Home Main Forums General Discussion How to repeal and replace ObamaCare today? Use Medicare.

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    • B Calm (752 posts)
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      1. Insurance companies need to be put out of business! We need

      National Health Care free of insurance supplements.

      “When I was a kid growing up, I think my instincts always were for the underdog.” – Bernie Sanders    
      • Charles (1166 posts)
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        2. Yes we sure do. America should no longer be the only major wealthy country

        without some form of universal health care

        http://www.politifact.com/virginia/statements/2015/sep/01/dan-gecker/dan-gecker-says-us-only-wealth-nation-without-univ/

        Sooner or later American will be so fed up at being left behind politicians will have no choice but to embrace it. Hopefully that will happen sooner than later….

      • jwirr (2942 posts)
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        7. I am not sure that Medicare works that way anymore. I am on Medicare and

        they make me choose between insurance programs – I have Medica which is a private insurance company. Can someone explain this to me?

        • GloriaMundi (463 posts)
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          12. You must be talking about a "Medicare Advantage" plan…

          …these are private, supplemental plans people buy to offset the 20% copays of Medicare.

          Medicare takes out a fixed amount from your Social Security check and you can go to any doctor that accepts Medicare, which in my experience is most doctors.

        • jeff47 (715 posts)
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          14. There's 4 major parts to Medicare.

          Medicare Part A: Covers 100% in-patient treatment in a hospital.  Has some limits to how long you can stay in a hospital.

          Medicare Part B: Covers 80% of out-patient treatment (Primary care visits, etc).  People frequently buy a private supplemental insurance plan to cover the other 20%.  These plans are relatively cheap because they’re only covering 20% of the cost.

          Medicare Advantage (Medicare Part C): An all-private, HMO-like system dreamed up by the Republicans to show how much money privatization would save.  It has never actually succeeded in being cheaper than “traditional” Medicare.

          Medicare Part D (Prescription drug coverage): Added under the W administration so that Medicare would pay some prescription drug costs.  Like Medicare Advantage, this part is not working at all like the Republicans promised.  Private supplemental insurance plans are often bought to make the Part D costs more reasonable, and again are much cheaper due to Medicare covering the extremely expensive situations.

          When you are choosing between insurance programs, you may be talking about Medicare Advantage, or you may be talking about a supplemental insurance plan to traditional Medicare.  If the former, you are required to choose between private plans.  If the latter, you are not required to buy a supplemental plan, but you will be on the hook for anything not paid by Part B or D.  For most people, buying that supplemental plan is a better deal.

        • Akallabeth (2234 posts)
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          54. The US has endorsed the for profit healthcare model irreversibly

          See http://unctad.org/en/docs/edmmisc232add31_en.pdf

          at the very beginning.

           

          "Out of many, one"
        • Akallabeth (2234 posts)
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          65. Read this, it explains it.

          This is the link.

          "Out of many, one"
      • Cleita (1921 posts)
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        22. Fifteen years ago I wrote an OP at SV about just that.

        I was of the opinion that the only way to get universal health care was to get rid of the insurance companies. The way to get rid of the insurance companies was to make it unprofitable for them. The way to make it unprofitable to them was to offer a non-profit plan run by the government that people could buy into as a choice opening it up to the free market and competition with the private companies. They are supposed to like free market or so they say. I opined that opening Medicare to the public to buy into would accomplish that.

        Oh well… :shrug:

        Then twelve years the ACA came along and guess what, a public option was put on the table, and ripped off so savagely it left a scar and the insurance companies in charge again. The premise still stands. In order to pry the health care market out of their cold, grubby hands is to make it unprofitable for them. How? Maybe passing legislation that forces them to operate like Medicare? They have to cover everything, charge a $100 deductible and pay 80% just like Medicare? Any suggestions?

        • Akallabeth (2234 posts)
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          66. Read the second chapter of this online book, okay?

          This online book– The second chapter.

           

          that will tell you the truth. The US media and ALL US politicians won’t.

           

          they are all “captured”. (Lying)

          "Out of many, one"
        • Akallabeth (2234 posts)
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          67. A "public option" cannot exist because public cannot be optional.

          Whats happening is millions of sock puppets online are lying to you. Half a million dollars a person in extra profits will pay for an awful lot of politicians and sock puppets.

          "Out of many, one"
      • Akallabeth (2234 posts)
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        46. They will do anything if you pay them enough. Buy the insurance companies

        and disband them as they appear. You cant make them go away but you could buy them out, given enough money.

        The magic of the marketplace. Deregulation will make healthcare more, not less expensive, for a given level of service. It will also raise the cost of foreign health care tremendously. Right now poor people can go overseas and get healthcare for a tiny fraction of what it costs here, but the plan the Republicans likely will fllow will end that making it some much higher percentage of the cost here because the US brokers of those overseas enabled plans will likely take a large cut. Also, they – by bringing the foreign countries and hospitals and providers in as co-conspirators will buy their silence on issues relating to legal standard of care issues like failure to diagnose, a serious problem here in the US and one which many people leave the country to escape (iatrogenic injury – harm done by the healthcare system – medical mistakes- is also now the third highest cause of death here in the US, because of criminally abbreviated US health care forced on doctors by ACOs and MCOs).

