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Interestingly, this is exactly what the Republicans said during the ACA negotiations. The old system could have been fixed without doing this by making small changes instead of upending the whole thing. So I find your protestations, when your preferred party isn’t the one leading the charge, somewhat amusing.

As someone who isn’t an R or a D, I don’t give a crap about who wins and loses, I only care about enacting solutions that work. Nothing proposed by either party in the last few years about healthcare is even close.

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Speaking of changes, physicians and residency programs would need to be changed radically if your program to increase the number of doctors was implementable. If you don’t find and increase the number of specialty residency programs available you will just dump a bunch of general practitioners on the market who won’t earn enough to pay back their debt.

I don’t see this as a larger obstacle than passing a healthcare bill with no debate or analysis that will remake 1/6 of the economy. Also, as far as I remember, there is still a huge shortage of GPs. So we could do with a glut of them until newer specialist programs have time to ramp up. I actually see this as a feature, not a bug. Even if there was a problem, there’s an easy solution; let people take their residency in a few other countries, and then have them practice here as long as they pass the USMLEs and boards. Do we really think our residency is so different from that in all of Europe that it’s simply not translatable? My father in law and a lot of people I know had to redo their residencies when they came here with a medical degree in hand – that’s silly, in my opinion.

Also, sorry but GPs makes an average of $150-180k a year – that is enough to pay back debt, even $200k worth of it. There is a larger problem with student debt in this country and most of them will already be in so much debt from undergrad anyways. Doctors make well above the level required to make their degree worth it.

I also have to agree with @ClaudnDaye that you will not be removing paperwork for doctors with this new legislation in any way, shape or form. There are a lot of elements of most jobs that people hate. To me, dealing with insurance companies is odious but really not any worse than some of the red tape that many people have to deal with in their jobs.

It’s a reconciliation bill so they’re not going to trim any of the fat or bureaucracy, they’re just going to create a math problem with no solution, and then who knows what happens when the whole system implodes.

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See my post from above:
Nothing proposed since the ACA from either party is what I would call good.

The current ACA system is set to implode, whether the proposed solution works or not doesn’t really bother me, since we apparently need the system on the brink of failure before anyone seems willing to do anything. Because of this, I support any change being offered because it at least offers the possibility of improvement.

I find people who wholeheartedly supported the ACA (an unworkable solution) whinging about change frustrating. The R’s at the time asked for small changes to the healthcare system to fix it, and were told to pound sand. Now they are the ones creating change, and the D’s are asking for small changes…

I don’t support either R’s or D’s wholeheartedly, so I never get to “win”, except when good legislation is enacted.

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My mother chose not to have medical insurance for 10 years from 55-64 years of age due to the cost. During that time she had two medical issues. The most serious was a cancer scare that required a surgery. She didn’t have any insurance, and paid as she went for all care. Because she needed surgery, she pre-negotiated everything with the hospital and the physician prior to the procedure and paid cash for the surgery. It was expensive, but she needed it and was able to pay for it after some kind discounts were offered by the facility. It wasn’t all doom and gloom like you are making it. For the most part, people were able to access care if they wanted it. Sure there were examples where this didn’t happen, but there still are today even after ACA…

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I think maybe you had a different experience in the years leading up to the passage of ACA than some of the rest of us.

I was still getting out of college or in grad school, working a number of paid but not full-time internships, and had a number of different short-term plans and crummy health care plans. Like I said, I was denied by one because I had used Retin-A in my teens. All the plans were crummy, none covered much, I was often sprung with surprise medical bills that the doctors and nurses said would be covered, but weren’t. And I spent hours on the phone trying to sort out what the bills were. I literally got married at the courthouse when I did so that when I had to go to an internship in another state where my insurance didn’t apply, that I would still be covered. I mean, do we really want people to be making life decisions like that so they can be covered? To me, the tagline for Obamacare should be “making shotgun weddings obsolete since 2010”

I think many people on here are older, were gainfully employed with good insurance prior to ACA. And they had a really easy time with their insurance and good coverage.

But If that was not you, then your experience with the insurance market at that time was probably abysmal. This I think is the issue with all healthcare. It’s a scarce good so there is no way to allocate it without some people benefiting and others being penalized. In the past, the winners were the employed – who got fairly good cheap health care, presuming they were well enough to work. The people who weren’t employed, were self-employed, between jobs, or just didn’t get decent health care through their employer were living a precarious and fraught existence. Now everyone’s experience is a little more crummy, but people at the bottom have a huge increase in their well-being.

