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HerbChestnut

(3,649 posts)
Fri Aug 23, 2019, 01:35 PM Aug 2019

M4A Comprehensive Benefits, Including Preventative Benefits and Long-Term Care

Last edited Fri Aug 23, 2019, 04:53 PM - Edit history (1)

Edit: Folks, please at least look at the bill before commenting.

There's been a lot of talk about Unions losing their negotiated coverage and private insurance becoming illegal under M4A. Let's be clear, this is nonsense. Here's a list of benefits under M4A taken straight from the bill, which has been public for months. Everyone, including Union members, will be entitled to these benefits once M4A is passed. Anything not listed here can be covered by a private insurance company.

Link to the bill: https://www.congress.gov/bill/116th-congress/house-bill/1384/text#toc-H28F0829CAF24404C941D53616AF9E604

SEC. 201. Comprehensive benefits.

(a) In general.—Subject to the other provisions of this title and titles IV through IX, individuals enrolled for benefits under this Act are entitled to have payment made by the Secretary to an eligible provider for the following items and services if medically necessary or appropriate for the maintenance of health or for the diagnosis, treatment, or rehabilitation of a health condition:

(1) Hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs.

(2) Ambulatory patient services.

(3) Primary and preventive services, including chronic disease management.

(4) Prescription drugs and medical devices, including outpatient prescription drugs, medical devices, and biological products.

(5) Mental health and substance abuse treatment services, including inpatient care.

(6) Laboratory and diagnostic services.

(7) Comprehensive reproductive, maternity, and newborn care.

(8) Pediatrics.

(9) Oral health, audiology, and vision services.

(10) Rehabilitative and habilitative services and devices.

(11) Emergency services and transportation.

(12) Early and periodic screening, diagnostic, and treatment services, as described in sections 1902(a)(10)(A), 1902(a)(43), 1905(a)(4)(B), and 1905(r) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A); 1396a(a)(43); 1396d(a)(4)(B); 1396d(r)).

(13) Necessary transportation to receive health care services for persons with disabilities or low-income individuals (as determined by the Secretary).

(14) Long-term care services and support (as described in section 204).


SEC. 204. Coverage of long-term care services.

(a) In general.—Subject to the other provisions of this Act, individuals enrolled for benefits under this Act are entitled to the following long-term services and supports and to have payment made by the Secretary to an eligible provider for such services and supports if medically necessary and appropriate and in accordance with the standards established in this Act, for maintenance of health or for care, services, diagnosis, treatment, or rehabilitation that is related to a medically determinable condition, whether physical or mental, of health, injury, or age that—

(1) causes a functional limitation in performing one or more activities of daily living; or

(2) requires a similar need of assistance in performing instrumental activities of daily living due to cognitive or other impairments.

(b) Eligibility.—The Secretary shall promulgate rules that provide for the following:

(1) The determination of individual eligibility for long-term services and supports under this section.

(2) The assessment of the long-term services and supports needed for eligible individuals.

(c) Services and supports.—Long-term services and supports under this section shall be tailored to an individual’s needs, as determined through assessment, and shall be defined by the Secretary to—

(1) include any long-term nursing services for the enrollee, whether provided in an institution or in a home and community-based setting;

(2) provide coverage for a broad spectrum of long-term services and supports, including for home and community-based services and other care provided through non-institutional settings;

(3) provide coverage that meets the physical, mental, and social needs of recipients while allowing recipients their maximum possible autonomy and their maximum possible civic, social, and economic participation;

(4) prioritize delivery of long-term services and supports through home and community-based services over institutionalization;

(5) unless an individual elects otherwise, ensure that recipients will receive home and community based long-term services and supports (as defined in subsection (f)(4)), regardless of the individuals’s type or level of disability, service need, or age;

(6) be provided with the goal of enabling persons with disabilities to receive services in the least restrictive and most integrated setting appropriate to the individual’s needs;

(7) be provided in such a manner that allows persons with disabilities to maintain their independence, self-determination, and dignity;

(8) provide long-term services and supports that are of equal quality and equally accessible across geographic regions; and

(9) ensure that long-term services and supports provide recipient’s the option of self-direction of services from either the recipient or care coordinators of the recipient’s choosing.

