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 Post subject: Re: Medicare for All
PostPosted: September 15 17, 1:40 pm 
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has a link from 538 to share
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G. Keenan wrote:
Does Bernie's plan extend to undocumented immigrants? Currently they are not eligible for Medicaid or Obamacare marketplace plans. I would be very surprised if Medicare for all were extended to the undocumented.


We don't actually know, because his primary plan was light on details. The paper assumes we do. If there's one assumption in the paper I think is too aggressive it's that one. That said, hospitals shouldn't turn away people in need, so we're going to have to absorb some cost. Here's some snippets:

Quote:
Although the Sanders campaign does not specify their intended treatment of the undocumented population, we assume they would be included because all government programs that currently help finance uncompensated care (e.g., Medicare and Medicaid disproportionate-share hospital payments) would be eliminated.


Quote:
Of the $2.2 trillion in total acute care spending for the nonelderly that we estimate would occur in 2017 under the Sanders proposal, we estimate that $77.0 billion would be spent on health care for undocumented immigrants (table 5)


Quote:
The following assumptions may tend to overestimate costs:

 Our estimates include costs associated with providing undocumented immigrants with acute care services for the nonelderly and long-term care services equivalent to that of citizens and documented residents (we were not able to estimate costs for providing coverage to elderly undocumented immigrants). If the new program excludes this population, those costs would be subtracted and government spending on uncompensated care would be added.


Schlich wrote:


This is an interesting article and it also links to another article I love . I think it better expresses my viewpoint in this thread: It’s time for Democrats’ wonk class to write some single-payer plans

It's a good read. Basically, I think if Dems want to make single payer a reality they need to start converting aspirational bills like Sanders in to something more workable or they are doom to fail.


Last edited by Michael on September 15 17, 2:00 pm, edited 1 time in total.

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 Post subject: Re: Medicare for All
PostPosted: September 15 17, 1:42 pm 
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Michael wrote:
Basically, I think if Dems want to make single payer a reality they need to start converting aspirational bills like Sanders in to something more workable or they are doom to fail.

Understandable why they haven't yet. Political tides turn so fast in the age of Trump and "the resistance." We've gone from a few sad leftists getting the cold shoulder in favor of pragmatism and actually needing to get the ACA in place to HEALTHCARE IS A HUMAN RIGHT awfully quickly.


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 Post subject: Re: Medicare for All
PostPosted: September 15 17, 1:49 pm 
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Arthur Dent wrote:
Michael wrote:
However, in the report I linked earlier they also discuss things like savings for citizens and businesses. On the balance they estimate a 16.5 trillion increase in medical spending over 10 years (table 1). They also estimate states local governments will spend around 4.1 trillion less over 10 years. That means if you held everyone's current health spending static (citizens, businesses and state/local gov) you'd still have a deficit around 12.4 trillion over 10 years. So basically everyone effectively pays the same AND you'd have to get additional revenue from Sander's options. You can reject the 32 billion figure, but I'm not sure you can trim 12.4 trillion off.

Maybe I'm confused, but I don't think you're reading that table correctly. Over 10 years, it says total health spending will increase by $6.6 trillion. There's a large increase in federal spending ($32 trillion) composed of taking on prior private spending ($21.9 trillion) state spending ($4.1 trillion) and the overall increase ($6.6 trillion). That sums to $32.6 trillion, which doesn't quite match their topline $32 trillion for reasons I don't understand.


I could be off, and it isn't entirely clear, however I think they treat federal and national expenditures separately:

Quote:
 National health expenditures for acute care for the nonelderly would increase by $412.0 billion
(22.9 percent) in 2017. Aggregate spending on acute care services for those otherwise enrolled
in Medicare would increase by $38.5 billion (3.8 percent) in 2017. Long-term service and
support expenditures would increase by $68.4 billion (28.6 percent) in 2017.