I personally am willing to accept those tradeoffs in exchange for protecting those more vulnerable classes of people. I had a friend who had an aneurysm at 28 – thank goodness San Francisco had a law mandating that restaurant workers get insurance coverage – or she would be totally broke and wouldn’t have gotten the rehabilitation she needed. I had another who developed leukemia as a 25-year-old fresh out of grad school and was saved by Romneycare. Another got breast cancer in her early 20s and went broke. I had a housemate who got into a bike accident and never got his face fixed because he didn’t have insurance. These things happened all the time. Only the employed weren’t personally facing those costs, so it was invisible on some level.

The level of frustration and hassle I had with health care, the anxiety I had, as a young healthy person, at that time – no comparison. Now my frustrations are when I have to wait a week to see my doctor or that I have to interface with the dumb-dumb medical records system at the big university system where I go, or frustration with what’s covered and not.

But I’d take that, hands down, to being billed twice for things, having legitimate claims be denied after the fact and having no recourse, being told that basic preventive care was not covered, being denied health insurance, and just not knowing if something happened to me if I would be financially ruined before I had even gotten my life started.

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If your mom HAD cancer, there’s no self-pay program in the world that would have covered her expenses, unless she was Zsa Zsa Gabor.

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Why yes, I do dislike the CBO, or at least how they score proposed legislation. They only take into account how the legislation would work if everything else stayed the same.

Like tax bills. It has been proven over and over again that lowering taxes across the board helps grow the economy (a la Kennedy and then Reagan). But the CBO looks at a tax cut bill only in context with the economy in its current depressed state.

So you really cannot rely on the CBO for a real evaluation because their methodology is flawed.

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It turned out to be a very large benign tumor (thankfully), but they didn’t know this before going in. She negotiated a $7000 rate for the surgery including anesthesia and $1500 for the physician. If it turned out to be cancer, she would have dealt with this as well. During those years she paid for physicians when it made economic sense, but I have complete faith that she would have found a way without insurance even if she had cancer. Medicine at the current “price” is hugely inflated and the insurance set-up is only making it worse.

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I’m really skeptical she could have dealt with out of pocket expenses for an actual cancer case. People routinely die from cancer because they cannot access the needed drugs, like I said I had a friend who went broke from BC in their early 20s. Yes there are indigent care programs but usually they would require people to have exhausted other resources and people may not have access to the actual standard-of-care, instead getting cheaper, older versions of drugs.

Do we really want a healthcare system where the only uninsured people who can get care are the ones most adept at haggling over chemo drugs like carpets at a bazaar? Does that make them better people more deserving of life?

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newer drugs are even more exorbitant… some are in the hundreds of thousands of dollars. All I know is that my friends who have had dire medical emergencies have run up hundreds of thousands of dollars of bills in a very short period of time.
Heck, even my first-born, who was born with a slight suggestion he might have a neonatal infection, spent 2 days in the NICU and the cost for that was billed at $50,000. Insurance paid half that, but half of $50k is not within reach for most people.

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I cannot see how one can compare allowing people to LIVE by helping them with health insurance to “giving them a 2500 sq ft house.” Ridiculous comparison. This isn’t the “free stuff” argument it’s life and death.

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California just passed a health care for all bill, price tagged at over $400B/yr.
Let’s just see how that one works out.
Noble intentions for sure. But not very well thought out. I just don’t want the rest of the nation to go in the same direction.

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@docslotnick, that bill is silly because it basically has no financial plan behind it. I doubt Governor Moonbeam will sign it, so it’s just a protest exercise.

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I am glad you are ready to pay 50% tax to get the healthcare system you desire. The problem is that if we give everyone in the US the top level of healthcare that our system is currently able to deliver, it will cost more than 50%. If we go to to a single payer, or some other system where everyone has insurance for every health problem, then we will bankrupt the country or limit what coverage people have.

If instead we are to join the rest of the world, then we will have significant limitations in care delivered, and the US population has voted again and again to NOT have limitations in the healthcare system. Those limitation will have to be similar to those in the UK for instance, where if you have any problem and the doctors decide you have 12 months to live, or you have comorbidities like dementia, or are frail, and have cancer then they only offer you palliative care. In this country when we tried to talk about having a doctor talk to patients about end of life decisions, they were labelled death panels.

