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View Diary: Senate Dems could blow this (283 comments)

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  •  I do not want Medicare for All, thank you (2+ / 0-)
    Recommended by:
    Elise, liberalpercy

    I want it to be a separate public plan as outlined by Schumer.

    "Those are my principles, and if you don't like them... well, I have others." - G. Marx

    by Skeptical Bastard on Wed May 06, 2009 at 08:37:09 AM PDT

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    •  Your reasoning, Mr. Bastard? nt (4+ / 0-)

      "Well, yeah, the Constitution is worth it if you can succeed." -Nancy Pelosi, 6/29/07.

      by nailbender on Wed May 06, 2009 at 08:49:17 AM PDT

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      •  Doctors will opt out (0+ / 0-)

        "Those are my principles, and if you don't like them... well, I have others." - G. Marx

        by Skeptical Bastard on Wed May 06, 2009 at 08:58:47 AM PDT

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        •  Then perhaps (5+ / 0-)

          they can also opt out of the trillions in federal subsidies they receive for building hospitals, parking garages, etc.

          A conservative is a man with two perfectly good legs who, however, has never learned how to walk forward. FDR

          by Betty Pinson on Wed May 06, 2009 at 09:02:04 AM PDT

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          •  trillions? (0+ / 0-)

            "Those are my principles, and if you don't like them... well, I have others." - G. Marx

            by Skeptical Bastard on Wed May 06, 2009 at 09:08:11 AM PDT

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            •  Doctors love Medicare...they would not opt out. (5+ / 0-)

              I am an RN working in health care for 30 years. POhysicians love medicare ans they are assured payment, it is highly efficient, etc.
              They would not opt out.
              Have you seen "Sick Around the World"...the frontline program investigation universal health care in industrialized Nations? A Public option is key in all the successful universal plans out there.

              •  Many doctors do opt out already. (3+ / 0-)

                The public option Schumer suggests is better for everyone - it's non-profit, so the doctors and hospitals get a fair wage for the services they're providing and the beneficiaries get good coverage.

                You don't want an expansion of Medicare - for 2 main reasons.

                1. At the moment, providers push off onto all their other patients the extra costs of providing for Medicare beneficiaries - the costs that the Medicare payments simply don't cover. These providers simply cannot operate on such a low scale of payment - not for everyone. For a segment of the population, sure.
                1. The risk pool is too large. If you have a relatively healthy pool of people to insure in a public option, you can bargain for the lowest prices. The more people on the plan, the more bargaining power you've got. We will be able to make the public more affordable than Medicare (for a family). That's a necessity because Medicare is not a family option. The costs are individual and they aren't cheap. This is an unhealthy pool of beneficiaries. Let them stay in their own group - covered by Medicare. The public option will be cheaper this way.
                •  Yes.. I agree.. (1+ / 0-)
                  Recommended by:
                  Elise

                  with everything you said.

                  One other consideration is this.. We have a population of primary care providers that is aging, and many are nearing retirement.  If they chose to opt out of a "medicare for all" plan, there is a worry many will simply choose early retirement.

                  We have a primary care crisis already in this country, we don't need to exacerbate that problem at a time when we will need even more primary care providers that ever!

                  "Those are my principles, and if you don't like them... well, I have others." - G. Marx

                  by Skeptical Bastard on Wed May 06, 2009 at 10:49:01 AM PDT

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                  •  Yesterday Senator Harkin addressed the problem (2+ / 0-)
                    Recommended by:
                    askew, Elise

                    of lack of primary care doctors. He suggested a bill that would put a person through medical school in return for a fair return on their education if they practice as primary care physicians for a period of time. Didn't give details.  But it is an interesting concept.

                    part of the reason the health care system is so costly is the over abundance of highly paud specialists and less well paid general practitioners.

                    people are acting as though it is an either/or sitation. It is NOT. The entire system, plus the way Americans consume health care, requires a massive overhaul and change of mindset.

                    •  yup.. I am hoping (3+ / 0-)
                      Recommended by:
                      luvmovies2000, Elise, soccergrandmom

                      the introduction of these mini-clinics in drugstores and even wal-mart will help this situation as we move forward.

                      The nurse-practitioners that run them, with consultation of an MD if necessary, can take quite a load off of primary care physicians.

                      It would be nice to see a public option (and even private insurers) pay for the entire visit to these facilities with no co-pays.  That would encourage their use.

                      It's criminal to see mother's bringing babies into the Emergency Room when they have no more than a case of the sniffles.. it's just plain bad management.

                      Like you said.. we need an overhaul of the way we consume and even think about health care.

                      "Those are my principles, and if you don't like them... well, I have others." - G. Marx

                      by Skeptical Bastard on Wed May 06, 2009 at 02:34:59 PM PDT

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                      •  I myself attend a group clinic that includes (1+ / 0-)
                        Recommended by:
                        Elise

                        various specialists. I see the nurse practitioner and she is every bit as competent as any physician I have ever seen.  They also have an excellent dermatologist who visits regularly plus is available to see in two other locations in nearby towns.  They all share the record keeping load and all one's records are available if one needs a specialist for heart for example.

                        My daughter in law, a brilliant graphic designer has gone back to school to study to be a physicians assistant. my other grandaughter's biological lesbian mother has also gone back to school to be a registered nurse.  People are already taking more responsibility for both their own health and their participation in the health field in the group I am associated with.

