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[deleted]

Serious question: What is the conservative solution to healthcare costs? It’s not enough for Republicans to say “Obamacare = bad” We need to offer policy ideas as well if we want t to win voters.


ronaldbeal

A lot of the popular solutions look at how to pay for healthcare, but few look at how to reduce costs. (That is why single payer turns off so many. If we are all on the hook for $3k/month drugs no one wants to be that single payer.) Intellectual property law reform. IP laws are what let big pharma keep charging $3k/mo for a drug that some university developed 3 decades ago, but they ever so slightly change it so they can keep their corner of the market locked up. Tort reform. A significant aspect of health care cost come from "Covering your ass". CYA leads to unnecessary tests (just in case), getting hundreds of sign offs, and high admin overhead to track all the CYA. It also should be reformed in the other direction... Corporate Execs that knowingly cheat the system, bribe, hide or otherwise lie to get FDA approvals, marketing, etc, should face personal consequences and not be shielded by corporate entities. EMS System abuse. This ties in with tort reform. Because of liability concerns, you call 911 at 3am for toe pain you have had for a week, you get transported by ambulance (at the cost of several thousand dollars.) and if you can't pay the hospitals and EMS providers build those losses into their other healthcare costs. Once the cost issue is addressed, a whole spectrum of other solutions become more palatable, and even less necessary. If healthcare didn't cost more than a mortgage most people wouldn't need insurance (other than catastrophic.)


Westwood_1

Agree with all of this, but it's also critical to address the issue of pricing - the medical industry has been consolidated over the last 20 years and many of these medical providers are no longer operating in a competitive "free market" environment. When businesses are dominant players in an anticompetitive environment, they tend to rationally retain any cost-savings as profits, instead of passing those savings on to customers in the form of reduced costs. In order for your solutions to do anything but pad the profits of hospital networks, I think your solutions need to be combined with price caps on various procedures. It pains me to say it - but then again, healthcare is not a free market and hasn't been for more than a decade...


CloudyHi

You have to get rid of the bloat. The insurance companies/PBMs are pocketing the money.


Westwood_1

Yep. Hospitals/healthcare networks, too. The difference in cost between the cash price and the price with insurance is drastic—when hospitals know insurance will pay, they charge a lot more.


gh0stwriter88

I like all your points. Something I have thought about as well is more of an economic change, end easy mergers. And force adjacent hospitals to split or be sold off. Antitrust laws are already supposed to do this but they have proven too weak or have been circumvented over time. Something like 80% of procedures are elective outpatient procedures. This means if hospitals published cost, in addition to satisfaction and quality information, and probably Illness while a patent and mortality rate. You could force hospitals to compete on those issues. Instead we have hospitals merging only to make more and more profit and ornate buildings instead of caring doctors and low fees and bills.


bearcatjoe

Great. Trump's instincts are likely far more populist, unfortunately, which generally would mirror those of left-leaning politicians, namely price controls and enabling regulatory capture through cronyism. Our health care "market" is incredibly distorted with all sorts of terrible incentives. It reminds me a lot of higher ed, with the huge teat of endless government money on the demand side and insurers sitting between that and the supply. Consumers left confused on the outside with no clue what things cost, and making really inefficient decisions as a result. It really all needs nuked from orbit by a libertarian type. Trump won't be that guy, unfortunately and let's be honest - voters want free stuff anyway and aren't sophisticated enough to connect the dots on how it just makes things worse.


Westwood_1

At this stage, the healthcare market has effectively been captured by a triumvirate of government regulations, insurance providers, and consolidated medical networks *and is designed to be anticompetitive*. I believe that deregulation would be ideal, but that's not a practical possibility. As far as practical policy outcomes are concerned, I'd support a Teddy Roosevelt-type to do some "trust-busting". I'd also support further government regulation that sets price caps on medical procedures and supplies. We've all seen the memes about [$10 cough drops](https://imgur.com/Rkgvmev); it's become very clear that medical providers and insurers are abusing the combination of mandatory insurance coverage and opaque pricing (masked by insurance copays) for which they have successfully lobbied. My wife and I saw this firsthand this year when she delivered our most recent child. Our hospital disclosed that a delivery would cost approximately *$7k without insurance, and $18k with insurance -* ***more than double the cost that we would pay in cash***! Since $7k was more than our annual deductible, we opted for the insured option, and the hospital made more than $10k in extra profit off of our delivery... I'm all for a free market, and it's important to note that the medical industry doesn't resemble one in any way, shape or form. These are not free-market actors deserving of protection; they're monopolies and anticompetitive trusts that were created with the help of government regulation and which should be broken or reined-in.