 Together, national health expenditures would increase by a total of $518.9 billion (16.9
percent) in 2017, and by 6.6 trillion (16.6 percent) between 2017 and 2026.

 The increase in federal expenditures would be considerably larger than the increase in national
health expenditures because substantial spending borne by states, employers, and households
under current law would shift to the federal government under the Sanders plan. Federal
expenditures in 2017 would increase by $1.9 trillion for acute care for the nonelderly, by
$465.9 billion for those otherwise enrolled in Medicare, and by $212.1 billion for long-term
services and supports.


So my math is:

increase in spending 12 trillionish = (32+6)-(22+4)

I think that's consistent with how the data is laid out. Regardless, what's a few trillion between friends?


Last edited by Michael on September 15 17, 1:53 pm, edited 1 time in total.

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 Post subject: Re: Medicare for All
PostPosted: September 15 17, 1:52 pm 
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Michael wrote:
G. Keenan wrote:
Does Bernie's plan extend to undocumented immigrants? Currently they are not eligible for Medicaid or Obamacare marketplace plans. I would be very surprised if Medicare for all were extended to the undocumented.


We don't actually know, because his primary plan was light on details.

The Senate Plan is somewhat more clear on the point, though, of course, the purpose of the bill is to be a statement of goals rather than legislation that will pass.

13 (a) IN GENERAL.—Every individual who is a resident
14 of the United States is entitled to benefits for health care
15 services under this Act. The Secretary shall promulgate
16 a rule that provides criteria for determining residency for
17 eligibility purposes under this Act.
18 (b) TREATMENT OF OTHER INDIVIDUALS.—The Sec-
19 retary may make eligible for benefits for health care serv-
20 ices under this Act other individuals not described in sub-
21 section (a), and regulate the nature of eligibility of such
22 individuals, while inhibiting travel and immigration to the
23 United States for the sole purpose of obtaining health care
24 services.


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 Post subject: Re: Medicare for All
PostPosted: September 15 17, 1:53 pm 
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thrill wrote:
Michael wrote:
Basically, I think if Dems want to make single payer a reality they need to start converting aspirational bills like Sanders in to something more workable or they are doom to fail.

Understandable why they haven't yet. Political tides turn so fast in the age of Trump and "the resistance." We've gone from a few sad leftists getting the cold shoulder in favor of pragmatism and actually needing to get the ACA in place to HEALTHCARE IS A HUMAN RIGHT awfully quickly.


I don't disagree. The article I linked is more of a call to wonks to take Sander's movement more seriously and come up with actual workable plans. It's something they haven't been doing.


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 Post subject: Re: Medicare for All
PostPosted: September 15 17, 2:20 pm 
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Michael wrote:
Arthur Dent wrote:
Michael wrote:
However, in the report I linked earlier they also discuss things like savings for citizens and businesses. On the balance they estimate a 16.5 trillion increase in medical spending over 10 years (table 1). They also estimate states local governments will spend around 4.1 trillion less over 10 years. That means if you held everyone's current health spending static (citizens, businesses and state/local gov) you'd still have a deficit around 12.4 trillion over 10 years. So basically everyone effectively pays the same AND you'd have to get additional revenue from Sander's options. You can reject the 32 billion figure, but I'm not sure you can trim 12.4 trillion off.

Maybe I'm confused, but I don't think you're reading that table correctly. Over 10 years, it says total health spending will increase by $6.6 trillion. There's a large increase in federal spending ($32 trillion) composed of taking on prior private spending ($21.9 trillion) state spending ($4.1 trillion) and the overall increase ($6.6 trillion). That sums to $32.6 trillion, which doesn't quite match their topline $32 trillion for reasons I don't understand.


I could be off, and it isn't entirely clear, however I think they treat federal and national expenditures separately:

Quote:
 National health expenditures for acute care for the nonelderly would increase by $412.0 billion
(22.9 percent) in 2017. Aggregate spending on acute care services for those otherwise enrolled
in Medicare would increase by $38.5 billion (3.8 percent) in 2017. Long-term service and
support expenditures would increase by $68.4 billion (28.6 percent) in 2017.