                        And as i have said if i should feel that my own health will be a drain on my families financial and capabilities as I grow older i shall not hesitate to return to England for my last days, or maybe even the Netherlands.  We all have options and choices.

                        I doubt if many people would carry car insurance if it wasn't mandatory so maybe a minimum basic menu of mandatory health insurance might be part of the beginning steps. At least that would widen the pool.

                        That suggestion will probably elicit a slew of you are an elitist bloated plutocrat who does not understand the plight of poor people barbs. Actually I have spent a great deal of my life living and working amongst people who make a dollar a day and for whom a $2 malaria net is a life saver.  So I personally don't take too much notice of the poor pitiful us crowd.  But then I am one of those unpatriotic people who believe that the dream for a better life is not for Americans only. Sorry.  Sometimes i get pretty mad.

                •  Its an easy fix (3+ / 0-)
                  Recommended by:
                  SarahLee, Brooke In Seattle, indres

                  Increase reimbursement to doctors under a public plan.

                  But killing off publicly funded health care programs is a big loser for real people, and unless doctors enjoy seeing people die for lack of health care, they'll want to see a better system too.  So far, I'm not convinced that all doctors want to see everyone in ths country have access to affordable health care.  Most do, but not all.  Such a shame, but that's America for you.

                  A conservative is a man with two perfectly good legs who, however, has never learned how to walk forward. FDR

                  by Betty Pinson on Wed May 06, 2009 at 10:53:40 AM PDT

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        •  No way (3+ / 0-)
          Recommended by:
          ferg, Brooke In Seattle, Ozzie

          If everyone is joining a public plan (or better single payer) they won't have any patients if they opt out.  That is just silly.

          •  You haven't thought this out.. (0+ / 0-)

            If everyone is joining a public plan

            That is by no means a given.  

            You have to remember, most people are insured already.  People will not drop their existing private plans until they see how successful a public plan is and see what kind of coverage the public plan provides vis-a-vis their own plan.

            So, yes there will be plenty of higher paying patients for quite some time for doctors to service.  If those doctors do not move over to the public plan because it pays shitty rates like medicare, it will have a negative feedback effect on any more people moving over to the public plan.  People won't join if their doctor isn't joining... and as long as their are private insured patients, there is no impetus for doctors to join a low paying public plan.

            Listen.. Schumer is not stupid.  He knows what he's talking about on this and it is key to a public plan working.

            "Those are my principles, and if you don't like them... well, I have others." - G. Marx

            by Skeptical Bastard on Wed May 06, 2009 at 10:59:51 AM PDT

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    •  You'll have a choice (6+ / 0-)

      If you want private insurance, you can still choose it.

      But millions of Americans want the government to use their tax dollars to provide them with a choice of a cost-efficient, sustainable system of health care for all.

      Those who don't want a public plan don't have to choose it.  

      We don't apply this same model to Social Security, why do we need to provide it for publicly funded health care?

      A conservative is a man with two perfectly good legs who, however, has never learned how to walk forward. FDR

      by Betty Pinson on Wed May 06, 2009 at 08:55:55 AM PDT

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      •  Schumer's plan for public option (0+ / 0-)

        creates a separate public plan that will better reimburse doctors and other providers.  I think his requirements for self-sufficiency are good and this plan must be kept separate from Medicare/Medicaid.

        A properly run public plan will provide competition to drop prices by the private insurers.  A crappy expansion of Medicare that no doctor/hospital wants to deal with will be considered a failure.

        "Those are my principles, and if you don't like them... well, I have others." - G. Marx

        by Skeptical Bastard on Wed May 06, 2009 at 09:07:25 AM PDT

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        •  The "self-sufficiency" argument is bogus (7+ / 0-)

          Any publicly funded program is self-sufficient based on the federal government's budget and US citizens' payments into the system for those goods and services.  

          Their request is the equivalent of asking the Dept. of Defense or Social Security to operate as profit centers wholly reliant on external revenue from users to purchase their services.

          A conservative is a man with two perfectly good legs who, however, has never learned how to walk forward. FDR

          by Betty Pinson on Wed May 06, 2009 at 09:19:58 AM PDT

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      •  Choice is highly over-rated when you're (3+ / 0-)
        Recommended by:
        SarahLee, indres, Betty Pinson

        between a rock and a hard place.

        Medical/surgical care is simply not appropriate for the market because, if it's successful, it's like fire suppression in that there's less and less need.  The market aims for increasing profit by increasing usage and need.  So, there's a counter-incentive to provide quality care.

        Insurers taking 30% out of the pot for unnecessary paper-work is another matter.

        The insurance industry has been a convenient capital accumulator by covering relatively rare events.  Illness, injury and disease are not rare and, indeed, increasingly prevalent as a consequence of industrial contamination and the increased longevity that resulted from improved sanitation in an earlier era.
        Of course, if the health professionals are to be believed, that increased longevity with which big end of life costs are associated is about to terminate.  Instead, we can look for chronic ailments  to increase costs.

        How do you tell a predator from a protector? The predator will eat you sooner rather than later.

        by hannah on Wed May 06, 2009 at 09:32:32 AM PDT

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