        "Out of many, one"
    • azurnoir (1676 posts)
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      3. when it comes to replacing Obama care with medicare

      be careful what you wish for-medicare has quite a few gaps too-and some medical groups are refusing medicare patients because what the government pays for various services isn’t enough

      we need to start over

      • jwirr (2942 posts)
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        8. The doctor at our clinic who works with hearing aids ect. refused to take my

        medicare insurance.

      • GloriaMundi (463 posts)
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        13. Well, when everyone is on Medicare…

        …it won’t make much sense to refuse Medicare patients!

        • Akallabeth (2234 posts)
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          47. Have you tried getting care overseas?

          or in Mexico. Its likely to be much cheaper and may be as good or better if you are poor.

          "Out of many, one"
          • GloriaMundi (463 posts)
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            50. No I have not ever been in that situation…

            …and I don’t doubt what you are saying.  But I fail to see what your reply has to do with my post?

            • Akallabeth (2234 posts)
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              58. Whatever the fix is, it has to be proprtionate to what people spend

              Medicare being non market driven depends on it being noncommercial, its no longer noncommercial, sorry. Once they start charging for it it has to become market driven. If nobody can afford it well, the leadership should have realized that was the case, as its been unaffordable to most Americans since 1992. So they had to keep it noncommercial, if they fucked up on something this important, intentionally, well. (Censored Unspeakable)

              Its right there in a NBER report.

              They fucked it up intentionally. It appears they are doing that with Social Security too.

              Here are the rules.

              There are no statutes of limitations in crimes against humanity.

              "Out of many, one"
      • Cleita (1921 posts)
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        23. The gaps can be fixed. Once everyone is covered with the same

        health plan, it can be improved and expanded because there will be nothing to stand in the way of doing it. It’s how it worked in Canada and other countries who have universal health care.

        • azurnoir (1676 posts)
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          28. sure the GOP controlled Congress will surely enlarge MediCare

          what will happen is that we will become even more teired than we already are when it comes to medical care-those that can afford private policies will have them – the rest of us can go pound sand

          • Cleita (1921 posts)
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            29. This Congress won't but future Congresses could. However,

            even half a loaf is better than none in the meantime.

            • azurnoir (1676 posts)
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              30. sure 'future' Congress could but will they?

              half a loaf? we already have half a loaf

              • Cleita (1921 posts)
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                31. Yes, I have the Medicare half a loaf and it's keeping me alive.

                Really, it’s better than no loaf. If I had to shop for medical care on the ACA exchanges I would get nothing that actually would allow me to see a doctor that I could afford.

                • azurnoir (1676 posts)
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                  33. as I noted below it won't matter that "everyone" has MediCare

                  because according to Medicares rules if the medicare payment doesn’t meet the clinic por hospital charges you pay out of pocket and trust me  that’s a dream scenario for some medical groups-talk about captive audience

                  • Cleita (1921 posts)
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                    35. I that's untrue. The medical care provider has to accept what Medicare

                    allocates. Then Medicare pays the 80% and you pay 20%. If it’s hospitalization they pay 100%. You pay nothing.

                    • azurnoir (1676 posts)
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                      37. Not according to MediCares rules they don't they can charge more

                      perhaps in some states saying the states rules take precedence and even in my state some medical groups are refusing MediCare patients

                      If you see a doctor who has not agreed to accept Medicare-approved amounts, you will pay more — possibly up to the full cost — for a doctor’s visit and care.

                      http://www.webmd.com/a-to-z-guides/condition-15/insurance/medicare-coverage

                      • Cleita (1921 posts)
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                        39. Medicare Advantage programs are often refused because they are

                        private insurance paid for out of Medicare funds. They are notorious for refusing payments so that’s why doctors don’t like them. The way you spell MediCare makes me believe you are talking about one of these programs. I’m totally against them because they deplete the traditional Medicare funding. Thanks I believe the Reagan Administration for those programs. But they are very popular with seniors who are unaware of the pitfalls because of the promises they make that they don’t keep.

                      • azurnoir (1676 posts)
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                        40. No I am not talking about MediCare advantage nor was it mentioned in the link

            • azurnoir (1676 posts)
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              32. Moreover here is MediCare currently covers -take note of the last line

              What Does Medicare Cover?
              Reviewed by Sarah Goodell on July 25, 2016

              If you’re eligible for Medicare and ready to explore your options, the first step is to get to know its four parts. Each part represents a different kind of coverage.
              Part A
              Also called hospital insurance, Medicare Part A covers the cost if you are admitted to a hospital, skilled nursing facility, or hospice. It also covers some home health services. Most people are enrolled automatically in Part A when they reach age 65.

