2020 Candidate Speculation

[jaygee]

Dec 17, 2019 13:25:22 GMT -6 dc2london said:

The debate will happen!

I’m glad the workers got a contract. I’m not enthused for another debate.

[punker1212]

I just read that EW flipped her M4A stance to choice.

ETA: in reading beyond the headlines, she’s just altering her verbiage regarding her already existing plan. My bad.

www.cnn.com/2019/12/16/politics/elizabeth-warren-choice-medicare-for-all-transition-iowa/index.html

[Uncaripswife]

I don't know exactly how to share a tweet, but this thread is what I was getting at re Buttigeig's talking about health coverage and "choice." It's all fake and Democrats shouldn't be using the GOP talking points. Republicans don't get to frame our message.

[greykitty]

One thing that I still get very confused about Warren and/or Sanders and their Medicare for All proposals - are they really basically talking Medicare Advantage (and closing classic Medicare) or are they talking Classic Medicare with added benefits - but many subscribers would still be purchasing Medigap plans? I know I'm not overly keen on current Medicare Advantage (but I was never a huge fan of HMOs, to tell you the truth, and always opted to a PPO instead - yes, it was good for me that I had a large employer who self-insured and was really into providing several tiers of healthcare). Bernie always sounds like Medicare Advantage to me.

I think Warren started backing down on her verbiage re M4A some weeks back but not sure it's helping her in the polls yet.

I do think there has to be a solid response to people's concerns about 'how' this would all work - saying let's see how people like it after they try it may not assuage fears, especially if they've had either less than stellar HMO or VA experiences. Or seniors' fears regarding the effect on current Medicare holders.

[jaygee]

Dec 17, 2019 18:10:00 GMT -6 greykitty said:

One thing that I still get very confused about Warren and/or Sanders and their Medicare for All proposals - are they really basically talking Medicare Advantage (and closing classic Medicare) or are they talking Classic Medicare with added benefits - but many subscribers would still be purchasing Medigap plans? I know I'm not overly keen on current Medicare Advantage (but I was never a huge fan of HMOs, to tell you the truth, and always opted to a PPO instead - yes, it was good for me that I had a large employer who self-insured and was really into providing several tiers of healthcare). Bernie always sounds like Medicare Advantage to me.

I think Warren started backing down on her verbiage re M4A some weeks back but not sure it's helping her in the polls yet.

I do think there has to be a solid response to people's concerns about 'how' this would all work - saying let's see how people like it after they try it may not assuage fears, especially if they've had either less than stellar HMO or VA experiences. Or seniors' fears regarding the effect on current Medicare holders.

My understanding is Medicare with expanded benefits and coverage.

So right now - Medicare doesn’t cover things like hearing aids or certain tests or procedures. Patients sign an notification and then we can bill them for things not covered by their Medicare. That would go away.

And then also copays (what people use Medicare supplemental insurance for now or Medicaid if they are dual eligible) would go away. I assume also lifetime reserve days and basically all the need for a secondary plan other than Medicare goes away.

I was under the impression that all insurance companies would go away due to lack of need (if everything is covered and their is no patient portion what is the need for anyone to have more insurance)

That’s part of why I preferred Kamala’s plan because I don’t think eliminating all private insurance is a great idea I like greatly reducing its need and influence and maybe one day eliminating it.

[jaygee]

I think the fear on the effect of current Medicare patients is easy to explain. Basically with Medicare all providers are in network (very small situations where a provider wouldn’t be - some because they have been suspended from the program which is yikes and some other very nuanced situations) so there is not going to be a flood of patients going to the Medicare providers that previously only Medicare patients had access to. In fact it is the true “if you like your provider you can keep her/him” situation (sorry Obama). There may be some flood of previously uninsured patients seeking care once they have coverage, but we’ve sort of already absorbed some of that with the ACA and the rush never materialized as much as it was feared when the ACA went into effect. Most people are still going to wait until they get sick because they are humans and hate going to the doctor until they have to.

