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   Steve Benen (stevebenen@journa.host)'s status on Wednesday, 18-Sep-2024 04:06:56 JST Steve Benen

   If you think Americans with preexisting conditions should pay more for health care coverage, you're going to love the new details of the Trump/Vance approach to health care "reform." https://www.msnbc.com/rachel-maddow-show/maddowblog/vance-signals-new-troubles-preexisting-conditions-rcna171442

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     🎓 Doc Freemo :jpf: 🇳🇱 (freemo@qoto.org)'s status on Wednesday, 18-Sep-2024 04:16:33 JST 🎓 Doc Freemo :jpf: 🇳🇱

     in reply to

     @stevebenen If there is one thing that is obvious to me this election its that neither Trump nor Harris have the first clue about what sane healthcare would look like.

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     🎓 Doc Freemo :jpf: 🇳🇱 (freemo@qoto.org)'s status on Wednesday, 18-Sep-2024 10:47:07 JST 🎓 Doc Freemo :jpf: 🇳🇱

     in reply to

     • argv minus one

     @argv_minus_one @stevebenen

     No. They both know. Trump doesn’t want it because it’s unprofitable. Harris doesn’t dare propose it because she’ll lose the election if she does.

     I doubt it. I hav emet very few people who propose sane health care that fixes all the problem. Most either propose universal healthcare, or for-profit, both of which are complete and utter failures. I have met maybe one or two people in my life who actually have a clue about how to do healthcare in a way that doesnt result in either abusive wait times, or abusive costs (and other issues).

     It is the American people who don’t have the first clue about what sane health care would look like.

     Agreed they dont, nor does Canada, Europe, the UK or anywhere else int he world.

     And that’s also true of the populations of Canada and the UK, which used to have it, and continue to elect politicians who promise to destroy it.

     facts

     I can’t believe our species has survived this long. We clearly don’t deserve it.

     yup

     And europe, agreed.

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     argv minus one (argv_minus_one@mastodon.sdf.org)'s status on Wednesday, 18-Sep-2024 10:47:08 JST argv minus one

     in reply to

     • 🎓 Doc Freemo :jpf: 🇳🇱

     @freemo

     No. They both know. Trump doesn't want it because it's unprofitable. Harris doesn't dare propose it because she'll lose the election if she does.

     It is the American people who don't have the first clue about what sane health care would look like. And that's also true of the populations of Canada and the UK, which used to have it, and continue to elect politicians who promise to destroy it.

     I can't believe our species has survived this long. We clearly don't deserve it.

     @stevebenen

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     🎓 Doc Freemo :jpf: 🇳🇱 (freemo@qoto.org)'s status on Wednesday, 18-Sep-2024 11:12:59 JST 🎓 Doc Freemo :jpf: 🇳🇱

     in reply to

     • argv minus one

     @argv_minus_one

     Sane healthcare would be one that addresses both sides of the equation... greed from unregulated for-profit healthcare that drives prices to insane levels due to supply and demand being broken (demand is infinite since people will give everything to live longer). It also needs to address the other side of the coin with highly-regulated universal health care, which is the lack of a free market to drive quality so things like wait times, availible medications, and other issues arise.

     There are a few solutions to this but the best one I have heard is co-op based health care. Essentially healthcare where the owners are the patients of the companies they use, and there are no owners otherwise (so all owners are equal owners). When you move to a new healthcare company then you loose ownership in the old one and gain ownership in the new one.

     This gives you supply-demand pressures that ensure your healthcare caters to what you want and need (or else loose their funding by patients moving), but keeps prices in check by eliminating the greed factor since any profits go back to the patients and insurance holders themselves.

     @stevebenen

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     argv minus one (argv_minus_one@mastodon.sdf.org)'s status on Wednesday, 18-Sep-2024 11:13:00 JST argv minus one

     in reply to

     • 🎓 Doc Freemo :jpf: 🇳🇱

     @freemo

     Well, now you've got me curious. What, in your estimation, does sane health care look like?

     @stevebenen

     🎓 Doc Freemo :jpf: 🇳🇱 repeated this.
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     🎓 Doc Freemo :jpf: 🇳🇱 (freemo@qoto.org)'s status on Wednesday, 18-Sep-2024 11:14:55 JST 🎓 Doc Freemo :jpf: 🇳🇱

     in reply to

     • ≠
     • argv minus one

     @amerika

     How do you figure that would fix the price problem with have? Why would that be driving up the price for doctors who are in no way effected by the act (it effects hospitals with emergency rooms)

     @stevebenen @argv_minus_one

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     ≠ (amerika@annihilation.social)'s status on Wednesday, 18-Sep-2024 11:14:56 JST ≠

     in reply to

     • 🎓 Doc Freemo :jpf: 🇳🇱
     • argv minus one
     @argv_minus_one @freemo @stevebenen
     
     Sane healthcare = repeal EMTALA, privatize everything
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     🎓 Doc Freemo :jpf: 🇳🇱 (freemo@qoto.org)'s status on Wednesday, 18-Sep-2024 11:24:31 JST 🎓 Doc Freemo :jpf: 🇳🇱

     in reply to

     • argv minus one
     • Eric's identical alien robot

     @SETIEric

     I do agree that we can better address our supply of doctors. Though my views there are a bit all over the place. For starters if i really had my way completely I would totally take away any authority doctors have. I would make all prescription drugs availible over hte counter. This works quite well in many countries and doctors are now someone you choose to consult rather than whoa re forced to. This would eliminate the need for the AMA.