              With Part A, you’ll pay:

              A deductible each year. This is how much you have to spend before Medicare starts to pay its part.
              Coinsurance. This is the part of the costs for hospital care you may be required to pay after you’ve met your deductible.
              If you or your spouse receives Social Security benefits , you don’t have to pay a monthly fee to have Part A and will be automatically enrolled.

              If you or your spouse doesn’t receive Social Security benefits, either because you are still working or because you don’t qualify, you may to pay a monthly fee to have Part A. You will  need to join through your local Social Security office.

              Together, Part A and Part B are called original Medicare or traditional Medicare.
              Part B
              Also called medical insurance, Part B covers outpatient care. For instance, it pays for your visits to a doctor’s office, tests, and preventive health care like cancer screenings and vaccines.

              Part B also covers some medical supplies, like blood sugar test strips, therapeutic shoes, and more. It’s common for people to be automatically enrolled in Part B, too.

              For Medicare Part B, you pay:

              A monthly fee.
              A deductible, which is a set amount you pay each year before Part B starts paying for any of your care.
              Twenty percent of the Medicare-approved amount for some types of care. These are doctor’s appointments, physical therapy, diabetes supplies, durable medical equipment like commode chairs, wheelchairs, and other care. You have to meet your deductible first and then pay 20% of the services you receive.

              If you see a doctor who has not agreed to accept Medicare-approved amounts, you will pay more — possibly up to the full cost — for a doctor’s visit and care.

              http://www.webmd.com/a-to-z-guides/condition-15/insurance/medicare-coverage

              It doesn’t matter that “everyone” will have MediCare – hospitals and clinics can still charge whatever they please it comes out of your pocket

              • Cleita (1921 posts)
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                34. I don't understand your problem.

                I have never been refused treatment. I have been refused, limited, denied by private insurance before I got Medicare. I had insurance that paid nothing because the deductible was so high, I was still paying for my medical and paying them a premium. Do you want things to remain the same with the ACA or do you want us to go back to those days I mentioned before? Because if that happens, my insurance is going to be either a ditch I can die in or a bullet.

                • azurnoir (1676 posts)
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                  36. I want an entirely new program

                  IMO MediCare sucks and the quality of care you get depends on the state in which live, with MediCare for all states that allow medicine for profit will have bonanza

                  • Cleita (1921 posts)
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                    38. Oh we'll. I want a pony too, but I'm not going to get one.

                    The only way you are going to get a whole new program is with a whole new grass roots Congress. In the meantime, it would be wise to protect and hang on to what you have and to work on expanding it and making it better as the opportunity arises.

                    • azurnoir (1676 posts)
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                      41. I want a pony- lordy where have heard that before?

                      • Cleita (1921 posts)
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                        42. It's an expression that's been around a long time.

                        SV didn’t invent it. Seems you just want to pick a fight with me not have a discussion about something that is very important to me and actually life and death for me, so have a nice day. I have to move on.

                • Akallabeth (2234 posts)
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                  69. People get sick when they get old, so the insurance companies do everything they

                  can to dump people before they become unprofitable/uninsurables.

                  "Out of many, one"
        • Akallabeth (2234 posts)
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          48. GATS rules would stand in the way because people who pay less have to get less

          and people who pay more have to get more, under WTO rules, unless a service is “supplied in the exercise of governmental authority” which basically means free to the end user, like Canada’s Medicare, not the US’s.

           

          here is the official text of the rule that makes that distinction- this is the official text:

          “For the purposes of this Agreement…
          (b) ‘services’ includes any service in any sector except services supplied in the exercise of governmental authority;
          (c) ‘a service supplied in the exercise of governmental authority’ means any service which is supplied neither on a commercial basis, nor in competition with one or more service suppliers.”

          "Out of many, one"
          • Cleita (1921 posts)
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            51. That is not the case with the Medicare seniors get here

            so extending it to all would not change that.

            • Akallabeth (2234 posts)
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              52. They cannot cause crowd out

              For example, give people who might be able to pay for something a better deal.

               

              The US is behind these international agreements so somebody would be nuts to think we would break them. So don’t expect any changes unless the underlying international agreement is changed. The WTO is in Geneva and its not a democratic institution. Additionally, India is challenging our quotas on visas and according to the CRS and the Indian press may win, if that happens, what will happen is a huge expansion in foreign workers who will likely work for very low pay so that will make health care much more profitable for the corporations so the likelihood of any changes will shrink to nothing, (foreign corporations will gain an entitlement that is superior to national laws, and not changeable by elections) because the preservation of a state of market access (if they are the low bidders) for jobs here in the US will become an entitlement of the lowest bidders with possible preferences (similar to affirmative action under the old system) for less developed nations, giving them an edge in supplying the low pay no rights workers.