[punker1212]

Dec 17, 2019 18:27:44 GMT -6 jaygee said:

Dec 17, 2019 18:10:00 GMT -6 greykitty said:

One thing that I still get very confused about Warren and/or Sanders and their Medicare for All proposals - are they really basically talking Medicare Advantage (and closing classic Medicare) or are they talking Classic Medicare with added benefits - but many subscribers would still be purchasing Medigap plans? I know I'm not overly keen on current Medicare Advantage (but I was never a huge fan of HMOs, to tell you the truth, and always opted to a PPO instead - yes, it was good for me that I had a large employer who self-insured and was really into providing several tiers of healthcare). Bernie always sounds like Medicare Advantage to me.

I think Warren started backing down on her verbiage re M4A some weeks back but not sure it's helping her in the polls yet.

I do think there has to be a solid response to people's concerns about 'how' this would all work - saying let's see how people like it after they try it may not assuage fears, especially if they've had either less than stellar HMO or VA experiences. Or seniors' fears regarding the effect on current Medicare holders.

My understanding is Medicare with expanded benefits and coverage.

So right now - Medicare doesn’t cover things like hearing aids or certain tests or procedures. Patients sign an notification and then we can bill them for things not covered by their Medicare. That would go away.

And then also copays (what people use Medicare supplemental insurance for now or Medicaid if they are dual eligible) would go away. I assume also lifetime reserve days and basically all the need for a secondary plan other than Medicare goes away.

I was under the impression that all insurance companies would go away due to lack of need (if everything is covered and their is no patient portion what is the need for anyone to have more insurance)

That’s part of why I preferred Kamala’s plan because I don’t think eliminating all private insurance is a great idea I like greatly reducing its need and influence and maybe one day eliminating it.

The issue with keeping private insurers is it fails to address the huge administrative costs providers incur dealing with them. So we won’t see as big of a cost savings if we are still paying many many people and labor hours to providers dealing with the headaches of private insurers.

But, in spite of my M4A love, I always say it has to be done well and done right and include direct care providers in the policy. Otherwise, yeah, I could see some major issues.

[greykitty]

jaygee, do you have a feeling how much either premiums would go up for Medicare under this type of system, or, how much taxes for seniors would go up if premiums were eliminated? I do agree with Bernie here that there is no way a transition will happen without a big increase in taxes - and how many people will see a benefit, or even a wash, in the first years may be difficult to calculate. Be interesting what sort of grandfathering would take place for those who'd completed all the necessary quarters of Medicare taxes paid into the system.

I guess I'm a little more anxious about all those economies of scale we'd supposedly start seeing, and what if we don't - I'm also concerned about how providers/hospitals stay in business at the current Medicare reimbursement rate. Or, if the labor portion goes down a lot with simplified billing, how does the economy absorb all the ancillary employees affected? I thought I saw Warren mentioned a transitional training program in response to Iowa questions.

I was basically assuming that many drugs and tests Medicare or Part D doesn't cover now would still not be covered, or would require physician intervention to obtain. I'd seen the talk about hearing aids and eye care, and I know adding that, assuming access to any provider, not dictated as it is currently in Medicare Advantage, would no doubt be very popular. I'm still having a hard time grasping the budget transition here, obviously. And still working on how employers would be expected to pay into this - if I understand that as an essential part of the budget process.

You know, I was thinking there might be an increase in concierge medical practices if M4A really happens soon, or the same sort of private insurance I understand a lot of European countries still have to allow subscribers to, how to word it, move up the queue faster for non critically essential treatments.

In any event, I think we're realistically still a good generation away from a major transformation - but looking how long it took to implement Medicare to start out with, a generation isn't all that bad.