If I were to vote in a presidential
primary today, I would vote for:
Undecided
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M4A Comprehensive Benefits, Including Preventative Benefits and Long-Term Care (Original Post) HerbChestnut Aug 2019 OP
What is the mechanism for mandated re-negotiation of longer term union lapucelle Aug 2019 #1
According to the bill... HerbChestnut Aug 2019 #3
I am talking about contracts that will still be in effect lapucelle Aug 2019 #4
I answered that question. HerbChestnut Aug 2019 #5
Where in the bill does it say that those union contracts still in effect lapucelle Aug 2019 #6
Your question was answered, twice. HerbChestnut Aug 2019 #7
"Where is it in the bill?" is the question. lapucelle Aug 2019 #8
"that doesn't even address contracts still in effect at the end of the transition period" HerbChestnut Aug 2019 #9
So even you admit it's not in the bill lapucelle Aug 2019 #12
... HerbChestnut Aug 2019 #13
Where is the mechanism in the bill itself that ensures voters that the statute lapucelle Aug 2019 #16
Not seeing that anywhere in the bill. (nt) ehrnst Aug 2019 #38
This message was self-deleted by its author HerbChestnut Aug 2019 #2
What is the pathway? ismnotwasm Aug 2019 #10
I'm not sure what you're asking. HerbChestnut Aug 2019 #11
Ok. ismnotwasm Aug 2019 #15
This bill restructures how Medicare pays healthcare providers. HerbChestnut Aug 2019 #17
Cool. ismnotwasm Aug 2019 #24
Again, this bill is about establishing national health insurance. HerbChestnut Aug 2019 #25
It is. ismnotwasm Aug 2019 #28
I've never seen this mentioned forthemiddle Aug 2019 #47
"The only thing that changes about the healthcare industry is how service providers get paid," ehrnst Aug 2019 #39
Exactly ismnotwasm Aug 2019 #46
"once M4A is passed." Really how many years, if ever, will that be? elocs Aug 2019 #14
How will any bill get passed? HerbChestnut Aug 2019 #18
Why does the word "disingenuous" come to mind when I read your reply? n/t elocs Aug 2019 #19
Because the argument, "How will it get passed?", is itself disingenuous. HerbChestnut Aug 2019 #21
How many years depends on the results of the primaries and G.E. Uncle Joe Aug 2019 #20
Then those who support MFA should be honest with people about that and not hold out false hope. elocs Aug 2019 #22
We are being honest we are fighting for it now and if we win enough seats in 2020 it Uncle Joe Aug 2019 #23
Ahh, the big "if" as in "if wishes were horses, beggars would ride". elocs Aug 2019 #34
+1000. ehrnst Aug 2019 #37
Actually, people say it's "easy" all the time. ehrnst Aug 2019 #35
Nicely said, I'm going to need to save all of that. elocs Aug 2019 #41
What about retirees whose benefits include their program paying for Medicare and offering a emmaverybo Aug 2019 #26
Those retirees are already in Medicare. HerbChestnut Aug 2019 #27
And they will pay higher taxes. And probably out of pocket for good quality care as occurs in emmaverybo Aug 2019 #29
Whoa whoa, tap the brakes. HerbChestnut Aug 2019 #30
Ok. You are a good spokesperson. NT emmaverybo Aug 2019 #31
Thank you. HerbChestnut Aug 2019 #32
OK, so my Medicare, which I pay for out of my SS check, will be expanded to cover... TreasonousBastard Aug 2019 #33
Not to mention most people paying into Medicare aren't actually on it. (nt) ehrnst Aug 2019 #42
Yes, it will all magically happen, healthcare Nirvana. elocs Aug 2019 #43
Read the OP that contains a list of benefits in M4A and you tell me. HerbChestnut Aug 2019 #44
Promises are cheap when you have no idea if MFA will work in this country, elocs Aug 2019 #48
Another bill that will not even pass the committee NYMinute Aug 2019 #36
SCOTUS stated that states didn't have to expand Medicare, as per the ACA ehrnst Aug 2019 #40
Are you sure you're an Elizabeth Warren supporter? HerbChestnut Aug 2019 #45
 

lapucelle

(18,037 posts)
1. What is the mechanism for mandated re-negotiation of longer term union
Fri Aug 23, 2019, 02:12 PM
Aug 2019

contracts still in effect after the two year transition period (including contractual specialized medical benefits that retirees are entitled to), so that no benefits are lost?

From the bill

SEC. 106. Effective date of benefits.

(a) In general.—Except as provided in subsection (b), benefits shall first be available under this Act for items and services furnished 2 years after the date of the enactment of this Act.

(2) OPTION TO CONTINUE IN OTHER COVERAGE DURING TRANSITION PERIOD.—Any person who is eligible to receive benefits as described in paragraph

(1) may opt to maintain any coverage described in section 901
, private health insurance coverage, or coverage offered pursuant to subtitle A of title X (including the amendments made by such subtitle) until the date described in subsection (a).


SEC. 107. Prohibition against duplicating coverage.

(a) In general.—Beginning on the effective date described in section 106(a), it shall be unlawful for—

(1) a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act; or

(2) an employer to provide benefits for an employee, former employee, or the dependents of an employee or former employee that duplicate the benefits provided under this Act.
If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

HerbChestnut

(3,649 posts)
3. According to the bill...
Fri Aug 23, 2019, 02:29 PM
Aug 2019

Any healthcare service not covered under M4A can be covered by private insurance. What you're talking about sounds like it would fall under Sec. 204, which tailors long-term care to the individual. As for how unions would negotiate with employers, Bernie's campaign just released a plan to drastically increase Union power in the workforce. Here's an excerpt:

A fair transition to Medicare for All: Bernie will require that resulting healthcare savings from union-negotiated plans result in wage increases and additional benefits for workers during the transition to Medicare for All. When Medicare for All is signed into law, companies with union negotiated health care plans would be required to enter into new contract negotiations overseen by the National Labor Relations Board. Under this plan, all company savings that result from reduced health care contributions from Medicare for All will accrue equitably to workers in the form of increased wages or other benefits. Furthermore, the plan will ensure that union-sponsored clinics and other providers are integrated within the Medicare for All system, and kept available for members. Unions will still be able to negotiate for and provide wrap-around services and other coverage not duplicative of the benefits established under Medicare for All.

