2020 Democratic Presidental Candidate Predictions

[rmt]

It really isn't. The health cost sharing model basically is a group of people sharing the cost of what has happened but offering no guaranteed coverage for what might happen in the future which is what real insurance is legally required to cover.

And that guaranteed coverage under Obamacare only lasts as long as the insurance company makes money and if not, pulls out the next year. At which time, one is forced to go to another company until they all pull out. The health sharing model cuts out the middle man (insurance company), encourages comparison shopping and (CHM) offers different levels of coverage ($45 per month/$5k per incident deductible to $150 per month/$500 per incident deductible). Look, I'm not here pushing these plans - just letting desperate people know of other options. At least, there are choices than the outrageous premiums on the exchanges (that's if your county has choices).

The direct care model really isn't lowering costs. It's actually more profitable for primary care physicians.

My wife's practice is around 3000-3500 patients and she bills around $650k per year. That's office visits, in house labs & other diagnostics. Her practice has a large in house lab so most labs are done in house. She keeps around 45% of that and the rest goes to overhead.

Under the direct care model physicians reduce their practice to around 1500 patients and charge them $50-75 per month which covers all office visits and in house labs/procedures but they don't accept any form of insurance. So even at the low end of $50 per month that direct care physician is taking in $900K per year, seeing half the # of patients, and reducing their overhead by not taking any insurance. Oh but look I don't charge for in house labs.

I know Hannity is always pumping the direct care model but he doesn't know what he is talking about. Primary care is not the cost driver in our healthcare system. In fact one of the things Obamacare was trying to do was incentivize primary care because more primary care means less spent on specialist care which accounts for about 75% of all outpatient payments.

It's not just direct care for primary care physicians but for diagnostic, blood labs, etc. When dh was not working, I had everyone take the $69 CWP in December (directlabs.com), took my kids to the pediatrician ($90 for annual) and paid my mammogram and ultrasound ($80 each) out of pocket. That's a total of $320 for me (most expensive in the family) for the year (plus $150 per month from CHM).

This year I have a health INSURANCE policy - went for my annual that's supposed to cover labs - am charged $259 for a vitamin D test (only $44 this month on directlabs) that the doc ordered and can't seem to get the correct code for Quest Labs to cover - it is simply outrageous what Quest charges. The mammogram which is supposed to be covered is billed $97 to me (along with a bunch of nasty letters) - that's more than the $80 cash I paid last year for the very same mammogram - same place - but with insurance and its premiums.

[SnakeBoy]

And that guaranteed coverage under Obamacare only lasts as long as the insurance company makes money and if not, pulls out the next year. At which time, one is forced to go to another company until they all pull out. The health sharing model cuts out the middle man (insurance company), encourages comparison shopping and (CHM) offers different levels of coverage ($45 per month/$5k per incident deductible to $150 per month/$500 per incident deductible). Look, I'm not here pushing these plans - just letting desperate people know of other options. At least, there are choices than the outrageous premiums on the exchanges (that's if your county has choices).

I'm not defending Obamacare. I'd like to see it repealed. I'm just pointing out what cost sharing is and isn't. Yeah it's an option for some people but it's not an answer to the overall healthcare problems.

It's not just direct care for primary care physicians but for diagnostic, blood labs, etc. When dh was not working, I had everyone take the $69 CWP in December (directlabs.com), took my kids to the pediatrician ($90 for annual) and paid my mammogram and ultrasound ($80 each) out of pocket. That's a total of $320 for me (most expensive in the family) for the year (plus $150 per month from CHM).

Your kind of making my point about direct care. You spent $320 but a direct care physician would have collected $600 for the year. It's not cheaper and it's not a solution to our healthcare problems. It is a good deal for the physician. Trust me, my wife has looked into it and concierge and I'm like Yeah Do It! Unfortunately (for me) she's all ethical and .

[SnakeBoy]

Back to the op

Is Schumer trying to set himself up for a run with his shots at Hillary?

[rmt]

I'm not defending Obamacare. I'd like to see it repealed. I'm just pointing out what cost sharing is and isn't. Yeah it's an option for some people but it's not an answer to the overall healthcare problems.