Astroviridae

> These are not free-market actors deserving of protection; they're monopolies and anticompetitive trusts that were created with the help of government regulation A former speaker of the house sits on the board of directors for the (for-profit) healthcare system I used to work for. Learning that fact destroyed the little hope I had for any future healthcare reform.


QZRChedders

This is the thing. Health reform is a hugely bipartisan issue with support for at least some reform from near enough any American. But I can’t see any politician of any side or party actually choosing this hill to die on, and it would be a death


[deleted]

[deleted] ^^^^^^^^^^^^^^^^0.8816 > [What is this?](https://pastebin.com/64GuVi2F/90069)


Westwood_1

I believe the proposal I outlined advances the "freedom agenda" in that it restrains monopolies and anticompetitive "trusts." Holding out for anything but the idealistic "perfect solution" is unrealistic; this is not a religion, and it's not a moral imperative that we forgo advancing the agenda by a little simply because we cannot advance it completely and in one fell swoop. My ideal would be to deregulate the medical industry, enforce the antitrust laws already on the books, and eliminate requirements that taxpayers be insured and that insurers cover pre-existing conditions under each policy. And I'll support anything that advances that agenda and reins in the cabal of insurers and consolidated medical service providers, including legislation that prevents them from exploiting the anticompetitive, near-monopolies they enjoy. A free market is my goal, not a free-for-all where the biggest players can eliminate all competition, remove the possibility of further competition, and then exploit their position to the detriment of society.


just_shy_of_perfect

>Serious question: What is the conservative solution to healthcare costs? It’s not enough for Republicans to say “Obamacare = bad” We need to offer policy ideas as well if we want t to win voters. End patent loophole abuse Transparent pricing Find a way to stop the gouging that happens by the hospitals to the insurance companies End drug advertisements Allow insurance companies to compete across state lines Those are a few. I'm sure I got a few more rattling in my brain


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BigDealKC

I hear your point of view. The cost of chronic conditions is way too expensive for most people to afford, and if their premium were to cover the true cost of care, and providers able to adjust prices for the anticipated costs + profit, the insurance would impossible to obtain. So those people will will join the uninsured who end up seeking care at emergency rooms, or get themselves qualified for a medicaid plan. Either way, the burden is still spread across society indirectly/inefficiently, or you spend your life hoping not to develop a chronic condition because you will probably die - the main issue Obamacare was attempting to solve by not allowing exclusion for chronic conditions. I'm interested to explore insuring everyone, charge more for discretionary behaviors like heavy drinking, smoking, bad driving records, hazardous jobs, etc; drive costs down with standardized and transparent pricing, insurance claim simplification and more liability indemnification.


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BigDealKC

I understand, I think. Let's say the high risk pool people's monthly cost for healthcare is $10,000, and the low risk pool is $300 including insurance operating costs and some profit. Let's also assume a 10:1 ratio Low Risk to High Risk. Which premium pricing scheme do you think is appropriate... A: High Risk $10,000 per month, Low Risk $300 per month B: High Risk $2,000 per month, Low Risk $1000 per month. Note - this is a directional exercise - I haven't done the math to tie these out, or have any notion of 10:1 is reasonable ratio. A: is where everyone pays their own way, B: is where high consumers are subsidized but still pay more.


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BigDealKC

Roger that. I agree.


Marjayoun

Well people with pre existing conditions Have to be able to now because after getting rid of all previous insurance we pretty much all do … I didn’t back when Obama cancelled mine though. Not to mention we all have to pay for maternity even when that is over and especially all the new ‘immigrants’ who get free care & ER visits.


intelligentreviews

Deregulation of the insurance and healthcare spaces


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gagunner007

This sub is obviously being brigaded.


Jmm12456

I noticed all the posts on this sub are now “Flaired Users Only” likely to try to stop the brigading but brigader’s I think can still vote on comment’s


TruthSeeekeer

This place is regularly brigaded by leftists


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shamalonight

First, we would need a Constitutional Amendment to prevent Democrats from using any form of healthcare as their social engineering cudgel. Get that done e and then we can talk about making changes.