If I were to vote in a presidential
primary today, I would vote for:
Undecided
 

lapucelle

(18,037 posts)
4. I am talking about contracts that will still be in effect
Fri Aug 23, 2019, 02:38 PM
Aug 2019

at the end of the two year transition period.

What is the statutory provision that mandates that those contracts, which were negotiated in good faith, must be re-negotiated so that they meet the bill's requirements without any loss of specialized medical benefits accepted in lieu of salary?

If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

HerbChestnut

(3,649 posts)
5. I answered that question.
Fri Aug 23, 2019, 02:43 PM
Aug 2019

To reiterate, if an old Union contract included specialized medical benefits not covered by M4A (unlikely, but we'll roll with it), new contract negotiations would occur between the Union and the employer under the supervision of a federal entity to ensure fairness. Here's the paragraph from Bernie's Union plan again:


Bernie will require that resulting healthcare savings from union-negotiated plans result in wage increases and additional benefits for workers during the transition to Medicare for All. When Medicare for All is signed into law, companies with union negotiated health care plans would be required to enter into new contract negotiations overseen by the National Labor Relations Board. Under this plan, all company savings that result from reduced health care contributions from Medicare for All will accrue equitably to workers in the form of increased wages or other benefits. Furthermore, the plan will ensure that union-sponsored clinics and other providers are integrated within the Medicare for All system, and kept available for members. Unions will still be able to negotiate for and provide wrap-around services and other coverage not duplicative of the benefits established under Medicare for All.


It's important to read that whole paragraph. M4A would not leave Union workers out in the cold.
If I were to vote in a presidential
primary today, I would vote for:
Undecided
 

lapucelle

(18,037 posts)
6. Where in the bill does it say that those union contracts still in effect
Fri Aug 23, 2019, 02:56 PM
Aug 2019

must be re-negotiated?

It doesn't say that anywhere in the bill.

Continual repeating of the talking point that that unions will still be able to negotiate future contracts does nothing to address the issue of contracts that will still be in effect after the two year transition period.







If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

HerbChestnut

(3,649 posts)
7. Your question was answered, twice.
Fri Aug 23, 2019, 02:58 PM
Aug 2019

Please read my responses to your concerns. The answer is there. I am not going to keep repeating myself.

If I were to vote in a presidential
primary today, I would vote for:
Undecided
 

lapucelle

(18,037 posts)
8. "Where is it in the bill?" is the question.
Fri Aug 23, 2019, 03:11 PM
Aug 2019

Responding by continually quoting a vague clause (that doesn't even address contracts still in effect at the end of the transition period) in a broad labor plan (rather than anything in the bill itself) does not answer the question:

"Where is it in the bill?"

The correct (and honest) answer is:

"It is not in the bill."


If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

HerbChestnut

(3,649 posts)
9. "that doesn't even address contracts still in effect at the end of the transition period"
Fri Aug 23, 2019, 03:16 PM
Aug 2019

Yes it does. Directly.

The passage came from the Sanders campaign's plan to empower Unions. Look, Bernie is arguably one of the most pro-Union representatives in a long, long time. He's not going to throw them to the side.

If I were to vote in a presidential
primary today, I would vote for:
Undecided
 

lapucelle

(18,037 posts)
12. So even you admit it's not in the bill
Fri Aug 23, 2019, 04:38 PM
Aug 2019

and that the "plan to empower unions" is a separate document that gives vague, general assurances concerning future contracts.

If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

HerbChestnut

(3,649 posts)
13. ...
Fri Aug 23, 2019, 04:42 PM
Aug 2019

UNION WORKERS WILL NOT LOSE THEIR BENEFITS.

If I were to vote in a presidential
primary today, I would vote for:
Undecided
 

lapucelle

(18,037 posts)
16. Where is the mechanism in the bill itself that ensures voters that the statute
Fri Aug 23, 2019, 04:48 PM
Aug 2019

we are discussing can actually deliver on the promises that a politician running for office is making?

Nowhere.