Until such time as this country is able to engage in an adult discussion of what the pros and cons of a system are, then we shouldn’t legislate something that will go bankrupt quickly, and give bureaucrats the ability to dictate not just what healthcare you get but if you should get healthcare. There is no way to have all of the cutting edge medicine we deliver today, at the price that everyone can afford.

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No, it will be more than just reduce the excesses. There will have to be real limits, and guess who gets to set them. Hint: not your physician. Read the stories like this from the NHS:

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Well, I visited Israel and they have a system of public care, but people can supplement that public care with private insurance for more expensive options if they so wish. My relatives seemed pretty happy with the system. One of them is a doctor so she’s pretty familiar with it.

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$400B/yr?! They’re doing something really wrong. What other country with the population size of California spends that much on health care? Even countries with much larger population sizes (like the UK and Germany) don’t spend nearly as much on health care.

This puzzles me as an outsider… Perhaps you or someone else can explain this to me. The US is a federal republic and as you said California passed its own health care bill. Every US state can do that, right? If I understand this correctly, each state can get whatever it likes: California, Oregon, Vermont and other blue states can have their universal health care while Texas, Utah, etc can have a free market system. Other states that aren’t deep red or blue can implement a ‘moderate’ system. Why even bother trying to do this on the federal level? Federal bills seem to be bound to fail, bound to become these monsters like the ACA and AHCA. Bills that nobody likes. And bills that both parties will try to repeal every time they get in power.
Why would you want a one-size-fits-all health care system in a federal state?

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@Boerenkool Good sense like yours is very rare in American politics these days.

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First off, the total expenditure already in California is $370 billion, so the $400 billion price tag is the cost for topping up the system to cover all the remaining uninsured people, at least from what I read (the stats i see are buried in this article somwhere) :

So yes, it’s stupid and ridiculous that California spends so much but a) we have 40 million people – how many people live in the Netherlands? and b) that’s because our existing healthcare in America is so messed up.

As to your question, in the past a few states did implement universal health care or implement their own state-based health care plans. Massachusetts, Oregon (I believe), and I was on a Washington state plan. And it worked okay but was not ideal. For instance, the Washington state health plan always had a wait and so it wasn’t truly universal and wound up covering relatively few of the uninsured. And even for people on the plan, what that meant is that if I went out of state even for a few days, there was literally NO doctor who was covered in case of emergency. I live in San Francisco, which also has universal care – but because it’s a small city, the same problem exists on a larger scale.

Then too, the repeal of Obamacare actually makes implementing certain types of state plans even more complicated and expensive. For instance, California really embraced the Medicaid expansion and the exchanges, so we actually have millions of people on those plans (may even be a third to 40% of the population). if they implement single payer, they will have even more uninsured to deal with than they do now, without a lot of the federal money they had been getting!

Also this country is supposed to be one country…people are mobile and most live in multiple states over the course of their lives. I have lived, in 35 years, in Texas, Washington, California, Washington, D.C., Pennsylvania, Wisconsin. So the idea that you could have such substandard care in some places versus others will make the idea of a united country seem even more nonsensical and splintered. If all we can get is a patchwork state plan, then I’ll take it … but it will make places like West Virginia or Alabama seem even more distant than they already are.

By the way the California plan as written seems pretty silly. It doesn’t even attempt to control costs and is fee for service, etc. I doubt it will pass the state assembly, and if it does, it will probably be vetoed by Jerry Brown. Also, I’m just not sure how they can implement it until they know the details of the federal plan they’ll be interfacing with.

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17 million, but that’s why I mentioned the UK (65 million, ~$190B/yr) and Germany (82 million, ~$385B/yr) as a comparison.

Then that’s a poorly designed system. It should be possible to design a system that covers (some) emergency care in other states and even other countries. If I need emergency care while abroad, my insurance will cover a maximum of the Dutch costs for the same treatment. I have to make up the difference if it costs more or I could buy additional insurance in advance. The British NHS covers some emergency expenses in foreign countries too. I don’t see why US states wouldn’t be able to make similar provisions for emergency care in other US states.

Maybe I don’t understand this, but how can anyone be uninsured under a single payer system?
Secondly, does California, one of the top ten largest economies in the world, really need federal money to implement single payer healthcare?

Well, yes, the US is one country, but it is also a federation of states. And I thought that leaving some controversial issues to the states, thereby ensuring that a country with huge regional differences won’t fall apart, was one of the benefits of having a federal system.

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