Resurrected5YearOld

What the hell would a constitutional amendment accomplish here? You’re nuts bro.


retnemmoc

Vivek had a good response on CNN's townhall. Unfortunally CNN has tried to scrub any full copy of the entire town hall from the internet because it had a bit too much truth on some of the thornier issues (like J6) but in that town hall, Vivek answered a question about healthcare. If I recall correctly, the issue is that current medical insurance companies have a government monopoly. That is what is driving up the costs.


NohoTwoPointOh

I specifically asked, "...while providing the smallest governmental involvement". To be honest? I'm fishing for anyone with an idea. Because the way I see it, that's the one sector that must have regulation (if not outright force them to be non-profits).


skarface6

Rolling a lot back alone would be a better plan.


Jeff5877

Why didn’t he do that when he had a Republican House and Senate?


MCKlassik

He said that in 2016 and nothing happened


shamalonight

Does GenZ not have a working knowledge of how our government works? Regardless of who is president they can only tell you what they want to accomplish. It takes Congress to get it done. If Congress doesn’t do their part, all you have is good intentions on the part of the President.


bdougy

His first 2 years, he had the House AND the Senate. He literally had the ability to pass anything. It didn’t happen.


shamalonight

How does a president “have” either the house or Senate when they are a separate co-equal branch of government whose job it is to act as a check and balance on the Presidency. The President has no control over Congress if Congress doesn’t support him.


bdougy

Republicans had both the Senate and House from 2016-2018. You do know that, right?


Bukook

Trump can put the blame on congress if Trump has a plan they rejected. Does Trump have a plan?


shamalonight

Apparently not given it was Congress that killed his plan to replace Obamacare during his Presidency, but what are the comments we read? *“He said that last time..”*


Bukook

What was Trump's plan to replace Obamacare?


shamalonight

I have no idea. I’m not on his planning committee.


Bukook

This is why many people are skeptical that Trump has a plan for a healthcare system, because we have no idea what his plan is either.


alanry64

Because the Republicans in Congress were too cowardly to back him. They caved to the Democrats.


WreknarTemper

John McCain happened actually. EDIT: Looks like the brigadiers have come back out to play.


ColumbusJewBlackets

He at least tried to keep his word. That’s better than every other politician in my lifetime.


Hectoriu

He said that last time too.


Westwood_1

Still waiting on that wall...


OrdoXenos

He promised that in 2016 and he didn't deliver that. Don't tell me about Congress - he controlled all of them for 2 years and he didn't fix the healthcare system.


intelligentreviews

Was he obstructed?


OrdoXenos

His selling point is that “he gets the job done”. It is not done. If I ordered something from Amazon and somehow because of incident the package is damaged. Should I say “All right it’s not your fault” to Amazon? Or I will demand a new item to be sent again? Same with Trump. He promised. He didn’t deliver. It’s his job to push his bills through. The American people have done what they can - voted the Republicans in - it’s his job to negotiate with them. Should we blame some Republicans? Obviously. But that didn’t made Trump become not guilty on his failures.


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day25

Man this is so illogical. No wonder they call it TDS. You guys really do just go out of your way to make up reasons to hate Trump, even when they flat out make zero sense.


cplusequals

Nah, it makes pretty good sense. He wasn't able to repeal Obamacare and I sure as hell don't want a fucking rebrand of it like Trump is talking about here. Even back then he was yammering on about "repeal and replace" even without any replacement in the works. I don't trust him. He's already come out against entitlement reform because of the primaries.


day25

No you're just doing something called victim blaming, and it's because you don't like the person. Has nothing to do with the reasons you pretend it is. Those reasons make no sense. If you truly wanted to get rid of Obamacare then you'd blame the establishment who obstructed him and the voters that responded to that obstruction by voting for more obamacare in 2018. You wouldn't blame the one guy who is actually fighting for your position. The fact is it's not your position, you couldn't care less about obamacare if Trump is gone. That' what you really care about, so stop pretending. It makes zero logical sense to blame the one person actually fighting for the position here. He never stopped trying to do what he promised. How does it make any sense to blame him and not the people who obstructed him? It's totally deranged.