If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

ehrnst

(32,640 posts)
38. Not seeing that anywhere in the bill. (nt)
Sat Aug 24, 2019, 08:32 AM
Aug 2019
If I were to vote in a presidential
primary today, I would vote for:
Joe Biden

Response to HerbChestnut (Original post)

 

ismnotwasm

(41,919 posts)
10. What is the pathway?
Fri Aug 23, 2019, 03:37 PM
Aug 2019

Where are the clinics, the hospitals, the Doctors, PAs ARNPs, RN, care technicians? Specialists in oncology, nephrology, plastic reconstruction, transplant vascular surgeries?(those are just the areas I work in) How do we reach rural areas? How do we renegotiate with drug companies (a number one priority to universal healthcare)

While I’m glad for a general outline, that’s all this is, is an outline. I want to see a plan for implementation that includes proper staffing, proper equipment and the plain ability to care for everyone.

This is reality. This is the reality I work with everyday. It’s not enough to say what something will cover if their is nobody to cover it.

I don’t even care about cost at this point. I want to see where the underserved areas are, the over populated and overwhelmed areas are, I want to see a comprehensive preventive healthcare initiative.

If we are going to do this, let’s do this in a systematic and realistic manner.

If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

HerbChestnut

(3,649 posts)
11. I'm not sure what you're asking.
Fri Aug 23, 2019, 04:11 PM
Aug 2019

"Where are the clinics, the hospitals, the Doctors, PAs ARNPs, RN, care technicians? Specialists in oncology, nephrology, plastic reconstruction, transplant vascular surgeries?(those are just the areas I work in) How do we reach rural areas? How do we renegotiate with drug companies (a number one priority to universal healthcare)."

The only thing that changes about the healthcare industry is how service providers get paid, meaning, instead of receiving money from a private insurance company they receive money from the federal government. This bill establishes a new national health insurance program. That's it. Expanding healthcare infrastructure has been, and will be, addressed in other bills. Terms of renegotiation with prescription drug companies is, according to the bill, to be done by the Secretary of Health and Human Services on an annual basis.

If I were to vote in a presidential
primary today, I would vote for:
Undecided
 

ismnotwasm

(41,919 posts)
15. Ok.
Fri Aug 23, 2019, 04:45 PM
Aug 2019

This is a basic misunderstanding with what’s going on with healthcare. When the ACA passed, we were srambling to get higher education for nurses, especially as practitioners so they could fill the empty spots left. We need a pathway we are facing a provider shortage. There are areas with little or poor access to healthcare. Again, the drug companies have to be addressed. Medicare already chronically under reimburses hospitals. I am talking about the practicalities of everyone having access to good medical care

If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

HerbChestnut

(3,649 posts)
17. This bill restructures how Medicare pays healthcare providers.
Fri Aug 23, 2019, 04:50 PM
Aug 2019

Infrastructure related issues like lack of practitioners, buildings, supplies, etc. will be addressed in other legislation. This bill is only meant to establish a national health insurance program.

As for drug companies, there's a whole section on it in the bill:

SEC. 616. Payments for prescription drugs and approved devices and equipment.

The prices to be paid for covered pharmaceuticals, medical supplies, medical technologies, and medically necessary equipment covered under this Act shall be negotiated annually by the Secretary.

(1) IN GENERAL.—Notwithstanding any other provision of law, the Secretary shall, for fiscal years beginning on or after the date of the enactment of this subsection, negotiate with pharmaceutical manufacturers the prices (including discounts, rebates, and other price concessions) that may be charged to the Medicare for All Program during a negotiated price period (as specified by the Secretary) for covered drugs for eligible individuals under the Medicare for All Program. In negotiating such prices under this section, the Secretary shall take into account the following factors:

(A) The comparative clinical effectiveness and cost effectiveness, when available from an impartial source, of such drug.

(B) The budgetary impact of providing coverage of such drug.

(C) The number of similarly effective drugs or alternative treatment regimens for each approved use of such drug.

(D) The total revenues from global sales obtained by the manufacturer for such drug and the associated investment in research and development of such drug by the manufacturer.

(2) FINALIZATION OF NEGOTIATED PRICE.—The negotiated price of each covered drug for a negotiated price period shall be finalized not later than 30 days before the first fiscal year in such negotiated price period.

(3) COMPETITIVE LICENSING AUTHORITY.—

(A) IN GENERAL.—Notwithstanding any exclusivity under clause (iii) or (iv) of section 505(j)(5)(F) of the Federal Food, Drug, and Cosmetic Act, clause (iii) or (iv) of section 505(c)(3)(E) of such Act, section 351(k)(7)(A) of the Public Health Service Act, or section 527(a) of the Federal Food, Drug, and Cosmetic Act, or by an extension of such exclusivity under section 505A of such Act or section 505E of such Act, and any other provision of law that provides for market exclusivity (or extension of market exclusivity) with respect to a drug, in the case that the Secretary is unable to success fully negotiate an appropriate price for a covered drug for a negotiated price period, the Secretary shall authorize the use of any patent, clinical trial data, or other exclusivity granted by the Federal Government with respect to such drug as the Secretary determines appropriate for purposes of manufacturing such drug for sale under Medicare for All Program. Any entity making use of a competitive license to use patent, clinical trial data, or other exclusivity under this section shall provide to the manufacturer holding such exclusivity reasonable compensation, as determined by the Secretary based on the following factors:

(i) The risk-adjusted value of any Federal Government subsidies and investments in research and development used to support the development of such drug.