[greykitty]

Dec 17, 2019 18:36:10 GMT -6 jaygee said:

I think the fear on the effect of current Medicare patients is easy to explain. Basically with Medicare all providers are in network (very small situations where a provider wouldn’t be - some because they have been suspended from the program which is yikes and some other very nuanced situations) so there is not going to be a flood of patients going to the Medicare providers that previously only Medicare patients had access to. In fact it is the true “if you like your provider you can keep her/him” situation (sorry Obama). There may be some flood of previously uninsured patients seeking care once they have coverage, but we’ve sort of already absorbed some of that with the ACA and the rush never materialized as much as it was feared when the ACA went into effect. Most people are still going to wait until they get sick because they are humans and hate going to the doctor until they have to.

Medicare Advantage programs have pretty strict networks, even in states where there is a lot of competition.  I once ran a provider search between classic Medicare and several MA programs - in all cases, the MA programs didn't cover the desired gyn or eye care provider (eye care ended up being Pearl Vision, IIRC).  Classic Medicare covered the desired providers, but, of course, was more expensive under a certain matrix.  Hence my concern about what exactly Sanders or Warren are talking about - more the HMO/MA model or classic Medicare.  I would think they have to be very careful in their wording about how it would be styled - nothing like riling up seniors and those close to that stage prior to an election.

Now, if it could be finagled that all current Medicare providers would be available to subscribers, that would go a long way to helping those fears. 

Now, even under ACA, didn't a lot of previously uninsured run into deductibles higher than they were comfortable with, and thus not seek out care?  With M4A, I think one question is that, hey, the insured has no immediate financial skin in the game, so off to the doctor they go fairly quickly (yes I know that's a good thing conceptually and it's actually what we want to happen, including a huge increase in utilizing preventive care) but would that create the rush on providers?

Heck, even under Medicare a lot of people are still terrified of calling for ambulance service due to the costs.   

[jkjacq]

Medicare afaik doesn’t cover maternity or pediatrics at the moment so yes there would be revamping of the plan probably closer to a tricare one

Yes your taxes might go up but
I pay almost five hundred a month in premium for my daughter. That is about 45% of the actual premium my employer picks up. As an employee they cover my medical premium at 100% it’s part of my fringe benefits

And that is REALLY good. Most companies don’t cover Med for employees at the total cost.

Right now I’m paying about four hundred to Medicare per month.

Now the actuarial table will tell you the more people paying into premium the lower the premium is. So while my taxes might go up so theoretically would my salary because my employer no longer has that fringe to offer me. It’s close to a wash.
My dads true blue ma plan costs him ~120/month with 5k ded. His medical bills typically run to half to three quarters of a million (yes million) dollars a year. His last extended hospital stay with a week in icu was half a million and it was his second this year. He’s had another since.

Even with that claims experience his premium isn’t rising exponentially.

My point is this can’t be broken into talking points about taxes because there is so much more to it.

So I will champion M4A alllllllll day long

[Minerva]

jaygee and Uncaripswife, what do you think about the point that many of the increases in healthcare costs are being driven by financiers who own the hospitals and medical practice groups? I know my friends with MDs complain about this stuff all the time - they basically all work for corporate groups that manage physicians on a regional or national scale. The doctors have minimal control over pricing, appointment durations, or even their own scheduling. They are pushed by management to bill for more things and spend less time with patients. I’ve also
increasingly seen the nickel-and-dining and inflated costs in our medical bills.

Thread with a few links:

It seems to me that being able to set prices and reduce the bureaucracy on the provider side are important to stop the rapid rise in healthcare costs and would be hard to accomplish without M4A. Would an expansion of Medicaid with more stringent regulations of private insurance be able to address this?

I find all of this stuff very confusing to sort through. I really appreciate the knowledge you bring to the discussion!

[dc2london]

Dec 16, 2019 20:30:25 GMT -6 punker1212 said:

Dec 14, 2019 9:57:17 GMT -6 dc2london said:

Man, I really like you

Well, don't get too excited!

Bernie's biggest problem, in my opinion, after letting it marinate a lot, is that he historically has approached his policies all from the privileged perspective that inequality issues are all economic, and if the economic inequalities are addressed, the racial/gender/etc inequalities will work themselves out.