Your kind of making my point about direct care. You spent $320 but a direct care physician would have collected $600 for the year. It's not cheaper and it's not a solution to our healthcare problems. It is a good deal for the physician. Trust me, my wife has looked into it and concierge and I'm like Yeah Do It! Unfortunately (for me) she's all ethical and .

My apologies - I was not clear in my previous post (when I mentioned $90 for an annual). I only want catastrophic insurance and to pay out of pocket for out of non-castrostrophic expenses. We really don't go to the doc for anything other than physicals. Colds/flus I treat with chicken soup and oil of oregano.

[Kim Jong-il]

Back to the op

Is Schumer trying to set himself up for a run with his shots at Hillary?

Even he's gotta know there's no way in an ultra Jewy New Yorker is ever getting into the White House.

[RandomGuy]

im completely ambivalent about slogans

Well, there is your slogan.

Time to figure out how to change "Believe." to "ambivalent about slogans".

[rjv]

i read, yesterday, that kamala harris is being targeted by the clinton faction as a preferred candidate. she just spent some time in the hamptons hobnobbing with wall street donors.

[AaronY]

Those evil Clintons! at it again!

[Reck]

i read, yesterday, that kamala harris is being targeted by the clinton faction as a preferred candidate. she just spent some time in the hamptons hobnobbing with wall street donors.

LOL dead on arrival.

If you want to have a chance, please dont associate your name with the Clintons.

[SnakeBoy]

i read, yesterday, that kamala harris is being targeted by the clinton faction as a preferred candidate. she just spent some time in the hamptons hobnobbing with wall street donors.

Gutless move by the Dems. They should go full black this time.

[hater]

Tulsi Gabbard negroes. Ahes hot and i vote for her. Love that pussy.

[RandomGuy]

I know Hannity is always pumping the direct care model but he doesn't know what he is talking about.

Anyone who thinks Hannity is a good source of information, deserves him.

[rjv]

LOL dead on arrival.

If you want to have a chance, please dont associate your name with the Clintons.

exactly. not sure why the dems can't seem to figure this out.

[RandomGuy]

It really isn't. The health cost sharing model basically is a group of people sharing the cost of what has happened but offering no guaranteed coverage for what might happen in the future which is what real insurance is legally required to cover.



The direct care model really isn't lowering costs. It's actually more profitable for primary care physicians.

My wife's practice is around 3000-3500 patients and she bills around $650k per year. That's office visits, in house labs & other diagnostics. Her practice has a large in house lab so most labs are done in house. She keeps around 45% of that and the rest goes to overhead.

Under the direct care model physicians reduce their practice to around 1500 patients and charge them $50-75 per month which covers all office visits and in house labs/procedures but they don't accept any form of insurance. So even at the low end of $50 per month that direct care physician is taking in $900K per year, seeing half the # of patients, and reducing their overhead by not taking any insurance. Oh but look I don't charge for in house labs.

I know Hannity is always pumping the direct care model but he doesn't know what he is talking about. Primary care is not the cost driver in our healthcare system. In fact one of the things Obamacare was trying to do was incentivize primary care because more primary care means less spent on specialist care which accounts for about 75% of all outpatient payments.

What % of all overhead goes to medical coding and billing?

Seems to me one of the largest drivers of inefficiency is that you have so many different insurance companies, with so many plans, you have to pay an army of full-time staffers to figure out who to bill, how much, etc.

This system is just too complex for automation, even now, so it requires sheer brute force human effort. Additionally, you have a for-profit company that has to factor in a profit margin. Some of these costs are absorbed by returns on profits from invested reserves, but health insurers earn vanishingly small returns on their reserves, a few percent at most.

So now, the adminsitrative costs of the doctor from the complexity of our payment system are passed on, the adminsitrative costs and profit costs are passed on, and the bill for systemic inefficiency lands at the premium payer, which is either an employer or an individual.

Costs are opaque to this payer. They generally don't see, or care, what the doctor charges. There is no price comparison that makes free-market systems efficient until this point. Copays work to a point to cause some elasticisty of demand, but the evidence/studies done is that we have already pegged that needle, i.e. more cost shifting to payers won't change anything.

Beyond this inefficiency, you have 50 state markets for health insurance. You can't portage a plan or coverage easily. Another layer of inefficiency, built into the system.

So you have administrative bloat driven by complexity of billing and payment.

This cost is then passed on to the insurance company.