(ii) The risk-adjusted value of any investment made by such manufacturer in the research and development of such drug.

(iii) The impact of the price, including license compensation payments, on meeting the medical need of all patients at a reasonable cost.

(iv) The relationship between the price of such drug, including compensation payments, and the health benefits of such drug.

(v) Other relevant factors determined appropriate by the Secretary to provide reasonable compensation.

(B) REASONABLE COMPENSATION.—The manufacturer described in subparagraph (A) may seek recovery against the United States in the United States Court of Federal Claims.

(C) INTERIM PERIOD.—Until 1 year after a drug described in subparagraph (A) is approved under section 505(j) of the Federal Food, Drug, and Cosmetic Act or section 351(k) of the Public Health Service Act and is provided under license issued by the Secretary under such subparagraph, the Medicare for All Program shall not pay more for such drug than the average of the prices available, during the most recent 12-month period for which data is available prior to the beginning of such negotiated price period, from the manufacturer to any wholesaler, retailer, provider, health maintenance organization, nonprofit entity, or governmental entity in the ten OECD (Organization for Economic Cooperation and Development) countries that have the largest gross domestic product with a per capita income that is not less than half the per capita income of the United States.

(D) AUTHORIZATION FOR SECRETARY TO PROCURE DRUGS DIRECTLY.—The Secretary may procure a drug manufactured pursuant to a competitive license under subparagraph (A) for purposes of this Act.

(4) FDA REVIEW OF LICENSED DRUG APPLICATIONS.—The Secretary shall prioritize review of applications under section 505(j) of the Federal Food, Drug, and Cosmetic Act for drugs licensed under paragraph (3)(A).

(5) PROHIBITION OF ANTICOMPETITIVE BEHAVIOR.—No drug manufacturer may engage in anticompetitive behavior with another manufacturer that may interfere with the issuance and implementation of a competitive license or run contrary to public policy.

(6) REQUIRED REPORTING.—The Secretary may require pharmaceutical manufacturers to disclose to the Secretary such information that the Secretary determines necessary for purposes of carrying out this subsection.

If I were to vote in a presidential
primary today, I would vote for:
Undecided
 

ismnotwasm

(41,919 posts)
24. Cool.
Fri Aug 23, 2019, 11:15 PM
Aug 2019

What I am trying to say, have been trying to say, is there are literally not enough healthcare workers, not enough clinics, not enough hospitals. Medicare already negotiates with Pharmaceutical companies, although I must say that wording looks good. I must point out, however, Medicare does not cover all drugs, and there are pharmaceutical companies that could give a shit less.

I’m not a fan of M4A, because it’s building off stressed system. Coding, bundling. HCCPS. Other regulations and restrictions. Medicare has a coding system that pays a certain amount for say, a procedure. Hospitals do not get paid if a preventable condition arises from a hospital stay. (Which has driven hospitals to try harder to prevent UTIs, pressure injuries nosocomial pneumonia etc, not a bad thing at all, a least for the larger hospitals ) Also, the VA is an entirely separate system, will it be incorporated?

I don’t see why we can’t build a universal healthcare system that provides reasonable timeframe to ensure everyone gets care. Throwing legislation at the country without the infrastructure path isn’t the best idea I’ve ever heard

(On edit, if you want to see what M4A COULD look like, study the coverage of renal disease and dialysis)

If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

HerbChestnut

(3,649 posts)
25. Again, this bill is about establishing national health insurance.
Sat Aug 24, 2019, 12:22 AM
Aug 2019

Healthcare infrastructure, while related, is fundamentally different and will be addressed in different legislation. As for the VA, it will be kept as a separate entity because veterans have unique healthcare needs.

I just want to make it clear that I agree with you about the lack of healthcare infrastructure like rural hospitals, nurses, etc. I believe Bernie would agree with you as well since he has helped pass legislation that expanded and added new community health centers around the country in the past.

M4A is a first step in overhauling the U.S. healthcare system, which I think we'd both agree, is a massive task.

If I were to vote in a presidential
primary today, I would vote for:
Undecided
 

ismnotwasm

(41,919 posts)
28. It is.
Sat Aug 24, 2019, 12:52 AM
Aug 2019

I am involved with my union and I remember the near panic in Washington state to incorporate all the newly insured, as the ACA was quite successful here. All the planning.

This is why, whatever path we take to universal healthcare I want to see a broader conversation. In Seattle, there are nurses marching outside (not on strike they’re negotiating) for safe staffing

This year, in Washington state we passed guaranteed break time legislation. Here’s our newsletter

https://www.wsna.org/news

And the union win

https://www.wsna.org/news/2016/wsna-wins-groundbreaking-arbitration-enforcing-rest-breaks-for-nurses
It’s too easy to overload the system we have in place. And while I’m personally at the point where I don’t give a shit what we call universal healthcare, as long as we actually have a realistic plan to obtain this goal.