I think he has learned some from 2016 and has worked to include more voices in his campaign this time around, but it's still there. I have to own this because I know for a long time this was part of my worldview too. I grew up and expanded my worldview and have done a lot of antiracism self work and just lived more life to see that in addition to economic injustice there also is a strong current of white supremacy and misogyny that is part of our structural and cultural history (and present) that won't be cured by economics. So, white privilege is so real and I keep doing work in that respect; I hope I never stop learning, growing, and pushing for change.

That being said, right now I think he is still my preferred candidate. He is authentic and many of his policies align with my values; he will probably do well with swing voters (but not the olds! Socialism!) and has drawn so  many into the political process. His ambition to limit "big money" in politics is essential to getting the government more functional, and in 2016 during a debate he was asked what our biggest national security threat was, and responded climate change. He was right and I think he does have a lot of foresight.

I really value this discourse. I am more open minded now and am more excited to watch the primary unfold before my state votes. I hope to stick around to hear more!

If any of this was supposed to make me side eye you, you failed 😜

[punker1212]

Minerva, I'm not an expert on this by any means. But, as an RN, I would absolutely agree that insurers and pharmaceuticals are only a piece of the problem and that the corporatization of healthcare is absolutely driving costs up. Will agree with your points about limitations providers have set by healthcare administrators- and a huge problem is that healthcare groups are gobbling up independent practices and community hospitals left and right, which has made competition nonexistent. The amount of healthcare execs/administrators is mind-blowing and completely unnecessary to providing services. So yeah, in my lay-person opinion, M4A has to come with some very heavy regulation to really change the system, which we have to be willing to do. Everyone is burnt out as is, trying to function in an imploding system.

[punker1212]

Dec 17, 2019 19:37:53 GMT -6 dc2london said:

Dec 16, 2019 20:30:25 GMT -6 punker1212 said:

Well, don't get too excited!

Bernie's biggest problem, in my opinion, after letting it marinate a lot, is that he historically has approached his policies all from the privileged perspective that inequality issues are all economic, and if the economic inequalities are addressed, the racial/gender/etc inequalities will work themselves out.

I think he has learned some from 2016 and has worked to include more voices in his campaign this time around, but it's still there. I have to own this because I know for a long time this was part of my worldview too. I grew up and expanded my worldview and have done a lot of antiracism self work and just lived more life to see that in addition to economic injustice there also is a strong current of white supremacy and misogyny that is part of our structural and cultural history (and present) that won't be cured by economics. So, white privilege is so real and I keep doing work in that respect; I hope I never stop learning, growing, and pushing for change.

That being said, right now I think he is still my preferred candidate. He is authentic and many of his policies align with my values; he will probably do well with swing voters (but not the olds! Socialism!) and has drawn so  many into the political process. His ambition to limit "big money" in politics is essential to getting the government more functional, and in 2016 during a debate he was asked what our biggest national security threat was, and responded climate change. He was right and I think he does have a lot of foresight.

I really value this discourse. I am more open minded now and am more excited to watch the primary unfold before my state votes. I hope to stick around to hear more!

If any of this was supposed to make me side eye you, you failed 😜

Haha, well there is still time! The foot always ends up in the mouth eventually.

[jaygee]

Dec 17, 2019 18:53:31 GMT -6 punker1212 said:

Dec 17, 2019 18:27:44 GMT -6 jaygee said:

My understanding is Medicare with expanded benefits and coverage.

So right now - Medicare doesn’t cover things like hearing aids or certain tests or procedures. Patients sign an notification and then we can bill them for things not covered by their Medicare. That would go away.

And then also copays (what people use Medicare supplemental insurance for now or Medicaid if they are dual eligible) would go away. I assume also lifetime reserve days and basically all the need for a secondary plan other than Medicare goes away.

I was under the impression that all insurance companies would go away due to lack of need (if everything is covered and their is no patient portion what is the need for anyone to have more insurance)

That’s part of why I preferred Kamala’s plan because I don’t think eliminating all private insurance is a great idea I like greatly reducing its need and influence and maybe one day eliminating it.