 Together, national health expenditures would increase by a total of $518.9 billion (16.9
percent) in 2017, and by 6.6 trillion (16.6 percent) between 2017 and 2026.

 The increase in federal expenditures would be considerably larger than the increase in national
health expenditures because substantial spending borne by states, employers, and households
under current law would shift to the federal government under the Sanders plan. Federal
expenditures in 2017 would increase by $1.9 trillion for acute care for the nonelderly, by
$465.9 billion for those otherwise enrolled in Medicare, and by $212.1 billion for long-term
services and supports.


So my math is:

increase in spending 12 tillionish = (32+6)-(22+4)

I think that's consistent with how the data is laid out. Regardless, what's a few trillion between friends?

Yeah, that's definitely not right. The $32t federal increase already includes the $6t overall increase. Under single payer, federal health spending IS total health spending. The sum is current_private+current_state+overall_increase=federal_increase => 21.9+4.1+6.6=32.6. The 0.6 discrepancy bothers me as they say private excludes provider payments, which would presumably also be taken up by federal spending, so something is overcounted a bit.

Anyway, the contrast is between Urban's projected $6.6 and the Sanders' campaign's projection of a $6.3 trillion decrease as they expected a large savings in administrative costs (currently ~15% while they projected Medicare's 2%) would swamp the costs of increased utilization. Urban thinks administrative costs would actually be 6% and project a quite large increase in utilization. But both sides of this equation obviously depend on the details, which is why I hope the wonk blockade on single player is lifted.


Last edited by Arthur Dent on September 15 17, 3:12 pm, edited 1 time in total.

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 Post subject: Re: Medicare for All
PostPosted: September 15 17, 2:34 pm 
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I really don't think they include the 6t national in the federal spending. In the paper federal and national expenditures and treated separately. Notice how they call them out separately in the header. I can look at it closer later, but it's friday, so yeah ha ha

edit - actually rereading it you might be right with the 6t. I'll have to dive in the details a bit more.


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 Post subject: Re: Medicare for All
PostPosted: September 26 17, 9:58 am 
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This guy



is really worth listening to on healthcare, whether you agree on single payer or not.

First heard him on Chapo and then on Ana Marie Cox's Crooked Media podcast this past week. Lots of f-bombs and he talks fast, but he knows his [expletive].

https://soundcloud.com/chapo-trap-house/episode-129-the-affordable-covfefe-act-feat-tim-faust-73017



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 Post subject: Re: Medicare for All
PostPosted: July 18 18, 10:01 am 
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OK, so I have heard over and over again that the reason the US should resist going to universal healthcare is that we'll have ridiculous wait times.

Well, today, I finally got a call back from my sleep specialist after leaving several messages over the span of more than a week, and was told his first available appointment was in the middle of SEPTEMBER.

I'm betting I could move to Canada and get into a sleep specialist there in the same amount of time. I was already convinced universal healthcare was worth implementing, even if it meant longer wait times. But now we have crappy wait times without universal HC, so, why-the-fvck-not???


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 Post subject: Re: Medicare for All
PostPosted: July 18 18, 10:42 am 
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GeddyWrox wrote:
OK, so I have heard over and over again that the reason the US should resist going to universal healthcare is that we'll have ridiculous wait times.

Well, today, I finally got a call back from my sleep specialist after leaving several messages over the span of more than a week, and was told his first available appointment was in the middle of SEPTEMBER.

I'm betting I could move to Canada and get into a sleep specialist there in the same amount of time. I was already convinced universal healthcare was worth implementing, even if it meant longer wait times. But now we have crappy wait times without universal HC, so, why-the-fvck-not???

In May I needed to see my doc. When I called they asked if I wanted to see the doc or a physicians assistant? The doc could be scheduled in August. The PA in a day or two.

Ha.


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