              And of course many currently performing those jobs in the US may lose them, unless they can underbid nations which may have no wage laws or benefits to speak of, due to no fault of their own.

               

              "Out of many, one"
        • Akallabeth (2234 posts)
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          59. Sorry, Cleita, Canada was grandfathered in. They had single payer health care

          before they joined the WTO. Which ended the ability for them to add new services, and put their healthcare on notice that it had to be free or be privatized like the US.

          Thats the way it works, you cant have it in between. Bernie was either wrong, or he was planning on getting us out of the wto, or he was lying.

          Public services to be public have to be noncommercial. And it has to be pre-existing. The United States is the most commercial country in the world on health care, so that means it has to be commercial and the care delivered has to be proportionate to the money spent. You get what you pay for. To prevent Crowd Out.

          For the government to help people who had any money at all would be framed in WTO court as an illegal theft from corporations.

          But you don’t have to suffer and die. No. How would you feel about getting care in India?

          At least for a few years, with the price going up a lot, but it still might cost 30 or 40% less than here. Even after gentrification.

          Say the price of healthcare in 2020 has gone up 300% here and 1000% in India, India would still be MUCH cheaper than here.

          Read Chapter 2 of this free online book.

           

          "Out of many, one"
          • Cleita (1921 posts)
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            64. I have Medicare.

            It works fine for me except for the prescription drug part, which I think I will drop until we get rid of Prez Bush’s toxic gift to big Pharma. Last week I had an endoscopy and colonoscopy. My Medicare and supplemental pays for 100% of it. As a result I was diagnosed with a hiatal hernia, for which I will have surgery and it will be paid for 100%. I pay $300 a month for both insurances. I don’t understand where the WTO has anything to do with it and I’m sure it doesn’t. I don’t believe Canadians handed their health care over to them either.

            Yes, Bernie has no love for any of the global trade deals and I’m sure would have worked hard to get rid of them had he been President.

    • Rider (1976 posts)
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      4. My impression is they want to cut "entitlements"

      So even if we all are added on, I don’t think the GOP intends for that program to remain the same at all.

      Way too much distressing chatter @ vouchers.

      :(

      If not now, when?
    • senz (4861 posts)
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      6. Trump said he wants it done quickly. This would do it, perfectly.

      The infrastructure is already in place, it is tried and true and works very, very well.

      Medicare for ALL.   Let’s push for it.

      • Caretha (614 posts)
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        17. We think alike

        I have been speculating it was the only alternative to do an immediate repeal and replace, which Trump talked about today in his press conference.

        I like the idea because it leaves the insurance companies and pharmas out of the process.  Then if he proceeds with that plan and follows it up with again what he said in the press conference, he wants to deal with the pharmaceutical companies (or his words I believe was bidding) for prices on medications.

        Shit who knows….it’s all in the details, which we really have none at this point.

        "But the moment eloquence or the language of debate enters, true reasoning becomes impossible. For the purpose of the debater is not to find the truth but to win the argument, and to this end he will often stray as far as possible from the real issues"   "Eloquence and debate are designed, not to decide issues, but to sway people, for this reason they lean heavily on appeals to emotion and prejudice, and make use of neat, clever, and sometimes humorous turns of phrase rather than profound analysis of ideas" "Of all this Confucious was contemptuous" Confucious by H. G. Creel 1913, Chapter "The Teacher"
        • senz (4861 posts)
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          19. Agree on all points, but the insurance companies would fight him tooth and nail.

          I don’t know how he would deal with that, since he is such a big supporter of capitalism.  Progressive thinkers have come up with categories of services that work better for society when supplied by the government (i.e., socialism), and most of us would agree that basic medical care should fall under that category.  So I hope someone can explain this to Trump well enough to convince him.  Perhaps he could mollify the insurance companies by letting them have a monopoly on “extra” medical care — like cosmetic surgery and other medical services not required for life and health — something along those lines.  Then he could be a big hero for achieving universal single payer health care for all Americans, something that would be very pleasing to his ego.  A win-win for everyone.

          Don’t you wish you had his ear?

      • Cleita (1921 posts)
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        25. It would be great if he did it, but he can't do it alone. Congress

        has to approve and they won’t.

        • senz (4861 posts)
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          26. If he got excited about it and started pressuring them

          that might do it.  He got them to back off a move to drop the ethics board or whatever it’s called, so they do listen to him.

          We have to do everything we can to influence all of them, too.

        • FugitiveBirdie (1266 posts)
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          27. Can the President executive order the Department of Health Services

          … to stop enforcing age when enrolling people for Medicare.

          • Akallabeth (2234 posts)
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            63. NO, because US Medicare is only allowed to be for retired people.

            Just like Social Security is only allowed to exist in a form which gives poor people more money than others IF its totally noncommercial.

            "Out of many, one"
            • Cleita (1921 posts)
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              68. That's the whole point.

