to be the issue in the midterm and Bernie is already on it.

However, to be successful, the Democrats really need to get on board single payer as a party and sideline those who resist, like Corey Booker. Corey Booker wants to be president some day. Forget about it. The guy is a special interest flak.

Bob said...

https://draftbernie.org

Time for Bernie to leave the sinking ship known as the Democrats.

Matt Franko said...

Well if by single payer you mean the government is the single "payer" that pays everybody $4000 a month to buy a healthcare guarantee then I agree single payer would be a good program but that is not what it means it means when you get sick and you're facing a life-and-death situation you go to a provider and have to bend over and pay them whatever they say they want ... f that...

Ryan Harris said...

Maybe public schools could start teaching ICD-10 codes and how to look up prices in introductory high school economics courses. Throw in a bit about how government budgets are different and voila. Enlightened public.

Practical skills are needed much more than supply-demand nonsense and normal survey of theory.

Tom Hickey said...

I have a friend in health insurance all his life and he explained it to me as I have explained it above. Here is another summary.

There are codes and associated prices based on the region of the US. The actual provider (physician) checks off the codes, which are sent to the billing department.

The billing department then submits the bill to CMS, the insurance cos, or individual if uninsured.

The billing is the same for all parties. The different parties then submit payment based on the fixed price (CMS) or negotiated discount in the case of the insurance cos.

Individuals are free to negotiate with providers if they wish and the provider is open to it. Some are and some are not.

The billing department doesn’t just pull prices out of the air. Each institution bills based on cost and mark-up. The billing clerks just apply these preset prices.

This is why there is no prices set across the board. Costs are different for different institutions, and the prices charged reflect that. The best rated hospitals have higher costs because they are technologically better equipped. They charge more to cover their relatively higher costs.

Most of the issues around health insurance for most people involve insurance cos rather than providers. One has to go to a provider that the insurance co approved and insurance cos may reserve the right to pre-approve treatment.

In the case of emergency, most people just go to the nearest facility, but not necessarily. I experienced an event in Boston and requested the ambulance to take me to Mass Gen rather than the closest hospital, which they did.

In the case of most other procedures or selecting a personal or family physician people generally choose providers based on reputation rather than price.

Noah Way said...

the Democrats really need to get on board single payer as a party and sideline those who resist

BO killed the government option in the ACA. Democrats are as corrupt and self-serving as the Reps and the corporations they both represent. Rather than do anything that would actually advance their support among the general population (who can't afford to buy their services) they spend their time trying to sabotage the "other" party.

Ryan Harris said...

I have a Blue Cross Blue Shield indemnity plan with 5,000 deductible but I've never spent more than 5000 in a year. I do get their negotiated rates on what I pay before 5000 is hit but I shop around like crazy for service.

The problem I had when I broke my leg was that different hospitals varied wildly for what they would charge for non-surgical set, xray and cast. Their BCBS rates varied from 2700 to 23000 depending on who I called and most refused to provide prices for the procedures. Since I pay most expenses out of pocket, I want to know what they are going to charge BEFORE I go. Medicare might be easier. I don't know.

lastgreek said...

I must admit that I admire your "freedom," Americans -- your "freedom" to acquire health insurance if you so wish.

I've even had "freedom"-loving Americans tell me this themselves -- about their love of "freedom." Seriously, the other night, on some American sports/weight-training blog that I visit on occasion, there was one guy (can I say "dick," here?) named George something who bragged in a thread -- it was a non-sports thread; rare, but they do pop up on occasion -- that he didn't have health insurance because he could not afford it. He said that when one day when he could afford to buy it, he'll have the "freedom" to do so if so desired, without "guv'mint" forcing him to buy it.

"Freedom"

Dan, I can't say I know how you feel. I was born and raised in a civilized country(Canada, and relatively speaking of course) where healthcare is a right and not a privilege, so I have never experienced what you are experiencing right now. I'd like to tell you to dump the states and move to Canada, but unfortunately that is easier said than done, I know.

Tom Hickey said...

Medicare might be easier. I don't know.

You don't need to ask. Just chose your provider unless one has opted for a HMO.

Medicare covers 80%. To cover the rest, most people opt for a supplemental plan from a private insurance co. There are several options and different cos offer different deals

Not all providers accept the Medicare assignment, so it is necessary to ask before treatment. If the provider doesn't, the patient is responsible for the balance that is not covered by insurance.

But generally speaking, Medicare is pretty much straight-forward and hassle-free.

Ryan Harris said...

My parents love their medicare and supplement. Never paid a penny out of pocket. My mom raves about it because it is so much better than the private insurance they always had.