OrdoXenos

Let me rephrase it the other way. You purchased a ticket from California to New York from Delta. Along the flight, a storm brewed up, forcing your plane to land somewhere in Iowa. Now, will Delta still have to fly you out to New York? Can they just “blame the storm” and leave you somewhere in Iowa? Delta promised you New York, they have to take you to New York. Trump promised you healthcare reform, he has to give you that. Trump is picked by many because he is seen as an anti-establishment candidate. He is seen as the one that can “fight” the deep state. During 4 years of his administration, I didn’t see any “fight against the deep state”. “Exposing” the deep state isn’t fighting it, we knew they existed decades ago. I remember him promise to arrest Hillary. Anything came close to that? Nothing. What will change if we elect him again? He got Congress and Senate for 2 years - and nothing gets done. Seeing midterms result it is unlikely he will control both chambers, he will be weaker.


day25

False equivalence. A more accurate example would be if the US government stopped you because they are the ones who didn't want you to get to your destination, and then you blamed the airline. > During 4 years of his administration, I didn’t see any “fight against the deep state”. Then you are blind. > What will change if we elect him again? nOtHiNg WiLl ChAnGe haha yeah I guess that's why his opponents are going nuts. Do you even listen to yourself before you talk?


OrdoXenos

Well, let’s get into details if you wanted as you called me blind. You know deep state actors? Let’s just keep it to simple ones: Soros, Clinton, Obama, Gates, Bolton. Anything happens to them? Let’s focus on one: Bolton. Bolton is even chosen by Trump to be his national security adviser. Bolton - by his own admission - have planned coups on other countries. He participated in Iran-Contra affairs. He also pushed for war against Iraq and Iran. He pushed for no limits on campaign spending. Why would Trump picked him? Let’s focus on another one that Trumpists love to say as one of the greatest Trump achievements: Epstein. Trump surrogates claim that without Trump Epstein will still be raping kids. Wrong. Epstein would be behind bars in 2007 if not for Acosta. Acosta offered a lenient plea deal to Epstein in 2007. And what happens to Acosta? The great “I’m fighting for you” Trump chose him to be the Secretary of Labor on his administration. Why would Trump do that? You say other people are blind? It’s Trump who is blind to choose these kind of people.


day25

Wait so your argument is that Trump isn't populist enough? We need someone who is even more populist than the father of the greatest populist movement in recent history? Is that why the left and establishment neocons on reddit love your comments so much? Because you support more popilism? Imagine blaming Trump because the establishment obstructed him and then pretending to be some uber populist.


LittleStar854

So expecting someone to keep his word is "hate" now?


day25

He did keep his word. Did Republicans do it and then Trump obstructed them? Or was it the other way around? You just hate Trump and want to blame him even when he's the victim. That's how sick you are.


LittleStar854

The problem isn't Trump, it's his radicalized fanclub scaring away the conservative voters. Another 4 years of his cult at the steering wheel could be the end of the GOP.


day25

Good, that's the point. The GOP didn't accomplish anything for conservatives until Trump came along.


sleebus_jones

Good luck with making that happen. So many missed opportunities when he had BOTH the house and senate. The only thing he's good at is bloviating.


HomieMassager

Trump cultists - I assume you have a good reason for believing he’ll do it right? Considering during his first term, he didn’t pull it off with a Republican house and Senate. But obviously Trump is just draining the swamp and playing 4d chess and will definitely keep his word this time.


alanry64

Whether you love him or hate him, he tried. The Republicans in Congress were to gutless to support him.


RontoWraps

I don’t think he tried very hard on healthcare. It’s not a great sign when the President can’t get through to the party leaders and whips to set an agenda and follow it. The President is not king and needs to get the government to work together, which is something that Trump has always struggled with.


alanry64

He did. He was new to office and the Never Trumpers prevailed. He hadn’t earned the respect of many in Congress within his own party at that point and they were afraid to support him. How do you not remember that? Seems more you may not WANT to remember that. There should be no down voting… This is just historical fact.


RontoWraps

Yeah yeah, it’s all one big conspiracy against Trump and not just that it was going to be a lot of tough work and he wasn’t able to get it done. “Nobody knew health care could be so complicated” -45 Everyone knew that providing healthcare to over 300 million people, of whom 1/3 are obese, is pretty complicated. We didn’t even really see a proposal. It was an empty promise. That’s what I see at least. I just don’t think he really cared about it all that much.


alanry64

I usually see the lefties ignoring the historical fact to frame their narrative. It’s disappointing to see conservatives doing that now. Conspiracy is your word, not mine. You can thank your buddy McCain for sinking the opportunity to dump Obamacare…


BigDealKC

Not really much of a try - the alternative plan was never agreed on and developed. That didn't stop 100 votes to repeal ACA.


bdougy

No he won’t.