              We want it for everyone, not just old people. The nice thing is that it is already set up and working. All that is need is more workers and offices to accommodate the increase in enrollment.

              • Akallabeth (2234 posts)
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                70. I know but we live in the United States of America. We are a FOR PROFIT

                healthcare system. Did you follow that link? Read the second chapter it explains how healthcare can either be free and publicly delivered or for profit and then it has to be completely for profit. Otherwise its a theft from corporations.

                And other countries. They might trade something for market access rights. india wants those rights.

                They buy the rights to SELL to you and they cant be devalued.

                 

                This is capitalism. They invest in the market and that means we cannot ever have single payer. We signed the deal in 1994 and it became effective January 1 1995. To get out of it we will need to explicitly exit from the agreement, but the insurance companies which have global aspirations to sell insurance to other countries wont allow that. How could US healthcare be both a success and a failure, it cant be. You don’t fail when you’re successful.

                So you must be fake news Cleita. You’re poor and you don’t exist, get used to it. 

                "Out of many, one"
              • Akallabeth (2234 posts)
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                73. But, they dont want to give up the business. Its all about money.

                Its not about us, its about money. get it? They couldnt care less if we live or die. Actually, if we are poor, they would likely prefer we die sooner. When we stop buying useless stuff, they consider us dead weight and want us to die. Thats the unvarnished truth. Buy or die. They consider milking poor people for money to be their entitlement.

                "Out of many, one"
      • Akallabeth (2234 posts)
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        61. By monopoly power he likely means that he wants to bring in foreign competition.

        He quite possibly will have to, as its likely already a done deal.

         

        Why do you think they claim they “have to” privatize and “deregulate” everything.

         

        They are doing the best they can to irreversibly trap us into the MOST COMPLEX MESS OF REGULATION EVER.  the WTO.

        "Out of many, one"
      • LWolf (91 posts)
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        81. Yes.

        Since my congressperson is leading the effort to dismantle the ACA, he will hear about this.  He’ll need to hear from many more people, though.

    • cyberpj (2365 posts)
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      9. MEDICARE is great and I would have kept it except for NO CAP for CATASTROPHIC

      EVENT CARE.

      If you have millions of dollars in expenses for something really major, you will still have to pay 20% of the millions.

      And then you still need to pay additional amounts for separate PRESCRIPTION, DENTAL AND VISION care -which are not included in standard Medicare coverage.

      QUESTION EVERYTHING 
      • jeff47 (715 posts)
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        15. Sorta.

        Part A covers 100% of in-patient treatment at a hospital, which is the really, really, really expensive part of that catastrophic event.  There are limits to how long you can stay in the hospital in a single “event”, but frequently it’s possible to work around it.  For example, admitted to the hospital.  Check out on day 91.  Check back in on day 92.  It’s now a new stay and you get another 90 days.  (Obviously that does not work with every possible situation.)

        Part B covers 80% of out-patient treatment.  That’s the 80% you are talking about.  It’s pretty rare to have a condition that runs up millions in costs that is an out-patient condition.  There are private supplemental plans to cover that remaining 20%, and they’re relatively cheap* since they’re only covering 20%.

        Part D does give prescription drug coverage to everyone.  But it has problems like the “doughnut hole” – A little bit of drugs are covered.  A medium amount of drugs is not.  A ton of drugs are, once you’ve gone through the “medium” part.  Again, supplemental plans exist that are relatively cheap* because Medicare is paying for the very expensive cases.

        *Note that “relatively cheap” is in comparison to what a 65+ person would have to pay for 100% private insurance on the open market.  Such as “only” $200/mo instead of $2,000/mo.

        • cyberpj (2365 posts)
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          18. Hey – good info. Thanks.

          One last concern would be the amount of previously considered in-patient care that is now being changed to out-patient care in order to cut costs.  Shorter hospital stays in exchange for more out-patient care requiring care-facility visits or short stays for rehab, etc.  But you made me willing to check it all out again.  Having progressive M.S., the ever-increasing costs of expensive M.S. medications (can average 2,000/month or more) along with the possibility of a return of a previous cancer scared me away from Medicare only.  The plan I settled on has an annual out-of-pocket limit which I have recently hit, twice.

          So, whatever happened to that protest for healthcare we used to chant to members of Congress?  “We just want what YOU have!”

          QUESTION EVERYTHING 
          • jeff47 (715 posts)
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            20. Sometimes, care-facilities are still "hospitals" as far as Medicare is concerned

            but I do not know the nuances that determine if it’s Part A or Part B.

      • Akallabeth (2234 posts)
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        62. I totally agree with you and if we had not signed the GATS in 1995 it would be

        possible without carve outs.

         

        But since we did sign, its absolutely necessary to get carve outs NOW. There is NO way in a million years you will get it without carve outs.