The issue with keeping private insurers is it fails to address the huge administrative costs providers incur dealing with them. So we won’t see as big of a cost savings if we are still paying many many people and labor hours to providers dealing with the headaches of private insurers.

But, in spite of my M4A love, I always say it has to be done well and done right and include direct care providers in the policy. Otherwise, yeah, I could see some major issues.

Oh yeah, I definitely agree with that long term. I just think it needs to be a gradual transition. I favor putting almost everyone on Medicare. I think unions that negotiated insurance should be phased in and I think supplemental insurance should exist for a period.

[jenna]

ResistBot messaged me asking to participate in a poll, and you see the results after you vote. Here are the results, I thought it was interesting, I would guess it is mostly comprised of young people.

[jaygee]

Out to dinner...be back to talk healthcare later. You know my love.

[punker1212]

Dec 17, 2019 19:54:40 GMT -6 jenna said:

ResistBot messaged me asking to participate in a poll, and you see the results after you vote. Here are the results, I thought it was interesting, I would guess it is mostly comprised of young people.

Williamson scores higher than Booker??

[greykitty]

jkjacq, I think one question would be why in the world would employers give raises to their employees if the employer is no longer paying for insurance. I think Sanders/Warren try to address this from a legislative standpoint and having employers pay increased payroll taxes to fund M4A , but I've seen nothing to indicate employers are leaping at the idea of increasing salaries, rather than investing that supposed 'found money' into other corporate interests; and what about people who are not working and now facing these increased taxes?

And my point about tax talking points - voters are going to be worried about tax increases - it's going to be a very easy campaign item to bring up. Real answers need to be there. It may not be the sexiest, most philosophical discussion point - but tax increases drive votes, not always in the direction people desire. And, of course, any M4A would require a major tax law restructuring - many of us remember just how fun doing that is.

And, honestly, I don't think Tricare is going to be a huge selling point to people who have good employer insurance, let alone union folks.

Again, I wouldn't be surprised if 25 years from now healthcare will look much different than today - I have absolutely no confidence that anything will happen sooner than that.

[jenna]

Dec 17, 2019 19:59:43 GMT -6 punker1212 said:

Dec 17, 2019 19:54:40 GMT -6 jenna said:

ResistBot messaged me asking to participate in a poll, and you see the results after you vote. Here are the results, I thought it was interesting, I would guess it is mostly comprised of young people.

Williamson scores higher than Booker??

and no Castro :/

[bunnyfungo]

I probably shouldn’t respond because of where I’m at today. But, as someone who currently doesn’t have health insurance, and unless something magical happens before 3am, won’t have health insurance next year, despite TRYING TO GIVE THE GOVERNMENT MY MONEY.....I dgaf if your taxes go up for me to be covered 🤷‍♀️🤷‍♀️🤷‍♀️ NOT SORRY.

[jkjacq]

Dec 17, 2019 20:04:56 GMT -6 greykitty said:

jkjacq, I think one question would be why in the world would employers give raises to their employees if the employer is no longer paying for insurance. I think Sanders/Warren try to address this from a legislative standpoint and having employers pay increased payroll taxes to fund M4A , but I've seen nothing to indicate employers are leaping at the idea of increasing salaries, rather than investing that supposed 'found money' into other corporate interests; and what about people who are not working and now facing these increased taxes?

And my point about tax talking points - voters are going to be worried about tax increases - it's going to be a very easy campaign item to bring up. Real answers need to be there. It may not be the sexiest, most philosophical discussion point - but tax increases drive votes, not always in the direction people desire. And, of course, any M4A would require a major tax law restructuring - many of us remember just how fun doing that is.

And, honestly, I don't think Tricare is going to be a huge selling point to people who have good employer insurance, let alone union folks.

Again, I wouldn't be surprised if 25 years from now healthcare will look much different than today - I have absolutely no confidence that anything will happen sooner than that.

To the first point only because attractive benefit plan attracts good employees
Health insurance is typically part of your compensation. So to compete for talent they have to figure out something if insurance is off the table.