If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

forthemiddle

(1,373 posts)
47. I've never seen this mentioned
Sat Aug 24, 2019, 12:12 PM
Aug 2019

But as of today, Medicare is not billed for care done at the VA (even for Vets that have Medicare),
But all other insurances are. So if you strip away private insurance the VA will suffer.
I worked in billing for the VA for years.

If I were to vote in a presidential
primary today, I would vote for:
Undecided
 

ehrnst

(32,640 posts)
39. "The only thing that changes about the healthcare industry is how service providers get paid,"
Sat Aug 24, 2019, 08:45 AM
Aug 2019

Nope.

Anyone who tells you there will be no change in delivery or the patient experience doesn't have any idea of how health care works. And by patient experience, I mean all patients, not just the ones who are getting care for the first time.

Health care delivery is different in the US than in Canada, the UK and the rest of the developed world.

Pricing cuts mean cuts in personnel, and reorganization of staff, delivery and facilities. We're talking consolidation, concentration and cutting redundancies that make it more convenient, but more expensive.

We also have to subsidize training of medical personnel, because there is currently a shortage, one that will be exacerbated if a surge in demand even greater than the Boomer population that is coming onto Medicare. If you are going to pay physicians less, then one will need to pay off their medical school debt. Is that included in the cost estimates?

Expanding healthcare infrastructure has been, and will be, addressed in other bills.


What other bills?

This bill establishes a new national health insurance program.


In two years. A politician who promised it in 8 years in his last campaign is competing against others who have their own plan this time, and two years is a WAY better promise than any of those.

That's just not realistic. It's a candidate making grand promises.

https://khn.org/news/democrats-unite-but-what-happened-to-medicare-for-all/




If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

ismnotwasm

(41,919 posts)
46. Exactly
Sat Aug 24, 2019, 11:49 AM
Aug 2019

Its already a hot mess. If we do not put forward a path to include all the newly insured along with the actual changes in insurance, it will be a ridiculous mess, and possibly destroy the actual chance for universal healthcare, as the system is overwhelmed and underfunded.

I work in a very good hospital with cutting edge technology and a decent reputation. Smaller hospitals transfer their patients to us for a number of reasons. Occasionally we “cap” a particular service because of too many patients. Occasionally we “divert” -send patients elsewhere. We are a large facility.


This is why “Medicare for all” as slogan campaigning bothers me so much. In my personal experience, healthcare professionals I work with all want universal healthcare. We know however, how difficult it will be to obtain. I do know, that an aggressive preventative healthcare plan needs to be part of anything we do, as these screenings help save lives.

I guess I’m glad there’s a robust conversation around this, as it is my passion.



If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

elocs

(22,474 posts)
14. "once M4A is passed." Really how many years, if ever, will that be?
Fri Aug 23, 2019, 04:44 PM
Aug 2019

Please explain in real world terms exactly how Medicare for All gets passed and becomes law.
Because in real life just because you wish something will happen does not mean it will.

If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

HerbChestnut

(3,649 posts)
18. How will any bill get passed?
Fri Aug 23, 2019, 04:52 PM
Aug 2019

Ever? When??? HOW?1?!!11

If I were to vote in a presidential
primary today, I would vote for:
Undecided
 

elocs

(22,474 posts)
19. Why does the word "disingenuous" come to mind when I read your reply? n/t
Fri Aug 23, 2019, 05:50 PM
Aug 2019
If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

HerbChestnut

(3,649 posts)
21. Because the argument, "How will it get passed?", is itself disingenuous.
Fri Aug 23, 2019, 07:21 PM
Aug 2019

Every politician who ever ran for office campaigned on hypothetical policies that would have to get through a legislative body. You know how policies get passed? When people vote candidates into into office that support them then keep the pressure on after they get elected.

If I were to vote in a presidential
primary today, I would vote for:
Undecided
 

Uncle Joe

(58,112 posts)
20. How many years depends on the results of the primaries and G.E.
Fri Aug 23, 2019, 06:02 PM
Aug 2019

of 2019 and 2020 and perhaps the elections of 2022 and 2024.

If I were to vote in a presidential
primary today, I would vote for:
Undecided
 

elocs

(22,474 posts)
22. Then those who support MFA should be honest with people about that and not hold out false hope.
Fri Aug 23, 2019, 10:06 PM
Aug 2019

Promises are easy, but just tell people it could be many years before MFA becomes a law, if ever.

If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

Uncle Joe

(58,112 posts)
23. We are being honest we are fighting for it now and if we win enough seats in 2020 it
Fri Aug 23, 2019, 10:15 PM
Aug 2019

will happen, if we don't the fight goes on, nobody said it will be easy, and nobody has a crystal ball.