This in turn, also requires an army of clerks sorting through all the claim requests.

As an insurance expert, who has audited HMOs, and spoken to CEOs of insurance companies, as well as hospital systems themselves, with responsibility for claims reviews and knowledge of how the money flows, I still find shopping for health insurance and evaluation of coverage difficult. I feel for the average joe who has to enter this process with less information/experience.

If memory serves 25% of all health care spending end up being eaten up by administrative costs from this grossly ineffient system, that isn't even really a free-market system, because the prices aren't really transparent.

I have come to conclude that a singe-payer, government run system, ala medicare would eliminate a great deal of this inefficiency. The government, for all its built in inefficiency, gets the advantage of efficiency of scale that the hundreds-thousands of individual health insurers could never hope to match. It also collectivizes bargaining power.

"But governments are inefficient"-- our current system is vastly inefficient now.
"but government is wasteful" -- our current system is vastly wasteful now.
"but people defraud the government"-- people defraud private companies, with less resources to go after people now.

Germans, and every other major industrialized country do this already. This is not magic.

You want a more "free-market-y" solution, great, I'd love to hear it. I have yet to see any workable conserative solution that even comes close to addressing the wasteful complexity of our not-really-free-market insurance system.

Your solution should address:
Billing complexity caused by differing plans
Payment complexity caused by differing plans
Cost shifting from uninsured/unreimbursed utilization at the hospital and practice level
Systemic complexity from differing plans and individual time spent evaluating choices


We have a disorganized, ad-hoc patchwork that costs us dearly. The studies done on the leading causes of personal bankruptcy show that medical bills top out the list. This cost shifting gets passed on to everybody who borrows, or loans, money.

[sickdsm]

On the subject of billing, I had a prescription written, i went to pick it up and it was $300. Called another place and it was $260. Wow that's high for what it is but whatever, bring you insurance in when you pick it up. With insurance, which doesn't cover it but goes towards my $5000 deductible it was now $900. Call the doctor, ask about a generic or anything else, she tells me XX will work, just not as convenient. With insurance that was $70, but hey, pay out of pocket and its $18 now. WTF?


Administrator told my wife to negotiate hospital bills 20%, they did 15% without blinking this winter on an ER trip.

[rmt]

Pay directly for non-castastrophic/emergency - cut out the middleman - no insurance company or government. Whoever thinks government is efficient is nuts - I'm back working for the government after 20+ years and it hasn't gotten any more efficient. Non-existent planning for the future - tons of legacy COBOL code and most mainframe programmers here are retiring within 5 years (they've entered the DROP program where one can collect pension and continue working). The mainframe is the core (live data) and they link to so many different vendors (it's madness) which change it seems on a yearly basis depending on whatever the fancy of the fools downtown. This situation is all over - the schools, the county, utility company. We, the taxpayers, are on the hook for all these pensions and products.

[rmt]

On the subject of billing, I had a prescription written, i went to pick it up and it was $300. Called another place and it was $260. Wow that's high for what it is but whatever, bring you insurance in when you pick it up. With insurance, which doesn't cover it but goes towards my $5000 deductible it was now $900. Call the doctor, ask about a generic or anything else, she tells me XX will work, just not as convenient. With insurance that was $70, but hey, pay out of pocket and its $18 now. WTF?


Administrator told my wife to negotiate hospital bills 20%, they did 15% without blinking this winter on an ER trip.

I encourage you to comparison shop. Our supermarket Publix offers 4 free drugs e.g. amoxicillin, Metformin and 2 others. No one in FL should be paying anything for these if they took the time to google. Check out Walmart $4/30-day and $10/90-day prescription list. Also, Costco is reasonable and you don't have to be a member to buy their drugs. And directlabs is cheap. They have monthly specials and their Comprehensive Wellness Profile is $69 in December.

[SnakeBoy]

i read, yesterday, that kamala harris is being targeted by the clinton faction as a preferred candidate. she just spent some time in the hamptons hobnobbing with wall street donors.