I also don’t think insurance should be tied to employment so there’s that.

Full disclosure my company will raise an employee wage when they reach Medicare eligible age to move them off our plan.

[blurnette989]

The talking needs to be yes, your taxes may go up a bit but you will no longer pay premiums, copays or deductibles. That is huge.

I pay more in taxes in Portugal. My employer pays substantially more in taxes to have me work in Portugal. But, I have the security of knowing that if I get into a car accident, I will not have to pay anything. ZERO.

That's what people need to emphasize.

Also greykitty you asked about taxes going up on someone not working, what taxes are you referring to? If someone lacks income they aren't paying taxes, right?

[dc2london]

Minerva we have twice gotten letters from PCP type physicians requiring what amounts to an annual medical membership fee bc they refused to be bought up by administrators who would slash patient contact time and demand more testing, but couldn't stay in business otherwise. We are fortunate to live in an area with plenty of providers, and we were able to decide for ourselves how to proceed, but far, far too many Americans are living in healthcare deserts

[Uncaripswife]

Minerva I suspect that if M4A were implemented the govts tight pricing controls would make owning hospitals and physician practices less profitable and so venture capitalists would get out of the business. But I think jaygee has more experience with healthcare financing than I do, so maybe she will weigh in.

[Sundae]

I would so much rather pay more taxes to have everyone covered. We already pay 13k a year in premiums. I don’t think our taxes would go up that much, but if they did? Meh. I want everyone to have healthcare. And college. And parental leave.

[Peekaru]

Dec 18, 2019 8:24:39 GMT -6 Sundae said:

I would so much rather pay more taxes to have everyone covered. We already pay 13k a year in premiums. I don’t think our taxes would go up that much, but if they did? Meh. I want everyone to have healthcare. And college. And parental leave.

I have a really excellent piece that I use at work regarding taxes. Essentially, tax cuts really started around the Reagan year and have been dropping since then. Currently, all programs are underfunded/ will be underfunded in the US unless taxes are raised. The platform of tax cuts is a lie, and I appreciate candidates saying that taxes will go up. 

I would gladly pay more in taxes to pay less in healthcare costs; but I also recognize that I am very lucky to be on a health care plan supported by a large company. 

[jaygee]

Dec 18, 2019 8:29:55 GMT -6 Peekaru said:

Dec 18, 2019 8:24:39 GMT -6 Sundae said:

I would so much rather pay more taxes to have everyone covered. We already pay 13k a year in premiums. I don’t think our taxes would go up that much, but if they did? Meh. I want everyone to have healthcare. And college. And parental leave.

I have a really excellent piece that I use at work regarding taxes. Essentially, tax cuts really started around the Reagan year and have been dropping since then. Currently, all programs are underfunded/ will be underfunded in the US unless taxes are raised. The platform of tax cuts is a lie, and I appreciate candidates saying that taxes will go up. 

I would gladly pay more in taxes to pay less in healthcare costs; but I also recognize that I am very lucky to be on a health care plan supported by a large company. 

This might align with your interests.

[jaygee]

Guys I really want to come and talk healthcare with y’all but I am so busy right and want to be able to fully digest the conversation so far and give thoughtful comments.

I’m a M4A supporter. It’s just a matter of how and when we get there. But more thoughts to come.

[Peekaru]

Dec 18, 2019 8:41:54 GMT -6 jaygee said:

Dec 18, 2019 8:29:55 GMT -6 Peekaru said:

I have a really excellent piece that I use at work regarding taxes. Essentially, tax cuts really started around the Reagan year and have been dropping since then. Currently, all programs are underfunded/ will be underfunded in the US unless taxes are raised. The platform of tax cuts is a lie, and I appreciate candidates saying that taxes will go up. 

I would gladly pay more in taxes to pay less in healthcare costs; but I also recognize that I am very lucky to be on a health care plan supported by a large company. 

This might align with your interests.

Oooooo!!! Graphs! I love a graph.