        "Out of many, one"
    • liberalguy (284 posts)
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      10. Exactly. I don't even care if they take credit for the idea.

      They can call it ‘Murica! Freedomcare!

      There is nobody so irritating as somebody with less intelligence and more sense than we have. - Don Herold
    • INTJ (1753 posts)
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      11. Just know that the R's will allow HMOs/Health Corps to bill above medicare and

      that individuals will be responsible for the difference.

      Hey, that house was just a pain in the ass to keep up wasn’t it?  Things will be so MUCH better when you sell it and don’t ever need to shovel snow again.

      What’s that?

      No. I’m sorry.  It’s not my fault you live in Miami and never shoveled snow.

       

      Grant us the vision to see what must be changed and save us from making it even worse.
    • Akallabeth (2234 posts)
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      16. Can't fixbecause of a trade deal regulating "all measures of general application

      affecting trade in services”.

       

       

      "Out of many, one"
      • jeff47 (715 posts)
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        21. I eagerly await your explanation of how one does

        international trade in hospital services.

        “We’ll ship you 27 cardiac patients by Tuesday!”

        (Yes, I’m aware some people think that agreement makes any health care reform impossible.  If this claim was true, then the ACA couldn’t exist)

        • Akallabeth (2234 posts)
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          43. Good paper by a well informed author

          Patient Mobility Beyond Calais: Health Services Under WTO Law

          https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1763416

           

          Abstract:

          The paper analyses the impact of WTO law on transnational patient mobility by transplanting the Watts case of the European Court of Justice into WTO law. The first part of the paper concerns the question whether medical or hospital treatment abroad concerns “trade in (health) services” in the meaning of the GATS. This part identifies the legal construction of this notion through the four modes of supply and also gives a short factual account of the scope and structure of trade in health services on a global level. The next part will ask more directly which measures fall into the scope of the GATS. In particular, it has to be determined whether the exclusion of services supplied in the exercise of governmental authority from the GATS influences the application of the agreement to health and medical services. Having determined under which circumstances the GATS applies to measures affecting the cross-border supply of health services, the subsequent part of the chapter discusses the substantive obligations of the GATS. After a short overview of the main principles of the GATS, the chapter will provide an in depth inquiry into the specific commitments in health services of the EU and other WTO Members, because only the exact analysis of the limitations and qualifications of these schedules allows us to clearly determine the impact of the GATS on the cross-border to provision of health services. In addition, the potential of the general exception clause of the GATS to justify regulations of health systems which violate GATS obligations needs to be ascertained. Lastly, the legal status of GATS in the EU legal order, in particular the contentious issue of direct effect, needs to be assessed, because only if the GATS is directly applicable would a patient who received medical treatment abroad be able to rely on the agreement to claim reimbursement of the costs of said treatment.

           

          "Out of many, one"
          • jeff47 (715 posts)
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            44. And the flaw is you are expanding it's relatively narrow situation into

            a universal situation.

            Inherent in your paper’s analysis is moving a person from one country to another while they are still receiving medical care.  That happens extremely rarely.

            Again, how does the ACA exist if this analysis is correct?

            • Akallabeth (2234 posts)
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              45. The WTO does not change country's laws directly, it can only fine them, if

              petitioned by a country whose interests are threatened.The fines are supposed to be proportionate to the expected lost profits which could hypothetically be impacted. So, online gambling= (as in the US-Gambling case) not so much. Health insurance=a very very large amount.

              However the three newer FTAs – were written (It seems more than any other country, perhaps) by the US to be much tougher.  they are “negative list” or top down, which means they function as an implicit “standstill” to some degree and include all service sectors (like we already have included health insurance in GATS) by default with them having to be explicitly “carved out” in writing at the beginning to remain unregulated.

              (See “HOW TO DESIGN TRADE AGREEMENTS IN SERVICES: TOP DOWN OR BOTTOM UP?”    –  WTO. org document ersd201308_e.pdf  page 8 or 9 I think)

              Thats what we would need to do to escape what appears to be this trap the corporate class are cynically laying for us, the poor people of the US. There is a conflict because this is clearly a crime against humanity (Violates both Helsinki and Nuremberg treaties on medical experimentation without informed consent)  Also Nancy Pelosi tacitly admitted the same.  “We have to pass the bill to see whats in it“)

              Its not acceptable to do things which you already know wont work and claim they are not known to be unlikely to be successful. Thats either intentional irresponsible killing or at best, still very very illegal medical experiments on living human beings.

              See ” State Health Reform Flatlines” (link) for how we knew from the beginning that another rehash of the same tired “managed competition” would fail before they even did it, not only did we know it would run into adverse selection, we knew how long it would take. When i say we I mean not including I because I am not a professional anything in this context, just a person who has been following this issue for a long time- non-professionally- that professionals certainly did know because even I an outsider with no official expertise in the field “knew” because I had read countless pieces of information that made its failure an almost certain inevitability from what I knew. And I said so in 2009. And time has proven that i was right.