     That said, i dont think id ever convince america to actually trust people to have autonomy over their own bodies, so I doubt that would happen.

     The other thing id do regardless of anything else is make all job training, mentorship, tradeschools, and education free to all people at any level (up to and including PhD or medical doctor). That should address the supply issue to some extent.

     @argv_minus_one @stevebenen

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     Eric's identical alien robot (setieric@mastodon.sdf.org)'s status on Wednesday, 18-Sep-2024 11:24:32 JST Eric's identical alien robot

     in reply to

     • 🎓 Doc Freemo :jpf: 🇳🇱
     • argv minus one

     @freemo @argv_minus_one @stevebenen Don't forget an association of doctors, the AMA, acting as a med-school gatekeeper, ensuring that the supply of doctors will never be sufficient to reduce their astronomical salaries. People must die so that doctors can be exceptionally rich.

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     🎓 Doc Freemo :jpf: 🇳🇱 (freemo@qoto.org)'s status on Wednesday, 18-Sep-2024 11:27:57 JST 🎓 Doc Freemo :jpf: 🇳🇱

     in reply to

     • argv minus one

     @argv_minus_one

     Right now a doctor tends to be in the "network" of many insurances at the same time, not a single one. Presumably that would still be true under a co-op system. Obviously the size of a provider network would be one of the factors that would make one insurance more appealing than another, but overall id expect you to be just fine switching providers and keeping your doctor.

     Also keep in mind with PPO type insurance you are never required to get a referral so can see any doctor at any time, with out of network being slightly more expensive.

     That said no reason an insurance cant be open to any and all doctors at an appropriate price point.

     @stevebenen

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     argv minus one (argv_minus_one@mastodon.sdf.org)'s status on Wednesday, 18-Sep-2024 11:27:58 JST argv minus one

     in reply to

     • 🎓 Doc Freemo :jpf: 🇳🇱

     @freemo

     Interesting thought.

     I foresee a problem, though. If you must join a co-op to receive care, and can only join one co-op at a time, then the vast majority of care providers are unavailable to you because they belong to a different co-op.

     Moreover, you can't leave your co-op for another one without leaving your entire care team behind and assembling a new one from scratch. You're locked in.

     It's like US health care's “out of network” problem, except even worse.

     @stevebenen

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     🎓 Doc Freemo :jpf: 🇳🇱 (freemo@qoto.org)'s status on Wednesday, 18-Sep-2024 11:55:47 JST 🎓 Doc Freemo :jpf: 🇳🇱

     in reply to

     • Louis Ingenthron
     • argv minus one

     @louis

     As far as i know current insurance isnt prone to corruption as the major issue driving price, it is prone to greed, which is a legal though undesired factor that is very different from corruption.

     As for the smaller co-ops not having negotiating power, since no insurance is driven by greed who would they competing against to negotiate. There would be no motivator for insurance to have **exclusive** deals. Doctors would want the largest networks, and insurance companies would want the largest, and there would be very little preventing that in most cases. Expensive doctors might prefer more expensive insurance, but if the patients of those doctors are likewise the owner inthe practice (not just in the insurance) even that goes away since the doctor is no longer setting their own price, their owner (the patients) are.

     @argv_minus_one @stevebenen

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     Louis Ingenthron (louis@ingenthron.social)'s status on Wednesday, 18-Sep-2024 11:55:48 JST Louis Ingenthron

     in reply to

     • 🎓 Doc Freemo :jpf: 🇳🇱
     • argv minus one

     @freemo @argv_minus_one @stevebenen I'd think the bigger problem is that smaller co-ops wouldn't have negotiating power while bigger co-ops would need a management structure that would be very prone to corruption and operate not too dissimilarly from the current providers.

     Then there would be the thorny questions of "can co-ops buy out or merge with other co-ops?" and "what happens when consolidation runs amok and anti-competitive practices proliferate?"

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     🎓 Doc Freemo :jpf: 🇳🇱 (freemo@qoto.org)'s status on Wednesday, 18-Sep-2024 12:01:25 JST 🎓 Doc Freemo :jpf: 🇳🇱

     in reply to

     • ≠
     • argv minus one

     @amerika @stevebenen @argv_minus_one

     And to answer your question, it would be like any other business. As long as a majority of the owners approve a merger, they can merge. Anti-competitive practices (anti-trust laws) would apply as usual. Something we dont enforce enough in the USA as we should, but we need to enforce that or the whole economy doesnt work.