If I were to vote in a presidential
primary today, I would vote for:
Undecided
 

elocs

(22,474 posts)
34. Ahh, the big "if" as in "if wishes were horses, beggars would ride".
Sat Aug 24, 2019, 05:04 AM
Aug 2019

So it's Medicare for All or nothing?
No plan B for when it's clear it will not become law soon if ever?
In the meantime, what kind of healthcare system will be in place for those who need it?

If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

ehrnst

(32,640 posts)
35. Actually, people say it's "easy" all the time.
Sat Aug 24, 2019, 08:09 AM
Aug 2019

"You just enroll everyone in Medicare - it's already set up."

"You just move half the money from Defense over to cover the expense. That won't have any real effect on the economy- the only businesses that will suffer are the big military industrial complex companies, not the small local businesses - the restaurants and vendors that provide services around military bases."

"The money that went to the insurance CEO's and shareholders will cover all the expenses for the transition. I don't know how that money will be moved, it just will be."

"There won't be any discernable change to actual health care delivery, it will just cost less because we're cutting out the middleman."

"There won't be any effect on the economy from cutting out the thousands of jobs in private health insurance companies, actuarial and billing staff being eliminated in the course of a few years. They can just go to work for the federal government - and even if they can't find a job near where they live, they'll at least have health insurance for free."

"Doctors will be paid less, but we can give them airline vouchers or something to even it out. Of course, nurses won't get a pay cut."

"Phasing in isn't necessary. It can all be easily done in eight years, wait, TWO years. It's not changing anything but the prices and where the money comes from. "

"The only 'experts' saying it's not that going to be easy and affordable are Big Pharma, Big Insurance and Wall Street, or they're shills, because I know they are, that's why."

"The only people saying it won't be that easy are people are haters."

"No one really knows how it will all work, so anyone's guess is as good as anyone else's at this point, so we might as well go with the guess that gives us way more for way less, in just a few years, with no drawbacks."

"The other countries with Single Payer manage to do it and make it cheaper than our system- I don't care how long it took them, and I don't care that they started from scratch, that doesn't apply to us."


If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

elocs

(22,474 posts)
41. Nicely said, I'm going to need to save all of that.
Sat Aug 24, 2019, 09:12 AM
Aug 2019

How will we get Medicare for All?
The easy-peasy, don't worry, be happy, it will all magically happen answer.

Is there another nation in the world with as big a population as the U.S. and just like us that has a single payer healthcare system? No.
Americans like choice, Democrats are supposed to be in favor of choice.
I'm on Medicare right now and I didn't choose to have traditional Medicare but went with a private insurance company and a Medicare Advantage plan because I would have gotten screwed with my pants on using traditional Medicare.

If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

emmaverybo

(8,144 posts)
26. What about retirees whose benefits include their program paying for Medicare and offering a
Sat Aug 24, 2019, 12:33 AM
Aug 2019

plan with 100 percent coverage, low to no co-pays, extremely low drug costs, for which they, the benefits/pension program, pay the the full premium?

Medicare4All is not going to be popular with a number of retirees in addition to union members.
Discount their vote at our peril for their vote is reliable and booming, as in an army of baby boomers.

If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

HerbChestnut

(3,649 posts)
27. Those retirees are already in Medicare.
Sat Aug 24, 2019, 12:44 AM
Aug 2019

Nothing would change for them except they would be entitled to all the benefits included with M4A, including extremely low drug costs, and they wouldn't have co-pays at all...

M4A is an upgrade for just about everybody.

If I were to vote in a presidential
primary today, I would vote for:
Undecided
 

emmaverybo

(8,144 posts)
29. And they will pay higher taxes. And probably out of pocket for good quality care as occurs in
Sat Aug 24, 2019, 12:55 AM
Aug 2019

many cases in Europe, from which systems Bernie draws his inspiration.

No thanks for NHS style waiting lists, huge doctor and nurse shortages, ERs shutting down for the day or night, disparities in quality according to service area, horror stories in nursing homes, waiting up to four months now to start cancer treatment, hip replacements called elective surgery so folks die before they get them, ill-trained physicians imported to fill in...

No thanks to a huge, new, untested infrastructure we can’t even begin to implement without legislation, an area Bernie is not so great in.

Don’t care how detailed his plan is.

It won’t be happening, but if he’s the nominee it might hand Trump four more years.

If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

HerbChestnut

(3,649 posts)
30. Whoa whoa, tap the brakes.
Sat Aug 24, 2019, 01:11 AM
Aug 2019

Nobody, including Bernie, is suggesting a socialized healthcare system like the NHS. Medicare for All is a nationalized health insurance program. All it does is replace most private health insurance with public insurance. Doctors, hospitals, retirement homes, etc. all remain privately owned and operated (unless they were public already, obviously).

They will not pay higher taxes because their pensions already include the costs of Medicare.

If you read my OP, you'll see all of the healthcare benefits included with M4A. The odds somebody would need healthcare services outside of what will be provided are very, very slim. In your example of a retiree who is currently on Medicare, M4A will expand their coverage.

Please read my OP. Ideally, read the bill.