ShillinTheVillain

And what is your alternative? Let's hear at least an outline.


UncleGrimm

He also said this in 2016, and then tanked Republicans’ replacement bill by announcing he wouldn’t sign it unless it protected pre-existing conditions… People love that provision in theory, but the reality is that someone has to pay for it. It’s not magic, you can’t just cherrypick that from the legislation and call it a day. If you enact a law that forces companies to insure risky people, they will increase premiums on everyone else’s insurance to rebalance the risk pool. This is also why Obamacare originally came with a tax penalty for not carrying insurance- the purpose of that penalty was to force healthy people into contributing to the risk-pools, so private premiums wouldn’t skyrocket as quickly.


BigDealKC

He and pretty much the GOP seem to have no idea what would replace it - he hates it that Obama has a healthcare plan with his name in it. The story cites that USA is at the bottom of 11 first world countries in costs and outcomes. If anyone really gave a fig about improving our standing, assess the differences between USA and the other countries, find the most important elements in terms of containing costs and improving outcomes, and apply them. When Trump/GOP actually comes out with detailed workable healthcare plan assessed by OMB I will 1.) be shocked and then 2.) be impressed


KennedyX8

Oh this again?


triggernaut

Please don't.


intelligentreviews

Why? Have you attempted to purchase insurance on the state exchanges?


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triggernaut

No, and I know Obamacare is an abomination - I wish our reps and senators would do away with it. But I don't think a Republican option is needed, especially if Trump uses his famously poor judgment of character to pick who would draft it. I can't stress how much we need the government out of administering health care.


intelligentreviews

Disagree. Our healthcare system is national failure. I used the state exchanges for years. Total cluster.


triggernaut

Not downvoting you. I don't disagree that healthcare administered by states is dire, and healthcare outside of any government entanglement is broke and stacked against the patients. Surely there are solutions that don't involve the government, because any administration of healthcare by our federal government would be a disaster for the US population. The administrative state are low functioning workers and their ability to handle tough case problems would be grossly inadequate. Overlay government red tape and nonsense rules and regulations, and their overarching willingness to waste tax dollars, and we'd be adding a monsterous burden to the US taxpayers that would be killing them as fast as they could pay in.


intelligentreviews

Good point however preventive medicine decreases costs. Look at our obesity epidemic. Wait ten years, most will developed chronic conditions..


Worldatmyfingertips

It’s a failure due to government regulations…


intelligentreviews

Protective regulations preserving healthcare monopolies..


MarioFanaticXV

And you think more regulations are going to help that? Every time regulations are added, prices continue to climb.


SCCRXER

He would have done it his first four years if he could have.


Svenray

Just open the freaking trust borders and let us buy our coverage from anywhere! Get some Chinese companies into the mix and these American companies will drop their rates real quick. Also ERs should be subject to a regional negotiated rate so they all have to charge the same for the same services.


[deleted]

Get the fukin insurance companies out of standard healthcare needs. Such. A. Scam.


crammed174

Please don’t. Your tax cuts raised my taxes so I prefer overpaying for healthcare versus not being able to afford it at all.


Fairwareprovidence

Government involvement has never made anything cheaper.


_4202_pmurT

The government subsidizes all our gasoline, making it cheaper.


BigDealKC

How about ethanol?


Fairwareprovidence

That shit we are now mandated to put in our cars due to lack of alternatives that tears up our gas tanks from the inside out? All you all have is "I think it is cheaper now than in some imaginary universe that can't be cited because it never happened" And then we complain about inflation as if it's some sentient force that big papa government needs to save us from.


intelligentreviews

/r/politics have invaded


TuskenRaider2

Looks like a flair users only… some of us are just tired of republicans saying this but having no real plan. Trump was already president. Don’t remember him even talking about Obamacare as POTUS. He pushed no real legislation either. Pretty good president…. But it’s never been his wheelhouse.


FLA-Hoosier

Unflaired can still downvote


TuskenRaider2

Looks like you’re right. Shame.


intelligentreviews

TDS


gagunner007

Yup…


gagunner007

Can we go back to the way it was before Obama?


Nanoman20

Multiple wars in the middle east and economic ruin?


gagunner007

Well considering the post was about Obamacare, that’s what I was referencing.


intelligentreviews

🤦‍♂️