Yeah, sounds like the DNC has already chosen the candidate for the peoples

The Democratic National Committee (DNC) has already begun to telegraph Sen. Kamala Harris aka Kamala Clinton as its presumptive nominee. They have already begun to fund her via the Clinton donor network and they have already begin the mass media assault based on a false projection of sexism and racism on to the progressive wing of the party. They have already begun ramping up the assault on progressives who they have deemed to be Bernie Bros; which in and of itself is a sexist term. Given these conditions and given the DNC’s known proclivity to put its finger on its primary election system’s scale by virtue of its elitist/anti-progressive control mechanism known as superdelegates, it is safe to say that any of Kamala Clinton’s progressive primary challengers will face an uphill battle against the very same establishment that fought against the nomination of Bernie Sanders tooth and nail.


And the progressive wing is already being told to stfu

[monosylab1k]

No clue if Kamala Harris could beat Trump, but it would be fun to watch her bend Trump over and butt him during debates. Trump won't have Richard Burr there to shut her up, either.

[boutons_deux]

Health care in america is ed and doomed to remain ed because BigInsrance has rigged it to be rigged for their profit NOT for health care

Medicare for all is the solution but it's impossible because BigInsurance, backed by its investors, owns legislators

Look at the insanity of health care reform, it's all about how to pay the prices, where to find the money demanded, extorted, not how to reduce costs

[Reck]

Yeah, sounds like the DNC has already chosen the candidate for the peoples

The Democratic National Committee (DNC) has already begun to telegraph Sen. Kamala Harris aka Kamala Clinton as its presumptive nominee. They have already begun to fund her via the Clinton donor network and they have already begin the mass media assault based on a false projection of sexism and racism on to the progressive wing of the party. They have already begun ramping up the assault on progressives who they have deemed to be Bernie Bros; which in and of itself is a sexist term. Given these conditions and given the DNC’s known proclivity to put its finger on its primary election system’s scale by virtue of its elitist/anti-progressive control mechanism known as superdelegates, it is safe to say that any of Kamala Clinton’s progressive primary challengers will face an uphill battle against the very same establishment that fought against the nomination of Bernie Sanders tooth and nail.


And the progressive wing is already being told to stfu

They never learn.

I mean, it worked with Obama but I dont think the masses care for a newbie coming in. Specially one backed by the Clintons. They just need to go away.

Besides, I think its too early even for her. She'll probably run and get bukakked by a more experience person. Bernie himself hasn't rule out running. The carcass.

But I agree with that guy's tweet. You cant attack Harris when she doesn't even have a resume' or know what she would bring to the table. Who the is she anyway?

The Bernie supporters need to chill out with their antifa-like behavior. They're a big part of why we have Trump to begin with.

[baseline bum]

The Bernie supporters need to chill out with their antifa-like behavior. They're a big part of why we have Trump to begin with.

What a load of crap. Clinton and the Democrats embracing free trade is what people in the battleground states of the rust belt voted against. Sanders was strong in the primaries there and his stances on free trade and immigration play well in the rust belt.

[Reck]

What a load of crap. Clinton and the Democrats embracing free trade is what people in the battleground states of the rust belt voted against. Sanders was strong in the primaries there and his stances on free trade and immigration play well in the rust belt.

He also thought the white vote was going to carry him. He badly underestimated the southern states and got his ass handed to him there. He essentially lost the fight early on because of it and only made a semi comeback because of the white voting state+ because they were caucuses.

I don't see how that statement is a "load of crap" given that they're still a huge obstacle to the party.

The Dem party will never go to the far left. They just have to live with that.

[baseline bum]

He also thought the white vote was going to carry him. He badly underestimated the southern states and got his ass handed to him there. He essentially lost the fight early on because of it and only made a semi comeback because of the white voting state+ because they were caucuses.

I don't see how that statement is a "load of crap" given that they're still a huge obstacle to the party.

The Dem party will never go to the far left. They just have to live with that.

All that deep south support that Clinton got is meaningless in a system where the electoral college elects the president. Sanders would have gotten the same number of electoral votes in the south that Clinton did.

[monosylab1k]

He also thought the white vote was going to carry him. He badly underestimated the southern states and got his ass handed to him there. He essentially lost the fight early on because of it and only made a semi comeback because of the white voting state+ because they were caucuses.

I don't see how that statement is a "load of crap" given that they're still a huge obstacle to the party.

The Dem party will never go to the far left. They just have to live with that.

He lost the South because old black people are ing re ed. They just remember how much Bill powdered their asses and thought Hillary would do the same. They never bothered to see that Bernie's ideas were by far the best for the black community.