               

              And the experts were saying that. The ones with credibility. Also, both of the Democrats running in 2009 were both telling the truth in that they both were accusing the others plans of being guaranteed to fail at what was then admitted to be the most difficult of the goals to achieve, covering the approximately 10% of Americans with serious pre-existing conditions. The group that is overrepresented among the Trump-voting constituency, the ones who will do the least well under neoliberal “reforms” opening up cross border data flows, and liberalisation of services to allow free trade in workers skills – a form of labor arbitrage to push US wages down towards those in developing countries without any commensurate fall in prices- an impossible situation they are setting up for our country. Both parties are drooling at this possibility. (God save us from their greed.)

               

              Those many who foolishly voted for Trump instead of Bernie, or Jill Stein, are the same ones whom it appears the GOP is ready to offer as another human sacrifice to their gods of mammon (right wing ideology)

              The political class's God of Mammon (money)

              Being politicians doesn’t somehow absolve people from responsibility.

              There is no statute of limitations for crimes against humanity.

              As its already been proven again and again that these kinds of structures do not work.

              Increasing profits by bringing other countries in isnt going to fix the adverse selection problem for example, just make the mess extremely complicated – because it will give an entitlement to market access which cannot be ever taken away, hijacking the possibility for immigration reform into a corporations first agenda and giving foreign countries whose expectations have been held at high levels an escape valve from the price of corruption they think, allowing corrrupt regimes to get away with corruption longer by sending the less well connected better educated workers away to work for a fraction of what they are worth elsewhere.. Given overly high expectations by what seems to me to have been almost two decades of back room negotiations with two timing administrations trade negotiators who basically seem to discount elections and emocracy as being unable to make any changes in these agendas, trade deals that basically now nullify the wishes of the people, rapidly making elections functionally meaningless if they cannot change things of extreme economic importance – instead giving them as entitlements to first, foreign countries and more reently, directly to multinational corporations! Like a new feudal system, they are tied not to countries governments – but to the land occupied by countries and their people, so even revolutions such as the ones in South Africa and in Eastern Europe, cannot free a people from the corporate entitlements they create.

              The poor countries have been told repeatedly that there is some new Deal for them which will funnel high value service jobs their way if they can just be the winning low bidders.

              The Republicans are falling for the fake deregulation frame as well. they will see, that deregulation will end up being orders of magnitude more complicated and the potential disputes much more more complicated – infinitely more complicated and messy.

              Don’t get me started on the obvious and unresolvable incompatibility between for profit healthcare and tropical diseases, foreign health care systems and workers, vector borne illnesses of poverty and the Mississippi/Missouri/Ohio river system, our low elevations, and global warming.

              "Out of many, one"
              • jeff47 (715 posts)
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                55. So where's the fine?

                The ACA does many things you claim are against WTO rules when it comes to single-payer.

                So where’s the fine?

                It’s almost like the WTO isn’t really a barrier, it’s just thrown up as an excuse designed to 1) stop the effort towards single-payer and 2) redirect anger at healthcare to anger at trade.

                • Akallabeth (2234 posts)
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                  56. Read two discussions about this

                  This is very good but be aware there are a few mistakes Ive found in it. For example, WTO rules require “progressive liberalisation”, which means more and more privatization with every change being locked in. That basically cancels out democracy UNLESS people always vote for “more privatization”, so naturally, they will always vote for that (*wink*) it will have to win. It could be 20 years (or in our case even longer) before people figure it out.

                  Slick!!!

                  It seems to me that the way they explained that in TradingLives (2007) didn’t really make that as clear as they should have.

                   

                  This is from the state of Maine. It explains why they ended their Drigio Health Care program.

                   

                  And this is from UNCTAD, it explains US healthcare’s (commercial) health care clash with the concept of public health care generally and explains how and why the two never never mix in a country under WTO law.

                  So, there are four authoritative sources of proof. Satisfied?

                  "Out of many, one"
                  • jeff47 (715 posts)
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                    77. Again, where is the fine?

                    Once again, claims people make about the WTO would block any reform run into the problem of we actually did some reform.  And there’s no WTO case after that reform.

                    Again, if any of this analysis is correct, where is the fine for the ACA?

        • Akallabeth (2234 posts)
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          71. Thats likely to be exactly what they do.

          Beggars cant be choosers. Poor in America is poorer than anywhere because of the high cost of living.

          "Out of many, one"
        • Cleita (1921 posts)
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          75. You are so right. I really don't know what this person

          is talking about. All you need to know about what we need in the way of health care here in the USA is at this website;

          http://www.pnhp.org/ the Physicians For a National Health Plan. This organization began at Harvard Medical School when physicians there realized that we could do better in getting health care to all Americans. It has nothing to do with WTO.