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     🎓 Doc Freemo :jpf: 🇳🇱 (freemo@qoto.org)'s status on Wednesday, 18-Sep-2024 23:45:42 JST 🎓 Doc Freemo :jpf: 🇳🇱

     in reply to

     • ≠
     • argv minus one

     @amerika

     Even a brolen clock is right twice a day.

     Harris/Biden and Trump are both morons. That said you can fibd a few isolated examples of things thry modsrately improved. Whether they deserve the credit is debatable even then however.

     @stevebenen @argv_minus_one

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     ≠ (amerika@annihilation.social)'s status on Wednesday, 18-Sep-2024 23:45:43 JST ≠

     in reply to

     • 🎓 Doc Freemo :jpf: 🇳🇱
     • argv minus one
     @freemo @stevebenen @argv_minus_one
     
     Amazingly, antitrust enforcement resumed under Trump.
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     🎓 Doc Freemo :jpf: 🇳🇱 (freemo@qoto.org)'s status on Wednesday, 18-Sep-2024 23:47:46 JST 🎓 Doc Freemo :jpf: 🇳🇱

     in reply to

     • ≠
     • argv minus one

     @amerika

     No not correct. Why would a doctor whonprovides no emergency services of any kind raise their prices? Most medical practices dont offer or have any connection to emergency services.

     @stevebenen @argv_minus_one

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     ≠ (amerika@annihilation.social)'s status on Wednesday, 18-Sep-2024 23:47:47 JST ≠

     in reply to

     • 🎓 Doc Freemo :jpf: 🇳🇱
     • argv minus one
     @freemo @stevebenen @argv_minus_one
     
     The price of emergency services going up means that doctors will charge more for the same services, correct?
     
     Doctors use the same insurance that hospitals use, correct?
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     🎓 Doc Freemo :jpf: 🇳🇱 (freemo@qoto.org)'s status on Wednesday, 18-Sep-2024 23:48:53 JST 🎓 Doc Freemo :jpf: 🇳🇱

     in reply to

     • ≠
     • argv minus one

     @amerika

     The democrats have a disturbing history of not following through. If they actually solved problems how would they co vince us we still need them?

     @stevebenen @argv_minus_one

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     ≠ (amerika@annihilation.social)'s status on Wednesday, 18-Sep-2024 23:48:54 JST ≠

     in reply to

     • 🎓 Doc Freemo :jpf: 🇳🇱
     • argv minus one
     @freemo @stevebenen @argv_minus_one
     
     I liked some aspects of Joe Biden's environmental policy but the follow-through appears to have gotten suspended in amber or something.
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     🎓 Doc Freemo :jpf: 🇳🇱 (freemo@qoto.org)'s status on Wednesday, 18-Sep-2024 23:59:02 JST 🎓 Doc Freemo :jpf: 🇳🇱

     in reply to

     • ≠
     • argv minus one

     @amerika

     Dont confuse hospitals with practices that may operate out of a hospital but is seperate. Generally hospitals are for emergencies or overnight stays. And yes one might expect overnight stays at a hospital to increase in price.

     But we are talking about general practituoners. They arent hospitals, they arent even competing with hospitals. Theyboffer entierly unrelated and isolated services.

     Its like arguing a tax on apples would cause an increase the proce of 2x4 because they are both something a construction worker might buy.

     @stevebenen @argv_minus_one

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     ≠ (amerika@annihilation.social)'s status on Wednesday, 18-Sep-2024 23:59:03 JST ≠

     in reply to

     • 🎓 Doc Freemo :jpf: 🇳🇱
     • argv minus one
     @freemo @stevebenen @argv_minus_one
     
     If a doctor offers a service at a lower price, he is both losing money and signaling that the service is lower quality.
     
     Emergency rooms are connected to the hospitals who absorb EMTALA costs.
     
     And they are significant... look at how many hospitals, especially rural, have closed in the illegal immigrant belt.
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     🎓 Doc Freemo :jpf: 🇳🇱 (freemo@qoto.org)'s status on Thursday, 19-Sep-2024 00:05:36 JST 🎓 Doc Freemo :jpf: 🇳🇱

     in reply to

     • ≠
     • argv minus one

     @amerika

     About 4%

     No not sure i see your point. Why would refering to a hospital at only 4% have a major effect? Also the bill your talki g about would only drive up prices in the case of the uninsured who dont pay. If they cant afford insurance or to pay why would they have a gp to begin with?

     @stevebenen @argv_minus_one

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     ≠ (amerika@annihilation.social)'s status on Thursday, 19-Sep-2024 00:05:37 JST ≠

     in reply to

     • 🎓 Doc Freemo :jpf: 🇳🇱
     • argv minus one
     @freemo @stevebenen @argv_minus_one
     
     GPs get what percentage of their clients from hospital references, and send their patients to where for specialized testing?
     
     I think you can see my point.