If I were to vote in a presidential
primary today, I would vote for:
Undecided
 

emmaverybo

(8,144 posts)
31. Ok. You are a good spokesperson. NT
Sat Aug 24, 2019, 01:18 AM
Aug 2019
If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

TreasonousBastard

(43,049 posts)
33. OK, so my Medicare, which I pay for out of my SS check, will be expanded to cover...
Sat Aug 24, 2019, 01:48 AM
Aug 2019

current copays, dental, drugs, all presently uncovered or limited treatment, eyeglasses, lifelong nursing home care, and a bunch of other stuff without costing me any more?

Sounds great!

Just one thing, though, we had both Houses of Congress and the White House when we barely managed to get a pared down Obamacare passed. Then we lost Congress and the opposition is still trying to kill what parts of Obamacare they haven't already destroyed. So what are the realistic chances of passing this great plan?

If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

ehrnst

(32,640 posts)
42. Not to mention most people paying into Medicare aren't actually on it. (nt)
Sat Aug 24, 2019, 09:16 AM
Aug 2019
If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

elocs

(22,474 posts)
43. Yes, it will all magically happen, healthcare Nirvana.
Sat Aug 24, 2019, 09:22 AM
Aug 2019

"M4A is an upgrade for "just" about everyone."
There's always a "just" and how big is it?

If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

HerbChestnut

(3,649 posts)
44. Read the OP that contains a list of benefits in M4A and you tell me.
Sat Aug 24, 2019, 10:52 AM
Aug 2019
If I were to vote in a presidential
primary today, I would vote for:
Undecided
 

elocs

(22,474 posts)
48. Promises are cheap when you have no idea if MFA will work in this country,
Sat Aug 24, 2019, 12:14 PM
Aug 2019

which is not western Europe or Canada. A diverse nation of over 300 million people, many who like choices in their life (Democrats are supposed to favor choice aren't they?).
Only this time it won't be "if you like your doctor, you can keep your doctor" but rather, "if you like your private health insurance, tough shit".
So what's the plan for the years or decades if ever before it becomes law? No plan B?
What will this conservative Supreme Court do to it? Nothing good.

If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

NYMinute

(3,256 posts)
36. Another bill that will not even pass the committee
Sat Aug 24, 2019, 08:15 AM
Aug 2019

People should stick to their core expertise -- like naming post offices.

If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

ehrnst

(32,640 posts)
40. SCOTUS stated that states didn't have to expand Medicare, as per the ACA
Sat Aug 24, 2019, 08:52 AM
Aug 2019

And that was a pre-Gorsuch, pre-Kavanaugh SCOTUS.

What makes you think that red states won't go to this SCOTUS and get a ruling that exempts them from participating in any way in expanding Medicare to all?

Any thoughts about that?

We will need states to participate in the delivery and administration of a national health care plan. Very few countries do this at the federal level - only those much smaller than the U.S. Canada has much of the administration taken care of at the province level.

In fact the vast majority of developed countries don't use single payer as national health care. They use a hybrid of payment mechanisms, including employer administrated plans.

Why do you think they didn't go Single Payer?

Democrats are working towards universal health care as the goal. If we can get there faster with a multi-payer plan, with some private elements like the vast majority of the rest of the industrialized world, that would be preferable than a bill that will likely meet the same fate as the requirement for Medicaid expansion did. If the 2010 SCOTUS struck down the ACA's mandate that states expand Medicaid to more poor people, even if the Federal Government paid for it, how do you think the current SCOTUS will rule on the inevitable challenge to a law that requires the expansion of Medicare AND Medicaid to everyone? Look at how the GOP was able to kneecap some of the many parts of the ACA.

We should not make mistake that anti-choicers make, by dismissing/demonizing health care policy experts as "shills of the Planned Parenthood and the abortion industry" who say that getting rid of Planned Parenthood will not stop abortions, and in fact, may increase their numbers and make them more dangerous. Their first goal stopped being to reduce abortion, and became "punishing the greedy doctors and those promiscuous women" rejecting any strategy, no matter how effective, that doesn't eliminate Planned Parenthood and criminalize providers.

(No, I'm not comparing Planned Parenthood to private insurance providers. I'm comparing the tribal thinking that the "solution" has become dogma, and demonizes anyone who points out the problems in that "solution" as heretics, "stupid," and/or "greedy bastards."

There are ways to get affordable health care to more people that would be quicker and more efficient than a bill that can't deliver what it promises, as per non-partisan, self-funded health care policy think tanks and experts.

I will believe those experts over a political promise any day.


If I were to vote in a presidential
primary today, I would vote for:
Joe Biden
 

HerbChestnut

(3,649 posts)
45. Are you sure you're an Elizabeth Warren supporter?
Sat Aug 24, 2019, 10:55 AM
Aug 2019

Because she supports M4A. Maybe someone like Delaney is more up your alley.

If I were to vote in a presidential
primary today, I would vote for:
Undecided
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