          • Akallabeth (2234 posts)
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            78. Right, its true, and they also have the best paper on the WTO issue

            but unfortunately its 27 year old author, Nicholas Skala, died shortly after his research was published.

             

            "Out of many, one"
    • DoctorJ (398 posts)
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      57. This is what turd way Barry should have done in 2009.

      Lower the Medicare eligibility age to 60, in exchange for signing heritage care into law.  Or, if boner and McConnell said no, lower it by executive order.  Then Let the republicans run on taking that away in 2010.  See how that worked for them.  Then repeat in 2011, and go into the midterms with all of the 55-65 year olds now on Medicare.  We’d have had 64 senators and 265 house members to start 2013.

      The ideal CNN story is a baby down a well, while the ideal Fox story is probably a baby thrown down a well by a Muslim terrorist or an ACORN activist. - Matt Taibbi, "Insane Clown President"
      • Akallabeth (2234 posts)
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        72. Youre on drugs if you think they ever will do it. Its all BS, because the WTO

        rules govern everything they do.

        "Out of many, one"
        • FugitiveBirdie (1266 posts)
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          76. Can we send a drone to bomb the WTO?

          I mean they sound like the real enemy.

          • Akallabeth (2234 posts)
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            80. No, I think we should instead try to engage with them.

            Because they are changing and the new membership – mostly developed countries, potentially understand our situation. The problem is, they likely have been promised jobs, (but not publicly, in private, Ive heard this again and again, going back >20 yrs to the 90s) in exchange for market concessions, and now they are really quite angry at us for not dishing them up in large quantities. (All they think they need to do is bid cheaply. Which is easy for them as $12-15 an hour is more than most doctors and engineers make in least developed countries.

             

            They also are pushing for and getting affirmative action programs in the form of a services waiver which will give them which will help them export services even if their bids are not the very lowest.

            This will be a form of affirmative action for the corporations from poor countries.

            This allows them to take advantage of their competitive advantage, cheap labour. We build the rocket ships (well, actually parts of them) We build the microchips (high value added products) they perform the cheap labour.  Thats the logic behind “Global Value Chains” pushed by the developed countries.

            How could we force them to pay their high skill workers $15 an hour when that eliminates their competitive advantage that they are entitled to use because of GATS.

            Its not true that as some put it, the “one and only area they excel in” is cheap labor.  Thats another lie told toprevent them from standing up on their own economically.The developed countries dont want them to do that, they want them to remain dependent on them not just for goods, also for jobs. To do that somebody has to lose those jobs. Huge market sectors like healthcare,education and construction (i.e. infrastructure) have to be privatized to put enough jobs on the table. So thats what the FTAs are doing. Starting with GATS but also WTO GPA and the three US FTAs and many others.Its not just us, its a global thing. Also, they want to push people out of the labor markets here and they want to push poor people out of the cities, and eventually out of the country.

            This is a global corporate takeover of the worlds future.

            A power shift that recognizes the increasing power of corporations and the rapidly diminishing power of human beings and governments to do anything. The power of the vote is being turned into a nothing, with no power.  Voting wont be able to reverse any of this, as its being given as international entitlements to corporations. Permanently.

            They have the best and highest paid lobbyists in the world. They have (some arguably faked, totally astroturf) NGOs for the “poor countries” (elites) whose negotiators all speak impeccable Oxford English and wear the most fashionable clothing, they clearly want for nothing .

            They have finagled for and gotten the powerful to buy in on their having a right to use it to displace the “overpaid” workers of the developed countries. There is a major global propaganda campaign going on to convince everybody its a good idea.

            Sacrifice the income of the developed country workers so that profits can be higher and the jobs can be given to the well connected poor rich kids from LDCs. (who often come from rich families and share their sense of entitlement with their benefactors in the Davos crowd.).

            See the problem? Its basically a war on the “overpaid” middle class (and “overpaid” working poor, which includes many former professionals just eeking out a living on part time work- because they are next) in the developed countries.

             

            It wont lower prices on health care, thats a BigLie(TM)

             

             

            "Out of many, one"
      • Akallabeth (2234 posts)
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        79. They will NEED carve outs FIRST, soon because of the 1998 standstill

        on financial services which you can learn about by searching on the phrase “Understanding on Committments in Financial Services”. (always use the British spellings because there is VIRTUALLY NOTHING in US English on WTO law.)

        When you find the documents, look for the phrase “standstill” or also, you may want to read the description of what a standstill is from the MAI. (so it is on the OECD web site.)

        Another suggestion, look at the WTO publication “HOW TO DESIGN TRADE AGREEMENTS IN SERVICES: TOP DOWN OR BOTTOM UP?” for the description of what “standstills” “top-down” trade in services deals, and the definition of “negative list” are, WHO IS PROMOTING THEM THE MOST, in what kinds of treaties, and so on.

        That document’s file name is ersd201308_e.pdf

        I hope that I have been helpful.

        "Out of many, one"